Hair loss: Diagnosis, treatment, and outcome
How do dermatologists diagnose hair loss?
Because so many things can cause hair loss, a dermatologist acts like a detective. He or she may begin by asking questions. They will want to know whether the thinning happened suddenly or gradually. Knowing this helps to eliminate the causes.
The information asked will determine what medicines you take, what allergies you have, and whether you have been dieting. It is important to give 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 will carefully look at your scalp and hair, during an exam, and may pull on it. Sometimes it is necessary to pull out a piece of hair to get the proper evidence. At some point and time there will be a need 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, and there maybe a small piece of the scalp removed. This is called a scalp biopsy, which can quickly and safely be performed during an office visit. A scalp biopsy can be essential to solving the case. Sometimes, a blood test is necessary.
Notably, several health conditions, including thyroid disease and iron deficiency anemia, can cause hair loss. While thyroid blood tests and other lab tests, including a complete blood count (CBC), on people who have ordinary hair loss are usually normal, it is important to exclude underlying causes in sudden or severe balding.
If you are concerned about some other underlying health issues, you may start by seeing your family physician, internist, or gynecologist for basic health screening. Dermatologists are doctors who specialize in problems of skin, hair, and nails and may provide more advanced diagnosis and treatment of hair thinning and loss. Sometimes a scalp biopsy may be taken to help in diagnosis of severe or unexplained loss of hair.
Although many medications list this problem among their potential side effects, drugs are also not overall common causes of thinning of hair. On the other hand, with cancer treatments and immune suppression medications including chemotherapy, losing hair is a very common side effect. Complete baldness often occurs after a course of major chemotherapy for cancer. Usually, hair regrows after six to 12 months
Because so many things can become factors in loosing hair, 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 thinning, and the recommendation is to treat it early. This means before you lose a lot of hair. Hair is hard to treat when a person has lost a lot of it.
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.