Hair loss: Diagnosis and treatment
How do dermatologists diagnose hair loss?
Because so many things can cause hair loss, a dermatologist acts like a detective. A dermatologist may begin by asking questions. The dermatologist will want to know whether the hair loss happened suddenly or gradually. Knowing this helps to eliminate causes.
A dermatologist also will ask what medicines you take, what allergies you have, and whether you have been dieting. It is important to give the dermatologist accurate information. Like a murder mystery, the slightest clue can solve the case. Women may be asked about their periods, pregnancies, and menopause.
The dermatologist also will carefully look at your scalp and hair. During an exam, the dermatologist may pull on your hair. Sometimes a dermatologist needs to pull out a hair to get the necessary evidence. And sometimes a dermatologist needs to look at the hair on the rest of your body to see whether there is too little or too much hair in other areas.
Sometimes the evidence lies in your scalp. The dermatologist may remove a small piece of the scalp. This is called a scalp biopsy. A dermatologist can quickly and safely perform a scalp biopsy during an office visit. A scalp biopsy can be essential to solving the case. Sometimes, a blood test is necessary.
Because so many things can cause hair loss, it can take time to find the cause. You may need to make a few appointments.
How do dermatologists treat hair loss?
Just as there are many causes, there are many treatments for hair loss. Dermatologists recommend treating hair loss early. Early means before you lose a lot of hair. Hair loss is harder to treat when a person has a lot of hair loss.
One or more of the following treatments may be part of your treatment plan. Treatment available without a prescription
- Minoxidil: This medicine is applied to the scalp. It can stop hairs from getting thinner and stimulate hair growth on the top of the scalp. The U.S. Food and Drug Administration (FDA) has approved minoxidil to treat hair loss. It is the only hair re-growth product approved for men and women. A dermatologist may combine minoxidil with another treatment.
- Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.
- Finasteride: The FDA approved this medicine to treat men with hair loss. It comes in pill form and helps slow hair loss in most (about 88%) men. It helps stimulate hair re-growth in many (about 66%) men. Finasteride works by stopping the body from making a male hormone, dihydrotestosterone (DHT).
- Corticosteroid: If your hair loss is caused by inflammation in your body, a dermatologist may inject a medicine called a corticosteroid into your scalp. This can help stop the inflammation that happens when a person has alopecia areata. A corticosteroid is different from an anabolic steroid.
The type of procedure that a dermatologist recommends will depend on how much hair you have lost. To achieve the best results, a dermatologist may use one or more of the following procedures:
- Hair transplantation: Skin on the scalp that has good hair growth is removed and transplanted to areas of the scalp that need hair.
- Scalp reduction: Bald scalp is surgically removed and hair-bearing scalp is brought closer together to reduce balding. Scalp reduction surgery can be performed alone or in conjunction with a hair transplant.
- Scalp expansion: Devices are inserted under the scalp for about 3 to 4 weeks to stretch the skin. This procedure may be performed before a scalp reduction to make the scalp more lax. It also can be performed solely to stretch hair-bearing areas, which reduces balding.
- Scalp flaps: A hair-bearing segment of scalp is surgically moved and placed where hair is needed.
Once your dermatologist knows what is causing the hair loss, your dermatologist can tell you what to expect. Sometimes hair loss does not need treatment. The hair will start to re-grow on its own. In some cases, changing what you do will stop the hair loss, allowing your hair to start re-growing. Sometimes treatment can restore hair.
*Photograph used with permission of the Journal of the American Academy of Dermatology. This photograph was published in the Journal of the American Academy of Dermatology, Vol. # 60, Gathers RC, Jankowski M, Eide M, et al. “Hair grooming practices and central centrifugal cicatricial alopecia,” 660-8. Copyright Elsevier (2009). Journal of the American Academy of Dermatology.
**Photo used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides