Doctors of South Melbourne welcomes our latest guest blog contributor, Dr Hope Dinh from Hope Dermatology.
Being a dermatologist sub-specialising in hair conditions, I see a lot of varied and interesting presentations of hair loss and hair thinning. We see hair loss in all age groups, from young children to the elderly.
My approach to hair loss is to first gain some clues from a GP referral letter. For example, it might be that the patient has had an iron deficiency which could still be impacting on their hair loss. They might have an autoimmune thyroid condition that’s associated with other autoimmune conditions such as alopecia areata.
The GP letter may also make note of medications the patient has had in the past, potentially affecting their hair. These might include chemotherapy medications, isotretinoin for severe acne, thyroid hormone replacement or the oral contraceptive pill. Such medications can sometimes impact a patient’s hair cycle and result in hair thinning and shedding.
A Thorough Patient History and Examination Are Essential
I usually ask key questions about:
- family history of hair loss;
- previous episodes of resolved hair loss;
- reports of excess shedding of hairs in the brush or on the floor;
- general reduction in hair density;
- hair styling practices such as excessive hair straightening, perming or pulling the hair back into an extreme ponytail;
- other medical conditions such as polycystic ovarian syndrome (PCOS) or signs of hormonal instability such as acne or excess chin hair (hirsutism); and
- recent stress, weight loss/exercise of change in diet.
A detailed examination includes:
- Looking for hair loss on the rest of the body (not just the scalp).
- Looking to see if hairs are easy to pull out. If hairs come out easily, it’s a sign that the hair condition is still quite active. It’s a good indicator for both a diagnosis of hair loss and a sign of recovery.
- lnspecting the ‘midline part’ in the centre of the scalp – a good indicator of male and female pattern balding.
- Looking for the receding hairline in both male and female pattern hair loss.
- Looking for patchy hair loss in the scalp and body hair. Patchy hair loss can be a sign of the autoimmune hair loss pattern alopecia areata.
- Examining for scarring hair loss. There are some conditions for which the hair loss can’t recover. These can be scarring hair loss diseases such as lupus or lichen planopilaris, or even a scarring folliculitis (inflammation around the hair follicle). Unfortunately, in scarring hair loss conditions, once the hair is gone it will NOT regrow. It’s always best to seek medical assistance for hair loss early!
- Looking to see if there’s a rash on other parts of the body (e.g. lupus can appear with a butterfly rash on the rash and a red/scaly rash on rest of the body).
- Assessment of the hair thickness.
- Dermoscopic examination of hairs. We’re looking for miniaturisation of the hairs (which occurs in male and female pattern balding). This looks like finer, thinner and shorter hairs compared with other normal hairs.
We also may consider investigations such as blood tests that look for nutritional markers, hormonal profile and autoimmune markers. For example, such tests might show an iron deficiency, which when corrected, may help hair loss recover.
For a more accurate diagnosis of the hair loss issue, we may take scalp biopsies of the involved area. We can do this in our clinic.
Hair Loss Treatment Can Be Complicated
It’s always best to have an accurate diagnosis done as treatment depends on the sub-type of hair loss you have. There may not always be a hair loss cure available, but we usually have treatments to slow the progression of hair loss.
We may suggest natural supplements/vitamins to help with a specific hair condition. If there’s a known vitamin deficiency, then supplements can help. Stress can make any skin condition, including hair loss. It’s always a good idea to have strategies for stress reduction – which may include speaking with your GP.
Though hair loss may not be completely curable, there are many ways we can manage a hair condition from getting worse. Treatments for hair loss include:
- Hormonal tablets such as finasteride/Proscar (a DHT blocker)
- Minoxidil (in both tablet and lotion form)
- Spironolactone (Aldactone)
Autoimmune hair loss can be treated with steroid tablets or steroid injections and immunotherapy or immunosuppressive. New medications such as the JAK inhibitors may be helpful.
It can take 2-3 months after starting a hair loss treatment to really see an outcome. This is because hairs take about a month to grow 1cm. Being the case, I always ask my patients to be patient!
Dr Hope Dinh is a prominent dermatologist and owner of Hope Dermatology at 230 York St, South Melbourne.