Some people embrace baldness, others want to flush out follicles. But what works? A dermatologist sheds a little light on hair health.
How common is balding in men? Women?
Balding, also called pattern hair loss or androgenetic alopecia, affects adult men and women. (The word "alopecia" is synonymous with hair loss and does not distinguish between forms of hair loss.) The prevalence of this type of hair loss depends on age since increased onset occurs with aging. On average, men may start to develop pattern hair loss in their 30s and women in their late 40s or post menopause. Up to 80% of men and women by age 80 report this type of hair loss.
Is it true that baldness is hereditary and carried through the mother?
Not totally. Studies have detected pattern or androgenetic alopecia to be related to strong signals on the X chromosome. However women get an X chromosome from the father as well. Pattern hair loss may be genetic and can be influenced by genetics from either parent or be present without an apparent family history.
What's the best way to maintain healthy hair/scalp?
Practice appropriate hair washing techniques and protect the hair and scalp from damage and injury with a shampoo and conditioner. Depending on the hair type and genetic background, hair should be washed two to three times a week for those of Caucasian, Latino or Asian backgrounds and once every week or two for those with drier or curlier hair of African descent. Use of gentle shampoos that tend to be sulfate-free can help maintain hydration and avoid drying and breakage. Products containing silicone can also be protective but may result in buildup. Hair is 100% protein held together with sulfide bonds and eating a balanced diet of foods high in protein, iron, vitamin D and other essential nutrients supports hair growth.
Are there ways to prevent baldness?
Yes. Currently, to keep hair appearing full and growing, topical minoxidil (known by the famous brand Rogaine) can promote hair growth and prolong growth cycles. However, it does not cure or stop the miniaturization of hair follicles that leads to pattern hair loss. If balding has started, the most effective way to stop and prevent baldness is to start oral dihydrotestosterone (DHT) blocking medications, which block this sex hormone and keep hairs from fading away.
Can the overuse of products and/or styling cause hair loss?
Indirectly, yes. Products and styling practices can cause damage to hair shafts or destructive pulling on hairs. For example, product use or overuse could result in buildup or drying of the hair shafts to cause dry, brittle, and inflamed hair. This could appear as frizz, texture change, breakage, or split ends. Dry shampoo may also lead to product buildup and hair loss from reduced washing to remove excess oils. Products could even result in contact reactions of the scalp and cause itch, burning, scaling or even pain. As mentioned above, traction alopecia can occur from pulling on the hairs too tightly through wearing various types of tight braids or heavy extensions and could lead to permanent hair loss if continued injury to the scalp persists.
How about stress?
Stress is relative and can impact hair growth cycles and cause hair loss. While it is difficult to determine what stress level or stressors will cause hair loss, it is clear that the stress of physical illness, such as infection or surgery, hormonal events, such as childbirth or hormone replacement, and significant emotional stress, such as the loss of a loved one, could all cause a shock to the body that causes an acute shedding of hair called telogen effluvium. Telogen effluvium occurs throughout the entire scalp about three to four months after the inciting event and typically does spontaneously resolve once the body has stabilized for the stressor, usually a month or two. Some people report more variable or cyclical shedding episodes that occur sporadically related to seasonal changes or immediately after stressful events or experiences. If hair loss continues for more than two months, it is best to see a dermatologist for evaluation and diagnosis.
What's a "normal" amount of hair loss and when should we be concerned?
There are about 100,000 hair follicles on an adult head. Each has its own life cycle with stages that involve growth, shedding and regrowth. About 10 to 15% of hairs are in the shed phase at any time and may be perceived to be hair loss. Therefore, it's normal to have anywhere from a few to about 200 hairs shed each day. The amount of normal hair loss is influenced by age, genetics, hormones, seasonal changes, health, illness, medications and other systemic stressors on the body. Be concerned if there is a change in your hair cycles with excessive hair shedding in clumps or with simple touch of the hair or if there are scalp symptoms associated with hair loss, such as worsening itch, pain, scaling, or breakage.
Will hair ever regenerate by itself?
No. There is a finite number of hairs on our head and body and they cannot be regenerated if irreversibly destroyed or no longer viable. If the hair follicle is only partially injured or damaged, like in traction alopecia, or is under a transient and immunologic attack like in alopecia areata, hair loss may be temporary and the hair may regrow if the hair follicle is intact. Once hair follicles miniaturize and fade away as in pattern hair loss or are destroyed by inflammation and replaced with scarring as in scarring alopecia, hair does not regenerate and will not regrow.
When is it time to call in the experts?
If you are experiencing a change in your hair cycle, pattern appearance, density, or increased shedding for more than two months and especially if the change is associated with symptoms like itch, redness, pain, scaling, tenderness, drainage, or other discomfort, it is time to see a hair expert who specializes in the diagnosis and treatment of hair disease.
If you could give an insecure balding person one piece of advice, what would it be?
Get evaluated as soon as possible and diagnosed because earlier intervention means better results. Pattern hair loss is the most common hair loss experienced and it is progressive and worsens over time. Once hair follicles get smaller and fade away they are gone forever. If it is not pattern hair loss and there are other symptoms, find out what it is to prevent permanent hair loss. Early intervention can address and prevent further hair loss to improve appearance and preserve your hair.
Dr. Margareth Pierre-Louis is medical director at Twin Cities Dermatology Center & Equation Medical Spa.