Hair Loss

Although it is customary to shed some hair each day, excessive hair loss can lead to a thinning hairline and areas of baldness on both men and women.

Hair loss treatments can either increase hair growth or conceal hair loss. Hair growth may recover without treatment for some kinds of hair loss.

Hair Growth and Hair Loss

It’s helpful to know how hair grows naturally to understand how hair loss occurs.

A hair follicle is responsible for the production of each hair shaft. Hair is produced by cells in the hair follicle for roughly 2-3 years. Each hair grows roughly 1 centimeter (1/2 inch) per month during this development phase known as “anagen.” After this growth phase, the hair follicle enters a resting phase called telogen, during which the hair remains in place but stops growing. This “resting phase” lasts 3-4 months, after which the hair starts to fall out. The hair follicle produces a new shaft of hair once the hair falls off.

At any given time, 90 percent of the hairs on the head are in the “growth phase” (and 10 percent are in the resting phase). People typically shed hairs each day as the hair follicles reach the end of the resting phase and prepare to produce new strands. A typical scalp sheds 50 to 100 hairs per day.

Causes of Hair Loss and Baldness

The most common cause of hair loss among men is called male-pattern baldness or androgenic alopecia. Men who have this type of hair loss have often inherited the trait. Men who start losing their hair at an early age tend to develop more extensive baldness. With male-pattern baldness, hair loss typically results in a receding hairline and baldness on the top of the head (vertex).

Women may develop female-pattern baldness. With this form of hair loss, the hair can become thin over the entire scalp. Female-pattern baldness is much more common than is generally recognized.

Other less common causes of hair loss include:

  • Alopecia areata — Alopecia areata is an autoimmune disease in which the body’s own immune system mistakenly attacks the hair follicles leading to hair loss. In most cases, the hair falls out in small, round patches about the size of a quarter. More severe cases can involve the entire scalp or other parts of the body.
  • Extreme stress — 3-4 months after a severely stressful event, such as an illness or major surgery, large amounts of hair may be lost. The stress caused the hair follicles to cease the growing phase prematurely. This stress-induced hair loss is temporary and the hair usually grows back.
  • Hormonal problems — Hypothyroidism or hyperthyroidism can lead to hair loss, as can imbalances in androgens (males hormones) and estrogen. For instance, anabolic steroids taken by athletes for performance enhancement can lead to premature hair loss. The correction of hormonal imbalances can, in some cases, return hair growth to normal.
  • Postpartum hair loss — Many women experience hair loss 3-4 months after having a child. This hair loss is also related to hormonal changes due to pregnancy. Elevated levels of certain hormones during pregnancy lead to the hair follicles staying in the growth phase longer than normal. When the hormones return to pre-pregnancy levels, those follicles enter the resting phase and start to fall out 3-4 months later.
  • Medications — Some medicines, such as blood thinners (coumadin), anti-hypertensives, antidepressants and birth control pills, can lead to excessive hair loss. This type of hair loss usually improves after medication use stops.
  • Fungal infections — Fungal infections of the scalp can cause hair loss and is easily treated with antifungal medicines.
  • Excessive tension on the hair — Wearing tight pigtails or braids or using tight hair rollers can pull on the hair and damage the hair follicle. This can lead to a type of hair loss called traction alopecia. The hair can grow back normally if the pulling is stopped before scars develop.

Hair Loss Treatments

Hair loss treatments are recommended based on several variables, including the type of hair loss, the degree of hair loss, your gender and your personal preferences.

Medications for Hair Loss

Several hair loss medications can help slow or prevent the development of common baldness (androgenic alopecia). The effectiveness of these medications depends on the cause of hair loss, the extent of the hair loss and the individual’s response. Generally, hair loss medications are less effective for more extensive cases of hair loss. These hair loss medications require 3-6 months of regular use to determine if they are helping.

Minoxidil (Rogaine®) is a non-prescription topical medication applied to the scalp to grow hair and to prevent further hair loss. It may also be used for the treatment of alopecia areata. Rogaine® is usually recommended for use twice daily and can be used by both men and women.

New hair resulting from minoxidil use may be thinner and shorter than previous hair. But there may be sufficient hair growth in some to hide bald spots and have the new hair blend with existing hair. It is important to note that hair growth stops after you discontinue the use of minoxidil. Side effects can include irritation of the scalp.

Finasteride (Propecia®) is a prescription medication taken daily by mouth. It is available for use by men only. Many men taking finasteride experience a slowing of hair loss and some may show some new hair growth. It may take several months for new hair growth to appear. Any hair growth obtained while taking finasteride will stop after the medication is no longer used.

Finasteride works by stopping the conversion of male hormones into dihydrotestosterone (DHT), which can shrink hair follicles in men who are susceptible to its effects.

Other hair loss medications that may be attempted in specific clinical cases include:

  • Corticosteroids — Injections of a corticosteroid into the scalp to treat alopecia areata. Treatment is usually repeated monthly. New hair growth may be visible four weeks after the injection. Doctors sometimes prescribe oral corticosteroids (prednisone) for extensive hair loss due to alopecia areata.
  • Anthralin is usually used to treat psoriasis, but it may be used in some cases to stimulate new hair growth for cases of alopecia areata. It may take up to 12 weeks for new hair to appear.

Platelet Rich Plasma

Platelet-rich plasma (PRP) is the component of your blood that contains a high concentration of platelets.  Platelets are the cells that are recruited to wounds that contain many beneficial growth factors and cytokines that promote healing, regeneration, and collagen formation. PRP can also help with hair growth.

  • Supports hair follicles that are growing
  • Is anti-inflammatory which prevents cells from dying

PRP is most effective for androgenetic alopecia, telogen effluvium, and alopecia areata.  It is possible that it may also help with other types of hair loss. A doctor will first determine the reason for hair loss before considering treatment.

PRP therapy must be consistent for the continued support of hair follicles and growth. For most patients that may include maintenance treatments 2-4 times a year.

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