5 ways to approach hair loss

My heart goes out to you on this.  In the past year, we’ve had several patients with the more severe form of alopecia areata (AA). It’s very scary for patients. As a disease it’s a bit mysterious.  It’s definitely autoimmune.  If you look at a biopsy slide of the hair follicles under the microscope, you’d see white blood cells attacking the follicles, and looking a little like a swarm of tiny bees.  But why?  That’s the 15 million dollar question.  It’s at least partly genetic in many cases, and often linked to other autoimmune diseases.  But many cases, have no clear reason why.

The good thing about this disease is that the follicles generally don’t scar so the hair can grow back.

Also, can I use this opportunity to say to everyone…..please get vaccinated if you haven’t been already. It may save you and your loved ones a ton of heartache and headache.

Patchy Hair Loss:

1.  Bald patches. If you have clear bald patches, even small ones, please see your dermatologist asap.  You may have AA. The sooner you start care, the more likely you are to go in remission with treatment.  They are usually very well demarcated and clumps may fall out in those areas.  This type of hair loss is usually not slow, and all over, but can be.  You may need to go to a University center nearby, to find a doctor who can use biologics (tablets or injections) to treat the more severe forms.
2. Hair loss from traction or breakage.  I’m not a huge fan of anything that pulls to much on the roots of hair.  Tightly pulled styles and hair extensions, can put extra stress on the roots. Gradual breakage or loss from the root results.  Most common cause of breakage is over processing.  Just pull on some hair and see if it comes out from the root or is just breaking. See you dermatologist if your not sure.

All Over Hair Loss:

1. Gradual hair loss. Most often genetic so look at your whole family tree, both on your mother’s and father’s sides.  Can be related to other things, including nutrition problems. See your doctor to discuss Rogaine, hormone adjustments, your thyroid and other lab tests, nutrition, and platelet rich plasma injections.
2. Sudden diffuse hair loss.  This is most often related to a sudden, often medical, life event.  Called telogen effluvium, the most common example is after delivering a baby. The hair roots (follicles) go into a bit of shock, cycle into resting phase and fall out. They start to grow back in, but it can take a year to really see a positive difference. Another example would be a pneumonia, Covid-19, or a serious other flu.
3. Nutrition related hair loss. Certain nutritional deficiencies can cause hair loss. In our country, protein deficiencies are rare, but can occur in vegans sometimes. I had a friend who went on a 3 month “cleanse” and developed severe hair loss. It grew back after she started eating protein again. Iron deficiency can cause loss.  The best test for this is a serum Ferritin. True celiac sprue (gluten allergy) also. A nutritionist, naturopath or doctor should be able to help.

A scalp biopsy is not painful, and can help figure out your diagnosis.  The pathologist looks at the roots of the hair follicle, and very often tell exactly what the problem is.

I hope this helps,

Dr. Brandith