Tag Archive for: Lichen Planopilaris

Is Scalp Inflammation Causing Your Hair Loss?

Why?  That’s the first question many people have when they realize they’re losing their hair.  It’s a perfectly logical question.  Unless you experience alopecia, you don’t have a reason to research the cause.  After all, who expects to see their hairline receding or their part getting progressively wider?

The truth is that there are many reasons why you can experience alopecia.  Genetics and autoimmune disease top the list.  However, people often blame inflammation for their hair loss.  It’s a natural connection given all the recent press.  Inflammation is linked to a countless number of medical conditions.  Everything from heart disease to skin issues seems to be associated.  All hair loss isn’t caused by inflammation, though.  So, how do you know whether scalp inflammation is at the root of your hair loss?  Read on.  We’ll help you understand what conditions can cause inflammation on your scalp and how hair loss from inflammation differs from other types of alopecia.  We’ll also share the latest options for treating and preventing hair loss caused by scalp inflammation.  

What is Scalp Inflammation?

If your scalp is red, itchy, or burns, it’s possible that inflammation is to blame.  But, what exactly does it mean when your scalp is inflamed?  Inflammation isn’t a stand-alone diagnosis, it’s triggered by a specific condition such as an infection, alopecia, or an allergic reaction.  It’s not random.  Uncontrolled inflammation does, however, contribute to hair loss.  It’s important to identify the condition causing the inflammation so you can stop any resulting hair loss and stimulate regrowth.  

What Causes Inflammation on Your Scalp?

If you’re experiencing scalp inflammation, one of many different conditions may be to blame.  Dermatitis, autoimmune conditions, infections, and alopecia are just a few.  Here’s what you need to know about them.

Dermatitis

Contact Dermatitis

Contact dermatitis is a rash caused by an allergic reaction to a substance such as a particular shampoo, conditioner, gel, or hair spray.  The rash appears within days after you’ve been exposed.  Not much treatment is necessary to get rid of the rash.  It usually clears up on its own within two to four weeks if you stop using the substance that causes the reaction.  Over-the-counter antihistamines and topical cortisone creams can help expedite the process. 

Seborrheic Dermatitis

You have probably heard of cradle cap, a condition that infants often experience.  It causes scaly, crusty patches on their heads.  You may be surprised to learn that adults get it too.  Only it has fancier names and is called seborrheic dermatitis, dandruff, seborrheic eczema, or seborrheic psoriasis.  Adults with seborrheic dermatitis experience redness, scaly patches, and thick dandruff.  The condition is unpredictable.  Sometimes it disappears without treatment.  If it doesn’t, you can use a special shampoo to reduce the build-up of dead skin and reduce oiliness.   Unfortunately, seborrheic dermatitis can also flare up without warning, so you may need to treat the condition more than once.  

Autoimmune Conditions

Discoid Lupus Erythematosus (DLE)

Discoid lupus is a rare autoimmune condition that primarily affects women and often runs in families.  The condition causes red, scaly, crusty patches.  The patches are distinctive because the center is lighter in color and the rim darker than the rest of the surrounding skin.  If your dermatologist suspects you have DLE, he or she will take a biopsy to confirm the diagnosis.  Treatment ranges from cortisone to prescription medications depending upon symptoms and severity.  

Folliculitis Keloidalis

Folliculitis keloidalis is a chronic inflammation of the hair follicles.  People with the condition usually get red, itchy bumps that worsen over time.  Although the exact cause is unknown, some believe it could be an immune reaction, irritation from close shaves or helmets, or androgen sensitivity.  Depending upon the severity, steroids, antibiotics, and retinoids are prescribed.  

Infections

Scalp Ringworm (Tinea Capitis)

Ringworm of the scalp is a contagious fungal infection that causes scaly bald patches that itch.  Fun fact:  no worm is involved.  Ringworm got its name because it has a circular appearance.  Oral medication and medicated shampoos kill the fungus and prevent the spread of the infection.  

Bacterial Folliculitis

Staph bacteria live on your skin all the time, but when they infect your hair follicles, itchy, white, pus-filled bumps can occur.  This is called bacterial folliculitis.  Fortunately, this condition is easily treated with topical antibiotic creams, lotions, or gels.  

Scarring Alopecia

Central Centrifugal Cicatricial Alopecia (CCCA)

Central Centrifugal Cicatricial Alopecia is a type of scarring alopecia.  Although it can affect anyone, middle-aged women and women of color are most commonly diagnosed.  Diagnosis is typically based on biopsy results, clinical features, and exclusion of other types of hair loss.  Early diagnosis is critical to minimizing hair loss.  

Lichen Planopilaris

Lichen planopilaris is a form of scarring alopecia that mostly affects middle-aged women.  People with this type of alopecia notice their hair thinning and often experience scalp itching or tenderness.  Lichen planopilaris can affect the hair line with frontal fibrosing alopecia, or along the part line.  As with any type of alopecia, early diagnosis will help prevent further hair loss. 

How to Treat Scalp Inflammation

Medications available to treat scalp inflammation are used for different purposes.  Some are even the same as what is used for alopecia which is not inflammatory.  Some examples of commonly used medications include:

Medications to Treat Inflammation

  • Cortisone – Reduces swelling, itching, and redness
  • Clobetesol – Topical steroid that treats swelling and itching.  Stronger than topical cortisone.  May be combined with antibiotics and / or antifungal medication.
  • Retinoids – A synthetic version of Vitamin A that reduces irritation on the scalp and improves absorption of other medications

Medications to Treat Infections

  • Antibiotics – Treat bacterial infections
  • Nystatin – An antifungal medication 

Medications to Treat Autoimmune Flares

  • Plaquenil – An malaria medication used off-label to treat Lupus, arthritis, and other autoimmune-related inflammatory conditions
  • JAK inhibitors – Janus kinase (JAK) inhibitor baricitinib is a newer class of medications recently FDA approved to treat alopecia areata and some types of scarring alopecia.  The medications work by blocking the body’s inflammatory response.  

Medications for Hair Regrowth

  • Minoxidil (Rogaine) – A vasodilator that enlarges the hair follicles to allow for new growth.
  • Finasteride (Propecia) – A DHT blocker that has been proven to generate hair regrowth and reduce atrophy in patients with Lichen Planopilaris.

It’s important to note that self-medicating for scalp inflammation is never a good idea.  Medications for inflammatory conditions causing hair loss, whether prescription or over-the-counter, should only be used under the supervision of a licensed dermatologist.

Does Diet Help Treat Scalp Inflammation?

Diets designed to eliminate scalp inflammation have gotten a lot of recent media coverage.  Do they work?  The jury is out.  One research study found that the Mediterranean diet, and diet rich in protein and soy may be a potential adjunct treatment for nonscarring alopecia.  The study warrants further exploration. (01)  Anecdotally, people have found the Auto Immune Protocol (AIP) diet to help control burning and itching associated with inflammation.  There isn’t much research to support the theory.  There isn’t a downside to trying a diet, as long as you are getting plenty of protein and all of the necessary nutrients. In our opinion, it’s worth a try.  

Are Vitamins and Supplements as Effective as Prescription Medications for Treating Inflammation?

Many vitamins have a reputation for alleviating inflammation.  Turmeric, Vitamin B3, Vitamin E, and other vitamins are known for reducing inflammation without any adverse side effects.  One research study found that turmeric tonic significantly improved scalp psoriasis by reducing redness, scaling, and thickness.  (02)

In some cases, vitamins or supplements may work on their own.  In other cases, they may work as an adjunct therapy to prescription medications.  The key is to ensure that you’re using the proper vitamin to treat the scalp condition you are experiencing.  If you are interested in trying vitamins as part of your treatment protocol, but your dermatologist doesn’t mention them, be sure to raise the topic.  Your dermatologist can tell you if vitamins or supplements are a good option for you.  

Temporary or long-term scalp inflammation can be uncomfortable.  Consulting with a dermatologist will help you get it under control as quickly as possible to alleviate your symptoms and prevent hair loss.  If you are looking for hair regrowth solutions, our board-certified dermatologists and hair specialists are here to help. We’re happy to answer your questions and make recommendations based on your diagnosis and needs.  

Resources:

(01) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109385/

(02) https://pubmed.ncbi.nlm.nih.gov/29607625/

5 Facts All Men Should Know About Hair Loss

A few weeks ago, my husband pointed out a Facebook meme that made us laugh.  It showed two photos of hair and body care products.  One photo included products that women use in the shower, and another photo showed the products that men use.   The women’s photo was loaded with products, including body wash, face wash, two different types of shampoos, and a couple of different types of conditioner.  The men’s photo only had one product, a lone all-in-one bottle of body wash, shampoo, conditioner, shaving cream, and toothpaste.  Not only was it funny, but it also depicted the scene in our shower pretty accurately. 

The truth is, though, although some men don’t give their hair a lot of thought, I don’t know of any who are thrilled about the idea of going bald.  It’s a super sensitive topic.  As nonchalant as my husband is about his hair, even a hint that his hairline is receding results in a very alarmed “What?” and a close scalp examination in the mirror that night.   

Hair loss in men is common, but that doesn’t mean you’re okay with it.  Nor does that mean that you have to accept your fate.  So, if you’re a guy with some recession, thinning, or balding, this one’s for you.  We’re here to fill you in on what you need to know about losing your hair and what you can do about it.  

1) Hair Loss in Men is More Common Than You Realize

According to the American Hair Loss Association, by age 50, 85 percent of all men will have significantly thinning hair. (01)  Yes, you read that correctly.  The majority of men will deal with some type of hair loss in their lifetime.  

Men lose their hair for a lot of different reasons.  Balding or thinning hair can be due to autoimmune conditions, Covid, or even stress.  The most common reason, though, is genetics. The vast majority of men with thinning or balding hair have androgenetic alopecia, male pattern baldness.  Yup, that’s right.  Your parents or grandparents may have passed along a baldness gene.  

Male pattern baldness, also known as androgenetic alopecia, occurs when your testosterone is converted to an androgen (a sex hormone) known as Dihydrotestoterone (DHT).  The DHT attacks your hair follicles and causes a reaction called miniaturization which shrinks the follicles.  When that happens, the hair that is already there falls out.  New hair has trouble emerging through the shrunken follicles, and eventually, the hair stops growing.  

Although Male pattern baldness is the leading cause of hair loss among men; it’s not the only reason men lose their hair.  Other forms of alopecia can cause hair loss among men as well.  For example, Covid or other illnesses can cause a temporary hair loss called telogen effluvium.  In this case, your hair will grow back within six to twelve months.  Alopecia areata is an autoimmune condition that causes sporadic bald patches.  Some men’s hair spontaneously regrows, but flares can occur at any time without notice.   Lichen planopilaris is another type of alopecia that causes inflammation, leading to scars over the hair follicles that prevent new hair growth.         

2) Timing is Everything When it Comes to Hair Loss Treatments

Many men avoid doctors like the plague. (02)  However taking a “let’s wait and see what happens” attitude isn’t recommended when it comes to hair loss.  If you don’t get treatment when you first notice that your hair is thinning, then your hair loss will most likely progress, leaving you with a higher number on the Hamilton-Norwood Scale.  In case you don’t know what that is, the Hamilton-Norwood Scale is a classification system developed to measure the extent of baldness.  You don’t want to get high scores on that test.  

If you visit a board-certified dermatologist as soon as you see signs of thinning or balding, your doctor will identify the cause of your hair loss.  Once you are diagnosed, your dermatologist can recommend treatments to stop your hair loss and to promote new growth.  

3) Hair Loss Consultations Are Not a Big Deal (Really!)

If the idea of any medical procedure secretly has you a bit nervous, don’t let that prevent you from seeing a dermatologist.  The exam is much easier than you would expect, and trust me, your dermatologist will not think you are vain for seeking treatment.  Dermatologists evaluate men for hair loss conditions all the time.  So, while you may be out of your comfort zone, your dermatologist certainly isn’t.   

Your dermatologist will ask questions about your health, medications, family history, and lifestyle during your exam.  The more detailed information you provide, the better.  Your dermatologist will examine your scalp to evaluate your hair loss pattern and possibly do a pull test.  A pull test measures the severity of your hair loss.  During the test, your dermatologist will gently tug on small sections of your hair to see if any strands fall out.  If six or more do, you have active hair loss.  Dermatologists usually diagnose androgenetic alopecia based on visual exam.  A blood test or a small biopsy may be ordered if he or she suspects another type of alopecia.  Don’t stress if you need a biopsy.  You’ll be numb, the biopsy area is small, and it heals within a week.

4) Today’s Hair Loss Treatments are Effective and Natural Looking 

After you get a diagnosis, you’ll have many treatment options.  The good news is more data than ever is available on hair loss treatments.  Research indicates that many are not only safe, they’re highly effective.  Here are some examples of the most popular prescription hair loss treatments used:

Minoxidil 

  • FDA approved to treat hair loss
  • Available in oral or topical formulas
  • Brings oxygen to the hair follicles, enlarging them so existing hair does not fall out and new hair can emerge

Finasteride

  • FDA approved to treat hair loss
  • Available in oral and topical formulas
  • Prevents testosterone from converting to DHT and attacking your hair follicles
  • First-line treatment for androgenetic alopecia

Dutasteride

  • Used off label to treat hair loss
  • Only available as a pill
  • Prevents testosterone from converting to DHT and attacking your hair follicles
  • Prescribed if patient does not respond to Finasteride
  • Lower dosage prescribed for Dutasteride than Finasteride

Cortisone

  • Available in pill and topical formulas
  • Reduces irritation and inflammation

Retinol

  • Available in topical formula
  • Proven to improve absorption of topical Minoxidil and Finasteride

Compounded Topical Formulas

Research has shown that combinations of topical formulas are more effective than monotherapy.  For example, topical Finasteride combined with topical Minoxidil works better than one of the medications alone. (03)  Finasteride and Minodixil combined with Retinol is more effective because the retinol helps the scalp better absorb the other two medications. (04)

Alternative Hair Loss Treatments for Men

You may also be a candidate for treatments such as Protein Rich Plasma (PRP), laser light treatments, and hair transplant surgery.  Let’s talk about what these are and how they work.

Protein Rich Plasma

PRP acts similarly to Minoxidil by bringing oxygen to the hair follicles to enlarge them.  During a PRP procedure, your dermatologist draws your blood.  The blood is then separated.  The plasma is then injected into sites where your hair is thinning or balding. 

Laser Light Treatment

You may have seen ads for laser light caps.  Do they work?  Well, the jury is out.  The philosophy behind them is that the light increases blood flow to the areas on your scalp that are thinning.  More oxygen and nutrients are able to reach the hair follicles, allowing the hair to grow thicker and longer.  Although research indicates that laser lights show promise for treating hair loss, the most effective intensity and frequency is still to be determined. (05, 06)  

Hair Transplant Surgery

In the 70s and 80s, you could always tell when a man had hair restoration surgery.  You could actually see little circular holes where the plugs were implanted.  It looked like a doll’s head.  Over time, dermatologists have been perfecting the surgery and today’s techniques give a natural appearance.  Dermatologists now move individual hairs from a place where the hair is dense to an area where the hair is thinning. (07)  You can’t even tell that the hair has been transplanted.  

5) Perceptions of Bald or Balding Men Have Changed for the Better

Men with thin or thinning hair tend to have lower self-esteem and lack confidence, which could explain negative perceptions of their appearance. (08)  The key is to work with what you do have so you feel as confident as possible.  

Yes, there was a time when bald or balding men were deemed less attractive.  That’s no longer the case, though.  Today, men who embrace their look are seen as intelligent, successful, and confident. (09)  Jeff Bezos, Samuel L. Jackson, Ed Harris, and The Rock are prime examples.  So if your hair is thinning or balding, work with your barber or hair stylist to find and own a fresh new look.  That look can evolve as you undergo hair loss treatment.  

If you notice some recession, thinning, or balding, and are concerned, contact us for a discrete consultation from the comfort of your home, on your schedule.  Our board-certified dermatologists and hair specialists are available to evaluate how much hair you’ve lost and your scalp’s condition.  Most importantly, they can offer a customized prescription solution to give you the desired results.  

 

Resources:

(01) https://www.americanhairloss.org/men_hair_loss/introduction.html

(02) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560804/#:~:text=At%20the%20societal%20level%20masculine,not%20go%20see%20the%20doctor.

(03) https://pubmed.ncbi.nlm.nih.gov/32166351/

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693596/

(05) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8906269/

(06) https://www.karger.com/article/fulltext/509001

(07) https://www.aad.org/public/diseases/hair-loss/treatment/transplant

(08) https://pubmed.ncbi.nlm.nih.gov/16307704/

(09) https://journals.sagepub.com/doi/abs/10.1177/1948550612449490

 

Is There a Genetic Test that Can Predict Hair Loss?

Nowadays, there’s a genetic test for just about everything.  Even to determine our dog’s lineage.   Just one quick saliva sample or blood test and, within days, you can find out if you’re destined for cancer, diabetes, or heart disease.  There’s even a DNA test to determine whether you’re likely to experience anxiety.  

Suppose a genetic test can give you accurate information to guide your health care plan and prevent future disease.  Can it also accurately predict whether you’re predisposed to losing your hair?  If a genetic test shows that you are likely to inherit your Great Uncle Bernie or Aunt Bonnie’s hairline, is there a way to ensure that you don’t follow in their footsteps?  Are genetic hair tests reliable?  Do dermatologists use DNA tests to help make diagnoses? Before you click “Buy Now” to order a genetic test kit, keep reading.  We’re here to answer your questions about genetic testing for male and female pattern baldness.

Can Alopecia Really be Inherited?

When people hear the word “alopecia,” they often think of hair loss caused by a medical condition.  Types of alopecia such as alopecia areata and lichen planopilaris are caused by autoimmune conditions.  Androgenetic alopecia, however, is a type of alopecia that is inherited.  It’s the most common type of alopecia.  As many as 80 percent of all men will experience male pattern baldness in their lifetime. (01)  In addition, many women experience female pattern baldness, usually around menopause.  

What’s the Link Between Genetics and Pattern Baldness?

A study conducted on twins confirms what we’ve long suspected.  Male and female pattern baldness have a genetic component. (02)  About 79 percent of men who were balding in the study could attribute their hair loss to their genes.  But, there’s a catch.  Researchers are still working to fully understand which genes are affected.  We’re still learning.  Here’s what we do know.  There are 63 genes that could potentially cause baldness.  Six of those are associated with the X chromosome, where the Androgen Receptors (AR) are found.  It’s also possible that not one isolated gene is the culprit.  Several genes working together may be to blame.

Can You Take a DNA Test to Determine Whether You Will Go Bald?

Ads make genetic testing very tempting, especially if your Mom or Dad starts losing their hair in their 20s.  It would be nice to know whether you will lose your hair too.  But, unfortunately, we’re not quite there yet.  As mentioned previously, there are still too many unanswered questions about which genes are involved and how the genetic process affects your locks. Also, false positives are not unusual with genetic testing.  You don’t want a test to tell you that you’ll experience androgenetic alopecia if that isn’t really the case. (03)

How do you Know if the Type of Alopecia You Have is Genetic?

When men and women experience androgenetic alopecia, they see specific hair loss patterns.  The first sign for men is usually a receding hairline.  The hair loss then progresses to the top, creating a horseshoe pattern above your ears that circles around to the back of your head.  Female pattern hair loss typically presents differently.  Women usually notice thinning on the top and crown.  Often, women will notice a widening of the center part.  Many other conditions cause hair loss besides androgenetic alopecia.  If you think your hair loss is genetic, be sure to have your dermatologist confirm your findings.  Early diagnosis is key to preventing further hair loss and to stimulating new growth.  You also want to make sure you’re addressing the right condition with the right treatment.  

Do Dermatologists Use Genetic Testing to Diagnose Male and Female Pattern Baldness?

The truth is that dermatologists don’t need high-tech tests to determine whether or not patients have androgenetic alopecia.  Most of the time, they can tell from your hair’s appearance and your hair loss pattern.  If there is any doubt, he or she may use a densitometer to magnify your hair follicles to see if miniaturization is occurring.  Miniaturization is when the hair follicles shrink, causing existing hair to fall out and preventing new growth.  Your dermatologist may order a biopsy and blood test to rule out other causes. Patients often ask about the benefits of running a hair analysis based on what they hear about on social media.   Hair analysis is not used to diagnose male or female pattern baldness.  Instead, it’s used to determine whether there’s lead, arsenic, or another substance causing your hair loss.  

What Can You Do to Treat Hair Loss Caused by Genetics?

Treatment for male or female pattern baldness is designed to meet two goals.  The first is to stop the progression of your hair loss.  The second is to promote new hair growth.   The best way to accomplish those two goals is by using a combination of medications simultaneously.  Here are medications often included in treatment plans for androgenetic alopecia:

  • Minoxidil topical foam – A vasodilator that enlarges the hair follicles
  • Finasteride, Dutasteride, or Spironolactone  – Prevents testosterone from converting to DHT that attacks the hair follicles and causes hair loss
  • Topical or oral cortisone – Treats any redness or irritation (not needed for evey patient)

Some men are concerned about experiencing sexual side effects with oral Finasteride.  If this is the case, topcial Finasteride has been proven to be just as effective without the side effects. (04)  Even better, topical solutions which mix Finasteride with Minoxidil, Cortisone and Retinol offer an even more effective all-in-one solution.  The retinol improves absorption of the other three medications.  

Are There Other Causes of Hair Loss Besides Genetics?

Male and female pattern hair loss are the only types of genetically induced alopecia.  However, other types of alopecia exist and treatment plans are designed to treat the type of alopecia you are experiencing.  Examples of other types of alopecia include:

  • Temporary Alopecia (Telogen Effluvium) – Occurs due to sudden illness, stress, or shock and usually reverses itself without treatment
  • Autoimmune Alopecia (Alopecia Areata and Lichen Planopilaris) – People experience flares and periods of remission
  • Trauma-induced Alopecia (Traction Alopecia and Trichotillomania) – Alopecia results from hairstyles that pull on the hair follicles or when people pull out their hair as a stress response)

Can You Prevent Hereditary Hair Loss?

Let’s play pretend for a minute.  Let’s say that a genetic test does exist that will determine whether or not you will lose your hair.  The tests come back showing that you are genetically predisposed to androgenetic alopecia.   Is there a way to prevent hair loss before it begins?  Sure, eating right, exercising, and managing stress never hurt.  But, even with that, you can’t necessarily fight Mother Nature.  That would be nice, though.  If male or female pattern baldness does rear its head, then it’s time to take action.  

Can You Reverse Hereditary Hair Loss

If you’re experiencing male or female pattern baldness and want to learn more about products available, contact us.  Although there isn’t a way to prevent androgenetic alopecia from occuring in the first place, there are things you can do to reverse the condition.   Minoxidil, Finasteride and other medications have been found to be safe and effective. Our board-certified dermatologists and hair specialists are available to answer your questions and help you develop the ideal treatment plan for your needs and lifestyle. 

 

Resources:

(01) https://www.ncbi.nlm.nih.gov/books/NBK538178/

(02) https://academic.oup.com/biomedgerontology/article/60/8/1077/545174

(03) https://www.nature.com/articles/gim201838

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/

 

How to Avoid Side Effects from Finasteride

If you’ve seen television ads for any medication, you know that almost all of them have potential side effects.  By the time the announcer gets to the end of the (sometimes very long) list, you’re probably wondering why doctors even prescribe the medication in the first place.  But, of course, some medications have more side effects than others.  And, some medications get a bad rap just because one or two out of thousands had unusual reactions.  

Fast forward to Finasteride.  Finasteride, also known as Propecia or Proscar, is often prescribed to treat hair loss due to various conditions.  Finasteride was originally marketed to treat men with enlarged prostates.  During drug trials, doctors noticed that men who took Finasteride as a prostate treatment experienced hair growth.  Finasteride was then FDA-approved to treat hair loss too.  In this case, the side effect was a good one.  However, some male Finasteride users have reported some undesirable sexual side effects.  Should you be concerned?  Not really.  The side effects aren’t typical.  Plus, there are ways to avoid the side effects if that’s a concern.  We’re here to share why you shouldn’t worry if your doctor has prescribed Finasteride to treat your hair loss.         

 

Why is Finasteride Prescribed for Hair Loss?

Finasteride is what’s called a DHT blocker.  DHT is an acronym for dihydrotestosterone, which is an androgen, a male sex hormone. When men and women experience androgenetic alopecia, an enzyme called 5-alpha-reductase converts testosterone to DHT.  When this happens, DHT can bind to the receptors on your hair follicles, shrinking the follicles during a process called miniaturization.  Over time,  the anagen phase of the hair growth cycle is reduced.  The result is hair that is shorter and thinner.  Eventually, new hairs become so small that they can’t penetrate the hair follicle.  As a DHT blocker, Finasteride prevents this process from happening, so you maintain your existing hair and continue to grow healthy new hair.    

What Hair Loss Conditions Does Finasteride Treat?

Oral Finasteride is FDA approved to treat androgenetic alopecia, male and female pattern hair loss.  Male and female pattern hair loss is the most prevalent type of alopecia worldwide.  There isn’t a way to predict who will experience pattern hair loss.  The condition is genetic and can be inherited from either the maternal or paternal sides of the family.  There isn’t a specific test to diagnose androgenetic alopecia.  Dermatologists and hair specialists can make the diagnosis by evaluating a patient’s hair loss pattern. 

Finasteride is also used to treat other types of alopecia, including alopecia areata and lichen planopilaris, which are caused by autoimmune conditions.  However, the prescription is considered off label when prescribed to treat hair loss other than androgenetic alopecia.   

Is Finasteride Effective in Preventing Hair Loss and Stimulating Growth

If you’re wondering whether Finasteride is worth the risk of whatever side effects could occur, that’s a valid question.  Although deciding whether to use Finasteride is highly personal, research indicates that Finasteride is highly effective in promoting growth and preventing further hair loss.  Over 80 percent of men who use Finasteride see improvement, and over 65 percent see new hair growth.  Not only that, the results are long-term.  A study of 1879 men indicates that hair count present after one year was maintained during the second year of treatment.

What are Finasteride’s Side Effects?

Side effects caused by oral Finasteride are usually mild and disappear after you stop taking the medicine.  Here are a few signs to watch:

  • Anxiety 
  • Depression
  • Dizziness
  • Weakness
  • Headache
  • Inability to urinate
  • Testicular pain
  • Runny nose
  • Rash, itching, swelling of the face, lips, or tongue, or other signs of an allergic reaction
  • Swelling of your hands or feet

Although these side effects aren’t exactly desirable, they aren’t most mens’ biggest fear.  Most are more concerned about potential sexual side effects such as:

  • Decreased libido
  • Erectile dysfunction
  • Decreased semen volume
  • Breast enlargement & tenderness
  • Premature ejaculation

The good news is that these side effects aren’t common.  Some men who do experience the sexual side effects find that their symptoms disappear over time as their bodies acclimate to the medication.  If not, discontinuing the use of Finasteride usually resolves the issue.

How Common are Side Effects from Finasteride?

As mentioned previously, side effects from Finasteride aren’t common.  The main reason is that the dosage typically prescribed to treat alopecia is usually very low, much lower than the dosage prescribed for prostate treatment.  As a matter of fact, only 3.8 percent of men who took Finasteride experienced side effects during the drug’s clinical trials.  That’s compared to 2.1 percent of men who took a placebo.  

Want to Avoid Finasteride Side Effects?  Use Topical Finasteride Instead

If you’re still a little worried about using Finasteride, even though the risk of side effects is low, there’s a simple solution. Use topical Finasteride instead of oral Finasteride.  The topical solution has been proven to be just as effective in treating male and female pattern baldness without the same risk of side effects.  Whereas oral Finasteride is metabolized in your stomach, topical Finasteride is not systemic.  Even better, topical Finasteride has less impact on serum DHT concentrations.  Think of it as a highly effective spot treatment for your hair.     

Research also indicates that combining Minoxidil with Finasteride yields even better results than using either medication alone.  Adverse reactions among patients were rare, indicating that the combined medication is not only a good choice, but a preferable one.  

Are You a Good Candidate for Finasteride?

Finasteride is often prescribed to both men and women to treat androgenetic alopecia.  The medication is generally safe for most people.  There are some exceptions though.  Finasteride is not recommended if you have kidney problems, prostate cancer, liver disease, or any other liver-related issues.  The medication is also not recommended to women who are pregnant, trying to get pregnant, or are breastfeeding.

What Should You Do if you Experience sexual or Other Side Effects from Finasteride?

If you think Finasteride is causing side effects, stop taking the medication and contact your dermatologist.  The side effects usually go away after the medication is out of your system.  However, you’ll want to work with your dermatologist to identify a substitute.  

When considering a new medication, it’s important to do your research and feel confident about your choice.  Finasteride is no exception.  If you have questions and are looking for answers, we’re here to help.  Our board-certified dermatologists and hair specialists look forward to giving you the information you need, when you need it, to get the healthiest, most effective hair loss treatment.  

 

Resources:

(01) https://pubmed.ncbi.nlm.nih.gov/9951956/

(02) https://pubmed.ncbi.nlm.nih.gov/9951956/

(03) https://pubmed.ncbi.nlm.nih.gov/34634163/#:~:text=Conclusion%3A%20Topical%20finasteride%20significantly%20improves,impact%20on%20serum%20DHT%20concentrations.

(04) https://pubmed.ncbi.nlm.nih.gov/32166351/

 

Hair Loss Reversal 101: What You Need to Know

If you’re experiencing hair loss, you’re not alone.  According to the American Hair Loss Association, at least two-thirds of all American men will have noticeable hair loss by the time they turn thirty-five.  Women account for forty percent of all Americans experiencing hair loss. (01) Those numbers are much higher than you thought, right?

Sure, most people expect to get some gray hair, wrinkles, and a few extra pounds as they age, but hair loss?  That’s not usually part of the plan.  We can color our hair, use Botox for our wrinkles, and spend some extra time at the gym.  But what can be done about a receding hairline?  More than you think.

There are Different Types of Hair Loss

The first step is to understand the different types of hair loss.  All hair loss is not the same, so not all hair loss will respond to the same treatment.  We’re here to give you a crash course.

The Term Alopecia Encompasses More Conditions Than Most People Realize

When people think of alopecia, they usually think of alopecia areata, the type that Massachusetts Representative Ayanna Pressley and actress Jada Pinkett Smith have.  However, if you use Dr. Google, you’ll see that WebMD defines alopecia areata as an “autoimmune disorder that causes your hair to come out, often in clumps the size and shape of a quarter.”  The definition is accurate, but not all hair loss is alopecia areata. Alopecia is an umbrella term for many different hair loss conditions.

There’s a Difference Between Non-Scarring and Scarring Alopecia

Alopecia falls under two broad categories:  non-scarring and scarring alopecia. There’s a big difference between the two types.

When people have non-scarring hair loss, their hair just falls out.  No redness, scaling, flaking, itching, or burning occurs. The alopecia can come on fast and furiously, leaving people holding clumps of hair in their hands, or gradually over a long period of time.

Scarring alopecia is a different story.  Also known as cicatricial alopecia, scarring alopecia is an inflammatory condition that occurs in otherwise healthy people. The hair follicle is destroyed and replaced with scar tissue.  The hair loss can happen over time and go unnoticed, or it can happen quickly, causing symptoms such as severe itching and burning. (02)  Speed is essential when it comes to treating scarring alopecias.  The goal is to slow or stop further hair loss and promote hair regrowth in unaffected areas.

What Type of Alopecia Do You Have?

Many different types of hair loss fall under the categories of non-scarring and scarring alopecia.  Once you know what type you have, your dermatologist will work with you to develop a treatment plan.

Examples of Non-scarring Alopecia

Telogen Effluvium

Telogen Effluvium is a form of temporary hair loss caused by stress, severe chronic illness, high fever, childbirth, thyroid disorders, major surgery, dieting, certain medications, etc.  Telogen Effluvium usually resolves itself over time.

Androgenic Alopecia

Also known as male and female pattern baldness, androgenic alopecia is a genetic condition experienced by up to 50 percent of men and women. (03)  Experts believe that pattern baldness is due to an excessive androgen dihydrotestosterone (DHT) response which causes hair follicles to miniaturize.  When the hair follicles shrink, hair loss occurs.  Androgenic alopecia typically causes frontal hair loss in men and diffuse hair loss at the crown and top of women’s heads.

Alopecia Areata

If your hair falls out in clumps around the size and shape of a quarter, you may have alopecia areata.  This condition is an autoimmune disorder that occurs when your body attacks its own hair follicles.  With alopecia areata, hair loss is unpredictable and can happen anywhere on your body.  Sometimes the condition resolves itself.  However, it can also reoccur without notice.  Many research studies are currently underway to understand the cause and effective treatment. (04)

Traction Alopecia  

Constant pulling on hair due to tight ponytails, buns, braids, cornrows or dreadlocks, hair extensions, weaves, and more can cause traction alopecia.  This condition, that’s common among actresses and models, can cause small bumps that resemble pimples.  Fortunately, traction alopecia can be reversed if you stop pulling your hair back.

Examples of Scarring Alopecia

Lichen Planopilaris

Lichen Planopilaris is the most common type of scarring alopecia.  Although it can affect both genders, lichen planopilaris is more likely to affect women aged 40 to 60 than men. (05)  Redness, itching, burning, and tenderness can accompany frontal or other pattern hair loss.

Central Centrifugal Cicatrical Alopecia (CCCA)

CCCA is found almost exclusively among black women aged 30 to 55 year-old.  The cause is still unknown and is being researched.  Women who experience CCCA experience inflammation and associated hair loss in the crown area. (06)

Effective Hair Loss Treatment Complements Your Diagnosis

After your dermatologist determines the cause of your hair loss, he or she will discuss treatment options with you.  Keep in mind that hair reversal treatments are not one-size-fits-all.  In some cases, “cocktails” which combine specific medications and protocols may be needed. Just to give you an idea of what’s out there, here are some of the most frequently used medications and treatments:

Minoxidil (Rogaine)

Minoxidil, also known as Rogaine, is available over-the-counter as a topical foam and liquid and by prescription as an oral pill.  Minoxidil is a vasodilator reduces miniaturization of the hair follicles and elongates the growth phase.

Minoxidil has proven to promote growth among men and women with male and female pattern hair loss.  Minoxidil is also often recommended to patients with scarring alopecia to promote growth in unaffected areas.

Once you start using Minoxidil, you need to continue. When you stop using the medication, any new hair that grows will most likely be shed.

Finasteride (Propecia, Proscar)

Finasteride is a 5 alpha-reductase inhibitor originally designed to treat enlarged prostates.  The medication, available both as a pill and a topical solution, blocks the conversion of testosterone to dihydrotestosterone (DHT), a hormone that inhibits hair growth.

Clinical studies have found Finasteride to be highly effective in reversing hair loss in both men and women with scarring and non-scarring alopecias. (0708)  Topical Finasteride is often used to treat androgenic alopecia, while oral is typically recommended for scarring alopecias.

Finasteride is only available by prescription and is not recommended for women of childbearing age.  Check with a board-certified dermatologist to see if you are a good candidate for the topical or oral treatment.

Corticosteroids

Topical or injected steroids are often used to treat hair loss that is induced by autoimmune diseases such as alopecia areata and lichen planopilaris.  The corticosteroids allow hair to grow by inhibiting the autoimmune disease.

Steroid treatments are only available by prescription and should be surprised by a qualified dermatologist.

Platelet-rich Plasma (PRP) Injections

PRP injections have become a popular treatment for healing wounds and regrowing tissue such as tendons, ligaments, and muscles.

PRP has regenerative properties and has been primarily tested on patients with androgenetic alopecia. (09)  When injected into the scalp, PRP is believed to stimulate hair growth by increasing blood flow to the hair follicles and increasing the size of the hair shaft.

As the name suggests, PRP injections are made from platelets derived from your blood.  Blood is first drawn, and then spun at super high speeds to separate the blood components.  The resulting plasma is highly concentrated.

PRP use is still in its early stages and can be expensive.  Research also indicates that PRP is most effective when used with Minoxidil, Finasteride, and other hair growth treatments.

Biotin

Biotin, also known as Vitamin B7 or Vitamin H, has become a familiar hair growth supplement.  Sold in supplements or as an ingredient in hair care products, Biotin is promoted as a way to make your hair grow longer and healthier.

Does it work?  Well, the jury is out.  Not enough research has been conducted to say yeah or nay. (10)  It won’t hurt you to try a new shampoo that contains Biotin, but there’s no evidence to indicate that it will help.  Biotin deficiency is rare. (11)  Most people get adequate amounts through their regular diets.

Many Biotin supplements sold are not FDA approved, and high concentrations of Biotin can interfere with the results of some lab tests. (12) As with any oral supplement, check with your doctor before testing it out.

Hair Transplants

Hair transplant procedures and techniques continue to improve over time.  Rather than using noticeable plugs, today’s surgeries move hair strips or carefully selected hairs from one area to another to promote growth that looks natural.

When determining whether a patient is an ideal candidate for a hair transplant, dermatologists consider several factors, including:

  • Type of hair loss
  • Degree and pattern of baldness
  • Patient age
  • Hair color
  • Donor hair density
  • Patient expectations

Although hair transplants are expensive and time-consuming, they are an effective, reliable, and safe way to get lasting results.

It’s Important to Set Realistic Expectations When Treating Alopecia

We’re fortunate to live during a time when hair loss research is prolific, and the list of hair replacement options is growing.  Whether you’re 25 or 55, you don’t have to live with bald spots, a receding hairline, or thinning hair, even if your genetics or immune system are working against you.

The first step is to find a board-certified dermatologist and hair specialist you trust and get diagnosed.  He or she will help you select the right treatment option for your type of alopecia and lifestyle.  Remember to set realistic expectations for your hair regrowth.  Treatments don’t work overnight, so be patient and track your progress over time.  After all, small signs of stubble today can lead to a fuller head of hair tomorrow.

Resources:

(01) https://www.americanhairloss.org/

(02) https://rarediseases.org/rare-diseases/cicatricial-alopecia

(03) https://www.ncbi.nlm.nih.gov/books/NBK430924/

(04) https://www.aad.org/public/diseases/hair-loss/types/alopecia

(05) https://www.ncbi.nlm.nih.gov/books/NBK470325/

(06) https://jamanetwork.com/journals/jamadermatology/fullarticle/2768748

(07) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809380/

(08) https://pubmed.ncbi.nlm.nih.gov/9951956/

(09) https://www.health.harvard.edu/blog/platelet-rich-plasma-does-the-cure-for-hair-loss-lie-within-our-blood-2020051119748

(10) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582478/

(11) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582478/

(12) https://www.fda.gov/medical-devices/safety-communications/update-fda-warns-biotin-may-interfere-lab-tests-fda-safety-communication