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Hair Loss

Hair loss has many etiologies. Common medical causes of hair loss include:

• androgenetic alopecia (male-pattern hair loss)

• telogen effluvium

• traction alopecia

• alopecia areata.

Androgenetic alopecia (male-pattern hair loss) is the result of genetic inheritance from many sources dispelling the common myth that it simply follows the mother's father. This condition may affect both males and females, and is commonly due to genetic influences from both the mother's and father's sides of the family. It is commonly noted as thinning of the hair on the front and top of the scalp. Hair loss is gradual and is often noted by more-than-normal hair fallout in the sink, shower, or on shirts and pillows. For women, a hormone screening for abnormalities, including hypothyroidism, may be performed. Treatment of androgenetic alopecia is primarily through over-the-counter minoxidil (Rogaine®), or prescription finasteride (Propecia®). A decreased concentration of minoxidil is available for women. Women may be prescribed aldactone, an androgen-blocking agent, or birth control pills in an effect to counteract male hormones that may be contributing to the problem. Women should NOT take or handle finasteride (Propecia®) tablets.

Telogen effluvium is an acute condition characterized by sudden diffuse hair loss 1-2 months after an illness, surgery, or childbirth. While the hair loss may be dramatic in some, complete hair re-growth is the norm and usually takes 4-6 months to occur. Hair re-growth may be quickened through the use of over-the-counter minoxidil (Rogaine®).

Traction alopecia is a condition caused by excess pulling on the roots of hair follicles. Often seen in African Americans, traction alopecia is most often due to the use of tight braids or application of hair weaves. Thinning of hair is seen over the frontal scalp starting at the forehead and temples and advances back over the scalp. Treatment of traction alopecia is primarily accomplished by releasing braids or constrictive hair styles, and by application of topical minoxidil (Rogaine®). Depending on the degree of damage, hair growth may not be achievable in some areas.

Alopecia areata is characterized by focal circular areas of hair loss throughout the scalp. It may on occasion be diffuse throughout the scalp. In alopecia areata, the body's immune system targets the hair follicles and leads to a disruption in hair growth. Alopecia areata is sometimes associated with thyroid problems or vitiligo. Treatment of alopecia areata includes steroid injections, oral or topical steroids, topical tar applications, topical minoxidil (Rogaine®), and contact sensitization therapy. This condition may be associated with thyroid dysfunction or diabetes. Make sure to alert your physician should you have any other bodily symptoms.

Don Mehrabi MD, FAAD
Dermatologist, Certified by the American Board of Dermatology
Los Angeles, California

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