Hair is an appendage of the skin. Although not a vital organ, its absence can have a tremendous psychosocial impact and suboptimal health function. In addition to providing social signals about our age, fertility, and health status, hair helps regulate our temperature, protects us from infection, and filters out external allergens, pollutants, and irritants.
Although many would categorize the absence of hair where it is normally present as a cosmetic concern, hair loss can be a signal that someone has a very serious underlying health condition.
In the Media:
Dermatologist Hair Loss Contents
- What is Hair Loss or Alopecia?
- Where do People get Hair Loss or Alopecia?
- Is Hair Loss an "Inside or Outside" Problem?
- What is the Difference Between Scaring (Cicatricial) and Noin-Scaring Hair Loss?
- How Does One Diagnose Hair Loss or Alopecia?
- Is Hair Loss Genetic?
- Alopecia, Race, and Gender
- African Americans and Hair Loss
- Hair Loss and Mental Health
- Hair Loss and Diet
- Hair Loss and General Health
- Alopecia and Skin Disorders
- Treating Alopecia
- When You VIsit the Doctor
Mary Calvi of CBS News New York Channel 2 interviews Dr. Strachan on alopecia
What is Hair Loss or Alopecia?
Hair loss, also known as alopecia, is a common problem that can represent a variety of diseases and conditions. It can be a problem with the hair and scalp itself, a reflection of the underlying health state, a side effect of a medication, the result of grooming practices, or the manifestation of a systemic disease.
Where do people get Hair Loss or Alopecia?
Although we are more familiar with the idea of hair loss on the head, people can also develop alopecia on any part of the body that normally grows hair such as eyebrows, eyelashes, beard, and under the arms.
Is Hair Loss an “Inside or Outside” problem?
When evaluating a person for hair loss it is important to determine whether the hair is breaking or falling out by the roots. Hair breakage is most commonly caused by grooming practices that change the color or texture of the hair, such as, blow drying, chemical relaxing, or dying. There are some scalp disorders and genetic hair shaft disorders; however, which predispose a person to hair breakage.
People with curly or kinky hair are more likely to experience hair breakage. Curly or kinky hair is naturally drier and has weak spots that are more likely to snap with tension. Straight hair is the least likely to break.
In the Media:
What is the difference between Scarring (Cicatricial) and Non-Scarring Hair Loss?
- Non-scarring hair loss (alopecia): Non scarring hair loss refers to types of alopecia in which there is the possibility that the hair can grow back. The hair follicles are still present and potentially functional.
- Scarring (cicatricial) hair loss (alopecia) In scarring or cicatricial alopecia some of the hair loss is permanent because of the absence of, or severe damage to, the hair follicle. It is often worth it to treat scarring alopecia even when some of the loss is permanent in order to prevent further loss and attempt to restore function to injured hair follicles.
How Does One Diagnose Hair Loss or Alopecia?
Hair loss is diagnosed by taking a patient history, doing a physical examination, and sometimes with other tests such as skin biopsies and blood studies. A board-certified dermatologist is usually the most expert doctor to diagnose your hair loss.
The diagnosis of hair loss can be challenging even for doctors, and even some dermatologists without intense training in this area. There is more involved in figuring out why someone’s hair falls out than exploring just their thyroid function or their diet.
In the Media:
Is Hair Loss Genetic?
Yes, some types are. Patients sometimes have difficulty identifying that the condition runs in the family because of the different ways it may present. Additionally, it is hard to know if you have a family history of hair loss because some people experience shame and conceal their hair loss even from their closest relatives.
Alopecia, Race, and Gender
Genetic, hormonal, and grooming habits seem to cause certain types of hair loss to be found more commonly or severely in certain racial and gender groups. Androgenetic alopecia, or familial hair loss, commonly affects both men and women; however, it is often more severe and noticeable in men. Frontal fibrosis alopecia (FFA) tends to occur predominantly in postmenopausal caucasian women, where as central centrifugal cicatricial alopecia (CCCA) is more common in African American women and acne keloidal nuchae (AKN) is more common in African American Men
Women often complain of new onset hair loss after childbirth and during perimenopause. Women with polycystic ovarian syndrome sometimes present with more severe cases of female pattern hair loss.
African Americans and Hair Loss
Although hair loss affects people of all ethnic backgrounds, African Americans experience certain types of hair loss more commonly for the following reasons:
- Hair Texture: Curly and kinky hair is more fragile and prone to breakage with grooming. In addition, people with curly or kinky hair are more prone to developing in grown hair, which can cause inflammation, scarring, and hair loss.
- Grooming Practices: Market research indicates that style is very important to African American consumers. Some grooming practices required to achieve certain hair styles traumatize the hair and scalp resulting in damage and hair loss.
- Genetics: Some types of hair loss, such as central centrifugal cicatricial alopecia (CCCA), which predominantly affects African American women, is thought to be caused by a genetic predisposition to develop chronic inflammation in the scalp as a result of traumatic hair styling practices such as tight braids, tight weaves, or heavy dreadlocks.
In the Media:
Hair Loss and Mental Health
Sometimes hair loss is caused by a compulsion to pull out one’s own hair. This is called trichotillomania, which is a body focused repetitive behavior (BFRB). BFRBs are thought to be abnormal grooming behaviors and have a genetic predisposition. Other BFRBs include nail biting and skin picking. Treatment for BFRBs not only need to address the damage caused to the hair but involve a behavior intervention.
Hair Loss and Diet
Certain nutritional deficiencies are associated with hair loss. These include protein malnutrition, biotin, zinc, and iron deficiencies. Although it is more controversial, some believe that vitamin D deficiency contributes. Vegetarians and vegans, as well as people with bowel problems that affect their ability to asorb nutrients are also at an increased risk of hair loss.
Hair Loss and General Health
As mentioned earlier, hair loss can be a sign of an underlying health problem. These include hormonal disorders, such as thyroid disease or polycystic ovarian syndrome or disease, autoimmune diseases such as lupus, and serious infections, such as syphilis. Hair loss sometimes occurs after surgery, childbirth, life-threatening stress, and as a side effect of some medications.
Alopecia and Skin Disorders
When a skin disorder such as eczema, seborrhic dermatitis, or an infection causes severe inflammation on the scalp this can result in secondary hair loss. If scarring hasn’t occurred, treating the skin problem can suffice to treat the hair loss.
How one treats hair loss largely depends on what is causing it. It may require a change in grooming practice, a change in diet, treatment of a medical problem, elimination of an offending drug, topical, oral, or injected medication, light thearpy, surgery, or just patience. Many times a combination of thearpies are required.
There are both medical and surgical techniques to address hair loss. Recommendations are based on the specific problem. If you are experiencing hair loss, we recommend you get evaluated and diagnosis by a board-certified dermatologist with expertise in hair loss.
When You Visit the Doctor
When you visit the dermatologist about hair loss it is helpful to be prepared for your visit. You hair and scalp needs to be available for examination. Ideally, your hair should be loose, not in braids or a weave. If you wear a wig, expected to remove it.
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If you feel you need a dermatologist hair loss consultation, please feel free to contact us.