Amelia K. Hausauer, MD
Board Certified Dermatologist, American Society for Dermatologic Surgery
Hair loss, medically called alopecia, is a dermatologic condition affecting people of all ages, races, ethnicities, and sexes, with a profound impact on psychological wellbeing and self-esteem. Board certified dermatologists are experts in hair medicine, so you need not suffer alone.
Broadly, there are two major categories of hair loss: non-scarring and scarring (cicatricial). Examples of non-scarring include:
- Androgenetic alopecia: (male or female pattern hair loss), which is the most common type of alopecia, often genetic, and increases with age, affecting 73.5% of men and 57% of women aged 80 and older, but often starting much younger.
- Telogen effluvium: abrupt onset hair loss with massive shedding of hairs as they go into a resting phase after stressful physical or emotional events, such as post-pregnancy, then typically re-growing spontaneously over months to a year.
- Alopecia areata: an autoimmune disease that can appear as fully bald patches or cover larger areas of the body in children and adults.
- Trichotillomania: occurs when individuals pull out their own hair.
Cicatricial alopecies are less frequent but result in replacement of hair follicles with scar tissue, making regrowth more difficult, especially at later stages of disease. Traction alopecia, discoid lupus erythematosus, llichen planopilaris, frontal fibrosis alopecia, central centrifugal cicatricial alopecia, and folliculitis decalvans are some forms. A scalp biopsy is often necessary to diagnose these conditions.
Estimates suggest that nearly $3.5 billion is spent annually on hair loss therapies with varying degrees of success and scientific data to support their efficacy. Each type of hair loss may require different therapies, so consulting a dermatologist who can help you navigate the options is key.
Medications such as topical minoxidil and oral finasteride are FDA-approved for androgenetic alopecia. After discussion with your doctor, other treatments may be appropriate, such as off-label oral medications for pattern hair loss or anti-inflammatory injections or pills for alopecia with inflammation. Supplements can be controversial, but low iron stores or vitamin D may limit healthy hair growth. Little data supports routine use of biotin for hair, and in fact, high doses may change other important lab markers, so biotin is not generally recommended.
Low level laser therapy uses light from caps, combs or bands to stimulate hair growth. Hair transplantation may be an appropriate outpatient procedure for certain patients. During surgery, hair is moved from one area of scalp to another, thus increasing fullness in sparse regions.
Platelet rich plasma (PRP) is an increasingly popular and studied treatment option that involves injecting a solution separated from one’s own blood, without additives but full of growth factors (signaling molecules) that combat the hormonal and inflammatory cues promoting hair loss. This has become a more widely accepted treatment for androgenetic alopecia and potentially alopecia areata with ongoing research for other type of non-scarring and scarring hair loss.
A landmark clinical trial investigating different frequencies of PRP treatment for male and female pattern alopecia found that three monthly treatments followed by a three-month booster session produced approximately 30 percent increase in the number of hairs and 30 percent increase in the hair shaft thickness at six months. Eighty-two percent of patients were satisfied or highly satisfied with minimal side effects and an average of only two out of 10 on a pain scale, making PRP a great addition to the arsenal of alopecia therapies. Hair is a complex organ. Diagnosis and treatment are highly individualized. Collaboration with a board certified dermatologist to create a customized treatment plan is the first and best step to achieving improvements in hair growth.
Disclaimer: All indications of PRP are off-label and under active research.