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INTRODUCTION

Leflunomide, which is often prescribed in combination with methotrexate, causes hair loss similar to the way methotrexate does in about 10 percent of users. In rare cases, biologics such as etanercept Enbrel or adalimumab Humira have hair loss side effects. Generally as a drug-related side effect, the hair loss is not drastic and the hair does not fall out in patches.

And it usually grows back after you stop taking the drug. But if you have inherited male or female pattern baldness, arthritis medications could trigger or accelerate such permanent hair loss. The most common form of hair loss, male pattern baldness affects up to 80 million Americans, and usually shows as a receding hairline or balding on top.

Diseases of the hair: Mayo Clinic Radio

Women tend to thin at the front and top of their scalp. Should your instinct be to drop the meds at the first sight of hair loss?

What Causes Hair Loss?

No, says Miller. Possible treatments include starting with topical minoxidil, anti-androgen medications, or finasteride although this one has had mixed results. Even melatonin has been suggested for some women. Hair transplantation is also an option when the hair loss becomes significant and unresponsive to medical therapies. Carmina tells EndocrineWeb. They will be able to interpret the laboratory data, order the right laboratory studies, and choose the drug therapies that are most effective for each specific patient. He concurs that key points have been highlighted to better guide healthcare practitioners in determining when medical therapy is needed to block androgens.

Anawalt tells EndocrineWeb. While this is good news for those of you who are experiencing noticeable hair thinning, for others experiencing non-hormonal types of hair loss such diffuse hair loss across the whole scalp or patchy losses, it will require looking for other causes, says Dr. For example, systemic illnesses, side effects of medication, and inflammatory skin conditions may be at play.

Hair loss due to systemic illness or induced by medications often resolves when the illness abates, or the causative agent is discontinued. On the other hand, dealing with hair loss related to skin problems ie, psoriasis is the hardest to treat, he says, but these too may respond to creams or anti-inflammatories injections with cortisone or immune-suppressing drugs. Anawalt says.


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A recommendation that women worried about hair loss try the hair pull test. More than that suggests telogen effluvium, which does not respond to anti-testosterone therapy but may reflect altered thyroid hormone or estrogen levels or a nutritional deficiency. As a final note, be sure to tell your physician if you are taking biotin supplements for hair health since it will result in a false result of any hormone testing, and therefore preclude an accurate diagnosis and prohibit prescribing the right treatment.

Email Print Discuss. Written by Lisa Jaffe. J Clin Endocrinol Metab. Evaluation and treatment of male and female pattern hair loss. J Am 1Acad Dermatol. You May Also Like:. The mechanism of action by which minoxidil promotes hair growth is unknown, but it appears to act at the level of the hair follicle. Minoxidil is an effective treatment for male and female AGA and is recommended as first-line treatment by the American Academy of Dermatology guidelines. Androgen-receptor inhibitors e. Hormone replacement. Oral contraceptives.

Hair regrowth.

Do You Need a Hair Loss Doctor?

Therapeutic agents. Dermatol Clin ;— Minoxidil should be applied twice daily, and one year of use is recommended before assessing its efficacy. In men, minoxidil may work better in areas with higher concentrations of miniaturized hairs, and its efficacy may be increased by the synergistic use of once-daily tretinoin Retin-A applied at separate times during the day.

Women who could be pregnant should not handle finasteride, because it may cause birth defects in a male fetus. Spironolactone, an aldosterone antagonist with antiandrogenic effects, works well as a treatment for hirsutism and may slow hair loss in women with AGA, but it does not stimulate hair regrowth. Estrogen may help to maintain hair status in women with AGA, but it also does not help with regrowth.

Few controlled studies have examined the many non—FDA-approved hair growth agents such as cyproterone acetate not available in the United States , progesterone, cimetidine Tagamet , and multiple non-prescription and herbal products. A full discussion of approved and unapproved treatments for AGA can be found elsewhere. Telogen effluvium occurs when the normal balance of hairs in growth and rest phases is disrupted, and the telogen phase predominates.

The disproportionate shedding leads to a decrease in the total number of hairs. Axillary and pubic areas often are involved, as well as the scalp. Lack of significant historical events and a delay in regrowth should raise suspicion for syphilitic alopecia. Hair diseases.

The Difficult Hair Loss Patient: A Particular Challenge

Med Clin North Am ; — Alopecia areata is characterized by a localized area of complete hair loss Figure 5. This may extend to the entire scalp alopecia totalis or the entire body alopecia universalis 12 , 13 Figure 6. Alopecia areata is probably secondary to an autoimmune reaction involving antibody, T-cell, and cytokine-mediated losses.

Spontaneous recovery usually occurs within six to 12 months, with hair in areas of re-growth often being pigmented differently.

CBD Oil for Hair Loss and Alopecia – Does it Work?

Persons with a family history of the disorder, atopy, or Down syndrome also have a poorer prognosis. Exclamation-point hair showing distal broken end of shaft and proximal club-shaped hair root. In addition to diagnosing and treating any underlying disorder, treatments for alopecia areata include immunomodulating agents and biologic response modifiers Table 5. Squaric acid dibutyl ester. Triamcinolone acetonide Kenalog , 0.

Intralesional steroids should be discontinued after six months if no improvement has been noted. Topical immunotherapy i. Many other agents have been used to treat alopecia areata, including minoxidil, psoralen plus ultraviolet A PUVA , and anthralin Anthra-Derm , but success rates vary. Patients with recalcitrant, recurrent, or severe disease should be referred to a subspecialist. Trichotillomania is a psychiatric impulse-control disorder. Patients also may eat the plucked hairs trichophagy , causing internal complications such as bowel obstruction. The scalp may appear normal or have areas of erythema and pustule formation.

A scalp biopsy may be necessary to rule out other etiologies, because patients may not acknowledge the habit. The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication. Because of its psychologic nature, the mainstays of treatment are counseling, behavior modification techniques, and hypnosis. Selective serotonin reuptake inhibitors and other medications for depression or obsessive-compulsive disorder may be used in some cases, although no medications are FDA-approved for treatment of trichotillomania.

In contrast to trichotillomania, traction alopecia involves unintentional hair loss secondary to grooming styles. Traction alopecia also occurs commonly in female athletes who pull their hair tightly in ponytails. The hair loss usually occurs in the frontal and temporal areas but depends on the hairstyle used. Treatment involves a change in styling techniques. Other hair-growth promoters may be needed in end-stage disease, in which the hair loss can be permanent even if further trauma is avoided. Tinea capitis is a fungal infection of the scalp, usually caused by Microsporum or Trichophyton species of dermatophytes 19 Figure It usually occurs in prepubertal patients.

The most severe form of tinea capitis is a kerion, a fluctuant, boggy lesion with overlying hair loss. Tinea capitis can result in widespread hair loss with increased fragility of the hairs and frequent breakage. If fungal infection is suspected, a potassium hydrochloride slide or culture can be obtained. A Wood's lamp fluoresces several types of fungi; however, the most common fungus in the United States i.

Treatment includes oral antifungal agents such as griseofulvin Grifulvin , itraconazole Sporanox , terbinafine Lamisil , and fluconazole Diflucan , with the newer agents having fewer side effects. Cicatricial alopecias tend to cause permanent hair loss. These disorders destroy hair follicles without regrowth and follow an irreversible course. Other processes may be caused by autoimmune, neoplastic, developmental, and hereditary disorders.

Among these are discoid lupus, pseudopelade in whites, and follicular degeneration syndrome in blacks. Dissecting cellulitis, lichen planopilaris, and folliculitis decalvans also may cause scarring alopecia. Some disorders respond to treatment with intralesional steroids or antimalarial agents.

Already a member or subscriber? Log in. He received his medical degree from the University of Michigan Medical School, Ann Arbor, where he completed a residency in family practice. Address correspondence to Karyn Springer, M. State St. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. Figure 5 is used with permission from Mark Luba, M.

Evaluation of Hair Loss