Untangling hair loss in women

American Academy of Dermatology News Jul 27, 2019

Many people think of hair loss as a men’s issue; however, hair loss is just as common in women as it is in men. In addition to hereditary hair loss, the hairstyles and products that women use on their hair can contribute to hair loss. Fortunately in most cases, a board-certified dermatologist can identify the type of hair loss and develop an effective treatment plan.

“Making sure you have the right diagnosis is critical for successful treatment,” says board-certified dermatologist Paradi Mirmirani, MD, FAAD. “However, to an untrained provider, this can be tricky, as hair loss can have many causes.”

Sometimes the diagnosis of hair loss can be made based on its pattern or location. Two of these patterns are female pattern hair loss (also known as hereditary thinning or androgenetic alopecia), which results in more pronounced thinning on top, and marginal alopecia, which is hair loss along the edges of the hairline. There are several types of marginal alopecia, with different treatments and prevention for each.

Female pattern hair loss is primarily caused by genetics, certain hormones, age, and menopause. Treatment options include topical or oral medications, hair transplants, and camouflaging the areas that are thinning.

Although the two main types of marginal alopecia—traction alopecia and frontal fibrosing alopecia—look similar, a dermatologist will ask questions about family history and lifestyle and run tests to determine the exact type of hair loss and how best to treat it.

Traction alopecia is caused by hairstyles that pull the hair tight, such as cornrows, weaves and tight ponytails or buns. Hair transplants and medication such as minoxidil can help the hair grow back; however, switching to gentler hairstyles is necessary to stop the hair loss.

Dr. Mirmirani says this can be difficult for some women who rely on pulling their hair back tightly in order to do things like exercise more comfortably.

“Regardless of your lifestyle, if your hairstyle is causing you pain, it’s not good for your hair,” says Dr. Mirmirani. “If you need your hair pulled back, work with your hairdresser to find a style that doesn’t put pressure on your scalp.”

Using too much heat or chemicals on your hair over a long period of time can also contribute to hair loss.

“For the most part, people can dye, perm, or heat their hair with no ill effects, but chronic use or using more than one of these treatments at a time can lead to hair loss,” says Dr. Mirmirani.

Frontal fibrosing alopecia used to be a rare condition; however, according to Dr. Mirmirani, there’s evidence it’s becoming more common. Some recent research suggests a connection between frontal fibrosing alopecia and facial products containing sunscreen ingredients. However, more research is needed on this association, says Dr. Mirmirani, and sun protection should remain a top priority.

“Skin cancer is the most common cancer in the United States, so it’s important that patients continue to protect their skin while outdoors by seeking shade, wearing protective clothing, and applying a broad-spectrum sunscreen with an SPF of 30 of higher,” says Dr. Mirmirani. “Patients with frontal fibrosing alopecia who are concerned about the association of sunscreen with this condition should wear a wide-brimmed hat whenever they’re in the sun and apply sunscreen on all other areas of the body not covered by clothing.”

Dr. Mirmirani notes that hair loss from frontal fibrosing alopecia comes from inflammation around the hair follicles, so anti-inflammatory medications are often used to treat it. “You want to be more aggressive in treating frontal fibrosing alopecia because it can cause permanent damage to the hair follicle,” Dr. Mirmirani says. “If left untreated, it also can cause hair loss in the eyebrows and eyelashes.”

For the best outcomes with hair loss treatment, Dr. Mirmirani says it’s important to keep your dermatologist’s follow-up appointments and to avoid hairstyles and hair care products that ultimately damage your hair.

“No matter the type of hair loss you have, seek treatment as soon as you notice it,” says Dr. Mirmirani. “I often see women who have delayed seeing a dermatologist because they didn’t realize their hair loss is caused by a medical issue or they didn’t think it’s treatable. However, it’s important for women to know that most cases of hair loss can be stopped or treated.”

For more information about hair loss, visit aad.org/hairloss. To find a board-certified dermatologist in your area, visit aad.org/findaderm.

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