Hair Loss - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Hair Loss or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Hair Loss Treatment
Hair loss is a common medical condition especially on the head (baldness) in men. Hair loss generally occurs as hair thinning and progresses to complete hair loss on major areas of the body such as legs, arms, back, and scalp. Although most people assume only men lose their hair, front scalp hair loss affects 58% of women and 75% of men. The common term for frontal baldness is "receding hairline" and typically advances to the mid to back of the head in male pattern baldness.
Causes of Hair Loss
Hair loss may occur because of various situations or medical factors. The term "Traction Alopecia" refers to hair loss induced by a person who pulls frequently on the hair. The same loss of hair can be induced by extreme force from a hairstyle such as cornrows or ponytails. Generally, hairstyles do not cause the loss of hair by themselves but if coupled with weak roots can contribute to mild baldness. Medical treatments such as chemotherapy or radiation, which severely weakens the body, are usually responsible for rapid and severe hair loss and may result in complete baldness. The hair often returns after the treatment stops. Individuals with hyperthyroidism also complain of patchy hair loss on the head, arms, and legs. Malnutrition, specifically lack of protein in the diet, often leads to thinning hair. Hair requires extensive protein use so without proper nutrition, the body cannot grow hair. Lastly, fungus infections of the hair follicle called folliculitis and ringworm infection of the scalp cause production of brittle hair that falls out easily.
Picture 1: Wide spread Alopecia Areata
Hair Loss Diagnosis
Although the hair loss is usually obvious, the underlying cause may take time to determine. Doctors will ask about social history to determine any life changes or new diets that can be contributing to hair loss. Often the reason for hair loss is simply older age.
Hair Loss Prevention
If genetic, an individual cannot prevent hair loss. Male pattern baldness, originally believed to be passed down from the mother's grandfather, actually is contributed to by both parents. Maintaining a protein-rich diet and general health can reduce the occurrence of hair loss with old age. Some studies show that exercise may also increase the rate of hair growth.
Hair Loss Treatment
Forms of hair loss related to diet or medical treatment usually reverse when the circumstances stop. Patients undergoing cancer treatment should ask their doctor if the medications will contribute to hair loss. Other problems such as fungal infections require anti-fungal drugs to kill the organism. Normal hair growth usually returns once the treatment is finished. A few new drugs for men that promote hair growth and reduce loss are finasteride, Propecia, and minoxidil. Women have their own set of hair treatment drugs which are, finasteride, Aldactone, and Tagamet. Both men and women may opt for surgical hair restoration which transplants another person's hair or an individual's own hair to the bald area. Non-surgical hair replacements, such as wigs, are also extremely common and might be the most affordable alternative.
Hair Loss Support Group and Resources
American Hair Loss Association
23679 Calabasas Road # 682
Calabasas, CA 91301-1502
How experienced are you in treating hair loss in young black women?
There are various causes of hair loss, some are related to the age of an individual however most are not. Hair loss is usually not a matter of skin color. A dermatologist is the professional trained to evaluate, diagnose and treat hair loss regardless of skin color or age. Please make an appointment for evaluation.
Franziska Ringpfeil, MD
Is there away to keep hair from turning gray? Thank you
Not yet
What is your experience with children and baldness before two? I have a daughter Marissa(2y.o.) who began loosing her hair just after 1 y.o. We have had numerous blood work and evaluation of her thyroid as well…Everything is normal… Marissa has Downs Syndrome, but does have new hair growth on areas of her head. The baldness is mainly to the rear left and her hair while fairly long is thinning.
Any information or recommendations would be outstanding.
It is unclear to me if Marissa has alopecia areata or telogen effluvium, and perhaps a biopsy may be necessary to determine the proper diagnosis. Telogen effluvium should improve over time when any stressful emotional or physical event has passed. It does not typically require intervention. Alopecia areata in very young children is difficult to treat as many standard medications as well as off-label medications or procedures could have undesired local or systemic side effects in a growing individual when used over periods of time. A treatment with intented temporary local effects is irritation of the skin with squaric acid. This is a treatment performed for recalcitrant warts and alopecia areata in children. It is somewhat limited to very small areas only. Another treatment without considerable side effects is low energy ND:YAG laser treatment, which can stimulate hair growth in alopecia areata. While I have used this laser in very young children for unrelated diagnoses, I have not yet treated a child as young as Marissa for alopecia. I also wonder if this treatment would be tolerable to her, as laser treatments tend to be more painful over bony areas. A general good resource is the National Alopecia Areata Foundation http://www.NAAF.org.
I’m 63. My hair has always been thin–but now it’s getting thinner. I’ve been a vegetarian for many years but do eat some dairy. Are their blood tests which would show if I could be protein or vitamin deficient?
Proper history taking and evaluation of the pattern of your hair thinning by a dermatologist is usually the first step in recognizing the underlying cause. Occasionally a scalp biopsy or blood work is indicated. As a vegetarian you could be deficient in vitamin D if you practice sun precautions and you could be deficient in vitamin B12. Although rare, vitamin D deficiency can play a role in some types of hair loss whereas vitamin B12 is not typically related to hair loss.
Dear Dr. Ringpfeil,
I am 58. About 5 years ago I developed patchy hair loss and more recently (last year), lost a great quantity of my hair throughout my scalp and lost my eyebrows and eyelashes completely. My derm told me I likely have telogen effluvium as well as alopecia areata. For the alopecia areata on the top of my scalp, I was given steroid treatment, which worked for some spots but not all. My hair texture has completely changed, from very thick and curly to thin and limp and lifeless. Since my derm does not specialize in hair loss, my case is kind of dismissed as ‘sorry, nothing we can do’. I am terribly worried that the hair loss will continue, and I would dearly love to know if there is any treatment, cosmetic or otherwise, for the hair loss and if there is anything to be done for the eyebrows and eyelashes. Thank you for any advice you can provide.
Desperately looking for help,
C.S.
Alopecia areata can be very difficult to treat ad not all alopecia areata treatment will result in success. Eyebrows and scalp can be carefully treated with low dose steroid injections, which is more efficient than application of a steroid cream, gel or lotion. The eyelashes, eyebrows and scalp may respond to Latisse, however, it can be very costly for the scalp as Latisse is not an insurance benefit.
i was referred to you by dr. rakel, then i was speaking with your staff explaining that i was looking for a homeopathic remedy for hair loss resulting from coming off of birth control pills. your staff was very nice and helpful; someone told me to check on your web site for the name of a tea (i think). i don’t see any mention of a homeopathic remedy or tea to help with hair loss on your site. please advise.
Rooibos is a plant from South Africa that has been implicated to promote hair growth. It is not a homeopathic medicine as it is not used in a diluted state but it is a natural remedy full of antioxidants. In one study it was used a s a concentrate directly applied to the skin. However, this is not yet commercially available. Drinking Rooibos tea regularly seems to have a very similar effect. One cup a day is recommended. It is not made form tea leaves and therefore can be consumed any time of the day.
I have a 15 yr-old daughter who is in recovery from anorexia. During her five weeks inpatient with refeeding, she has lost about 50% of her hair. I realize this while take months of healthy nutrition to get her old, thick, beautiful hair back but I was wondering if there is anything that could help in the meanwhile. Are there laser treatments? Shampoos/topical treatments? She is eating lots of protein and taking biotin in pill form OTC. Her self esteem is greatly impacted by the severity of the hair loss. Any suggestions??? Thanks, Lara Stone.
The type of hair loss that your daughter experiences is called telogen effluvium. It is reactive and entirely reversible. Unless, her anorexia has caused damage to her thyroid, and as long as her iron and other essential mineral stores are already repleted, the hair loss will cease after 3-4 months. Her hair is probably already regrowing but hair grows very slowly and may not yet be visible on the scalp. Biotin and zinc supplements as well African Rooibos tea may be helpful. Minoxidil 2% over the counter solution also speeds up hair growth. It is applied to the scalp twice daily. It should only be used if her blood pressure is not below normal and if she has not developed heart disease from her anorexia. It can safely be discontinued once the hair is fully growing without fear that the newly grown hair will be falling out.
I am a43 yr old female with baby fine hair who has had hair extensions for over two years. The extensions have severely damaged my hair! I can’t be without them because I look like I am on chemo. Please tell me there is something we can do…Thankyou.
Severe damage to hair is your scalp’s cry for help. In order to rescue what is possible, you must take a break from anything you do to your hair (including extensions) for at least 6 months. Most of our patients will use a wig or clever hair piece to get them through this time.
I am 39yrs old and recently diagnosed with Androgenetic Alopecia. I have PCOS and had a total thyroidectomy in 2006 (due to thyroid cancer). Is there anything I can do to reverse hair loss? Are there vitamins, medication (natural or chemical), or any combination of treatment?
Hair transplantation is the only treatment that permanently restores hair in an area where hair was irreparably lost. Alternatively, treatment with topical minoxidil and oral spironolactone will be able to hold on the hair you have and prevent it from undergoing miniaturization. Hair follicles that have very recently miniaturized may be able to be coaxed back into production. This regimen may also be considered after hair transplantation.
Hello, do I need to be referred by my primary health provider in order to book an appointment?
Whether or not you need to be referred to a specialist depends on your insurance plan. Most HMOs will require a referral from a specialist.Please check with your insurance.