Hair loss is a problem for men and women. Scientific studies have shown that hair loss can create loss of self-esteem and even affect job performance. People feel less attractive when they are experiencing hair loss and it can have a great effect on relations with the opposite sex. The most common type of hair loss is called pattern hair loss both male and female types and is also called androgenetic alopecia.
Many people still believe the myth that hair loss only comes down from the mother’s side of the family. The truth is that hair loss can come from either side of the family. It may follow a very predictable pattern from either your mother or your father, or it may be a combination from both sides. Occasionally a young patient will come to us with extensive baldness when there is no family history of early baldness from either parents’ side. It is helpful to think of hereditary Pattern Hair Loss as a random shuffling of the genetic cards. The genetic ‘hand’ you are dealt will determine when your hair loss appears and how quickly it progresses. There has been some work on gene therapy for hair loss but there are no effective treatments on the horizon at this time.
There is a new gene testing product called HairDx® which claims to identify those prone to significant hair loss in their lifetime. Dr. Cooley is waiting for more studies to be published before recommending this to his patients. At the Carolina Dermatology Hair Center, we rely on the family history as well as the patient’s own history of hair loss as a guide to estimate what a patient can expect in the future. It is just an estimate as there is no way to accurately predict at this point in time how bald someone may become. In general, the more family members with extensive baldness and the earlier in life someone’s hair loss appears, the more extensive it will become.
Types of Hair Loss
Dermatologists classify hair loss as either “non-scarring” or “scarring alopecia”. Pattern hair loss is a type of non-scarring alopecia. The use of the word scarring is a bit confusing and misleading. It means that hair follicles are absent, from microscopic scarring within the scalp. In non-scarring alopecia, even though hair shafts have been lost, the hair follicles are still present within the skin. In scarring alopecia, inflammation or trauma has resulted in the actual destruction of hair follicles and may or may not be associated with visible scars on the surface of the scalp.
Besides pattern hair loss other types of non-scarring alopecia include Telogen effluvium, Alopecia areata, and Trichotillomania. Telogen effluvium is a common condition where the person experiences rapid shedding of hair. The hair grows in stages, which is known as the hair cycle. The growing phase (anagen) lasts for about three years followed by a resting phase (telogen) which lasts for 3 to 4 months after which the hair shaft is shed and a new growing cycle begins. Usually the hairs are in different stages of the cycle and only a small amount of hair is shed every day. However there are certain trigger factors which can send the hair from the growing phase into the resting phase followed by shedding 3 to 4 months later. These trigger factors
include stress, hormone changes, medication side effects, vitamin deficiencies, etc. Usually Pattern Hair Loss appears and progresses slowly while Telogen Effluvium appears suddenly. A dermatologist can usually tell the difference but if not a biopsy of the scalp may be performed. The treatment for Telogen effluvium is to correct the
underlying cause and the normal hair cycle will naturally be reestablished.
Alopecia areata is an autoimmune condition where small patches of hair are lost to create smooth bald spot rarely this will progress to involve the entire scalp or even the entire body in which all hair is absent. Steroids (topical, injected, or systemic) are the mainstay of treatment and are generally effective. For patients with extensive alopecia areata (totalis or universalis), there are exciting new treatments available for this
condition at the Carolina Dermatology Hair Center. Patients with Alopecia areata are generally not candidates for hair transplantation.
Trichotillomania is a condition where the patient compulsively pulls out their own hair. Sometimes they are unaware of it and will deny that this is occurring. If the condition goes on long enough, permanent bald spots may occur. If this occurs and the condition has been quiet for a long time, the patient may be a candidate for hair transplantation to fill in these bald spots. Of course if the condition comes back, the patient may lose the transplanted hair as well.
Types of scarring alopecia include Lupus, Lichen planopilaris, Frontal Fibrosing Alopecia, Central Centrifugal Cicatricial Alopecia (CCCA), as well as scarring from accidents, burns, or radiation treatment for cancer. Discoid Lupus results in scarring and bald spots within the scalp and must be treated with steroids to prevent further hair loss. Patients are not candidates for a hair transplant unless condition has been inactive for a very long time. Lichen planopilaris is also an autoimmune condition in which the pattern of hair loss is a little different than Lupus. There is usually redness, itching, and a characteristic scaling around the base of the hair shaft. Steroids are also the mainstay of treatment but a transplant may be considered if the condition has resolved. However the chance that the disease will reactivate must be considered because if this occurs the transplanted hair will also be lost.
Central Centrifugal Cicatricial Alopecia (CCCA) is relatively common among African-American women and Dr. Cooley has extensive experience treating this condition. It may begin as a small round area on the top of the scalp and gradually progress outwards with an enlarging bald spot. It is usually accompanied by dry skin, redness, burning, and itching. Some have theorized that this condition is due to various styling practices such as perms and relaxers but this has never been proven. CCCA is treated with injected steroids as well as topical steroids, and the patient is encouraged to minimize harsh relaxers. Dr. Cooley encourages patients to consider letting their hair grow naturally or to use relaxers as little as possible. At the Carolina Dermatology Hair Center, we consider a woman with this condition to be a good candidate for hair transplantation if the CCCA is under control with no symptoms or hair loss for significant period of time. After
undergoing a hair transplant, Dr. Cooley has patients use once or twice a week topical steroids indefinitely to ensure that the CCCA does not flare up. If it does, Dr. Cooley immediately treats the patient with injected steroids to prevent loss of hair.