Tag Archive for: female pattern hair loss

Can Female Pattern Hair Loss be Reversed?

Women have a reputation for being fixers.  When something goes wrong, the first thing we want to do is fix it.  So it’s not surprising that when we lose our hair, we want to take action and figure out if there’s anything we can do to make it grow back.  Fortunately, female pattern hair loss can be treated.  It doesn’t happen overnight, but women start to see improvement within six months to a year.  If you have questions about what products are most effective and if there are any side effects, you’ve come to the right place.  Here’s everything you need to know.

Female Pattern Hair Loss Is Common

Female pattern hair loss, also called androgenetic alopecia, is the most common type of alopecia among women.  Over 21 million women in the United States experience hair loss due to the condition.  Besides normal recession that happens to most people as they age, the front of the hairline isn’t usually affected.  There is a very distinct, recognizable pattern, though.  The process usually starts with a widening of the center hair part and thins on the top and crown of the scalp, making a Christmas tree pattern.  Women usually don’t become near or totally bald the way men do.  

Too Much DHT Causes Hair Loss

The exact cause of female pattern hair loss isn’t completely understood. Experts believe that there are genetic and hormonal connections.  If one of your parents or grandparents lost their hair due to androgenetic alopecia, there’s a chance that you may too.  

What we do know is that an androgen called Dihydrotestosterone (DHT) is to blame.  Just as men have small amounts of estrogen, women have small amounts of testosterone.  Hair loss begins when some or a lot of that testosterone is converted to DHT.. DHT interrupts your hair’s growth cycle.  The androgen miniaturizes the hair follicles, which means that the hair follicles shrink.  Existing hair in miniaturized follicles thins or falls out.  New hair can’t break through.

Myths About Female Pattern Hair Loss

Many myths about what causes female pattern hair loss exist.  Let’s discuss three common topics that women often blame for their hair loss:

  •  Vitamin Deficiencies 

Vitamin deficiencies, especially iron and Vitamin D, are linked to hair loss.  However, they don’t cause androgenetic alopecia.  Vitamin deficiencies cause a temporary condition called telogen effluvium.  Once the deficiency is identified and treated, hair loss typically stops and new hair grows.

  • Birth Control Pills 

Research indicates that during initial use of oral contraceptives, women may experience more shedding than usual.  However, after a few months, the hair grows back on its own. (01)  The same is true when women who are stable when taking oral contraceptives go off of the medication.  

  • Antidepressants

There is a lot of talk in various Facebook and support groups about whether antidepressants are the root of women’s hair loss.  If you think that your antidepressants are causing an issue, it’s important not to change your dosage or stop taking your medication without first consulting with your doctor.  Yes, it’s true that some antidepressants can cause medicine-induced alopecia, although it’s rare.  The type of alopecia induced is typically a temporary form of telogen effluvium.  However, if hair loss due to antidepressants concern, be sure to consult with your dermatologist.  Effective hair loss medications can often be used in conjunction with antidepressants.  

There’s No Age Limit 

Women of all ages can experience female pattern hair loss.  Although most women start to notice their hair thinning in midlife, meaning ages 40 through 60, hair loss due to androgenetic alopecia can start any time after puberty.  

Patterns of Hair Loss Are the Key to Diagnosis

There isn’t one specific test that dermatologists use to determine whether or not you have female pattern hair loss.  Dermatologists can typically make a diagnosis based on a visual evaluation since androgenetic alopecia has such specific patterns in women.  Other information that he or she will use includes:

  • Medical history
  • Blood tests to check vitamin levels
  • Pull test to see if strands fall out easily
  • Visual inspection of hair follicles to check for miniaturization

Your dermatologist may also do a biopsy to rule out other forms of alopecia.

Treatments for Female Pattern Hair Loss

If you are diagnosed with female pattern hair loss, medications are available and have been proven to be effective.  One is over-the-counter, and the others are only available by prescription.  

  • Minoxidil (Rogaine)– Available over-the-counter in two and five-percent foams.  Although the five percent is designated for men, women often use the five percent formula.  Stronger liquid formulas are available by prescription.  Oral pills are also available, but carry a very small risk of hirsutism.  
  • Finasteride (Proscar, Propecia)– A DHT blocker FDA approved for men, prescribed off-label for women.  An effective topical formula is also available.  
  • Dutasteride (Avodart) – Another DHT blocker that is prescribed as a second-line of treatment after Finasteride.  Dutasteride blocks two enzymes, while Finasteride blocks one.  Finasteride is effective for most women, so Dutasteride isn’t prescribed as often.
  • Spironolactone (Aldactone) – A DHT blocker that is prescribed when women’s treatment has plateaued using other treatments.  

Potential Side Effects from Hair Loss Medications

Potential side effects of taking oral hair loss medications are different for women than for men.  Minoxidil can cause a temporary, initial shedding among some women because it speeds up the resting phase of your hair.  This makes your hair fall out faster than normal when you first start using the medication.  Minoxidil also makes the growth phase last longer.  If you use Minoxidil and experience irritation, you may want to test a formula without propylene glycol.  Research indicates that the culprit is often the propylene glycol, not the Minoxidil. (02)

Finasteride, Dutasteride, and Spironolactone are not typically prescribed for women of child-bearing ages.  Aside from that, side effects are usually rare and mild, if present at all.  If you are concerned about side effects, or interactions with other medications you are taking, topical hair loss treatments may be a better option for you.  Topicals are proven to work as effectively as oral medications without the same risk of side effects since topicals are not systemic. (03)  You can also combine topical treatments with oral treatments.  

Treatment for Female Pattern Hair Loss Isn’t One-size-fits-all

Treating female pattern hair loss may take some experimenting.  Different treatments are effective for different women.  Whereas five percent topical Minoxidil may work for some, others may need ten percent.  The same is true for Finasteride and the other DHT blockers.  Also, remember that combinations of medications with different objectives are often used.  For example, Minoxidil and Finasteride are often used at the same time.  Retinoids are also often used to enhance the absorption of other medications.

If you have female pattern hair loss and would like more information on treatment options, we’re here to help.  Our board-certified dermatologists are happy to review your case and recommend the hair loss medication that would be best for you.  Best of all, our prescription medications can be customized and will be delivered directly to your front door.

 

Resources:

(01) https://pubmed.ncbi.nlm.nih.gov/4736624/

(02) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684510/

(03) https://onlinelibrary.wiley.com/doi/10.1111/jocd.14895?af=R

 

 

When Women Get Male Pattern Hair Loss


Female pattern hair loss can progress from a widening part to overall thinning.

I met my friend Barbara (01) twelve years ago when our boys were toddlers.  Barbara is a tiny woman with lots of spunk.  I always thought of her as strong, smart, and confident.  She called one day and confided in me that it bothered her that her hair was thinning.  She had been losing hair on the crown of her head since she was in her late 20s, and she never did anything about it.   She knew that I had lichen planopilaris and wanted to get the name of the dermatologist I used to treat my hair loss.  

Anyone knew just from looking at Barbara that her hair was sparse, and it took me by surprise that she hadn’t already had it checked out by a dermatologist or a hair specialist.   But then again, Barbara isn’t exactly a fashionista.  She’s an elder care nurse who spends most of her weekdays in scrubs and her weekends in sweats.  But still, I was surprised.  Barbara visited my dermatologist, and it turns out that she has androgenic alopecia, also known as male pattern baldness.  Who knew that women can get male pattern baldness?  And who knew that it could start so young?

How do Women Get Male Pattern Baldness?

Women get male pattern baldness for the same reasons men do.  Also known as androgenic alopecia, female pattern hair loss is usually inherited.  The condition occurs when a woman has a shorter than normal period of hair growth and a longer than normal period between when her hair sheds and grows.  In some cases, women have the misfortune of inheriting smaller hair follicles and thinner strands of hair.  

Almost every woman experiences female pattern hair loss at some point in her life.  Most first notice androgenic alopecia around menopause, but it can start any time after puberty begins.  If anyone on either side of your family has lost his or her hair, it’s more likely that you will too. 

What Does Female Pattern Baldness Look Like?

There’s some good news if you have female pattern baldness.  Women’s hairlines usually don’t recede and you won’t end up with a donut.  The other good news is that women typically don’t go completely bald.  Usually women with androgenic alopecia have one of three different patterns of hair loss.  A bald spot can form at the crown of your head, you could lose hair along your center part, or your hair could thin all over.  In some cases, hair gets so thin that the scalp can be seen.

If you’re a Woman, How do you Know if you Have Male Pattern Baldness?

Although it’s tempting, don’t try to self-diagnose or treat yourself if you think you have androgenic alopecia. Get an appointment with a board-certified dermatologist and hair specialist.  Your dermatologist may do one or several of the following:

  • Evaluate your hair loss pattern
  • Review your medical history
  • Rule out other possible causes for your hair loss, such as iron or vitamin D deficiency, thyroid disease, or another type of scarring alopecia
  • Determine whether you are producing too much androgen (male hormone)
  • Use a dermoscope or a microscope to look at the structure of your hair shaft
  • Take a small biopsy of your scalp and send it to a pathologist

Androgenic Alopecia Often Goes Undiagnosed in African American Women

Women of every race are affected by androgenic alopecia and other types of hair loss.  African American women are no exception.  In a 2016 survey conducted at Boston University’s Sloane Epidemiology Center, 47.6 percent of African-American women surveyed reported hair loss. (02)   

However, like my friend Barbara who noticed that her hair was thinning and didn’t do anything about it, many African-American women are not seeking treatment for androgenic alopecia.  Out of the group surveyed, 81.4 percent reported that they had never consulted with a physician about their thinning hair or bald spots.

The moral of this story?  If you think that your hair is thinning and have a history of hair loss on either your Mother’s or Father’s side of the family, don’t ignore it.  Make an appointment with your dermatologist to get evaluated and treated. 

Do Asian Women get Alopecia?

Asian women do get alopecia, but traditionally rates have been lower than those of Caucasian or African-American women. (03)  That number seems to be on the rise, though.  Diet is believed to be a contributing factor.   

Early research indicates that diets rich in vegetables, herbs, and soy may contribute to hair growth and health thanks to their anti-inflammatory nutrients. (04)  The traditional Asian diet, loaded with fish and vegetables, meets that criteria.  

Today’s modern Asian diet looks more like a typical American diet though, filled with processed foods.  The fat, salt, and empty calories lead to higher BMI and blood sugar levels that have been linked to female pattern hair loss. (05)

What Treatments are Available to Women with Female Pattern Baldness?

Treatments for androgenic alopecia are designed with two goals in mind:

  1. Prevent further hair loss
  2. Stimulate hair growth

Sounds logical, right?  Well, it is.  Here are medications that dermatologists typically prescribe:

Retinol (Tretinoin)

Retinol is derived from Vitamin A and has been found to be effective for treating female pattern hair loss when used either alone or in combination with Minoxidil. (06)  Retinol has been proven to stimulate growth and improve the absorption of other ingredients that promote hair growth.

Minoxidil (Rogaine)

Minoxidil, sold over-the-counter under the name Rogaine, is a hair regrowth treatment.  It works by enlarging the hair follicles and elongating your hair’s growth phase.  Minoxidil is available in both a topical foam and a pill.  Although the foam is available in a two percent formula for women and a five percent formula for men, dermatologists often recommend the five percent for women to use for androgenic alopecia.  Any hair growth realized while using Minodixil can be lost if you stop using the product, so it is highly recommended to use it under the care of a licensed dermatologist.

Finasteride (Propecia)

Finasteride is a prescription medication that was initially designed to treat enlarged prostates.  Because it prevents testosterone from converting into dihydrotestosterone (DHT), the medicine is helpful for women with female pattern hair loss. (07)  Finasteride is available as an oral medication and as a topical solution.  Many women prefer topical to avoid potential side effects.

Dutasteride (Avodart)

Dutasteride is similar to Finasteride.  Both medications prevent your body from converting testosterone into DHT, which causes female pattern baldness.  Dutasteride is newer to the market and is used off-label for androgenic alopecia in women. Finasteride is highly effective for most women, but when stronger medications are required, Dutasteride is a good option. (08)  Like Finasteride, Dutasteride is best for women who are not pregnant or thinking about becoming pregnant.   

Spironolactone (Aldactone)

Spironolactone is an effective treatment for hormone-induced hair loss that is only prescribed to women.  The medication blocks DHT production by simultaneously decreasing testosterone and increasing estrogen.

Data indicates that Spironolactone is highly effective for treating female pattern baldness.  In a research study conducted, 74.3 percent of patients who were treated with Spironolactone reported stabilization or improvement in their hair loss. (09)  

Oral Spironolactone can cause low blood pressure, drowsiness, and other side effects.  Topical Spironolactone, which does not go through the digestive system and is less likely to induce side effects, is often prescribed and preferred.  Topical Spironolactone is often compounded with Minoxidil to help your hair grow even faster and thicker.   

Compounded Topical Treatments

If you’re not thrilled about using multiple products, all-in-one topical treatments that combine multiple medications into one are now available and can be more effective than using just one medication alone. (10)   Popular combinations are:

  • Retinol, Minoxidil, and Finasteride 
  • Minoxidil and Spironolactone

Many women appreciate the convenience and ease of applying just one formula twice a day.  

With so Many Medications Available to Women with Androgenic Alopecia, How do you Choose?

Are you confused about all of the different options?  If so, that’s understandable since some of the DHT blocking medications work similarly.  Thankfully, dermatologists have experience selecting the right medications for patients with female pattern hair loss.  Your dermatologist will help you choose the right medication, dosage, and combination of medication based on the severity of your hair loss and your medical history.  

Remember that treatment for female pattern hair loss isn’t one-size-fits-all.  Different medications work for different women.  It’s common to go through a trial process to see what works best for you.  

Also, keep in mind that patience is key when treating androgenic alopecia.  Medications work over time, so it may be a few months before you see a noticeable improvement, no matter which treatment you and your dermatologist choose.

Women with Androgenic Alopecia Often Need a Support System

Every woman deals with androgenic alopecia differently.  My friend Barbara took her diagnosis in stride, but many women are devastated.  Hair is a huge part of a woman’s identity, and losing it can take a toll on a woman’s confidence.  

If you’re having trouble coping with your hair loss, resources are available to you.  Best of all, some of the resources are free.  Facebook has a closed group dedicated to females with androgenic alopecia.  Members share information about their diagnosis and treatment plans. Sometimes, they’re just there to tell each other that it’s okay to be sad about their hair loss.  Whether it’s on Facebook, another social media outlet, or in person, support groups are a good way to connect with others who are feeling the same way as you about your hair loss situation.  

If you’re not in a good place mentally, make sure you contact a qualified psychologist or a psychiatrist.  Depression and anxiety are common among women with female pattern hair loss.  It’s important to seek help so you can regain your sense of self.

Resources:

(01) Name has been changed to protect confidentiality

(02) https://www.sciencedaily.com/releases/2016/03/160304093239.htm

(03) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560543/

(04) https://www.karger.com/Article/Fulltext/504786

(05) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560543/

(06) https://pubmed.ncbi.nlm.nih.gov/3771854/

(07) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060023/

(08) https://pubmed.ncbi.nlm.nih.gov/25382509/

(09) https://www.jaad.org/article/S0190-9622(15)01878-2/fulltext

(10) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314881/

 

Why using Sunscreen on your Scalp is Crucial for Thinning Hair

Everyone knows sunscreen is an essential part of a healthy skincare regimen. You’re probably diligent about applying sunscreen on your arms and face, probably even the tops of your ears! As awesome as you are at applying sunscreen, you might be missing one crucial area – your scalp.

Sun Protection for Your Scalp

There are three ways you can shield your scalp from the sun. 

  1. Have thick hair. 
  2. Wear a hat. 
  3. Use sunscreen. 

An article published in the journal Photochemistry and Photobiology found that your hair acts like natural sun protection, called hair ultraviolet protection factor (HUPF). (01) HUPF works as a sun barrier and helps to prevent skin cancers caused by ultraviolet (UV) radiation. 

So, if you have lots of hair or intend to wear a fedora whenever you’re in the sun, then you’ve got it all covered. If your hair is thinning, cut very short, or if you’re without any hair, however, then your scalp is vulnerable. Unlike the skin on your face, your scalp lacks the same barrier strength, which makes your scalp sensitive to UV radiation and environmental toxins. Because your scalp’s skin barrier is thinner than the barrier on your body, safeguarding your scalp should be an important part of your skincare routine. (01)

Do people with hair loss conditions need sunscreen?

Hair loss affects a larger portion of the population than most people realize. According to the Cleveland Clinic, about 25% of men experience their first signs of hair loss by the age of 21. And roughly 50% of all the men undergo some level of hair loss by age 50. 

However, it’s not just men who are affected by hair loss. About 30 million women have a condition called female pattern hair loss (FPHL). It could happen to anyone. In many cases, people may have hair loss only in very specific areas on their scalp, while other parts remain flush with hair. Hair loss varies from person to person, and it’s the exposed scalp areas that need sun protection the most. (02, 03) 

Sunscreen for the scalp is a relevant consideration for all people, but especially for people with hair loss conditions. The following are few examples of hair conditions that may benefit from sunscreen use.

  • Androgenetic alopecia
  • Alopecia areata
  • Cicatricial alopecia
  • Folliculitis Decalvans
  • Frontal fibrosing alopecia 
  • Central centrifugal cicatricial alopecia
  • Discoid Lupus erythematosus
  • Male pattern baldness 
  • Loose anagen syndrome
  • Hypotrichosis
  • Lichen planopilaris
  • Anagen effluvium
  • Telogen effluvium

Even people who don’t have a hair loss condition may need to use sunscreen on their scalp. Most people are unaware that they have sections of their scalp showing. For example, people have a whorl of hair at the crown, often showing a bit of exposed scalp. Spend enough time outdoors without sun protection, and this small patch of unshielded scalp can become sunburnt. 

Can your scalp get a sunburn?

Just like the rest of the skin on your body, your scalp can burn from too much sunlight. For this reason, protecting your scalp from the sun is crucial to reducing skin damage, lowering your risk of developing skin cancer, and preventing painful sunburns.

Sunburns and Your Hair Follicles

In general, if you’re already dealing with hair loss, injury from the sun can create more challenges. Third and fourth-degree sunburns, for instance, may damage and physically stress hair follicles, causing a temporary condition of hair loss called telogen effluvium. Maintaining your scalp health means potentially keeping more of your hair, which makes sun protection paramount. (03)

Sunburns and Skin Cancer

Sun damage may cause further hair loss, but it can also lead to something life threatening — skin cancer. The American Academy of Dermatology Association (AADA) reports that about one in five people will develop some form of skin cancer in their lifetime. (04) Out of that population, about 2% to 18% affect the scalp. (05) Furthermore, cases of skin cancer continue to rise each year. Keeping this information in mind, your scalp should receive the same – if not more – sun protection as the rest of the skin on your body. 

What is a Sunburn?

Environmental pollutants and UV radiation accelerate the signs of aging, injure cells, and damage DNA within the skin barrier and deeper tissues. Sunburns are an inflammatory response to excessive UV radiation, which destroys the upper layers of skin. (06) Melanin, which darkens skin with exposure to sunlight, helps to protect your skin cells from the sun’s damage. Contrary to popular belief, a glowing tan doesn’t indicate healthy skin. A tan means that your skin cells have reacted to the sun’s radiation!

How your skin reacts to UV radiation is primarily based on your genetic makeup. Some people undergo gradual skin darkening, while others immediately experience a sunburn. While both are signs of skin damage, people with sunburns experience more pain and visible skin cell injury. Repeated sunburns or exposure to UV radiation can place individuals at a higher risk of skin cancers like squamous cell carcinoma, basal cell carcinoma, and melanomas. (07)

What does a scalp sunburn feel like?

Whether or not a person feels pain with a scalp sunburn depends on the severity of the burn. Most sunburns are first or second-degree burns, but they can still cause some discomfort. With a first or second-degree sunburn, you might experience signs and symptoms like: 

  • Redness
  • Swelling
  • Irritation
  • Flaking
  • Itching
  • Burning 

Pain from a sunburn is typically at its worst 6 to 48 hours after exposure to the sun. (07) Severe cases of scalp sunburn may result in significant pain and blistering, which may take longer to heal. Fortunately, most sunburn symptoms are temporary and go away after three days to a week. The damage to cells and DNA, however, can remain for decades.

Treating a Scalp Sunburn

Caring for sunburn on the scalp takes a little TLC. To encourage healing, moisturize the area while the scalp is damp. Keeping the scalp moisturized cuts down on unsightly peeling and flaking. If you’re searching for sunburn medication, products that contain aloe vera may help to reduce inflammation and soothe irritation. 

  • Avoid oil or petroleum-based products because their ingredients can aggravate the scalp and cause more pain. 
  • Use shampoos that are sulfate-free and gentle on the scalp. 
  • Instead of hot water, run cool water over your scalp to cleanse the area. 
  • Stay hydrated and well-nourished to prevent further water loss and promote wound healing. 

Choosing the Right Sun Protection for Your Scalp

Fortunately, you have a variety of options when it comes to shielding your scalp from the sun. It may take some trial and error to find what suits your needs and lifestyle the best, but the effort is worthwhile.

Hats and Hair Loss

If you’re using headwear to protect your scalp, then you’ve got an array of style choices. From beanies to cowboy hats, your options are endless. However, wearing hats do come with a few drawbacks. 

Here are a few things to consider before you start your hat collection.

  • Remember that hats with openings in them, like snapback and trucker caps, allow sunlight to penetrate through parts of the hat.
  • Hats retain heat, and your head is one of the primary ways your body regulates its temperature. Wearing a hat in the sun may make you feel excessively warm. 
  • Hats that are hot or are too tight may reduce blood to hair follicles, depriving them of nutrients and causing stress — which can encourage further hair loss! (08)
  • Be wary of developing traction alopecia when choosing a hat. Constant pulling or tension of hair can lead to traction alopecia hair loss, so choose a loose-fitting hat. (08)

Don’t like hats? Don’t want to risk any more hair loss? Then you’ll need sunscreen. 

Helpful Hints for Choosing a Sunscreen for Your Scalp

Keep in mind that finding the right sunscreen for your scalp can be tricky. If you have thinning hair, you’ll want a formula that’s thick enough to protect your delicate scalp but won’t cake into your strands of hair. Finding the right sunscreen for your scalp is a bit like Goldilocks looking for the happy medium – you want something “just right.” 

Here are a few factors to think about when you’re on the lookout for a good scalp sunscreen: (09)

  • Sunscreens for the skin on the body tend to be oily. You may not want an oily sheen covering your scalp and hair. 
  • Stick sunscreen is excellent for small areas (like your crown or part) but not ideal for use over large areas with thinning hair. 
  • Powder sunscreen options for the hair are convenient and can make hair appear thicker. However, powder sunscreen can be twice the price of other types of sunscreen. 
  • Sunscreen sprays or mist are practical and are reasonably priced, though they can sometimes weigh hair down. 
  • Chemical sunscreens absorb the sun’s rays and prevent radiation from reaching your scalp and skin. These kinds of sunscreen don’t typically leave that white cast on the skin that sunscreen is known for.  

A few ingredients found in chemical sunscreens are: 

  • Avobenzone
  • Octisalate
  • Oxybenzone
  • Octocrylene
  • Octinoxate
  • Homosalate
  • Mineral sunscreen physically blocks or shields UV radiation. This sunscreen blocks the rays of the sun and deflects them back out. People with sensitive scalps or chemical sensitivities may find mineral sunscreen less irritating. 

A few ingredients found in mineral sunscreens are: 

  • Titanium dioxide
  • Zinc oxide

What is the best sunscreen?

According to the AADA, the sunscreen that’s best for you is the one you will use consistently. Whatever sunscreen you choose, make sure it meets the following criteria: (09)

  • Broad-spectrum for both UVA and UVB rays
  • Consists of an SPF of 30 or higher
  • Water-resistant

In short, if you have thinning hair, you need sun protection for your scalp. Whether you’re looking for some fun in the summer sun or you’re working outdoors, remember that you – quite literally – have skin in the game. Protect it! 

Resources

(01) https://pubmed.ncbi.nlm.nih.gov/25682789/

(02) https://pubmed.ncbi.nlm.nih.gov/25682789/

(03) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320655/

(04) https://www.aad.org/media/stats-skin-cancer

(05) https://onlinelibrary.wiley.com/doi/full/10.1111/ddg.13546

(06) http://skincancer.org/risk-factors/uv-radiation/

(07) https://jamanetwork.com/journals/jama/fullarticle/2383280

(08) https://health.clevelandclinic.org/can-wearing-a-hat-make-you-go-bald/

(09) https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs