Understanding Alopecia With Dr. Doris Day

Over 50% of women across America will experience some sort of alopecia in their lifetime. To better understand the condition, SHEVY caught up with one of New York’s leading hair loss experts, Dr. Doris Day, MD, FAAD, MA, Board-Certified Dermatologist & Founder of Day Dermatology & Aesthetics, who tells us about the different kinds of alopecia, their causes and the best treatment options available in the market.

WHAT EXACTLY IS ALOPECIA?

The most common types of alopecia are non-scarring. This means the follicle is still present but the hair is so miniaturized that it is invisible. These include:

• Androgenetic Alopecia (aka hereditary hair loss)

This is the most common type of hair loss. Hereditary hair loss accounts for 95% of all hair loss in both men and women and it can be inherited from either the mother's or father's side. In both men and women, it can start in their early 20’s.

In men, it usually starts as recession in the temples, progresses to the crown, and then meets in the middle with total loss of the frontal scalp leaving a semicircle zone of hair just above the ears going to the back of the scalp. Women have a fear of going bald, but they present in a different pattern than men in that the frontal hairline is usually retained but the part slowly widens and they thin in the crown region. In some cases, this can become severe leading to near total loss, but in most cases the thinning is usually centered over the top of the scalp in the crown.

The reason women often have a milder course than men may be because women have ½ the amount of 5-alpha reductase enzyme that men have and also women have more aromatase enzyme in follicles that aromatizes testosterone to estradiol.

• Telogen Effluvium (aka stress shedding)

This is not true hair loss, but rather a hair shedding process that usually occurs about 3-4 months after a major physiologic stress. The process is self-limited and the hair will grow back on its own in about 3-4 months. Factors such as hormonal shifts from pregnancy along with crash dieting and certain medications have been shown to trigger Telogen Effluvium.

• Alopecia Areata (aka autoimmune hair loss)

Alopecia Areata is a type of hair loss that occurs when the immune system mistakenly attacks hair follicles, which is where hair growth begins. It usually begins when clumps of hair fall out, resulting in totally smooth, round, hairless patches on the scalp.

It can occur anywhere on the body where hair grows, but is most bothersome when it occurs on the scalp or in the beard area for men. It may also be associated with other autoimmune diseases, but having one or treating one does not affect the other. There is a genetic predisposition with an increased occurrence in 1^st degree relative. The underlying cause remains unclear but it may be triggered by environmental factors.

• Hair loss due to medication

There are many medicines that have hair loss mentioned in the label. This is sometimes confusing because it simply means that people taking the medication also reported hair loss and is not an otherwise absolute known cause. SSRI’s (a class of antidepressants) is one medication that stands out in this category.

Medications known to cause hair loss are chemotherapeutic agents used in the treatment of cancer. This is a temporary hair loss and in the vast majority of cases the hair grows back, often thicker and better than before treatment. There are now caps and other protective measures being used to minimize the hair loss around cancer treatments and it has had a very positive impact on patients.

Scarring alopecia can happen from chronic use of hair extensions, tight ponytails, tight braids or from some medical conditions like lupus or sarcoidosis. In those cases the follicle is scarred or gone and the hair cannot regrow.

IS THERE A CURE FOR ALOPECIA?

Depending on the type of alopecia there are measures we can take to improve or control it but in most cases there is no cure. The goal is to protect against further hair loss and scarring.

CAN ALOPECIA BE REVERSED? 

In many cases, with proper evaluation and treatment, it can be reversed partially or completely.

WHO IS MOST SUSCEPTIBLE TO ALOPECIA?

Those with strong family history, high stress, or who wear extensions regularly or have had tight braids or ponytails over the years.

IS THERE A DIFFERENCE BETWEEN HAIR LOSS AND ALOPECIA?

No, they are the same. Alopecia is the medical term for hair loss.

WHAT ARE SOME OF THE MOST SUCCESSFUL TREATMENT OPTIONS AVAILABLE FOR ALOPECIA PATIENTS?

 - Minoxidil – The FDA approved concentration of 5% minoxidil, available over the counter, is now the same for both men and women with androgenetic alopecia. My version of minoxidil is an upgraded formula with 6% along with niacinamide and caffeine for better penetration and anti-inflammatory benefits. While it is something you will have to use indefinitely, the good news is that as long as you keep using it, it keeps working!

-  Hair Growth Kit -This is a 3 step system for hair re-growth, consisting of a specially formulated shampoo, that removes daily build-up and a conditioner, that adds fullness to thin lifeless hair, which work together to prepare the scalp for the Rapid regrowth serum. Visible results can be seen within 30 days of use. 

- Fotona Dynamis: In office Smoothbeam Erbium in-office laser treatment has had excellent results, alone and in combination with other therapies to help restore hair growth. We do treatments at two week intervals for 12 sessions and then once every three months for maintenance. 

- Low Level Light Therapy (LLLT): There are in-office laser devices as well as at home devices which are FDA cleared for hair growth. They influence hair growth in 3 stages: stopping hair loss, thickening current hair and helping regrowth of new hair.

-  PRP: I spent years researching and reviewing data and devices for PRP (an in-office treatment) for the scalp before deciding to add it to my hair growth program. The hair promoting effects of PRP are supported by studies showing a faster transition to the growing (anagen) phase of hair cycling back from the resting and transitional phases, and also an increase in the number of newly formed follicles and earlier hair formation.

You also have cortisone injections, hair transplantation and prescription medications, but again, it’s about finding out which course of treatment is best suited to your individual needs and your physician can help with that.

Doris Day, MD, is a board-certified dermatologist specializing in laser, cosmetic, surgical and aesthetic dermatology. She is a medical educator and a highly respected and sought-after media personality.

To learn more about Dr. Doris Day and her practice, please visit: dorisdaymd.com