Alopecia (Hair Loss)

Alopecia is a general term that means “hair loss.”

There are many types of alopecia, the most common types being:

Alopecia Areata

alopecia-areata
This is spontaneous hair loss, typically in circular patches. It most commonly occurs on the scalp and beard, but may occur anywhere. It is a benign condition and typically the hair re-grows on its own over time. Alopecia areata is caused by the immune system attacking the hair follicles. Stress and other traumatic events can often bring this on.  Dr. Tareen may treat alopecia areata with small cortisone injections into the skin to suppress the overactive immune system locally and to promote hair re-growth.

Androgenetic Alopecia

This is a hereditary type of hair loss that may occur in both men and women. It is associated with shrinkage of the hair follicles and shortening of the active growth phase (anagen phase) of the hair follicle.  In men, androgenetic alopecia is characterized by hair loss on the crown and temples.  In women, the frontal hair line is preserved, but there is diffuse thinning of the crown.  Hair loss in androgenetic alopecia is not inevitable. Dr. Tareen provides cutting edge treatments with oral and topical medications, as well as laser treatments.

More information on female pattern hair loss:

Some women may feel ashamed or embarrassed by hair loss – Dr. Tareen would like you to know that she has personally suffered from androgenetic alopecia (female pattern hair loss) since her early 20s. Female pattern hair loss can occur in isolation or may be attributed to hormonal imbalanced. Dr. Tareen and her team will provide a comprehensive and compassionate analysis and will provide you with solutions to help prevent and re-grow hair! Female hair loss is often due to a hormone known as DHT. This hormone miniaturizes hair follicles, slowly shrinking. This results in shorter and finer hair until the hair growth stops completely.

 

 

Some options for female pattern hair loss include: biotin, Viviscal, scalp massage as well as the prescription medications spironolactone, finasteride, and dutasteride. Dr Tareen will personalize a regimen for you to restore your hair to its best.

Information on female hair loss medications used at Tareen Dermatology in Minnesota:

1. Biotin: this is an over- the- counter B vitamin. It is water soluble (meaning that it DOES NOT) concentrate in your fat cells. It is very safe with minimal side effects.

2. Viviscal: this is an over-the-counter supplement that has been shown to strengthen and regrow hair. Dr Tareen herself takes Viviscal and thoroughly believes in it. There is a lower strength of Viviscal available at drugstores and a professional grade Viviscal, only available through hair loss experts such as Tareen Dermatology in Minnesota. Click on this link for more information on Viviscal professional.

3. Minoxidil/ Rogaine: These are topical medications that prolong the hair growth cycle. They are safe to use with minimal side effects. However, once started, if these medications are stopped, the new hair growth will be shed. Dr. Tareen has used these medications for over 10 years with fantastic results!

4. Spironolactone: this is an oral medication that was initially used for blood pressure management. Dermatologists use this medication off label to help women with hormonal acne and hormonal hair loss. Dr. Tareen took this medication for over 5 years with great results. This medication is not to be used if planning pregnancy or pregnant as it interferes with hormones (this is why Dr Tareen stopped it). There are side effects to spironolactone so it should be carefully discussed with your doctor. In some rat studies, the incidence of breast cancer was higher in the rats treated with spironolactone. Dr. Tareen and her colleagues will determine if spironolactone is right for you.

5. Finasteride/ Dutasteride: These medications inhibit an enzyme that breaks down testosterone into DHT (the main culprit behind female pattern thinning). An easy DNA test called HairDx can determine if these medications are right for you. You may actually see more hair shedding with this medication before hair regrowth occurs. Typically, it takes 6 months to 1 year to see regrowth of hair. Women of childbearing age should avoid these therapies as they harm fetal growth. Unfortunately, as these are used off label, these medications are typically not covered by insurance.

More information on male pattern hair loss:

Hair loss is an extremely common problem in men seeking the care of a dermatologist.  It can occur in men as early as the late teenage years and can therefore be an extremely sensitive issue for many young men. In others, it may become more apparent later in the 20′s or 30′s. There are a number of possible causes of hair loss in men but most hair loss is due to male pattern hair loss or “androgenetic alopecia”. This type of hair loss results from the action of dihydrotestosterone on the hair follicle which causes it to miniaturize and close up. Dihydrotestosterone is a product of the enzyme 5 alpha-reductase acting on testosterone.

There is a strong genetic component to this kind of hair loss and it typically runs in families. A common myth is that this type of hair loss runs exclusively on the maternal side of the family. In reality, however, male pattern hair loss can result from multiple patterns of inheritance that include both maternal and paternal factors.

Male pattern hair loss has a typical pattern of involvement of the scalp. Bitemporal recession is often an early sign in which hair thins out on the sides of the upper forehead. Additionally, there is often thinning on the vertex of the scalp. Gradually over time the hair continues to be lost on the top of the scalp uniformly. There are many stages in the evolution and progression of male pattern hair loss and rates of progression can vary from person to person greatly. In some individuals, the hair loss will progress at a more rapid rate over months to years while in others, it can progress very slowly over decades.
Treatment options for male pattern hair loss may include medical or surgical options. The two FDA approved medications are:

  • Topical minoxidil (Rogaine):  This medication was originally utilized as a blood pressure medication and was incidentally found to be beneficial in growing hair.  It is FDA approved in a concentration of 5% for men and is available in solution and foam formulations. The main and most common side effect of topical minoxidil is scalp irritation. It may also produce some light hair growth on the face although this is a more common side effect in women. There may also be some increased shedding of hairs initially which should recover with time.
  • Oral finasteride (Propecia): this medication is FDA approved in a dose of 1 mg daily for treating androgenetic alopecia. It works by blocking the action of 5 alpha-reductase. Studies have shown that up to 80-90% of men will retain or regrow hair with daily use. It is generally considered a very safe and effective medication and is well tolerated by most men.

For those who choose the surgical path, hair transplantation is an excellent treatment option.  It is very safe and effective and newer techniques are available to restore hair without scarring. To maximize benefit, minoxidil and/or finasteride may be used in conjunction with hair transplants.

There are a few caveats and considerations that patients must bear in mind when taking finasteride.

  1. Studies have demonstrated a low incidence of sexual side effects which may include decrease in libido, change in sperm quality and counts, or erectile dysfunction. The incidence of the side effects are exceedingly low and are generally considered to be reversible with discontinuation of the medication. However, a  recent study has suggested that in some patients, sexual side effects may be persistent even with discontinuation of the medication. This is an area that needs further investigation and research.
  2. There is some data to suggest that daily use of finasteride may be associated with the development of more aggressive types of prostate cancer in men who may be predisposed to developing prostate cancer later in life. However, this is also a controversial area because there are also some data to suggest that finasteride may have a protective effect against prostate disease and cancer. In fact, finasteride has been used for decades to treat a condition known as benign prostatic hypertrophy (BPH). Again, this is an area that warrants  further research and investigation.
  3. Finally, it is important to understand that if either finasteride or minoxidil is discontinued, the benefits on hair retention will be lost and any hairs that were maintained or regrown may be lost fairly rapidly over several weeks/months.

As with any medication, it is important to have an open dialogue with your doctor regarding the possible benefits and risks of treatment so you can make an informed decision about your healthcare and determine the best course of action for you.  Minneapolis dermatologist Dr. Tareen will discuss risks and benefits of all treatments recommended during your visit.

 

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