Hair loss or alopecia, is a very common presenting symptom and there are a range of conditions that can cause it
Hair loss or alopecia,
is a very common presenting symptom and there are a range of conditions that
can cause it. Hair loss is categorized into two broad categories: scarring,
which leads to permanent destruction of the hair follicle, and nonscarring, in
which the hair follicles remain intact. The vast majority of hair loss is
nonscarring and includes such conditions as pattern baldness, telogen effluvium
and alopecia areata. Scarring alopecia is less common and includes such
conditions as discoid lupus, lichen planopilaris, folliculitis decalvans,
traction alopecia and central centrifugal cicatricial alopecia. Overall, the
majority of hair loss in both men and women is pattern baldness, also referred
to as androgenetic alopecia. Both genetic and hormonal factors play a role in
pattern baldness. Another common cause of hair loss is telogen effluvium or
excessive hair shedding. A thorough patient evaluation is important in order to
identify potential triggers of telogen hair shedding. Common triggers for
telogen hair shedding include a major illness, surgery, parturition, rapid
weight loss, nutritional deficiency, thyroid dysfunction, stress and certain
Specific factors that can cause hair loss:
Medications, vitamins, or minerals:
medications used to treat high blood pressure, heart problems, depression or
gout; chemotherapy or radiation treatment for cancer patients; and in some
cases, unusually high levels of vitamin A or low levels of iron or protein. For
women, birth control pills can cause hair loss.
Illness, including thyroid disease
and severe infection.
Scalp conditions, including
psoriasis, seborrheic dermatitis, tinea capitis and folliculitis.
Trauma, including traction alopecia
resulting from certain hair styles that cause trauma to the hair follicles and
trichotillomania resulting from repetitive pulling and breaking of one’s own
What are the treatment options for hair loss?
Therapies for hair
loss include identifying and treating underlying cause, topical minoxidil,
antiandrogen medication and hair transplantation in selected patients.
Minoxidil (Rogaine) is
FDA-approved for treating male and female pattern baldness. Minoxidil is a
topical solution that is applied by directly rubbing it onto the scalp where
hair growth is desired. It is available over-the-counter and does not require
FDA-approved to treat male pattern baldness. Finasteride is not approved for
female pattern baldness. Like all prescription products, Finasteride should be
given under a physician’s care.
Permanent hair loss
can also be treated by hair transplantation or hair replacement surgery. Hair
replacement surgery is a cosmetic procedure and includes such replacement
procedures as micro-grafting, slit grafting, punch grafting, and scalp
reduction. The type of hair loss as well as the patient’s circumstances and
desires determine which hair replacement procedures are most suitable.
Who is a candidate for hair replacement?
Men with male-pattern baldness.
Some women with thinning hair.
A person who has lost some but not
all hair as a result of burns or other scalp injuries.
Who is not a candidate for hair replacement?
Hair replacement is
not recommended for the following patients:
Women with a diffuse, or wide-spread,
pattern of hair loss
Those who do not have sufficient
"donor" sites (hair-bearing portions of the head from which
hair-bearing skin is taken)
People who form keloid scars or thick
fibrous tissue that can result from trauma, burning, or radiation injury
Those whose hair loss is due to
Common hair replacement procedures
Grafting: Grafting is an outpatient procedure performed
in the dermatologic surgeon’s office. Micro-grafts contain only one to two
hairs per graft, while slit grafts contain between four and 10, and punch
grafts hold 10 to 15 hairs. A local anesthetic is injected into the scalp and
sedation is available, if needed, for relaxation and comfort.
What happens during and after the procedure?
surgeon first removes a disc-shaped portion of the hair-bearing scalp from the
back of the head. Then, the surgeon cuts the removed scalp into small segments
with varying amounts of hair in each graft to achieve a very subtle thickening
and "natural" look with this technique.
With each session, 100
to 1,000 hair-bearing segments are transplanted. "Donor" sites are
closed with stitches, which usually are then concealed by the surrounding hair.
After the grafting session is complete, the scalp is cleaned and covered with
gauze and, if necessary, a bandage. Stitches will be removed approximately 10
How long does the procedure take?
Three to four sessions
may be needed to achieve satisfactory "fullness." After each session,
a healing process of two to four months is usually recommended prior to the
Are there any side effects?
Most side effects that
come with a hair transplant usually go away within one to three weeks. Among
the most common side effects are:
Bruising around the eyes
Crust may form on the
"donor" and "recipient" sites of the scalp
A lack of feeling or decreased
sensation around the "donor" and "recipient" sites of the
Itching in the "donor" site
Scalp reduction: A scalp reduction is the removal of
non-hair-bearing skin from the scalp so that the remaining hair-bearing skin
can be stretched to fill in the bald area of the head. Scalp reduction can
reduce as much as half of the bald area. It is a procedure performed to cover
bald areas on the top and back of the head and is not found to be beneficial
for the frontal hairline.
How is this procedure done?
The scalp is injected
with local anesthetic and a bald segment of scalp is removed. The surrounding
skin is then loosened and gently stretched so that the sections of hair-bearing
scalp are brought together and closed with stitches. This procedure may also be
performed during punch grafting sessions.
What are the side effects?
Scalp tightness (temporary)
Scarring at the suture lines