Subscribe
Share
Share
Embed
Hair loss can happen for many reasons, and finding the right treatment starts with understanding the cause. Dr. Zain Husain, Heather Murray, and Courtney Carroll break down the most common types of non scarring alopecia, including pattern hair loss, alopecia areata, telogen effluvium, anagen effluvium, traction alopecia, and trichotillomania.
The team discusses how genetics, hormones, stress, illness, medications, and hairstyles can contribute to hair loss. They also explain common diagnostic approaches and explore treatment options such as minoxidil, finasteride, growth factor serums, PRP, red light therapy, steroid injections, and hair transplantation.
The conversation covers important medication considerations, why hair loss treatments can take months to show results, and why identifying the correct type of alopecia matters. They also highlight the importance of recognizing potential triggers, protecting hair follicles from repeated tension, and seeking guidance from a board certified dermatologist.
00:00 Understanding non scarring alopecia
00:00 Understanding non scarring alopecia
00:30 Androgenic alopecia and pattern hair loss
01:30 Diagnosing pattern hair loss
03:00 Minoxidil and treatment options
04:30 Minoxidil safety around pets
05:00 Finasteride risks and considerations
07:30 Growth factors, exosomes, and PRP
09:00 Red light therapy for hair growth
10:30 Hair transplantation
11:00 Why early treatment matters
12:00 Alopecia areata explained
12:45 Steroid injections and treatment options
14:00 Treatments for more severe alopecia
15:00 Diagnosing alopecia areata
16:00 Telogen effluvium and stress related shedding
17:00 Hair loss after illness and weight loss
18:00 Understanding temporary hair loss
20:00 Anagen effluvium and chemotherapy
21:30 Traction alopecia and tight hairstyles
23:00 Trichotillomania and repetitive hair pulling
25:30 Vitamin deficiencies and thyroid disorders
27:00 Why the right diagnosis matters
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
74 - Skinside Out Deeper Dive: Non-Scarring Alopecia
===
Dr. Zain Husain, MD: [00:00:00] Welcome to Skin Side Out. I'm your host, Dr. Zain, with Heather and Courtney. So today we're talking all about alopecia, specifically non-scarring alopecia from the inside out. So let's get started.
Real skin, real science, real confidence with Dr. Zain Hussain. Welcome to- Skin Side Out.
Heather Murray, PA-C: we'll dive into each different type of non-scarring alopecia, what, um, some causes may be, what symptoms might, um, occur with it as well, what we use to diagnose, and how to treat it.
Dr. Zain Husain, MD: Perfect. So let's get right into it. Let's start off with the one we see the most commonly in our clinic, androgenic alopecia, also known as male or female pattern hair loss. So Courtney, tell me a little about androgenic alopecia.
Courtney Carroll, LE Host: Sure. So androgenic alopecia is the most common type of hair loss. It's usually, um, got a genetic component, so mom or dad might have experienced some thinning.
Um, it's extremely common. We see it almost... Like almost every patient- Oh my gosh ... I feel like brings [00:01:00] it up. Yeah. In men you might see more of that kind of like crowning where, you know, the, the receding hairline or kind of the, um, less fullness, yeah, in the, in the mid-scalp.
Um, women will tend to get that widening part, and then a lot of that like temporal like recession as well, so a little bit less hair through there. There's a lot of different treatments for it, so, um, don't fret.
Dr. Zain Husain, MD: Yeah. And like you talked about the distribution that we see, so especially the frontal temporal crown area is the one that's most affected, and a lot of my patients ask me why specifically those areas.
Those hair follicles are actually more sensitive to a hormone called DHT. DHT, dihydrotestosterone, is the driving force for what's leading to these changes in these hair follicles. It leads them to become miniaturized and eventually fall out prematurely. So that's important because some of the medication that we use to treat, um, you know, this common type of hair loss, um, is based on reducing DHT levels.
Heather Murray, PA-C: as far as diagnosing, it's [00:02:00] usually a clinical diagnosis. We o- often don't need a biopsy to diagnose androgenic alopecia. Um, again, like Courtney mentioned, it's pretty much just, um, taking into the clinical presentation, um, what the scalp looks like, but also maybe genetic factors, if they have a family history of hair loss, um, what they have noticed over time.
Usually this is not a very, um, sudden type of hair loss. It's usually very gradual.
Dr. Zain Husain, MD: Yeah. And a lot of our patients often ask us, "Hey, don't I need to do lab work? I mean, could I have a vitamin deficiency? Could I be deficient in iron or, have thyroid issues?" You can potentially have those issues, but the vast majority of the time when the clinical presentation fits this pattern, that's what's going on.
Yeah. I mean, those other factors can potentially exacerbate a little bit. Um, but typically there's a different presentation when they're solely derived from like an anemia or a thyroid [00:03:00] dys- disorder.
we talked about the diagnosis, so how do we treat? So Courtney, go for that.
Courtney Carroll, LE Host: Yeah. Usually, um, you know, with, with hair loss, you can really do a kind of combination of treatment.
So a lot of times oral minoxidil is recommended. Um, you can also start with a topical minoxidil, which is over the counter. Um, the oral minoxidil can be paired with other orals such as, uh, finasteride. Um, we use that a lot in men. Um, for women, we'll use spironolactone sometimes. So different kind of, um, drugs to, again, treat that more hormonal aspect of the, of the hair loss.
Dr. Zain Husain, MD: Yeah. So let's go a little bit deeper into those medications 'cause we get a lot of questions about them. So specifically minoxidil. So a lot of people get confused because minoxidil was originally a medication used to treat hypertension or high blood pressure, and not the greatest, um, you know, blood pressure lowering agent, but it- Mm-hmm
that's what it was originally used for, and we found that its side effect was hair [00:04:00] growth. So we're actually using it for its side effect. Um, a lot of our patients ask us if that will lower their blood pressure or if they're gonna have any issues with passing out or, you know, getting lightheaded, and it's rare.
It can happen, but the vast majority of our patients really don't know that they're on it, and we're using such low dose oral minoxidil that it barely touches your pressure, if at all. Mm-hmm. However, if you do have a cardiac history, that's something important to know because there can be some side effects that you can see in this particular population.
Swelling in the legs, also known as, uh, you know, edema, as well as effusions around the heart, so pericardial effusions. Um, those can be a little bit more concerning and something that you should definitely disclose. Um, definitely make sure that you check it out with your cardiologist before going on any oral therapy.
Better yet, maybe just stick with topicals in those instances.
Courtney Carroll, LE Host: Yeah. And the topicals... It, it's sad. I just saw a video of a guy [00:05:00] recently, uh, I saw it, like, two days ago actually. The topicals are really toxic for pets, specifically cats, but dogs as well, and, um, this poor guy just lost his one-year-old kitten- Oh
uh, due to minoxidil and- That's
Dr. Zain Husain, MD: so sad ...
Courtney Carroll, LE Host: it was awful, and I just think there needs to be a lot more, um, education about that- Mm-hmm ... because- Mm-hmm ... a lot of people don't know that. Mm-hmm. And even in really small doses, even if you wash your hands, if your cat or dog's, like, licking your scalp or maybe your hands where the medicine was, I mean, I think- Even
Heather Murray, PA-C: just petting
Courtney Carroll, LE Host: your- Even petting.
I mean, it's- Wow ... so toxic, so I think that's super important for people to know.
Dr. Zain Husain, MD: Yeah.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: Now, the other medication which we actually get more questions about is finasteride. So Heather, where's the controversy?
Heather Murray, PA-C: So finasteride works by blocking that DHT, that dihydrotestosterone, and so, um, I think people get really nervous about it because that can contribute to, um, things like sexual dysfunction or erectile dysfunction, so that's, like, the most well-known side effect that people, um, hear about.
I have had patients say that they experience that. [00:06:00] I also have patients who Say they don't experience that, but it can happen with finasteride. Um, this is also something that we do not do for premenopausal women because if, um, if they are of childbearing age, and especially if they are pregnant, they don't even wanna touch the medication, um, because it can have severe birth defects too.
Dr. Zain Husain, MD: Specifically, it can feminize a male fetus- Mm-hmm ... which is no bueno.
Heather Murray, PA-C: Yeah. finasteride does work really well to preserve the hair that you have. Um, I think there are also some other side effects that, um, people may hear of too, like there could potentially be, and there have been reports of, like, mood changes.
Dr. Zain Husain, MD: Depression.
Heather Murray, PA-C: Um, yeah, depression, suicidality. I thankfully have not had any patients experience any of that, but it is something that we definitely don't wanna s- you know, sweep under the rug.
Dr. Zain Husain, MD: Yeah. We definitely disclose this information to our patients when we're prescribing these medications, but I do have to, you know, let you know that they're very [00:07:00] rare.
Yeah. They're not common. And I know there is a huge vocal movement, um, with post-finasteride syndrome, irreversible damage, and I think that it is a little bit exaggerated in the media because the voices that you're hearing are people who may have been affected or think that they may have been affected, and they're the ones you typically hear about.
A lot of the men who have been on these for years or decades, they're doing fine, and they really have no reason to speak out about it, right? They- they're doing great. They're keeping their hair. So I just wanna caution you to, you know, when you're making that decision, it's not a very common issue. Yeah.
And it is exceedingly rare.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: So what else can we do to kinda help with hair growth in these patients?
Courtney Carroll, LE Host: there's a lot of different both topical and procedures, um, that patients can do. Um, you know, we've talked about exosomes and, um, growth factors on the previous episodes and, um, [00:08:00] I think we talked a little bit about how they are kind of coming into their role when we're looking at, uh, hair loss.
So a lot of, uh, brands like, you know, Plated, um, Kerafact is another brand, Xtresse, um, all these different growth factors and, and exosomes are, you know, being used to stimulate hair growth. So, um, whether that be, like I said, through a topical serum, there are shampoos, uh, there are serums that you apply after a procedure where you are creating microchannels.
I know some offices do microneedling. We do, um, laser MD in our office, which is, I would say, a lot less painful than microneedling. Yeah. Um, so just a different modality of getting, uh, that serum into the, the follicles.
Dr. Zain Husain, MD: Yeah. And, uh, technology that was even earlier than that is PRP, platelet rich plasma- Mm-hmm
where we're using our own body's growth factors, which is found in our blood, circulating through our body, and we extract these, um, you know, these platelet rich plasma, um, you know, serum, and we basically will inject it into the scalp, and [00:09:00] similarly stimulate those hair follicles or stem cells to go into the growth phase.
So these are more regenerative medical treatments, and they are effective, and I feel like we're getting more and more advanced as time goes on. I feel like that's the way that medicine is heading, and, um, it's a great thing for hair loss.
Heather Murray, PA-C: Mm-hmm. Yeah.
Dr. Zain Husain, MD: Now, what about low-level light therapy? What are your thoughts on that?
Heather Murray, PA-C: Yeah, red light therapy works great. I think it works well by itself, but it can also help activate some of the growth factor serums, too.
Dr. Zain Husain, MD: Yeah. And I know that it looks gimmicky, like these hats, helmets, combs emitting red light, but there is good clinical data behind them. Um, a lot of people don't necessarily see the growth right away, and they often stop way too soon.
Yeah. So it really takes about a year to see the full efficacy from red light therapy. It's the same with the medications, too. You see that peak efficacy at about a year. Mm-hmm. So a lot of people stop their minoxidil and finasteride way too soon, and they're not really reaping the benefits because they're just discontinuing too early.
Courtney Carroll, LE Host: I've started seeing... I just [00:10:00] saw a video, um, of, uh, like a blowout brush, one of those hot brushes that had red light on it. Interesting. Wow. So I think it's kind of, like, transforming into the haircare world.
Dr. Zain Husain, MD: Is it also, like, a hair dryer? Like, it's blowing heat?
Courtney Carroll, LE Host: It's... Yeah, there's, like, round brushes. Um, they call 'em, like, hot brushes, but yeah, it's- it's basically a blow-dryer.
Um, but yeah, the-
Dr. Zain Husain, MD: Isn't the heat, like, also, like, damaging to the hair?
Courtney Carroll, LE Host: Yeah. So in my mind, I was like, "How much is the red light really doing?" Yeah. But I thought it was... Uh, the, the woman on the video was talking about, "Oh, I use infrared for all of my, my clients," and I just thought it was interesting that it's, yeah, being used on these tools.
They're incorporating
Heather Murray, PA-C: it, yeah.
Dr. Zain Husain, MD: Yeah. And, you know, obviously there is also hair transplantation. We did an episode on that, and that is a fantastic option for certain patients. I usually tell my patients that I would consider it after doing a year of medical therapy to stabilize, see what we can grow back, maybe reduce the amount of grafts that we would need if they do end up wanting to do it.[00:11:00]
But, um, you know, it is a good permanent type of hair restoration, and we can get really nice natural, um, results. And, you know, I often have my patients still doing some type of therapy along with their hair transplants so that they get the best possible result.
Heather Murray, PA-C: Mm-hmm.
Dr. Zain Husain, MD: Cool. And just one last note on androgenic alopecia.
I know it affects both men and women and can have devastating emotional consequences. So I'm a big proponent on, you know, starting to treat early. Mm-hmm. The earlier you treat, the easier it is to get better results and have a more successful outcome. The more advanced the hair loss is, the harder it is to stimulate some of those dormant or senescent, um, hair follicles and really get the maximum benefit.
So if you're starting to see these changes early on, especially, like, these teenage patients, sometimes, like, these teenage boys who are, like, coming in with hair loss, I mean, really, it's... the time to act is now.
Heather Murray, PA-C: [00:12:00] Mm-hmm.
Dr. Zain Husain, MD: Okay. Let's move on to another common type of alopecia that we hear about, alopecia areata.
So Heather, tell me a little bit more about that.
Heather Murray, PA-C: So alopecia areata, um, is more of a hair loss that is related to your immune system. So your immune cells are kind of, uh, targeting the hair follicles. And oftentimes it presents as just a very discreet, clear, circular patch. You might have one, you might have five.
You might have your whole scalp involved. You might have your whole body involved. And so alopecia areata has a very wide spectrum of, of involvement. Um, the nice thing, though, is the follicle is not destroyed, and so response with medications or therapies is really successful.
Dr. Zain Husain, MD: Yeah. How do we typically treat our alopecia areata patients?
Courtney Carroll, LE Host: usually we'll kind of do the same things, um, in, as supportive, but a lot of times we'll also use, um, things like steroid injections or ILK injections- Mm-hmm ... um, which we use [00:13:00] Kenalog or a type of steroid to basically, trigger like an immune response for that hair to grow back. And I think the ILK injections work pretty well.
Um, sometimes we'll use topical steroids for patients to use at home. Um, sometimes even non-steroidals, things like tacrolimus, um, Elidel, um, you know, other, other things again once you kind of come off that steroid, um, just to trigger that immune response to get that hair growth back.
Dr. Zain Husain, MD: And oftentimes, uh, your hair just grows back.
Courtney Carroll, LE Host: Mm-hmm.
Dr. Zain Husain, MD: You don't necessarily have to treat it. Um, typically, you know, after a few months, most of our patients notice hair regrowth anyway. But I understand when patients come in panicking with this like crop of hair that's missing and, you know, they're self-conscious. So treating it does facilitate regrowth faster.
So I think that it's, you know, the very minimal risk and, you know, great benefit. So I think that treating it, there's no issue with that, but you can wait. However, the more severe forms of alopecia are, you know, sometimes a little bit [00:14:00] more, you know, concerning and emotionally devastating, so alopecia totalis and alopecia universalis.
So these are cases where a patient loses all the hair on their head or even their entire body. And especially, I mean, for any patient, but younger patients, the pediatric population, it's really, really, you know, concerning, and then also in, in adults. And, you know, patients are very self-conscious and, you know, in the past, we used to use like heavy immunosuppressive medications, um, you know, oral or IV steroids and other immunosuppressing medications.
Uh, you know, had a lot of side effects. However, things have changed in the past decade with the advent of JAK inhibitors and these specific biologic molecules that are helping these patients grow hair. I mean, we've had a number of patients with- Mm-hmm ... you know, severe alopecia who have done well on these JAK inhibitors.
What have your experiences been?
Heather Murray, PA-C: Yeah, really successful. Yeah. I think, um, the benefits definitely outweigh the risks for a lot of people.
Dr. Zain Husain, MD: Yeah. [00:15:00] But they do take a while to work.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: So I do tell my patients, "You have to be patient." Mm-hmm. You know, typically, we're looking at least about six months of therapy before you're really seeing some significant improvement.
Heather Murray, PA-C: And we often see alopecia areata after like stressful events. Mm-hmm. Um, it's not a guarantee that if you have a very stressful event that you will get alopecia areata, but there's also a little bit of like gener- uh, genetic like susceptibility to it as well.
Dr. Zain Husain, MD: aside from the hair, which is pretty obvious, what other clinical findings can we see associated with alopecia areata, uh, that we can see on physical exam?
So like nail pitting.
Heather Murray, PA-C: Oh, yes.
Dr. Zain Husain, MD: Yeah, so we can definitely see that, um, and texture changes. So that's another clue- Mm-hmm ... that something's going on- Mm-hmm ... um, in terms of immune dysfunction.
And obviously we have these different ways of, you know, diagnosing alopecia areata.
Is there a lab marker or a blood test that shows this or is it typically just a clinical diagnosis?
Heather Murray, PA-C: [00:16:00] it's typically clinical. It's really, um, it's commonly Very similar in a lot of different people. Um, like I said, it's a very discrete circular patch. Sometimes what we might use certain like, like trichos- trichoscopy, which is like dermoscopy, um, for the scalp.
So looking at the scalp and the hair follicles under a magnifier and seeing different components within that hair follicle, and if the follicle is still open, um, and, and what the hair follicles look like up close.
Dr. Zain Husain, MD: Yeah. Great. All right, let's move on to the next common type of hair loss that we see, and we see a lot of this also, telogen effluvium.
Courtney, tell me all about it.
Courtney Carroll, LE Host: Um, so telogen effluvium is a, yeah, very, very common... Um, we tend to see this in patients who have undergone a major stress in their life. And, you know, even stress like, uh, surgeries, giving birth can be a major trigger, uh, car accidents, loss of job. I mean, just any kind [00:17:00] of major life event.
Um, so your hairs are always gonna be in one of three stages. Um, you have your anagen phase, which is your growth phase, um, and then you have your telogen phase. Um, in the telogen phase, um, sometimes those hairs will enter prematurely and start to shed. So it can be a little startling. Patients can sometimes lose up to 50% of their hair during this telogen effluvium process, which I think is, like, really unsettling 'cause you're essentially pulling out clumps of hair that you might not have been pulling out before.
And I mean, on average, we do shed, I think, what? It's like 100 hairs, uh, a day. So some shedding is normal, but these patients really are experiencing, um, an abnormal amount of shedding. So it can be very, uh, quick onset and, and very, um, like I said, just unsettling.
Dr. Zain Husain, MD: Distressing for sure. Yeah. And, um, some other common causes that we've been seeing more recently, especially in light of the pandemic, COVID- Mm-hmm
um, and other infections- Mm-hmm ... can definitely [00:18:00] lead to a ton of hair loss. Mm-hmm. And also with the, you know, rise of GLP-1 medications- Mm-hmm ... patients are losing a lot of weight and can subsequently lose a lot of hair. So these are things that we're seeing much more commonly in our clinics.
Heather Murray, PA-C: Yeah, and I think the timing is really pertinent to, um, you know, when did you have your stressful event, or when did you start this medication, and when did you start noticing the hair loss?
Oftentimes, it's just a, um, a couple months or several months after.
Dr. Zain Husain, MD: Yeah. And in terms of treatment, this is a type of hair loss that is temporary, so we really wanna reassure our patients that this is generally a temporary, you know, type of phenomenon. After a while, it plateaus and you start regrowing your hair.
But, you know, obviously it's a distressing situation and, you know, some patients really want treatment to kind of help their hair grow back as quickly as possible. So I often treat my [00:19:00] patients who have telogen effluvium similarly to how we treat our anagen, I mean our, um, androgenetic alopecia patients, because a lot of the treatments that we have are stimulating those hair follicles, you know, to go into the growth phase.
I typically don't do minoxidil or, you know, spironolactone or finasteride for these type of patients because they're not really hormonally driven, you know, like that chronic type of hormonal induced hair loss that's due to genetics. This is an acute type of, you know, reaction and what we just want is get that patient through the stressful period, get their hair growing back, because you don't want to be dependent on like minoxidil for instance, because you can get h- that hair growth, but then you can get a shed when you come off of it.
Mm-hmm. And that can be a second, uh, stage of distress for the patient.
Courtney Carroll, LE Host: Mm-hmm.
Dr. Zain Husain, MD: Mm-hmm. Cool. And I think that Heather was definitely right, the timing is really key. So it's really important to get a good history. Spend time with your patients, figure out, because sometimes patients don't [00:20:00] even think about something that happened like six- Mm.
Mm-hmm ... months ago- Mm-hmm ... um, that could even be related to their hair loss. And, you know, that's sometime the key to the puzzle.
Courtney Carroll, LE Host: And sometimes even if they don't f- I, I get a lot of times patients are like, "Well, I don't think I was stressed during that time period," but- Mm-hmm ... they just don't realize that maybe you're mentally okay, but your body is still...
You know, just like a car accident. "Oh, well, it's just a little fender bender." Mm-hmm. But it's still a stressful experience. Mm-hmm. It's still, you know, something that your body is physically responding to. Mm-hmm. So sometimes using, yeah, a little bit of detective work's important.
Dr. Zain Husain, MD: Yeah. Okay. So moving on to the other type of hair loss, similar, but it's called anagen effluvium.
So what does this mean, Heather?
Heather Murray, PA-C: Um, anagen effluvium is, a type of hair loss that we see within the anagen phase. Um, so it's very different than telogen effluvium, both like timing and mechanism. Oftentimes, I think the most common thing that we see being an- um, anagen [00:21:00] effluvium is like chemotherapy- Mm-hmm
causing, um, hair loss. And so something is abruptly interfering with the activity and the growth of the hair follicle. So it's usually not months down the line where something happens. It's usually a lot quicker.
Dr. Zain Husain, MD: Yeah. And, um, other things that can, you know, cause this, radiation therapy as well because that's also targeting these actively proliferating cells in the hair follicle.
Um, other toxic exposures. So these are all things that, you know, there's often inciting type of agent that's causing this. And, you know, oftentimes we see a, um, you know... I've seen a few patients with this and, you know, you do a hair pull test and you just kind of see them just like-
Courtney Carroll, LE Host: Mm-hmm ...
Dr. Zain Husain, MD: come out- Mm-hmm
um, with the bulb and everything. So that's something that, you know, you can see on clinical exam.
Courtney Carroll, LE Host: Mm-hmm.
Dr. Zain Husain, MD: All right. Traction alopecia. So this is something we see a lot in our female patients. Mm-hmm. So Courtney, what's traction [00:22:00] alopecia?
Courtney Carroll, LE Host: so traction alopecia is kind of almost what it sounds like. Um, the, the traction over time, um, whether that be from, uh, we see it a lot in like, uh, dancers, like ballerinas that wear a really tight bun or gymnasts that wear a really tight, uh, ponytail or bun, um, in different, um, hairstyles such as, you know, tight braids, tight, uh, cornrows, things like that.
And that traction is basically creating, um, that hair to, you know, break apart and lose over time. So it's something that I would say is a little bit preventable by changing maybe the type of hairstyle that you're, you're using. Um, but it is something that can happen pretty much over time.
Dr. Zain Husain, MD: Yeah. I mean, you were a gymnast, right, Heather?
Did you have this?
Heather Murray, PA-C: Oh, yeah, probably. Yeah. And I think the, the thing that we need to kind of watch out for is, um, traction alopecia can turn into a scarring type of hair loss, and once it gets to that point, it is a lot harder to treat. [00:23:00]
Dr. Zain Husain, MD: Yeah. And we do see this in certain ethnic groups as well. Um, we do see it in, um, you know, African American patients who have like tight braids or, you know, tight hairstyles, so that can definitely put stress on the hair follicles.
Um, Muslim patients where the women wear hijabs, um, they have their hair often pulled back constantly, um, so that also places stress, um, on the hair follicles. So, you know, when in doubt, just, you know, stay on the loose end if possible, um, because that is just repetitive trauma over time and that will eventually, you know, lead to hair loss.
Heather Murray, PA-C: Mm-hmm.
Dr. Zain Husain, MD: Is there anything that you can do after that hair loss occurs?
Heather Murray, PA-C: you can do... Like, we do have good success with steroids, topical steroids or steroid injections. Um, you could potentially do something like minoxidil, but again, if you end up stopping it later on, you could potentially have the shedding.
Dr. Zain Husain, MD: Great. Trichotillomania, this is one of my favorite words. [00:24:00] So what is trichotillomania, Heather?
Heather Murray, PA-C: it is a type of hair loss that is related to some sort of repetitive behavior that, um, causes the breakage within the hair. So, um, I think a lot of times we see this with, like, anxiety, um, compulsive behaviors, any sort of, like, constant rubbing in a particular area.
I had a patient once who had trichotillomania on the back of her scalp, and she didn't realize that she was doing it, but she was really stressed during finals in college, and she was, like, constantly, like, picking at this one spot in her hair. And, um, trichotillomania looks very different-
Dr. Zain Husain, MD: Mm-hmm ...
Heather Murray, PA-C: than the other types of hair loss.
It is usually, um, like a circular patch, not always, but it's, it's, I guess, a little bit more irregular. Alopecia areata is- Mm ... circular as well- Yeah ... but it's very discreet.
Dr. Zain Husain, MD: It's more, like, geometric.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: Yeah.
Heather Murray, PA-C: And so, um, [00:25:00] trichotillomania also has these, like, exclamation mark hairs that we see, and we often see the hairs in different-
Dr. Zain Husain, MD: Stages of
Heather Murray, PA-C: Yeah, stages and break points. Mm-hmm. So they're not all gonna be cut off at the same length. Yeah, they're
Dr. Zain Husain, MD: like different lengths. Some are, like- Yeah ... a little stubble and some a little bit longer. Yeah. And it just looks very bizarre.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: Um, and I definitely see this more in the pediatric and adolescent population.
Yeah. Just those with compulsive, um, you know, disorders and just anxiety, and it's just something that, you know, the physical exam really does play a big role in diagnosis.
Heather Murray, PA-C: Yeah. Mm-hmm.
Dr. Zain Husain, MD: And I feel like, um, these patients often do well with, like, SSRIs- Yeah. Mm-hmm ... and certain other medications to help- Therapy
reduce their anxiety. Mm-hmm. Exactly. Yeah.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: any other non-scarring alopecias we haven't covered that we see in our office?
Heather Murray, PA-C: I know you kind of briefly mentioned this as far as, like, lab [00:26:00] abnormalities. Um, I do think some of those we can definitely see in conjunction with things like androgenic alopecia.
We also can see them, um, kind of on their own. Um, I do see a lot of vitamin D and iron deficiencies. I think those are very popular.
Dr. Zain Husain, MD: How many of those cases do you think are relevant to the hair loss, though?
Heather Murray, PA-C: I think the iron deficiency, I think it's relevant. I do think, um, vitamin D, there are, um- I feel
Dr. Zain Husain, MD: like everyone's vitamin D deficient
Heather Murray, PA-C: Yeah. I, I think it's, it's something that we're, a lot of us are combating. But, um, I do think iron deficiency definitely exacerbates androgenetic alopecia.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE Host: And a lot of thyroid disorders too. Mm-hmm. I feel like I notice a lot of, um, yeah, thyroid, uh, connection with shedding and hair loss.
Heather Murray, PA-C: Yeah. There are other things like, um, auto- other autoimmune conditions, um, like other nutritional deficiencies.
Those [00:27:00] aren't as common though.
Courtney Carroll, LE Host: Even sometimes things like, uh, seb derm or dandruff, when you have that inflammation on the scalp, it can cause things like breakage or- Mm-hmm ... you know, um, just, yeah, inflammation to the hair follicles, stunting some of that growth. So sometimes you treat the seb derm, and that hair loss ends up getting better too.
Mm-hmm.
Dr. Zain Husain, MD: Yeah. For sure. And we see a ton of seb derm.
Courtney Carroll, LE Host: Yes.
Dr. Zain Husain, MD: Yeah, so I think this was a fantastic discussion on non-scarring alopecias. These are quite common. We see this a lot in our clinic, and a lot of people suffer from this. So if you are dealing with some type of hair loss, I think that we mentioned that the physical exam and clinical presentation is so important, and getting the diagnosis correct is critical for the right treatment.
So make sure that you see your board certified dermatologist to really get the diagnosis down and come up with an effective treatment plan. Because if you're treating the wrong type of hair loss with the wrong treatment, you're not going to really see the benefits, and it can actually prolong this, you know, [00:28:00] hair loss period and cause more stress.
Yeah. So it's really critical. And, you know, y- the team can look at lab work. They can look at the physical exam, even do a biopsy if we need to, to really pin down that diagnosis. So if you enjoyed this episode, please like, comment and subscribe, but until next time, Skin Side out.
Out.