A Dermatologist’s Approach to Hair Loss

by | Mar 8, 2019 | General Health | 4 comments

🕓 Reading time: 3 minutes

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 many varied and interesting presentations of hair loss and thinning.

I see hair loss in all age groups, from young children to the elderly.

My approach to treating hair loss is first to gain some clues from a GP referral letter. For example, a patient might have had an iron deficiency, which could contribute to their hair loss.

One might also have an autoimmune thyroid condition associated with other autoimmune conditions such as alopecia areata.

The GP letter may also note medications the patient has had in the past that potentially affect 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 vital 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;
  • the 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, or a 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 strands 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 hair loss can’t recover. These can be scarring hair loss diseases such as lupus or lichen planopilaris or 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 the 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 may also consider investigations such as blood tests that look for nutritional markers, hormonal profiles, and autoimmune markers.

For example, such tests might show an iron deficiency, which, when corrected, may help with hair loss recovery.

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, as treatment depends on your subtype of hair loss. Although there may not always be a hair loss cure available, 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 cause 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)
  • Androcur

Steroid tablets, steroid injections, and immunotherapy or immunosuppressive treatments can help with autoimmune hair loss.

New medications, such as JAK inhibitors, may also be helpful.

It can take 2-3 months after starting a hair loss treatment to see an outcome, and 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.

4 Comments

  1. Paul

    Could I please arrange a consultation thanks

    Reply
    • Doctors of South Melbourne

      Hi Paul,

      Thanks for getting in touch. To make an appointment with a GP at our clinic, please call us on 8579 6838 or click the BOOK ONLINE button at the top of this page.

      Please be aware that you’ll need a referral letter from a GP to see a dermatologist.

      Kind regards,
      Doctors of South Melbourne

      Reply
  2. Niva

    Hi There,

    I have hair loss problem since last 12 months, also have itchy scalp.

    Could you please let me know when is the earliest appointment available?

    Reply
    • Doctors of South Melbourne

      Hi Niva,

      Thanks for your comment.

      We generally have appointments available each day with at least one of the GPs. To find a time that suits you, please click the BOOK ONLINE button at the top of this page, or call us on (03) 8579 6838.

      If the doctor feels you’ll benefit from specialist advice, they’ll likely refer you to a dermatologist.

      Kind regards,
      Doctors of South Melbourne

      Reply

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