Exploring Treatment Options for Hair Loss

By Judy Horan
Published in the Omaha World Herald
Monday April 9, 2012

Hair loss, called alopecia, has many causes.  The sooner you see a doctor, the better chance you have of saving some hair from going down the bathroom drain.

The most common cause is androgenetic alopecia, a genetic condition that could come from either side of the family.  It’s sometimes called female-pattern or male-pattern baldness.

In female-pattern baldness, the part widens over the scalp but the frontal hairline is preserved.  There is thinning but not baldness.  In male-pattern baldness, there is receding at the temples and hair is lost over the crown, which can lead to baldness over the front hairline.

Other causes of hair loss can be medications, illnesses such as diabetes or autoimmune conditions such as lupus.  Children diagnosed with alopecia areata could be losing hair because of a thyroid problem or anemia.

Pregnancy, surgery, a high fever or death in the family can cause stress-related hair loss, called telogen effluvium, which typically recovers on its own within three to four months.

“But some people, especially women, can go into a chronic condition, in which case we treat it,” said Dr. Mary Finnegan, an Omaha dermatologist.

You might have heard that wearing a hat can cause hair loss, but that’s a myth, according to Dr. Douglas Ramos, an Omaha plastic surgeon.

“Women that apply a lot of traction to their hair, like corn rows and permanents or pull at their hair can lose hair,” he said.

Finnegan advises paying attention to your body, especially if you see a sudden change.

“Not everything is attributable to agin,” she said.  “Hair loss can be indicative of an internal medical problem.”

A dermatologist will look at your medical history and changes in medication and ask about hair loss over other body sites such as eyebrows, eyelashes, arms and torso.

Is there itching or burning? What shampoo are you using? An exam checks the width of the hair’s part in women to see whether it’s widening and looks for receding around the temples and crown of the scalp for men.

“We look for scale around hair follicles and for redness and scalp diseases that can cause hair loss,” said Finnegan.
Blood tests and biopsies might follow.

“In many cases, biopsies can give us prognostication of a chance for recover,” she said.


Some people wear their baldness proudly or cover their head with wigs, hats and scarves.  Others try medications such as the topical treatment minoxidil (one brand name is Rogaine) or finasteride pills for hair loss from treatable causes.

Minoxidil can be purchased over the counter. Depending on their diagnosis, many people are able to taper off use of the product after hair growth.  Results are seen in three months; full results take one year.  Five persent dosages are recommend for men; 2 percent for women.  However, at times a dermatologist will recommend the 5 percent dosage for women.

“Finasteride pills are the most effective treatment for male-pattern hair loss,” Ramos said. “It will first stop hair loss in young males and grow hair in approximately half of men in the back part of the scalp but doesn’t work up front.”

However, finasteride pills (one brand is Propecia) are not meant for women, especially women of child-bearing age.  “The use of finasteride in women is taken on a case-by-case basis,” Finnegan said.  “It depends on the dermaotlogist’s preference.”

Ongoing research may eventually provide additional medication options for male-pattern baldness.  Drugs now being tested for facial flushing and allergic inflammaiton of nasal pathways block a protein called prostaglandin D2, or PGD2, which inhibits hair growth.  Some sicentists believe that removing the inhibition might prevent hair loss.

Although Ramos performs hair transplants, he would rather see people use other treatments at an early stage of hair loss to avoid that last step.

When performing a transplant, he takes grafts from the back of the scalp and puts the hair where needed.  Most of his patients are men ages 30 to 70, but he can transplant hair in women who have mixed or male-pattern hair loss.

“Patients cannot do any strenuous activity for seven to 10 days, and it takes a year for all the hair to grow in.  Ninety percent of grafts survive.”

The average cost of hair transplantaiton in the United States is $3 to $5 per graft.  The procedure can cost $2,400 to $10,000.
Ramos cautions patients to carefully evaluate the physician who will do the transplants.  He also receommends checking with state licensing and registration boards for any sanctions aains the physician.  The information often is on the Internet.


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