Age-related Skin Concerns
Hair Loss
Hair loss seems inevitable with age. By 70 years of age, approximately 80% of Caucasian men have some balding and nearly 40% of Caucasian women have noticeably thinning hair. For many, visible hair loss begins years earlier. The cause of this hair loss is often hereditary. That is, we inherit genes from our parents that cause hair loss. When hereditary hair loss occurs, it is possible to treat it. Treatment can give men and women of all ethnic backgrounds a more youthful appearance. 
Also Called
- Hereditary hair loss
- Male-pattern baldness
- Female-pattern baldness
- Androgenetic alopecia
Women Concerned About Hair Loss
A woman who is concerned about hair loss should see her dermatologist, who can evaluate her for many causes of hair loss, including hormonal changes. Fluctuating hormones, such as those that occur during menopause, can cause hair loss.
How Dermatologists Treat
Before recommending treatment, a dermatologist will first diagnose the cause of the hair loss. Once the cause is known, treatment can be discussed. Options for hereditary hair loss include:
Surgical Procedures for Hair Restoration
- Hair transplantation – Skin on the scalp that has good hair growth is removed and transplanted to areas of the scalp that need hair.
- Scalp reduction - Bald scalp is surgically removed and hair-bearing scalp is brought closer together to reduce balding. Scalp reduction surgery can be performed alone or in conjunction with a hair transplant.
- Scalp expansion - Devices are inserted under the scalp for about 3 to 4 weeks to stretch the skin. This procedure may be performed before a scalp reduction to make the scalp more lax. It also can be performed solely to stretch hair-bearing areas, which reduces balding.
- Scalp flaps - A hair-bearing segment of scalp is surgically moved and placed where hair is needed.
Medication for Hair Restoration
- Finasteride – Approved by the U.S. Food and Drug Administration (FDA) for treatment hair loss in men, this pill helps slow hair loss in approximately 88% of men and stimulate hair re-growth in about 66% of men. Finasteride works by blocking the formation of the active male hormone, dihydrotestosterone (DHT). It is available by prescription.
Over-the-Counter Treatment for Hair Restoration
- Minoxidil - This topical solution works on hair follicles to reverse the shrinking process and stimulate new growth on the top of the scalp. Minoxidil is approved by the FDA for use by men and women. It is the only hair re-growth ingredient approved by the FDA for use by women. A dermatologist may combine topical minoxidil with another topical treatment such as a topical corticosteroid or topical tretinoin to enhance hair growth.
- Laser devices – Brushes, combs, and other hand-held devices that emit low laser light may stimulate hair growth or make hair look more youthful in some people.
It is important to know that the FDA requirements for approval of a medical device are not as stringent as those needed for approval of a medication. Additionally, long-term effectiveness and safety of these devices are not known.
When to be Concerned
Any person who feels that hair loss is a problem should consult a dermatologist. While hair loss is often a sign of aging, it also can be the first sign of an underlying medical condition. A dermatologist can diagnose the cause of your hair loss. An accurate diagnosis is essential for effective treatment.
References:
Paus R, Olsen EA, Messenger AG. “Hair Growth Disorders.” In: Wolff K, Goldsmith LA, Katz SI et al.Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008. p. 766-9.
Satino JL, Markou M. “Hair regrowth and increased hair tensile strength using the HairMax LaserComb for low-level laser therapy.” Int J Cosm Surg and Aesthetic Derm 2003; 5(2): 113-7.
