Hair loss or Alopecia is a very common but highly distressing issue that occurs in both men and women. Numerous studies have shown that hair loss affects self-confidence and is associated with depression and anxiety. Fortunately, there are numerous, non-surgical, treatment options that can help!
Important Note – Not all hair loss or alopecia is the same! If you are currently experiencing hair thinning or hair loss, you owe it to yourself to consult a board-certified dermatologist who is an expert in diagnosing and treating hair loss. This is critical as we often encounter patients who have either been evaluated elsewhere and been misdiagnosed or who have tried and failed numerous, expensive treatments with little to no scientific evidence. This can be costly and disheartening. In addition, time is critical when dealing with hair loss as early treatment provides the most effective results.
While there are many types of hair loss, they typically comprise two broad categories: Scarring and Non-Scarring.
Scarring Hair Loss (Cicatricial Alopecia)
Scarring hair loss is often the result of inflammation that damages hair follicles.
Common causes of scarring hair loss include:
- Inflammation Disorders (including, but not limited to, Discoid Lupus Erythematosus, Alopecia Mucinosa, Dissecting Cellulitis, Acne Keloidalis, Folliculitis Decalvans, and Central Centrifugal Cicatricial Alopecia)
- Hair Infections due to fungal agents
- Chemicals (such as harsh hair care products that contains Sodium Lauryl Sulfate)
- Although scarring hair loss is often irreversible, early diagnosis and treatment may possibly lead to regrowth.
Non-scarring Hair Loss (Non-scarring Alopecia)
Male and female pattern hair loss is the most common type of non-scarring hair loss.
It affects 80% of men and women in the course of their lifetime. This “hair loss” is a misnomer as the hair follicles are still present but gradual shrinking or miniaturization results in thinning hair and visible scalp. If diagnosed early, this type of hair loss can be effectively treated and hair growth can be restored.
Common causes of non-scarring hair loss include:
- Natural aging
- Stressor events leading to Telogen Effluvium (infections, hospitalizations, emotional stress)
- Nutritional Deficiencies
- Medical conditions like thyroid disease
Hair Loss Treatment Options
During your consultation with Dr. Shyam, a detailed medical history and evaluation will be performed. In addition, blood work may be requested as part of the work up. Sometimes, a scalp biopsy may also be utilized to determine the cause of alopecia. Once Dr. Shyam has diagnosed the cause of the hair loss, a specific personalized treatment regimen will be formulated. This may include topical medications, oral medications, steroid injections or platelet-rich plasma therapy.
Minoxidil* – This FDA-approved medication stimulates hair follicles by increasing blood flow to expand the growth phase of hair follicles. This medication is most commonly referred to by its brand name, Rogaine.
Finasteride* – More commonly known as Propecia, this FDA-approved medication inhibits the enzyme responsible for converting testosterone to dihydrotestosterone (DHT). Excess levels of DHT in men results in miniaturization of hair follicles, and a prolonged dormant and shedding phase which manifests as classic pattern hair loss.
Photobiomodulation (Low Level Light Therapy) – An FDA-cleared device that emits low energy red light (~680nm wavelength) that stimulates the mitochondria (energy producing centers) of the hair cells to increase their growth factors and prolong the anagen growth phase.
Platelet Rich Plasma (PRP) – An innovative multi-step treatment in which platelet-rich plasma from a patient’s own blood sample is injected into the scalp. These injections amplify the body’s natural growth factors to restore hair loss and support follicles for better hair growth. Main Line Dermatology is one of the few area practices that provides this promising new hair loss treatment performed by Dr. Shyam, an expert in the field.
CAUTION: Not all PRP treatments are the same. Experience matters!
*These treatment options are only partially effective (range from 40% to 60% efficacy) and have the potential for unwanted side effects. A complete history and evaluation are required prior to the recommendation of these medications.
Acne is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Every year, about 80% of adolescents have some form of acne and about 5% of adults experience acne.
Acne is made up of two types of blemishes:
- Whiteheads/Blackheads, also known as comedones, are non-inflammatory and appear more on the face and shoulders. As long as they remain uninfected, they are unlikely to lead to scarring.
- Red Pustules or Papules are inflamed pores that fill with pus. These can lead to scarring.
In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance called sebum. The sebum moves from the bottom to the top of each hair follicle and then spills out onto the surface of the skin, taking with it sloughed-off skin cells. With acne, the structure through which the sebum flows gets plugged up. This blockage traps sebum and sloughed-off cells below the skin, preventing them from being released onto the skinâ€™s surface. If the poreâ€™s opening is fully blocked, this produces a whitehead. If the poreâ€™s opening is open, this produces blackheads. When either a whitehead or blackhead becomes inflammed, they can become red pustules or papules.
It is important for patients not to pick or scratch at individual lesions because it can make them inflamed and can lead to long-term scarring.
Treating acne is a relatively slow process; there is no overnight remedy. Some treatments include:
- Benzoyl Peroxide â€” Used in mild cases of acne, benzoyl peroxide reduces the blockages in the hair follicles.
- Oral and Topical Antibiotics â€” Used to treat any infection in the pores.
- Hormonal Treatments â€” Can be used for adult women with hormonally induced acne.
- Tretinoin â€” A derivative of Vitamin A, tretinoin helps unplug the blocked-up material in whiteheads/blackheads. It has become a mainstay in the treatment of acne.
- Extraction â€” Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.
A blister is a soft area of skin filled with a clear fluid. Blisters may form in response to an irritant. Frequently, the blister is caused from friction, such as a coarse fabric rubbing repeatedly against a person’s skin. In other cases, blisters form in response to a chemical or allergic irritant, which is known as contact dermatitis. Some oral and topical drugs may cause blisters to appear. Blisters can also be symptomatic of bacterial or viral skin infections, such as cold sores, chicken pox, shingles, impetigo or ringworm. Lastly, blisters occur when the skin is exposed to a flame, comes in contact with a hot surface or is overexposed to the sun.
Most blisters do not require medical attention. The most important information to remember is never to pop or break open a blister. A blister acts as a protective covering for damaged skin and helps prevent infection. If a blister does open on its own, be sure to leave the covering in place to support further healing. Simply wash the area gently with mild soap and water, pat it dry and apply an antibacterial ointment. Cover the blister with bandage to keep it clean. Replace the dressing at least once a day. Watch for signs of infection, such as a white or yellow pus coming from the blister, redness or red streaks around the blister or an increase in skin temperature around the blister.
To avoid blisters, you need to eliminate the irritant. Some simple ways to avoid blisters are to avoid tight clothing, make sure socks and shoes fit properly, and when doing heavy work with your hands, wear work gloves.
Birthmarks are abnormal skin colorations in spots that are either present at birth or appear shortly thereafter. They can be flat or slightly raised from the skin. They can be any number of colors, including red, brown, black, tan, pink, white or purple. Birthmarks are generally harmless. There are two major categories of birthmarks: pigmented birthmarks and red birthmarks.
Pigmented Birthmarks can grow anywhere on the skin and at any time. They are usually black, brown or skin-colored and appear singly or in groups. They can be moles (congenital nevi) that are present at birth, Mongolian spots, which look like bluish bruises and appear more frequently on people with dark skin, or café-au-lait spots that are flat, light brown or tan and roughly form an oval shape.
Red Birthmarks (also known as macular stains) develop before or shortly after birth and are related to the vascular (blood vessel) system. There are a number of different types:
- Angel kisses, which usually appear on the forehead and eyelids.
- Stork bites, which appear on the back of the neck, between the eyebrows on the forehead, or on eyelids of newborns. They may fade away as the child grows, but often persist into adulthood.
- Port-wine stains, which are flat deep-red or purple birthmarks made up of dilated blood capillaries (small blood vessels). They often appear on the face and are permanent.
- Strawberry hemangiomas, composed of small, closely packed blood vessels that grow rapidly and can appear anywhere on the body. They usually disappear by age nine.
- Cavernous hemangiomas are similar to strawberry hemangiomas but go more deeply into the layers of the skin. These can often be characterized by a bluish-purple color. They also tend to disappear naturally around school age.
It is estimated that about one-third of people with diabetes will have a skin disorder at some time in their lives caused by the disease. Diabetics are more susceptible to bacterial and fungal infections; allergic reactions to medications, insect bites or foods; dry itchy skin as a result of poor blood circulation; and infections from foot injuries for people with neuropathy.
There are a number of diabetes-specific skin conditions:
Acanthosis Nigricans. A slowly progressing skin condition, which turns some areas of skin, usually in the folds or creases, into dark, thick and velvet-textured skin. Acanthosis nigricans often precedes the diagnosis of diabetes. It is sometimes inherited, but is usually triggered by high insulin levels. It can occur at any age and usually strikes people who are obese. There is no treatment for the condition except to reduce insulin levels. Prescription creams may help lighten the affected area.
Diabetic Blisters. Rare blisters that appear on the hands, toes, feet or forearms that are thought to be caused by diabetic neuropathy.
Diabetic Dermopathy. Round, brown or purple scaly patches that most frequently appear on the front of the legs (most often the shins) and look like age spots. They are caused by changes in small blood vessels. Diabetic dermopathy occurs more often in people who have suffered from diabetes for decades. They are harmless, requiring no medical intervention, but they are slow to heal.
Digital Sclerosis. This condition appears as thick, waxy and tight skin on toes, fingers and hands, which can cause stiffness in the digits. Getting blood glucose levels back to normal helps alleviate this skin condition.
Disseminated Granuloma Annulare. A red or reddish-brown rash that forms a bull’s eye on the skin, usually on the fingers, toes or ears. While not serious, it is advised that you talk to your dermatologist about taking steroid medications to make the rash go away.
Eruptive Xanthomatosis. A pea-like enlargement in the skin with a red halo that itches. It most frequently appears on the hands, feet, arms, legs or buttocks. It is often a response to high triglycerides. Keeping blood glucose levels in the normal range helps this condition subside.
Necrobiosis Lipoidica Diabeticorum. This condition is similar to diabetic dermopathy, but the spots are larger, fewer, deeper in the skin and have a shiny porcelain-like appearance. It is often itchy or painful. It goes through cycles of being active and inactive. It is caused by changes in collagen and fat underneath the skin. Women are three times more likely to get this condition than are men. Typically, topical steroids are used to treat necrobiosis lipoidica diabeticorum. In more severe cases, cortisone injections may be required.
Vitiligo. Vitiligo refers to the development of white patches anywhere on the skin. It usually affects areas of skin that have been exposed to sun. It also appears in body folds, near moles or at the site of previous skin injury. The condition is permanent and there is no known cure or prevention. However, there are some treatments that can be used to improve the appearance of the skin, such as steroid creams and ultraviolet light therapy.
Eczema is a general term used to describe an inflammation of the skin. In fact, eczema is a series of chronic skin conditions that produce itchy rashes; scaly, dry and leathery areas; skin redness; or inflammation around blisters. It can be located anywhere on the body, but most frequently appears in the creases on the face, arms and legs. Itchiness is the key characteristic and symptom of eczema. When scratched, the lesions may begin to ooze and get crusted. Over time, painful cracks in the scaly, leathery tissue can form.
Eczema affects people of all races, genders and ages. It is thought to be hereditary and is not contagious. The cause of eczema remains unknown, but it usually has physical, environmental or lifestyle triggers. Coming into contact with a trigger, such as wind or an allergy-producing fabric, launches the rash and inflammation. Although it is possible to get eczema only once, the majority of cases are chronic and are characterized by intermittent flare-ups throughout a person’s life.
For mild cases, over-the-counter topical creams and antihistamines can relieve the itching. In persistent cases, a dermatologist will likely prescribe stronger medicine, such as steroid creams, oral steroids (corticosteroids), antibiotic pills or antifungal creams to treat any potential infection.
The best form of prevention is to identify and remove the trigger. You should also use mild cleansers and keep your skin well moisturized at all times. Also avoid scratching the rash (which can lead to infection) and situations that make you sweat, such as strenuous exercise.
Leading Types of Eczema
Eczema takes on different forms depending on the nature of the trigger and the location of the rash. While they all share some common symptoms like itchiness there are differences. Following are some of the most common types of eczema.
The most frequent form of eczema, atopic dermatitis is thought to be caused by abnormal functioning of the body’s immune system. It is characterized by itchy, inflamed skin. Atopic dermatitis tends to run in families. About two-thirds of the people who develop this form of eczema do so before the age of one. Atopic dermatitis generally flares up and recedes intermittently throughout the patient’s life.
Contact dermatitis is caused when the skin comes into contact with an allergy-producing agent or an irritant, such as chemicals. Finding the triggering allergen is important to treatment and prevention. Allergens can be things like laundry detergent, cosmetics, jewelry, fabrics, perfume, diapers and poison ivy or poison sumac.
This type of eczema strikes the palms of the hands and soles of the feet. It produces clear, deep blisters that itch and burn. Dyshidrotic dermatitis occurs most frequently during the summer months and in warm climates.
Also known as Lichen Simplex Chronicus, this is a chronic skin inflammation caused by a continuous cycle of scratching and itching in response to a localized itch, like a mosquito bite. It creates scaly patches of skin, most commonly on the head, lower legs, wrists or forearms. Over time, the skin may become thickened and leathery.
This form of eczema appears as round patches of irritated skin that may be crusted, scaly and extremely itchy. Nummular dermatitis most frequently appears on the arms, back, buttocks and lower legs, and is usually a chronic condition.
Seborrheic dermatitis is a common condition that causes yellowish, oily and scaly patches on the scalp, face or other body parts. Dandruff, in adults, and cradle cap, in infants, are both forms of seborrheic dermatitis. Unlike other types of eczema, seborrheic dermatitis does not necessarily itch. It tends to run in families. Known triggers include weather, oily skin, emotional stress and infrequent shampooing.
Also known as varicose eczema, this form of eczema is a skin irritation that appears on the lower legs of middle-aged and elderly people. It is related to circulation and vein problems. Symptoms include itching and reddish-brown discoloration of the skin on one or both legs. As the condition progresses, it can lead to blistering, oozing and skin lesions.