Expert advice from a dermatologist specializing in hair loss and scalp disorders
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Photo: Courtesy of Erika Elliott
If you’re experiencing any type of hair loss, the first step should be to see a dermatologist. Some people think they need to be seen at a specialty hair-loss clinic, but every dermatologist is trained in hair loss and scalp disorders and can diagnose you.
Establishing a base to get a diagnosis is incredibly helpful. It’s much more effective than trying over-the-counter products at home on your own. The biggest thing that upsets me is when I see patients who spend a ton of money buying shampoos, serums, and things that are marketed to them with no evidence backing that they do anything.
Another reason it’s important to be seen by a doctor is that hair loss and scalp care are hard to separate, because they can be related and on the same spectrum. In my clinic, I explain the etiology of alopecia, the medical name for hair loss, and whether their condition is non-scarring or scarring.
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In most cases of non-scarring alopecia, when you look at the scalp, there aren’t any skip, or missing areas of hair and there are lots of hair follicles and minimal inflammation. Male and female pattern hair loss, or androgenetic alopecia, are some of the most common examples of non-scarring hair loss.
Another common type of non-scarring hair loss is called telogen effluvium. When a patient undergoes a stressful event, it can cause the hair to switch from the growth—or anagen phase—into the telogen or shed phase.
These events could be something like a hospitalization, major life event, a medical illness, a new vitamin deficiency, or a new medication. The hair responds to this stressor by switching into the shed phase, and patients may find it alarming because they’ll begin to see a lot of hair in the shower or on the pillowcase—but the good news is it usually self-resolves over 6-12 months. The hair will slowly start to regenerate into the growth phase, but it can be stressful waiting.
The last example of a non-scarring alopecia we will touch on is alopecia areata, which is an autoimmune condition where patients get perfect circles of hair loss that can progress to losing the hair on your entire scalp. In these cases, the immune system attacks the hair follicle, mistaking it for a foreign object, and causes the hair to fall out. In addition to minoxidil treatment, patients respond well to topical, injectable, and oral immunomodulatory therapies.
On the other hand, patients can experience scarring alopecia, which is due to chronic inflammation on the scalp. Most of the cases of scarring hair loss are associated with burning, itch, or pain. Those are signs of inflammation in the scalp, which will cause the hair to fall out and leave a scar at the site of inflammation. This can lead to permanent hair loss because it’s hard to grow hair through scar tissue, similar to how it would be hard for hair to grow through a scar from an injury or surgery.
There are more nuanced forms of scarring hair loss, too, but that’s why it can be so important to see a physician or dermatologist who specializes in the field, because the scars themselves can be very sneaky. Once we identify the diagnosis, we ask questions like how aggressive do we need to be to treat it and what treatment options are available. That’s why I always encourage patients if they have any form of hair loss and it’s bothering them, to get evaluated sooner rather than later because there are treatments available for all forms of hair loss.
Erika Elliott is associate program director for dermatology and an associate professor at Tufts University School of Medicine, and a practicing dermatologist specializing in hair loss at Tufts Medical Center.
