Hair Loss? Now What?!

Hair loss (AKA alopecia) is stressful. Our hair is personal and directly impacts our self image and confidence. While it can be a sensitive topic, we gotta talk about it to make it better!

What is Alopecia?

Alopecia is simply the broad medical term for hair loss. Dermatologists are not just trained in disorders of the skin - we also learn the ins and outs of hair and nail disorders too.

We divide alopecia into two broad categories: scarring (cicatricial) and non-scarring. Non-scarring hair losses are reversible (in most cases) because the hair follicle, or ostia, is not destroyed by inflammation. Thus, we have options to help improve the quality and density of the hair. Common non-scarring hair loss types include alopecia areata, telogen effluvium, androgenic alopecia (AKA male or female pattern hair loss), traction alopecia, and more.

Scarring hair loss on the other hand can be permanent if the inflammation causes the destruction of the follicular structure. Common inflammatory hair loss types include central centrifugal cicatricial alopecia (CCCA), lichen planopilaris (LPP), fungal infection (kerion), and others.

What to do when Experiencing Hair Loss?

Dr. Swigost is an expert in hair loss and diseases of the scalp.

Step one: Do not panic! Hair shedding to a certain degree is normal. Your hairs are in a constant cycle: anagen (growth), catagen (transitional), and telogen (rest). The average human will lose 100 hairs per day. So, if you are noticing some hair clumping in the shower drain or in the corner of your room, remember it may be a normal amount (also, take note that longer hair will look more dramatic because there is more hair mass relative to someone with shorter hair).

If your hair loss has rapidly picked up, you are experiencing pain or itch, or you are noticing obvious patches of thinning, see your dermatologist! There are so many direct to consumer platforms offering patients easy access to prescription topicals and even oral medications (remember many of these platform get you access to a ‘licensed provider’ that may not be a board-certified dermatologist). In some ways that is convenient, but an in depth consultation with a dermatologist, like Dr. Swigost at Dapper Dermatology, is still the recommendation. We want to be sure that we isolate the correct diagnosis and get you on the correct treatment. For example, if you have scarring alopecia and you just start Rogaine or minoxidil, this will not treat the underlying problem and can lead to progressive worsening of your hair loss. I have sadly met many men and women who were not treated correctly initially, and this complicated their longterm prognosis.

What are the Treatments?

Hair loss has lots of options! Almost everyone can benefit from topical minoxidil or Rogaine, and I include this in the vast majority of my regimens. Some patients are unable to tolerate it due to an allergy to the preservatives (most commonly propylene glycol). In those cases, we may recommend switching to a specialty compound or considering other options. Topical ketoconazole shampoo, a common treatment for dandruff, has also been shown to potentially aid with androgenic alopecia by decreasing the conversion of testosterone to dihydrotestosterone (DHT) at the hair follicle.

Oral minoxidil is also effective for hair loss. It does come with potential side effects which your dermatologist can discuss with you. Oral minoxidil also become trendy last year following a piece in the New York Times, see here. Hormonal therapies such as spironolactone, finasteride (AKA Propecia), and dutasteride are also common considerations.

Procedures are also increasingly popular among patients. Platelet rich plasma, injectable kenalog, and hair transplant may be reasonable depending on the patient’s history and longterm goals. Ultimately, I tell my patients that hair loss therapies are best used in synchrony and with synergy. The more consistent you are - the better the results can be.

How Long to see Results?

Hair loss is a marathon, not a sprint. Think of how slow your hair grows between haircuts as a great example - we are talking millimeters per day. I usually tell patients its takes 4-6 month to start to see the benefits of therapy. So, if your hair loss is bothering you, schedule a consultation now! Get yourself back on track to feeling your best.

Hair Loss Supplements…

A brief word on supplements in hair loss (and in dermatology as a whole). Supplements and nutraceuticals can be awesome and effective adjuncts to you treatment plan. However, it is really important to not believe everything on the bottle. For example, biotin has been shown in multiple studies to not improve hair and nail quality, yet it is constantly marketed to consumers for such issues. Depending on the underlying disease, vitamin D, Nutrafol, among others are potential avenues. However, you should not begin a supplement without first talking with your physician - supplements can interact with medications, interfere with laboratory studies and cause potential harm when not taken in consideration of your health history.

As a dermatologist who loves integrative medicine, we can create a plan that is both safe and effective. Interested in a consultation? Click here and set up your appointment with Dapper Dermatology today!