Hair Loss: Types and Treatments

Hair loss, or the medical term, alopecia, is a common condition a dermatologist treats. However, the dermatologist and the patient alike can probably agree that it is a troubling condition. As for the patient, hair loss can bring anxiety, as well as physical and social embarrassment. For the dermatologist, to treat hair loss can be very rewarding, but in many cases, it is frustrating because the hair loss can be permanent, thus, there is a feeling of not being able to help. On the other hand, improvements can be made, but the progress can be slow, and still not meet the expectations of the patient.

Often when one seeks treatment, it is stated that a friend or family member used a particular product or was given a certain treatment, and the outcome was amazing. However, there are different types of hair loss, thus, different treatments are rendered.

The Hair Growth Cycle The hair cycles in three phases. Anagen is the growth phase, and about 90% of hair is growing at any one time. The telogen phase is the resting phase, which usually encompasses 10% of hair. This phase typically lasts two to three months. When this phase ends, the hair falls out, which is known as the catagen phase of the hair growth cycle. It is normal to lose 100 hairs a day. On average, scalp hairs grow about half an inch per month, but the rate slows as people age.

Hereditary thinning is called androgenetic alopecia. This is the most common cause of hair loss. It is common in males as early as the teen, 20s, or 30s. Although it can occur at any age, females usually encounter this later in life, averaging in the 50s. There are topical and oral medications that provide benefits for many people; however, because there is no cure, these treatments are often long term. In addition, if hair is grown, it may not necessarily be the same length or volume it once was.

An autoimmune type of hair loss is alopecia areata. This occurs at any age, and most people are in good health. This type of hair loss often presents as discrete patches of hair loss. This is most common on the scalp, but can occur on any part of the body. Topical and locally injected medications are often used with good results, but recurrence is common.

Telogen effluvium is when the resting phase of the hair growth cycle is much longer than the typical two to three months. This is characterized by an abundance of hair shedding, thus giving an appearance of thinned hair. This condition usually resolves on its own, particularly if the underlying cause is corrected. However, this can take several months. Common causes of telogen effluvium are:

  • Major surgery • Long-term illnesses • Thyroid disease • Low iron counts • Childbirth • Various medications • Low protein diet

Scarring alopecia is a rare type of hair loss that results in patchy hair loss. It is often accompanied by itching and/ or pain. Inflammation around the hair follicle causes the scarring, thus damaging the hair follicle. The cause of scarring, or cicatricial alopecia, is unknown. However, certain hair care practices, inflammatory conditions, and genetics have been suggested. The goal of treatment is to decrease and stop the inflammation. As a result, when treatment is sought early, improvement is possible. On the other hand, late stage scarring alopecia can result in permanent hair loss.

There are other forms of hair loss due to infection, breakage due to improper chemical treatments, and psychological conditions where there is a habit of hair pulling, but the above mentioned are the more common forms of alopecia that bring people to the dermatologist.

As previously discussed, there are topical, oral, and locally injected medications that can help to improve alopecia. There are also surgical procedures, such as hair transplantation, and devices, such as lasers and light sources that can aid in the management of some types of alopecia.

The take home message is to seek treatment from a dermatologist early to try to get the best possible outcome. Furthermore, since there are many types of alopecia, individual treatment is necessary

Dr. Dwana Shabazz received her undergraduate degree at Xavier University of Louisiana and both her medical degree and masters of public health degree at George Washington University. She remained at George Washington University for her internship in Internal Medicine. She then moved to Los Angeles for her Dermatology Residency at King Drew Medical Center/Harbor-UCLA. Dr. Shabazz has been in private practice in the Northern Virginia area since 2006. She opened her own practice, Renascance Dermatology, in 2013. Dr. Shabazz is a Fellow of the American Academy of Dermatology, a Diplomate of the American Board of Dermatology, and a member of the Women’s Dermatologic Society.