Hair loss is a common medical problem, and can encompass many different diagnoses. The general medical terminology for hair loss is “alopecia.” Alopecia can be divided into scarring and non-scarring alopecia. The distinction is important as scarring alopecia may lead to permanent hair loss whereas non-scarring alopecia, when appropriately treated, has chance for hair regrowth.
Scarring alopecia
Scarring alopecias are due to chronic inflammation around the hair structures leading to scarring over time and permanent hair loss. Imagine pouring cement over a grassy lawn making it very difficult for the grass to continue to grow. The common types of scarring alopecia include lichen planopilaris (LPP), discoid lupus erythematosus (DLE), morphea, traction alopecia, folliculitis decalvans, and dissecting cellulitis. Diagnosis is made clinically by physical examination with trichoscopy and may be confirmed by biopsy. Depending on the diagnosis and severity, patients may be treated with a mix of topical, intralesional, and/or oral steroids along with systemic treatments such as antibiotics, anti-malarials (i.e. hydroxychloroquine (Plaquenil), and/or immunosuppressive medications.
Non-scarring alopecia
Non-scarring alopecia is more common than scarring alopecia and include conditions such as alopecia areata, telogen effluvium, and androgenetic alopecia.
Alopecia areata is an autoimmune disease with 3 main subtypes alopecia areata localized (few small circular/oval areas of hair loss), totalis (total loss of hair of scalp, sometimes eyebrows and eyelashes), and universalis (total loss of hair all over body). Treatment involves intralesional injections for localized disease. For widespread, patients may require systemic treatments such as JAK/STAT inhibitors (i.e. tofacinitib (Xeljanz)).
Telogen effluvium is also known as stress-induced hair loss and can be due to either physical or psychological stress. Usually this presents anywhere between 6-12 months after initial stressor. Common triggers may include post-partum hair loss, acute/chronic illness, surgery, accident, divorce, weight loss, exercise, medications, etc. To identify the cause of telogen effluvium, comprehensive blood tests are required to exclude medical illnesses such as low red blood counts (anemia) or thyroid disease (hyper- or hypo-thyroidism). Hair regrowth occurs upon removal of the trigger (i.e. stress) and treating underlying cause but can take period of several months-years after the initial shedding.
Androgenetic alopecia is also known as hormonal hair loss or male/female pattern hair loss. This hair loss is characterized by specific patterns in males – for example, receding hair line and bald spot at the vertex. For women, hair starts to thin at the crown making hair part more visible. Usually there is a strong family history of similar patterns of hair thinning/shedding in grandparents, parents and/or siblings. Treatment is supportive to prevent further hair loss. Some common treatments for women include topical minoxidil (Rogaine), oral minoxidil, oral contraceptives, spironolactone, and in post-menopausal women, finasteride. Hair transplantation is often reserved for end-stage disease. Hair powders may be used to minimize the appearance of thinning.
Thus, not all hair loss is the same, nor all hair loss is permanent. There is hope but one has to make the correct diagnosis to get to the correct treatment.
I am a board certified dermatologist based in Los Angeles. I am a comprehensive dermatologist caring for families. I love seeing children and adults. My youngest patient was 0 days old and her oldest was 110 years old. I have had psoriasis since the age of 8 and considered an expert in psoriasis and psoriasis treatments. I have lectured locally and nationally and published numerous papers on other topics such as skin manifestations of eczema, hidradenitis suppurativa, systemic lupus erythematous, granuloma annulare, microbiome, skin cancers, and more. My expertise includes knowledge in managing complex skin diseases. I am experienced with surgical treatment of skin cancers, as well as non-surgical methods to treat skin cancer and precancerous lesions. I run a full medical, cosmetic, and surgical dermatology practice. I am experienced with the use of complex dermatologic therapy, including biologic therapy, immunosuppressive medications, and phototherapy. I also treats fine lines and wrinkles non-surgically with combinations of botox, fillers, chemical peels, lasers, and radiofrequency. I perform minor surgeries such as excisions for cysts, lipomas, basal cell skin cancer, squamous cell skin cancers, and early stage melanoma. I am physician expert for Kopa for Psoriasis, part of Happify. I have been featured on podcasts and quoted in numerous online and print publications. I am honored to be named “Top Doctor” in Los Angeles magazine. In my free time, I volunteer for community events such as skin cancer screenings and at the local free clinics. I also teach internal medicine and dermatology residents at several academic centers. I try to do yoga every day and every year, I run a half-marathon at the Golden Gate Bridge.