Causes of Hair Loss

This question comes from a member of our hair loss social community and discussion forums

I’ve been losing my hair for several years. I initially thought I suffered from androgenic alopecia or male pattern hair loss; however, members of online forums now say it may be diffuse unpatterned alopecia or DUPA. What is DUPA? Can it be fixed with hair transplant surgery?

DUPAI’m not 100% sold on the idea of “DUPA” or it’s cousin “diffuse patterned alopecia” (“DPA”).

Traditionally, non-scarring alopecia is broken down into several categories: focal, patterned, and diffuse. Focal alopecia includes conditions like alopecia areata; patterned includes androgenic alopecia and female pattern hair loss; and diffuse covers conditions like telogen effluvium, anagen effluvium, loose anagen syndrome, atrichosis, and hyoptrichosis. However, it does not – traditionally – include “DUPA” or “DPA.” Maybe the categorization is out of date, but I generally try to stay away from these terms – or at least from DPA. I do understand that “DUPA” is a good description for one clinical picture – which I will explain below.

I would classify hair loss fitting this diffuse pattern as follows:

Either: diffuse androgenic alopecia that is best described by the Ludwig and not the traditional Hamiltion-Norwood hair loss scale; OR you could call it diffuse unpatterned alopecia if you are experiencing thinning in the donor region (which is the only time I really think this term is appropriate).

This question comes from a member of our hair loss social community and discussion forums

I’ve taken an antidepressant medication without side effects for years. During this time, I also experienced some hair loss. I always attributed the thinning hair to “male pattern hair loss”, but I recently read about antidepressant drugs causing alopecia, and now I’m wondering: is an antidepressant causing my hair loss? Is it true that antidepressants can even cause hair loss?

antidepressantsIn a perfect world, pharmaceutical medications would treat diseases effectively with no adverse side effects. We, unfortunately, do not live in this world. Medications are not perfect. While many are considered “modern miracles,” and cure people of ailments responsible for significant morbidity and mortality in the past, these powerful “wonder drugs” often come with a set of equally powerful – but much less wonderful – side effects. Unfortunately, hair loss is a side effect of several trusted and proven antidepressant medications.

However, all is not lost …

Of the numerous types of antidepressants available today, two classes are (most commonly) associated with hair loss: tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI). Both classes of drugs officially list “hair loss” as a potential side effect; however, both also report hair loss occurring only in a very small number of medication users. For example, several types of SSRIs list hair loss as a “rare” side effect that occurs in approximately 1-2% of users. Even more encouraging, many see a reversal of the hair loss after stopping the medication. This is, however, not guaranteed – as many drugs “unmask” dormant permanent types of alopecia like androgenic alopecia (“male pattern baldness”). In these cases, the hair loss is not reversible. In these instances, however, it’s important to understand that the drug only revealed or accelerated an underlying condition; it did not actually cause a primary hair loss.

AA before and afterTwo months ago, news broke that tofacitinib citrate – a rheumatoid arthritis drug – regrew a full head of hair in a patient suffering from alopecia areata. Now, it appears as if alopecia areata sufferers have more cause for celebration: Earlier today, Columbia University Medical Center announced that ruxolitinib, a drug used to treat a bone marrow disorder called myelofibrosis, restored hair in patients suffering from alopecia areata.

Alopecia areata differs from traditional androgenic alopecia, or male pattern hair loss, in several important ways: first, it is defined as an “autoimmune alopecia” – meaning it occurs when the body’s immune system mistakenly attacks and damages hair follicles; second,  it can progress and cause hair loss in regions of the face and body (this is commonly known as alopecia totalis and alopecia universalis); and third, it was, until very recently, extremely difficult to treat and caused disfiguring hair loss in an estimated 6.5 million in the United States alone.

One of these 6.5 million is Dr. Angela Christiano, a researcher in the dermatology department at Columbia University. Dr. Christiano’s team spent years determining the specific cause and underlying pathway behind alopecia areata, and came to the following conclusions: alopecia areata is caused by immune cells in two specific pathways; and both pathways could be blocked by a class of drugs known as JAK inhibitors.

I have been prescribed isotretinoin for my seborrheic dermatitis and I’m afraid that it might cause hair loss?

accutane-pillsThinning hair is one of the of the many known side effects of Accutane (isotretinoin). In many cases, this hair loss is temporary. However, for those susceptible to the effects of androgenic alopecia (genetic baldness), there is always a chance that these weakened hairs may not regrow.

I have no documentation to support this, but I suspect that Rogaine (minoxidil) may help to counter the increased balding from Accutane as it is a vasodilator that increases blood flow to the follicles. But, I would certainly discuss that with your dermatologist.

David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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This question comes from a member of our hair loss social community and discussion forums:

I was diagnosed with androgenic alopecia (male pattern hair loss) several years ago. I recently underwent routine lab work with my primary care doctor and was told I suffer from an underactive thyroid or hypothyroidism. I’m now wondering if my hair loss could be caused by my thyroid gland and not the androgenic alopecia?

thyroid hair loss betterHypothyroidism – where the thyroid gland secretes too little thyroid hormone and, as a result, the pituitary gland in your brain secretes excessive thyroid stimulating hormone (TSH) – is associated with alopecia.

However, hair loss in hypothyroidism is more commonly seen in female patients and likely wouldn’t resemble a patterned alopecia- like you would see in androgenic alopecia. If your hair loss resembles the characteristic “patterns” seen in male pattern hair loss, like vertex thinning and thinning in the frontal-temporal regions, then it is likely caused by androgenic alopecia and not the thyroid.

However, hair loss caused by thyroid problems is usually reversible and could be seen in men as well. If the hair loss is related to the thyroid, appropriately treating the thyroid problems by closely following your doctor’s recommendations could affect the alopecia as well. Make sure to discuss this thoroughly with both the doctor treating the thyroid and a hair loss expert.
Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

This below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by recommended hair restoration surgeon Dr. Wen-Yi Wu:

Does the hair loss medication Propecia affect beard hair growth?

staffs1en[1]Since Propecia (finasteride) is a DHT blocker, it would be reasonable to assume that DHT stimulates beard growth. Thus, blocking DHT (with finasteride) would tend to inhibit its growth.

In practice, this does not seem to be the case, i.e. we don’t find that the medical hair loss treatment Propecia has any effect on facial hair. The reason is not clear.

Dr. Wen-Yi Wu
David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Michael Beehner:

How is Lichen planopilaris diagnosed? Is it just a visual diagnosis or are there tests?

Dr_Beehner_photoThe clinical picture and a biopsy are the usual ways to to diagnose Lichen planopilaris (LPP). It is thought to probably be of an autoimmune etiology. It can sometimes overlap with Alopecia Areata in its clinical appearance, but the hair loss is usually more “splotchy” with multiple, small patches irregularly spread all over the head, including in the donor area. It leaves a “scarring alopecia” result, which means that in each of these little bald patches there are no pores or follicular elements of any sort.

We usually wait at least two years after any sign of disease activity (enlarging, redness, scaling) before considering hair restoration surgery. Some hair transplant surgeons will then perform a repeat biopsy to make sure there are no lymphocytes present around nearby follicles near the edge of these lesions before transplanting. When the diagnosis has already been confirmed before a patient reaches me, I will often give the patient the choice between re-biopsying or doing test grafts. The good news about this diagnosis, as opposed to alopecia areata, is that it often will “burn out” and remain inactive for a long time or for that patient’s life span.

I experienced hair loss in the crown area when I first began taking warfarin (blood thinner) in 2004 for bi-lateral pulmonary emboli, which ended up being a permanent condition. Thus, I have to take warfarin for life. As they say, this is better than the alternative.

I am now old enough (50’s) that some thinning hair might be inevitable. I take very good care of the hair. I shampoo gently and use a wide tooth comb, never pulling etc.

My question is has anyone experienced hair loss with blood thinners and, if so, are there ways to counteract the effect of Warfarin? Also, I was wondering if products like volumizing powder (which really does make the hair appear thicker), gels or any products that go against the scalp might clog the follicles and cause hair to fall out.

Most directions for hair products do not say to put it directly on the scalp, but volumizing powder does say to apply directly to the roots, making it difficult not to apply it to the scalp as well. I also wonder about hair loss concealers like Toppik or Miracle Hair. Is one markedly better than the other? Miracle Hair is much less expensive & seems to be similar. Do they block the follicles, causing hair loss?

I appreciate any help regarding these issues and thank you in advance. Oh, I guess I should ask what brand of hair color is least damaging to fragile hair. Again, my sincere thanks.

I have taken 1mg of finasteride for several years and am now in my mid-fifties.  Surprisingly, I have maintained decent coverage despite poor genes.  Recently my hair has changed significantly in texture and volume.  This has seemed to coincide with a bout with a kidney stone.  I was unable to keep anything down due to nausea including meds.  My hair wasn’t a priority and my finasteride dose was sporadic for almost a month. I have resumed my daily dose but fear that irreversible damage has been done.  Could this interruption have such dramatic effects on my hair health?

Propecia BoxStopping Propecia (finasteride) for one month can result in noticeable thinning. Unfortunately, no one can predict if restarting the drug will regrow hair that is lost during this period. The only way to find out is to start taking it again and wait for new hair growth. This can take up to 6 months to become noticeable.

It’s important to remember that hair grows an average of 1/2 inch per month. The hair shaft is made of dead keratin proteins. Because this visible hair is already dead, its texture doesn’t change quickly without some sort of external influence like chemical treatments. Instead, texture changes happen slowly over time as older hair is replaced with newer hair growth. That change can take several months to become noticeable.

I had the Brazilian keratin treatment done 11 months ago to straighten my hair. Immediately after, my hair started diffusing all over with scalp tightness. It falls out directly from the root when washing, drying and by just touching. I have tried everything and found hundreds of people online with the same problem. However, there are no solutions.

My hair is more than half gone. The hair’s texture changed from course to thin fragile hairs. The little new hair growth is also fine, miniature and thin with a light frizz halo around my crown. You can see my scalp everywhere.

Will my hair grow back? Will the hair eventually stop falling? My dermatologist says it’s telogen effluvium.

simplysmooth3Your dermatologist is most likely correct. Telogen effluvium (TE) can occur when the body is exposed to stress or trauma. Chemical treatments can damage or shock the roots, resulting in thinning hair. Hair loss due to TE is normally temporary but it may take many months to regrow hair to its former fullness.

Another less likely possibility is that your scalp suffered chemical burns from improper application. If your scalp was scarred, three is a possibility that some hair will not regrow.

Unfortunately, no one will be able to accurately predict your future hair growth at this stage. Only time will tell. In the meantime, you may find Rogaine (minoxidil) helpful in jump starting the growth and adding fullness to your hair.

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