Got Hair Loss? It’s Alopecia!
Every woman fears it, and honestly, most men probably do too, but maybe are more willing to accept it—hair loss or what dermatologists call alopecia. Alopecia is the medical term for hair loss but it’s more complex that what most people realize. Alopecia can be caused by multiple things. Think of causes of alopecia in three main categories. First, skin conditions that affect the skin directly, internal causes and external causes. Some skin conditions that affect the scalp directly and result in hair loss include alopecia areata, lupus, lichen planopilaris, fungal infections or psoriasis. External causes are more broad and include trauma, certain hair care practices or products, medications and physical and emotional stressors. Physical stressors include things like an illness, hospitalization, surgery, rapid weight loss or giving birth. Examples of emotional stressors are just that—the stuff that stresses us out—financial worries, a difficult boss, caring for a loved one or death or divorce in the family. Even the stress of losing hair can cause more hair loss! The last category is internal causes: This has to do with things going on inside that body that may account for hair loss such as hormonal changes, thyroid disease and nutritional deficiencies.
And a lot of times, the cause of alopecia is multifactorial—meaning there isn’t just one reason why someone is losing hair and it can be hard to figure out the predominant cause. Sometimes my patients simply have thinning because of the hormonal changes that come with aging, while others have a combination of things going on, like low zinc and thyroid disease combined with thinning due to emotional stress at work. And even more, you need to address all of those causes to adequately treat someone. So yes, you may have alopecia, but the type of alopecia you have is important to identify so that the treatment can be right for you. Part of an alopecia visit at the dermatologist includes a physical exam of your scalp but also other areas that have hair like your eyebrows, eyelashes or body hair. In addition to an exam, part of an alopecia work may include lab tests and a biopsy of the scalp. A scalp biopsy can help clarify what type of hair loss you have.
In the dermatology world, we also think of alopecia as scarring and non-scarring. This can sometimes be seen on exam but more easily seen when a skin pathologist, a doctor that specializes in reading skin under the microscope, looks at your scalp biopsy. Scarring means that the hair follicles have been destroyed and as a result, regrowth is unlikely. Nonscarring refers to the fact that the hair follicles are still alive and might be able to regrowth hair. The most common form of nonscarring alopecia is androgenetic alopecia, what we call male- or female-pattern baldness or age-related thinning. The good news is that hair loss caused by stress or even medications is nonscarring, so it can be reversible. Scarring hair loss includes conditions like central centrifugal cicatricial alopecia, lupus or lichen planopilaris. It’s important to identify scarring hair loss early because once those hair follicles are gone, we typically can’t get them back to grow hair again.
Treatment for alopecia depends on the type of alopecia you have. So when you hear your best friend tried this and it worked for her, but your dermatologist didn’t recommend it for you, it may be because your type of hair loss if different. In addition to seeking a dermatologist’s care for alopecia, be weary of all the ads and products out there promising full heads of hair. Some of them may be not work on your type of alopecia and some may not work at all. Alopecia is an emotionally taxing experience for anyone and unfortunately, good marketing can play to your emotions and make you spend lots of money with little results.
Trotter’s Take: If you have hair loss, it’s time to get to the dermatologist so that you have an accurate diagnosis. Treatment of hair loss can be challenging, so the earlier the better.
Listen to my podcast with Dr. Melissa Piliang, chair of the Department of Dermatology at the Cleveland Clinic, as we tackle age-related hair loss.
