Hair Loss, What’s A Woman To Do?
By: Anna Camille Moreno, DO NCMP • Posted on November 21, 2017
Hair Loss and Hair Thinning
Hair loss or hair thinning, also known as alopecia, is very common and affects most people at some point in their lives. It can be very distressing and can have a significant social impact on an individual’s quality of life. Most adults shed about 100 to 150 hairs a day, but anything more than 150 hairs per day can be of concern.
A majority of women who lose hair are bothered by hair loss and they may choose to cover it up with hats, wigs, hair spray and other cosmetic products. Most seek out treatment to restore hair growth and prevent further loss.
Why Do We Lose Hair?
For men and women alike, hair loss can be due to the following causes:
- Health condition: illness and infection
- Poor nutrition
- Side effect of a medication
- Hereditary changes
- Aging process
Before talking to your women’s health physician, it’s important to be familiar with the types, causes, and initial treatment of hair loss.
What Pattern of Hair Loss Do you Have?
- Bald patches - focal, smooth spots
- Diffuse hair thinning - hair shedding
- Gradual thinning on top of the head - hair receding from the forehead
What are the types of hair loss?
Nonscarring (noncicatricial) Alopecia
- Reversible and more common
- Lack of permanent destruction of hair follicles
Scarring (cicatricial) Alopecia
- Irreversible and less common
- Permanent destruction of hair follicles
- Best evaluated by a dermatologist
What are the types of Non-Scarring Alopecia?
1. Alopecia Areata
- Acute, patchy hair loss
- Exam will show short, vellus hairs, yellow or black dots, and broken hair shafts
2. Anagen Effluvium
- Diffuse hair loss days to weeks after exposure to a chemotherapeutic agent (~65% incidence after chemo)
3. Androgenetic Alopecia
- Family history of hair loss, also termed “Female Patterned Hair Loss”
- Men: bitemporal thinning of the frontal and vertex scalp, also termed “Male Patterned Baldness”
- Women: diffuse hair thinning of the vertex with sparing of the frontal hairline
4. Telogen Effluvium
- Clumps of hair come out in the shower or hair brush
- Associated with physiological or emotional stress
5. Tinea Capitis
- Dermatophyte infection of the hair shaft and follicles
6. Trichorrhexis Nodosa
- Hair breaks due to trauma or because of fragile hair (excessive brushing, heat application, hairstyle that pulls on hairs, and excessive scalp scratching)
- Patches of alopecia
- Typically frontoparietal, that progresses backward and may include the eyelashes and eyebrows
8. Alopecia Totalis
- Whole body hair loss including eyebrows, eyelashes and pubic hair
What are the types of Scarring Alopecia?
Scarring Alopecia are mostly due to severe infections, burns, radiation, tumors and traction.
1. Lichen Planopilaris
- Rare skin condition that affects the scalp causing hair shedding, itching, scaling, burning and tenderness
- Lichen planopilaris is associated with postmenopause
2. Central Centrifugal Cicatricial Alopecia
- Also known as “hot comb alopecia”
- Due to certain hair practices such as hair weaving and use of chemical relaxers
- Referred to as “noninflammatory patchy alopecia”
- Cause is not known but believed to be due to an autoimmune condition
- Linked to Lyme disease
4. Traction Alopecia
- Due to physical traction like a tight hair bun, tight braiding or hair weaving
5. Secondary Systemic Scarring Alopecia
- Due to a systemic disease such as scleroderma and discoid lupus erythematosus
What important “clues” can lead you to your type of hair loss?1
- Telogen effluvium: Hair that comes out in “clumps.” Associated with febrile illness, stressful event, and pregnancy
- Trichorrhexis nodosa: Use of hair products such as straightening agents or certain shampoos
- Androgenetic alopecia: Associated with a family history of hair loss, worse at menopause with loss of estrogen
What should you do?
- Talk to your physician and make sure you are not depleted in vitamins, eating a well-balanced diet with high quality protein and your stress levels are controlled.
- We recommend getting the following levels checked: Zinc, Vitamin D, Ferritin, Estrogen and Thyroid.
- Use a proper shampoo daily for a total of 6 months to see its full effect. RogaineHP foam is effective for female pattern baldness called androgenic alopecia/female patterned hair thinning and must be used for at least 6 months to see an effect..
- Talk to your physician about all the medications you take, including herbal and vitamin supplements.
- If you have signs and symptoms of menopause such as: hot flashes, sleep disturbance, vaginal dryness, and pain with sexual intercourse, talk to your women’s health specialist about starting on hormone therapy.
- Learn more about treatment options for hair loss.
- For eye brow thinning which is common with age and thyroid problems, besides using eyebrow pencils, you can try RogaineHP foam applies to Qtip to apply nightly to the brow line!
- TOPPIK spray or powder can be applied to the scalp in your matching hair color to instantly and cosmetically make your hair appear thicker and can cover a widening hairline part.
Be Strong. Be Healthy. Be in Charge!
Anna Camille Moreno, DO NCMP
Department of Obstetrics & Gynecology
Duke Women's Health Associates
Duke University Medical Center
- Phillips, T. Grant, et al. “Hair Loss: Common Causes and Treatment .” American Family Physician, AFP, 15 Sept. 2017, aafp.org/afp/2017/0915/p371.html
- “Frontal Fibrosing Alopecia.” Genetic and Rare Diseases Information Center, U.S. Department of Health and Human Services, 30 Oct. 2017, rarediseases.info.nih.gov/diseases/10886/frontal-fibrosing-alopecia
Anna Camille Moreno, DO is a Family Medicine Doctor at Duke Women's Health Associates. Dr. Moreno is dedicated to an interdisciplinary women’s health practice focusing on the care of midlife women as it relates to menopause, perimenopause, hormone therapy, and their associated medical problems. Dr. Moreno is a graduate of the Specialized Women's Health Fellowship Program at Cleveland Clinic.