Understanding Hair Loss and the Role of a Hair Loss Doctor

Hair loss, also known as alopecia, is a prevalent condition impacting millions of people in the United States. While often viewed as a cosmetic concern, it can significantly affect an individual's self-esteem and emotional well-being. It is characterized by losing more hair than normal or when lost hair fails to regrow. It can manifest suddenly or gradually, and its nature (temporary or permanent) depends on the underlying cause. Dermatologists are medical doctors specializing in the health of skin, hair, and nails, and they are well-equipped to diagnose and treat hair loss.

Recognizing the Signs of Hair Loss

It's normal to lose up to 100 hairs every day. Common symptoms of alopecia include:

• Sudden loosening or shedding of hair: Hair may come out in handfuls when combing or washing, resulting in hair thinning.
• Gradual thinning of hair: In men, hair may recede from the forehead. Women may experience a widening where they part their hair. This is the most common type of hair loss.
• Balding in patches: It may affect the scalp, beard, or eyebrows.
• Full-body hair loss: Loss of nose hair or eyelashes may leave you more susceptible to infections.

Hair loss can be a symptom of an underlying condition and is easier to treat in its early stages.

Diagnosing the Cause of Hair Loss

Determining the exact cause is crucial for effective treatment. NYU Langone dermatologists are experienced in recognizing the signs of hair loss, whether the cause is genetic, medical, or environmental. They visually assess the pattern of hair loss to ascertain the type of hair loss and confirm diagnosis by using advanced techniques.

Medical History and Physical Exam

To determine the cause of hair loss, a dermatologist asks about when hair loss began, its patterns, typical hairstyles, family history of hair loss, and other symptoms. Details that may seem unrelated-such as diet or recent childbirth-may provide a clue about the cause. A dermatologist examines the scalp for inflammation, redness, sores, or scarring, and closely examines the hair to determine the amount being lost, the pattern, and whether there is hair breakage.

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Diagnostic Tests

Several tests may be performed to learn more about the health of your hair:

• Pull Test and Tug Test: The pull test measures the severity of hair loss. If six or more strands fall out when a dermatologist gently tugs on small sections of hair, it indicates active hair loss. The tug test involves grasping a section of hair and tugging to see if any strands break, providing information about the brittleness or fragility of hair strands.
• Card Test: A dermatologist uses a card test to examine the health of hair shafts and to evaluate the number of new hair strands that are growing. New hair strands, even very small or broken ones, are visible against the felt card and can be counted and examined.
• Trichometric Analysis: Dermatologists use trichometric analysis, a sophisticated computerized measurement tool, to analyze characteristics of the scalp and hair. Doctors use a digital assessment system called Folliscope® which consists of a small handheld device containing a high definition, microscopic camera. The Folliscope® can magnify these images by up to 100 times, giving doctors a detailed look at hair, hair follicles, and the scalp. The Folliscope® also provides information about hair coverage, including the total number of hairs on the scalp and the diameter of each strand of hair.
• Fungal Culture: A fungal culture is a laboratory test that can confirm the presence of a fungus in hair or scalp cells. A dermatologist may recommend this test to determine whether a fungal infection called tinea capitis, or scalp ringworm, is the cause of hair loss.
• Punch Biopsy: If more information about the hair follicle or scalp is needed, a doctor may perform a scalp biopsy. Dermatologists use a device the size and shape of a pencil to puncture the scalp and remove a small tissue sample. This sample is sent to a lab for testing, and the incision is closed with a few stitches. Biopsies are frequently used to distinguish between the types of cicatricial, or scarring, alopecia.
• Blood Tests: If doctors suspect the hair loss may be due to an underlying medical condition, a vitamin or mineral deficiency, or a hormonal imbalance, they may recommend one or more blood tests. For example, it may appear that a woman whose hair is thinning all over the scalp has hereditary hair loss, but it’s possible that the cause is actually an iron deficiency. Iron Deficiency: Too little iron in the bloodstream may contribute to hair loss. Doctors use blood tests to check the level of ferritin, a protein that indicates how much iron is stored in the body. Adding foods rich in iron to your diet may help hair to regrow. Thyroid Disease: Hair loss may be a sign of a thyroid disease such as hyperthyroidism or hypothyroidism. Androgen Excess: Women who have thin hair with no bald patches may have a hormonal imbalance caused by excess levels of androgens, a class of hormones that includes testosterone. A blood test can reveal an elevated androgen level.
• Photography: Dermatologists use digital photography to track the progress of your treatment.

Causes of Hair Loss

You should work with the dermatologist to determine what is causing your alopecia so that the underlying condition can be treated. Some of the common contributing factors to alopecia include:

• Genetics: The most common cause of hair loss is hereditary-pattern baldness, also known as androgenetic alopecia.
• Stress and Trauma: Physical or emotional shock can trigger hair loss, a condition known as telogen effluvium.
• Cancer treatments: Some types of radiation therapy and chemotherapy
• Diet: Not enough protein or certain vitamins and minerals, such as vitamin D or iron
• Hair disorders: Includes alopecia areata, an autoimmune disease that often causes round patches of hair loss
• Heredity (male-pattern baldness or androgenetic alopecia): Passed from parents’ genes and the most common cause of hair loss or thinning
• Hormonal changes: From pregnancy, childbirth or menopause
• Medical conditions: Thyroid disease, anemia, lupus and others
• Medications: Includes those used to treat heart problems, high blood pressure, depression and arthritis
• Physical or emotional shock: Such as from childbirth or a major illness
• Scalp infections: Includes ringworm, which is more common in children

Types of Hair Loss

Types of hair loss include:

• Androgenic alopecia: The most common type of hair loss, is a type of hereditary (inherited) baldness that can affect anyone. It includes male pattern baldness and female pattern baldness.
• Alopecia areata: Is an autoimmune disease that causes you to lose the hair on your head and body.
• Anagen effluvium: Is rapid hair loss that happens from medical treatments like chemotherapy.
• Telogen effluvium: Or excessive hair shedding, is the result of stress, illness or sudden hormonal changes, including pregnancy.
• Traction alopecia: Happens when you wear your hair in tight hairstyles repeatedly and for long periods of time, damaging your hair follicles.
• Hair loss due to trauma: Can come from burns and other injuries that cause scarring.
• Scarring alopecia: Occurs when burns, chemicals, or autoimmune disorders cause inflammation that destroys your hair follicles. Scar tissue replaces the follicles, making it impossible for hair to regrow.

Treatment Options for Hair Loss

Effective treatments for some types of hair loss are available. You might be able to reverse hair loss, or at least slow it. With some conditions, such as patchy hair loss (alopecia areata), hair may regrow without treatment within a year. Once the cause of hair loss is identified, dermatologists can recommend personalized treatment plans.

Medications

Medications are available to treat pattern (hereditary) baldness.

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• Minoxidil (Rogaine): Over-the-counter (nonprescription) minoxidil comes in liquid, foam and shampoo forms. To be most effective, apply the product to the scalp skin once daily for women and twice daily for men. Products with minoxidil help many people regrow their hair or slow the rate of hair loss or both. It'll take at least six months of treatment to prevent further hair loss and to start hair regrowth. It may take a few more months to tell whether the treatment is working for you.
• Finasteride (Propecia): This is a prescription drug for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show new hair growth. It may take a few months to tell whether it's working for you. You'll need to keep taking it to retain any benefits. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer.

Other Treatments

• Hair transplant: During a hair transplant procedure, a dermatologist or cosmetic surgeon removes hair from a part of the head that has hair and transplants it to a bald spot. Each patch of hair has one to several hairs (micrografts and minigrafts). Sometimes a larger strip of skin containing multiple hair groupings is taken. This procedure doesn't require hospitalization, but it is painful so you'll be given a sedation medicine to ease any discomfort. Possible risks include bleeding, bruising, swelling and infection. You may need more than one surgery to get the effect you want.
• Laser therapy: The Food and Drug Administration has approved a low-level laser device as a treatment for hereditary hair loss in men and women. A few small studies have shown that it improves hair density.
• Platelet-Rich Plasma (PRP) Therapy: Platelet-rich plasma (PRP) injections may help restore some of your hair and prevent you from losing more of it. They use your own platelets (cells that help your blood to clot) to encourage hair to regrow.

Lifestyle and Home Remedies

Dermatologists can offer guidance on lifestyle changes and hair care routines that can help manage hair loss. You might want to try various hair care methods to find one that makes you feel better about how you look. For example, use styling products that add volume, color your hair, choose a hairstyle that makes a widening part less noticeable. Use wigs or extensions, or shave your head. Talk with a hair stylist for ideas.

The Role of a Dermatologist

Dermatologists are medical doctors specializing in the health of skin, hair, and nails. They are well-equipped to diagnose and treat hair loss.

• Accurate Diagnosis: Determining the exact cause is crucial for effective treatment.
• Personalized Treatment Plans: Once the cause of hair loss is identified, dermatologists can recommend personalized treatment plans.
• Lifestyle and Hair Care Advice: Dermatologists can offer guidance on lifestyle changes and hair care routines that can help manage hair loss.
• Monitoring Progress: Regular follow-ups with a dermatologist allow for monitoring the effectiveness of treatments and making necessary adjustments.
• Support for Psychological Impact: Hair loss can significantly affect a person’s mental health.

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