A question I hear frequently in my dermatology office is, "Doc, I’m losing my hair. What can I do?" It’s understandable to want a quick fix, but the reality is that hair loss is a complex issue with many potential causes. No two cases are exactly the same, and each requires careful evaluation to determine the root cause and find the best course of action.
Here’s a breakdown of the most common types of hair loss, along with some key information on how to address them.
1. Androgenetic Alopecia (Male & Female Pattern Hair Loss)
The most common cause of hair loss in both men and women is androgenetic alopecia, or pattern hair loss. This condition is genetic and tends to run in families. In men, it typically starts as a receding hairline or thinning at the crown, while in women, it manifests as diffuse thinning, often at the crown.
This type of hair loss is progressive and chronic, meaning it tends to get worse over time. While it doesn't cause permanent follicle destruction (scarring), the hair follicles may become less responsive to treatment as the condition progresses. Medications like minoxidil (Rogaine) and finasteride (Propecia) can be effective in slowing or stopping the hair loss, but it’s important to understand that this is a lifelong treatment. If you stop, you may lose the progress you’ve made.
2. Telogen Effluvium (Stress-Related Hair Loss)
Telogen effluvium is a type of hair loss triggered by significant stress, illness, or other life events. It’s often rapid and can cause noticeable shedding over the course of a few days or weeks. Common triggers include surgery, trauma, childbirth, or even emotional stress.
The good news is that telogen effluvium is typically reversible. Hair usually begins to grow back within 6 to 12 months once the underlying stressor has been addressed. If you’re diagnosed with this condition, the best thing you can do is be patient and give your body time to recover. Most people find that their hair regrows fully over time without the need for treatment, though some may opt for treatments like supplements or topical minoxidil to support the regrowth process.
3. Alopecia Areata
Alopecia areata is an autoimmune disorder where the immune system attacks hair follicles, causing round, smooth patches of hair loss. This condition can affect both adults and children, though it’s more common in younger individuals. While the exact cause of alopecia areata is unknown, it’s thought to be triggered by a combination of genetics and environmental factors.
In many cases, alopecia areata resolves on its own, but it often requires treatment, particularly in more extensive cases. Corticosteroid injections (like triamcinolone) are commonly used to stimulate hair regrowth. For more severe cases, systemic treatments like prednisone, methotrexate, or JAK inhibitors may be recommended. While the condition is usually not scarring, if left untreated, it can cause permanent hair loss in certain areas.
4. Central Centrifugal Cicatricial Alopecia (CCCA)
CCCA is a form of scarring hair loss that primarily affects black women, although it can also impact black men. It often begins in the center of the scalp and can spread outward, leading to irreversible follicle damage. This condition is linked to inflammation around the hair follicles, which can be exacerbated by hair grooming practices such as tight hairstyles, heat, or chemical treatments.
CCCA is a serious condition that requires early intervention to prevent further follicle damage. Treatment options may include corticosteroid injections, oral medications, or platelet-rich plasma (PRP) therapy, which has shown promise in some cases. Recently, topical metformin emerged as another possible cutting edge treatment for CCCA. If you suspect you have CCCA, it's crucial to see a dermatologist as soon as possible to get an accurate diagnosis and prevent further hair loss.
5. Lichen Planopilaris
Lichen planopilaris (LPP) is another autoimmune condition that causes scarring hair loss, primarily on the scalp and sometimes on the eyebrows. It presents as red, itchy, and inflamed patches of skin, which can lead to permanent hair loss in the affected areas if not treated promptly. LPP tends to evolve rapidly, and the hair loss can be significant if left unchecked.
Treatment for LPP generally includes corticosteroids or other immune-suppressing medications. Because LPP is an inflammatory condition, early treatment is key to preventing further follicle destruction and improving outcomes.
How We Approach Hair Loss Treatment
Diagnosing hair loss requires a detailed evaluation. I typically start by asking patients questions like:
- How long have you noticed the hair loss?
- What areas of the scalp are affected?
- Have you had any major life events or stressors recently?
- What treatments have you tried?
In some cases, further testing such as blood work or a scalp biopsy may be necessary to get to the root of the issue. A biopsy can help differentiate between different types of hair loss, especially when multiple conditions overlap.
It’s important to remember that hair loss treatment can take time—months or even years in some cases. While some conditions may respond quickly to treatment, others require long-term management, and in some cases, there’s no guarantee of a full recovery. For conditions like androgenetic alopecia, staying consistent with treatment is crucial. Discontinuing treatment can lead to a reversal of any progress made.
Final Thoughts
If you’re experiencing hair loss, it’s important to seek professional advice from a dermatologist. The sooner you get a proper diagnosis, the sooner we can begin working toward a solution. Whether your hair loss is temporary or permanent, there are treatment options that can help slow or reverse the process. Don’t wait—get the care you need to protect your hair and scalp health.
If you found this helpful, subscribe to Dr. Bibi's Newsletter for cutting edge skincare and share this article. For further insights into skincare simplification, check out my book "Sick Skin - Skin Care Made Simple" on Amazon, now available in audio.
Thanks for reading and God bless.
Yuval Bibi, MD/PhD - Board Certified Dermatologist
Share and get 15% off!
Simply share this product on one of the following social networks and you will unlock 15% off!