Dr. Jane Sadler: What you can do about hair loss

Is your hair here today, gone tomorrow?

By the age of 50, approximately half of all men and women will have begun to experience hair loss. Over time, hair loss progresses and the cosmetic effects can damage a patient's mood, self-esteem and body image.

Hair loss can be the result of physical or emotional stress, autoimmune conditions or surgery. Contributing medical conditions include prolonged fever, childbirth, thyroid disorders, fungal infections, weight loss and anemia, among others.

Some forms of chemotherapy, contraceptives, antidepressants, and blood pressure and epilepsy medications are just a few examples of drugs that may promote a form of hair loss called telogen effluvium. (For a list, visit the American Academy of Family Physicians at aafp.org and search for "Diagnosing and Treating Hair Loss.")

Tight hair-braiding or ponytails seen in some celebrities (Katy Perry and Madonna) can contribute to another form called traction alopecia. Trichotillomania is a variation of traction alopecia stemming from compulsive hair-pulling or scalp-rubbing.

Hereditary-pattern hair loss is the most common cause of hair loss in both men and women, according to the AAFP. It is classically referred to as male pattern balding or androgenic hair loss. Androgens, derived from the male hormone, testosterone, tend to promote hair loss in some people. Celebrities John Travolta and Nicolas Cage have the classic receding hairlines seen in male pattern baldness.

Successful treatment depends on the cause and choice of treatment. Here are a few possibilities listed by aafp.org and from the American Academy of Dermatology.

Fertile females with hair loss should consider a contraceptive pill with low androgens. There are many on the market. Examples include Mircette, Ortho Tri-Cyclen and Zovia.

A tablet a day may keep further hair loss away. Finasteride (Propecia) inhibits specific androgens and restores some degree of normal function to hair follicles. However, it does not work on permanently damaged hair follicles. It is not recommended in women because of the risk of birth defects and because it does not work in post-menopausal females.

A few drops may do it. Minoxidil awakens and enlarges the hair follicles while reducing hair shedding. Patience is needed, as it may take up to one year to see improvement. In women, both the 2 percent and 5 percent strength are effective, but there is a risk of developing facial hair with the 5 percent strength. A treatment caveat: If you stop using minoxidil, you will probably lose any hair it helped you restore.

You may need a shot. Injections may be an option for some people. For those with autoimmune conditions such as alopecia areata, multiple small corticosteroid injections may be performed in the bare scalp regions. For other forms of hair loss, platelet-rich plasma therapy and stem cell injections are being studied as potential remedies. These treatments are not FDA-approved for hair regrowth but have had some success in scientific trials.

Let's shed some light (not hair) on the subject. Low-level laser (light) therapy might help stimulate new hair growth. There are several FDA-approved combs and helmets on the market. The American Academy of Dermatology cautions on their use and recommends more studies are needed to determine safe and effective dosing strategies.

Listen to your mother: Drink your milk and eat your fruits and veggies. People suffering from chronic disease, vitamin deficiency or iron loss could benefit from nutritional or vitamin supplements. A 2013 University of Cairo study demonstrated that low levels of vitamin D (a common deficiency) were associated with hair loss.

In most studies, biotin and folic acid supplements commonly intended for hair and nail strengthening have no significant effect on hair growth and thickness, according to AAFP.

Be realistic about the shampoos. Hair-loss shampoos may help the hair retain moisture and lessen hair breakage, making hair look thicker and healthier. Unfortunately, they do not grow hair.

When in doubt, cut it out. Surgical solutions such as scalp reductions remove strips of bald skin. Hair flaps implant a strip of skin with healthy hair to a balding area. Robotic technologies help surgeons precisely remove and transplant follicles. Costs can range up to $10,000 or more. Surgeries do not stop additional hair loss.

While there are many options to treat hair loss, there are not many quick, reliable and permanent solutions. The benefits of hair growth in treatments such as finasteride and minoxidil are lost when the medication is discontinued and other treatment methods are less promising or expensive and may not prevent further hair loss.

Newer treatment options include stem cell and platelet-rich plasma therapy, but more studies are needed to assess long-term benefits. Tofacitinib (Xeljanz), a drug used to treat rheumatoid arthritis, was reported in the Journal of Investigative Dermatology (2014) to have promising effects on certain patients who suffered complete hair loss (alopecia totalis). But continued use of this immunosuppressive medication is not advisable and long-term outcomes are uncertain.

Meanwhile, we will all keep our eyes to the horizon and look beyond the hairline for more answers.

Dr. Jane Sadler is a family medicine physician on staff at Baylor Medical Center at Garland. She blogs at healthblog.dallasnews.com.

Source: Dr. Jane Sadler: What you can do about hair loss