The often devastating impact of hair loss in women forces dermatologists to diagnose and soothe the underlying condition as quickly as possible, usually using combination therapies followed by long maintenance term.
Wendy Roberts, advises patients against seeking answers online that are concerned about hair loss.
“Find a dermatologist who specializes in regrowing hair and ask them about the best supplements and nutritional products,” she explains. “Don’t be that person who comes with a bag of 20 products, € 5,000 later. consult a specialist. It will cost less and you will get results. ”
Dr. Roberts recommends Viviscal, Nutrafol and Vitalize Hair supplements differently for milder hair loss.
“Some people in take two. Some can spin two, ”she says.
Vitalize gummies provides a basic multivitamin, with an increased amount of hair growth aids, including biotin, zinc, folate and vitamin D.
“L ‘ AminoMar by Viviscal is a special ingredient. I may also want patients to be convinced, ”adds Dr. Roberts. “Nutrafol’s ashwagandha tackles stress-related issues”
Dr. Roberts usually recommends that patients eat more sulfur-rich foods such as beef.
Root of the problem
Valerie Callender says that if the cause can be determined, most patients can regain growth.
A key aspect of examining hair loss is determining whether the problem is caused by the scalp or the hair shaft. Doctor Callender performs tear-off tests in different sections of the scalp.
“I usually do the test at the top, at the two parietal sides and at the occipital region of the scalp,” she explains. It is best to select 15 or more hairs from each section and pull. I am looking to see if the hair is falling out or coming out of the scalp, or if there is broken hair that correlates with hair breakage. ”
The shampoo restrictions associated with hair pulling tests are controversial, adds Dr. Callender.
Traditionally, it was believed that women should avoid washing their hair five days before the pluck test. However, a study of 181 patients published in the Journal of the American Academy of Dermatology showed that this had no effect on the time when patients washed or brushed. the hair before the plucking test.
Hair breakage or acquired trichorrhexis is generally due to grooming habits such as chemical treatments and excessive heat, such as dryers.
“The hair becomes dry and brittle and lacks moisture. This can happen in winter when the hair and skin tend to be much drier, ”says Dr Callender.
[detaching from the scalp generally means a scalp or a systemic component.
“If it’s systemic, the first thing we think about is telogen effluvium. We also consider hair loss on female models (FPHL), ”she says.
The most common type of hair loss in all women, FPHL is classified by very slight loss.
With the scent of telogen, combing or shampooing causes significant hair loss. The loss of 50 to 100 hairs per day is considered normal. “But if you’ve never lost 50 to 100 hairs a day and it happens to you, it’s abnormal,” says Dr. Callender.
Dermatoscopy can help distinguish different forms of hair loss in women.
“Using a dermatoscope,” she said, “you can do the diagnosis non-invasively and in some cases you don’t have to have a scalp biopsy. This technique allows the clinician to determine if the hair loss is alopecia like androgenetic alopecia (AGA), or if there is an inflammatory scar component. ”
Platelet-rich subcutaneous plasma (PRP) can help AGA. In a 2018 study published in Dermatologic Surgery , Hausauer et al. showed that a treatment regimen comprising three monthly sessions with an additional booster every three months (group 1) was greater than two sessions administered every three months (group 2). 2 investigators randomized 40 patients with moderate AGA according to one of the treatment regimens and found that at only six months, the two groups had presented a statistically significant increase in the hair count (p < 0.001). The average improvement in group 1 was 29.6%, compared to 7.2% in group 2 (p <0.001). In addition, the two regimens resulted in similar significant increases in the caliber of the hair shaft.
In clinical practice, most dermatologists use the three-month session regimen with an additional reminder every three months.
“Boosters are important because, even if the three-month sessions tend to grow back, the follicles will become vellus hair again if they are not stimulated continuously,” says Dr. Callender.
SPECIAL CONSIDERATIONS FOR WOMEN
Hair loss in women who do not suffer can indicate hyperandrogenicity, which can produce the syndrome polycystic ovaries (PCOS). 3 additional signs of PCOS may include acne, hirsutism (facial hair in a male cast) and abnormal menses.
“Hair loss can be a sign of an internal or systemic problem. This is why the balance sheet is important, “said Dr. Callender.
Other forms of hair loss in women include anagen effluvium, alopecia areata and traction alopecia.
Scarring (scarring) alopecia tends to be secondary to other factors such as infections, trauma, tumors, or inflammatory processes. Central centrifugal scar alopecia (CCCA) is particularly common in women of color, with an estimated prevalence of 5.6% in women of African descent. 4
“Previously, we thought that the CCCA was caused by heat or the straightening of hair using a thermal device such as a comb or a flat iron” says Dr. Callender. “Then, when women chemically read their hair, we thought that the hair straighteners irritated the scalp.”
A recent study suggests that there is a genetic component in the PADI3 variant of CCCA. 4 In a cohort of 16 women, the study in the New England Journal of Medicine found that five patients (31%) had abnormalities in this gene, a splicing site and three heterozygous missense mutations. PADI3 codes for peptidyl arginine deaminase type III (PADI3). This enzyme post-translationally modifies other proteins essential for the formation of the hair shaft.
“It’s revolutionary,” says Dr. Callender. “If you can identify a gene, you may be able to develop new therapies based on that gene.” It is important that patients understand that treatment with CCCA is focused on stopping the progression of the disease.
“This means that we use anti-inflammatory agents, including topical and intralesional corticosteroids, to treat the inflammation that precedes the healing process,” she said. “We also use doxycycline primarily as a systemic anti-inflammatory agent.”
Once the inflammation is resolved and the scalp is stable for at least a year, patients can undergo a hair transplant.
Often, dermatologists stop treating CCCA after the inflammation is resolved so that the outbreak does not continue.
“I tell my patients that there is an active phase and a maintenance phase of treatment,” says Dr. Callender. “We need to inform patients that we cannot cure CCCA, so most patients must follow maintenance regimen after treating it effectively. ”