Hair Loss

HAIR TODAY.... GONE TOMORROW...WHY? AND WHAT CAN BE DONE?

WHY DO PATIENTS EXPERIENCE HAIR LOSS?

People who notice hair falling out, thinning, or appearing in large amounts on their comb or brush should be evaluated. With the correct diagnosis, the staff at ADAS can help you. We can determine whether the problem will resolve on its own or if medical treatment is needed. This is very important for our patients in Jacksonville, Ponte Vedra Beach and Fleming Island

HAIR FACTS

• About 90 percent of the hair is growing at any one time, and the growth phase lasts between two and six years.
• Ten percent of the hair is in a resting phase that lasts two to three months, and at the end of its resting stage the hair is shed.
• When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again.
• Scalp hair grows about one-half inch per month, but as people age their rate of hair growth slows. This leads to a gradual thinning effect.
• Most hair shedding is due to the normal hair cycle It is normal to lose between 50 to 150 hairs per day.

CAUSES OF EXCESSIVE HAIR LOSS

Hair loss can be attributed to many different causes. In many instances such as after pregnancy or with thyroid replacement, the hair will regrow spontaneously. For forms of hair loss for which there is no cure at present, there is research in progress that holds promise for the future. Talk to our ADAS providers about the options which are available for you. You will be glad that you did.

IMPROPER CHEMICAL TREATMENTS

Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, straighteners, and permanent waves. These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often. If hair becomes brittle from chemical treatments, it is best to stop until the hair grows out.

HEREDITARY THINNING OR BALDING

Also known as androgenetic alopecia, this is the most common cause of hair loss, and can be inherited from either the mother's or father's side of the family. Women with this trait develop thinning hair, but do not become completely bald. Hereditary hair loss can start in one's teens, twenties, or thirties. While there is no cure, medical treatments are available that may help some people, including:

• Minoxodil, a lotion applied to the scalp twice a day, which can be used by men and women
• Finasteride (Propecia™) - an oral prescription medication used by men only which blocks the formation of the active male hormone in the hair follicle. There are some side effects with this medication but this is a wonderful treatment for maintenance.
• Biotin (Appearex™) - has been shown to help hair thinning at a dose of 5000 mcg a day. This is also a wonderful product for nail fragility.
• Tricomin™ - During the hairs growth phase, the base of the hair follicle (dermal papilla) is richly endowed with substances such as collagen and various proteins. These substances are virtually absent during the resting phase. Copper has been shown to stimulate the cells responsible for production of these substances

ALOPECIA AREATA

The cause of alopecia areata is unknown, but it is thought to be an autoimmune condition (the body makes antibodies to its own hair) that may affect children or adults of any age. The affected persons are generally in excellent health. Sometimes, the alopecia areata has been associated with other disorders such as vitiligo, atopic dermatitis, thyroid disorders, collagen vascular disorders, Downs syndrome, Diabetes, emotional stress, and pernicious anemia. This type of hair loss usually causes totally smooth, round patches about the size of a coin or larger. Nails can also be pitted. Although rare, it can result in complete loss of scalp and body hair. In most cases the hair does regrow after several months or years.

Treatment includes:

• cortisone injections in the scalp where the hair loss occurred
• topical medications (steroids)
• a special kind of light treatment (PUVA)
• pills (Cyclosporine, Dapsone)
• immunotherapy (DNCB)
• alpha interferon
• minoxidil

TELOGEN EFFLUVIUM

This is a cause of nonscarring hair loss that has a sudden onset. Illness, stress, and other factors can cause too many hairs to enter the resting (telogen) phase of the hair growth cycle, and it produces a dramatic increase in the amount of hair shed (effluvium), usually without bald patches. In many cases, telogen effluvium usually resolves in a few months on its own. Causes of telogen effluvium include:

• High Fever, Severe Infection, Severe Flu
• Major Surgery/Chronic Illness
• Thyroid Disease
• Inadequate Protein in Diet
• Low Serum Iron
• Medications
• Birth Control Pills
• Cancer Treatments
• Allergic Contact Dermatitis

Sometimes we will check a blood count to evaluate your iron ingestion, CBC and thyroid levels. It is also important to avoid crash diets, ensure adequate protein ingestion and eliminate sources of excessive Vitamin A intake.

TINEA CAPITIS (SCALP RINGWORM)

Tinea capitis is a disease caused by superficial fungal infection of the skin of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles. The disease is considered to be a form of superficial mycosis or dermatophytosis. Several synonyms are used, including ringworm of the scalp and tinea tonsurans. In the United States and other regions of the world, the incidence of tinea capitis is increasing. Peak age range is in patients aged 3-7 years.

Caused by a fungal infection, tinea capitis is characterized by patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing on the scalp. Laboratory diagnosis of dermatophytosis depends on examination and culture of skin rubbings, skin or nail scrapings, hair pluckings (epilated hair), or nail clippings from lesions. Infected hairs appearing as broken stubs are best for examination. Woods light evaluation can sometimes show that the fungus has fluorescent properties (see picture to the left). Oral medication will cure it.


TRICHOTILLOMANIA (HAIR PULLING)

Trichotillomania, a primary psychiatric disorder, is, from a dermatological standpoint, one of traumatic alopecia. The causative trauma to the hairs occurs as a result of the patient's repetitive hair-pulling behavior. In terms of the behavior, 2 subtypes have been described: (1) focused pulling and (2) nonfocused pulling. Focused pulling is an intentional act to control negative emotional states such as anxiety or anger. The compulsion is characterized by increasing tension that is finally relieved when the hair is pulled. Nonfocused pulling is an automatic nonintentional, habitual-type of pulling that occurs primarily devoid of the patient's awareness.

Children, and sometimes adults, will twist or pull their hair, brows, or lashes until they come out. Oftentimes this is just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses. Trichotillomania is primarily a psychiatric disorder. Physical exercise is always advisable. It is thought that many of the childhood and adolescent patients with trichotillomania spend too much time in study for examinations in school, sitting at a desk, rather than participating in physical activities.

CICATRICIAL (SCARRING) ALOPECIA

This rare disorder can cause patchy hair loss and associated itching and/or pain. Inflammation around the hair follicle causes damage, scarring, and permanent hair loss in the affected area. The cause or trigger of cicatricial alopecia is unknown. Treatment focuses on stopping the spread of inflammation.

HAIR RESTORATION SURGERY

Dermasurgeons perform hair restoration surgery to correct hair loss and create a natural-looking hairline. Patients with well-defined baldness, thinning hair, and those with limited hair loss due to scalp injury or burns are generally good candidates for hair replacement surgery.


48-year-old male with male pattern baldness


Seven months later after three sessions

The type of hair replacement surgery chosen depends on the extent and pattern of hair loss. To achieve the best results, a dermatologist may use one or more of the following procedures:

HAIR TRANSPLANTS

Hair transplant surgery is based on the principle of donor dominance, which means that hair from healthy donor sites will take root and grow normally when transplanted into balding, recipient sites. Hair transplantation involves:

• removing small strips of hair-bearing scalp from the back and sides of the head, known as the "donor region," which contains hair that will grow throughout a lifetime
• repairing the donor region, usually resulting in a very narrow scar which is hidden by overlying hair
• harvesting strips of hair-bearing scalp and dividing into grafts for placement in the balding areas

The amount of coverage varies depending on the extent of baldness and the specific procedure performed. Within one month, much of the transplanted hair is shed. About two months later, hair starts to grow and continues to grow at a normal rate. After six months, the transplanted hairs begin to take on a natural appearance.

SCALP REDUCTION

Scalp reduction offers a special benefit to patients with extensive balding. In this procedure, bald areas are reduced or even eliminated by removing several inches of the bald skin, then pulling the sides together and suturing them. Scalp reduction surgery can be performed alone or in conjunction with a hair transplant.

SCALP EXTENDERS OR TISSUE EXPANDERS

These devices are inserted under the scalp for about three to four weeks to stretch hair-bearing areas, and may be used to increase the effectiveness of scalp reductions. The extender acts like a large rubber band, and the expander works like a balloon, allowing for an even greater reduction in the balding area.

For hair restoration surgery, the patient can expect:

• Treatment performed using local anesthesia in the dermatologist's office, an ambulatory surgery center, or other outpatient facility.
• To resume their normal activities, avoiding strenuous physical exercise until further notified.
• Mild side effects which may include: some swelling and brusing around the eyes after two or three days (which can be minimized by ice compresses and sleeping in a semi-reclined postion), and some numbness at the donor and recipient sites which usually disappears within three months.
• Multiple sessions at various intervals are usually required, and the entire process can take months to years to complete.
• As with all surgical procedures, there is always some risk. However, complications from the surgical treatment of hair loss are rare and generally minimal

For more information on hair loss or to set up a consultation, click here or call 904-285-7546. Thank you and we look forward to helping you.