Diane S. Berson, MD is a Board Certified Dermatologist, an Associate Professor of Dermatology at Weill Medical College of Cornell University, and an Assistant Attending Dermatologist at the New York-Presbyterian Hospital. She has a private dermatology practice in New York City. Widely regarded as one of the leading dermatologists in the United States, Dr. Berson is frequently featured in national print, broadcast, and online publications.
Our go-to dermatologist, where hair health is concerned, is the nationally recognized hair loss expert Diane Berson, MD. We get many questions about how to handle hair loss for women, so we figured she'd be the perfect person to break it down for us. Here, Dr. Berson describes the most common types of hair loss as well as their causes, and she outlines the best available treatments that actually work for each type of hair loss.
Ayla: What is the most common type of hair loss that you see?
DR. BERSON: One of the most common types of hair loss is androgenetic alopecia, or female pattern hair loss. This looks like a diffuse thinning of the hair on the top of the scalp. Women go into this phase at different ages, but as you get older, it can progress more. There are different things that can lead a woman to enter this cycle at a younger age:
- Hereditary factors
- Hormonal changes: Pregnancy and post-pregnancy, going on or off birth control, perimenopause, and menopause — which is the most common cause of androgenetic alopecia in healthy women
- Stress: Medical stress (for example, flu, fever, surgery, or anesthesia) as well as emotional stress. When your body is under emotional stress, your adrenal glands release cortisol. If your adrenals are all revved up, they also release androgens — which can cause flares of hair loss and thinning hair (because the androgens interact with hair follicles).
- Certain types of medication: Sometimes hair thinning can occur with the use of diuretics, antidepressants, and blood pressure medications
When someone comes in with a complaint of hair thinning or hair loss, we do a step-by-step evaluation process to determine the cause. Other things we look for are iron deficiency anemia and thyroid disease.
Ayla: How do you treat androgenetic alopecia?
DR. BERSON: The specific treatment depends on the cause and other lifestyle factors, but here’s the list of possible treatments — some are proven and some have been shown to work anecdotally.
1. Topical rogaine, or minoxidil: This was originally discovered because people who took the medication for blood pressure noticed hair growth as a side effect. It’s FDA approved for the treatment of thinning hair.
2. Aldactone, or spironolactone: This is a hormonal treatment, an anti-androgen, which basically blocks testosterone from interacting with the hair follicle. It works because it’s the male hormone that’s thought to be involved in hormonally driven hair loss. It’s not recommended if you’re planning a pregnancy, but it’s otherwise good for all women and can be helpful for acne, too.
3. Birth control pill: This is also a hormonal treatment that can be very helpful for hair loss as well as acne.
4. Biotin: No formal studies have been performed to demonstrate its efficacy, but it’s safe to take, and anecdotally, it might make hair and nails a little stronger and grow faster. I usually suggest taking 2500-5000 mcg daily for 3-6 months to see if you think it’s helping. B vitamins are generally helpful, so you might take a variety of B vitamins as opposed to pure biotin.
5. Viviscal: This is another pill that’s become very popular. It contains shark cartilage; no one knows exactly how it works, but its manufacturer has provided some good data demonstrating that it helps with hair growth.
6. Cosmetic remedies: These include things like microfiber pigmented products that match the color of your hair to help camouflage a balding scalp. Short, curly hairstyles can help camouflage thinning, too — and they don’t pull on the scalp, which is beneficial if you’re concerned about hair loss. Extensions can help camouflage thinning, but you have to be careful about pulling on existing hair and worsening hair loss mechanically.
- At-home laser devices and helmets – these emit low-level light to stimulate hair growth. As with the other remedies previously discussed, these can be helpful for some patients.
- Hair transplants — this is a surgical procedure where hair follicles are removed from the back of the scalp and transplanted to the top.
8. New research: There are newer therapies that are being investigated to promote hair growth, including using Stem cells and a procedure called Platelet-Rich-Plasma therapy, which utilizes your own blood that’s injected into your scalp.
Ayla: What are the other types of hair loss that you commonly see?
Telogen effluvium is very common 3-6 months after childbirth or another stress to the body. During pregnancy, everything in the body is growing — so you have more hair that’s in the growth cycle. All of this hair then enters the resting phase at the same time and all falls out. So it basically evens out: You have more hair, but that additional hair then falls out. This can also happen when women go off the pill.
Alopecia areata is an autoimmune condition where the body develops an immune reaction to its own hair follicles, and as a result, one develops round areas of bald spots — sometimes one, sometimes just a few, sometimes many. It can be diagnosed with a biopsy, but usually we don’t have to do that because it’s an obvious clinical diagnosis. Alopecia areata can affect both women and men. We do like to evaluate these patients for other autoimmune conditions, such as autoimmune thyroid conditions, vitiligo, and diabetes.
Alopecia areata is very easily treatable with monthly steroid injections into the scalp, which gets rid of the inflammatory infiltrate that’s targeting the hair follicles. The steroid treatments usually lead to hair regrowth in the affected areas. There’s always the potential that the condition might flare again at a later time, which usually happens due to stress. So certainly avoiding stress can help.
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About Dr. Berson:
Diane S. Berson, MD, is an Associate Professor of Dermatology at Weill Medical College of Cornell University and an Assistant Attending Dermatologist at the New York-Presbyterian Hospital. She has a private dermatology practice in NYC and volunteers at the NY Presbyterian Hospital Department of Dermatology, where she teaches medical students and residents. Dr. Berson has been quoted in the Wall Street Journal and the New York Times, and many magazines including Allure, Town and Country, W, and More. She has also been interviewed often in the media, including NBC’s Today Show, ABC World News Tonight, and CNN Headline News. She lectures regularly at national dermatology conferences and is on the editorial boards of Practical Dermatology, Journal of Drugs in Dermatology and Dermatologic Surgery. Read more about Dr. Berson’s impressive background here.
Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.