Alopecia is defined as a loss of hair and is a common problem that Dr. Michele Green treats in her NYC office. Hair loss can be an important sign of an underlying systemic disease and needs to be evaluated seriously by a skilled and experienced dermatologist. A proper diagnosis is essential in order to determine what the right course of treatment will be for you. Dr. Green will do a comprehensive analysis of both hair and blood to determine the cause of your hair loss.
Male patient treated with 3 cortisone shots for Alopecia Areata (2 months)
There are different types of alopecia and they can generally be divided into two different categories based on the presence or absence of scarring and focal or diffuse hair loss.
Non-Scarring alopecia is the result of the reduction or slowing of the hair growth without damaging the hair follicle. There are many disorders that cause non-scarring alopecia, from androgenetic alopecia (male pattern hair loss or female pattern hair loss) to medication related or stress related (telogen effluvium) or hair loss due to Tinea Capitis (fungal infection of the scalp). Perhaps the most well known form of alopecia is Alopecia Areata, which is actually an autoimmune skin disease. Alopecia Areata begins as hair loss in just one or two patches on the scalp, and may progress to total loss of all hair on the scalp as well as elsewhere on the body. This unpredictable disease is cyclical, and may come and go at different times throughout the patient’s life.
Alopecia Areata is most common in people younger than 20, but children and adults of any age may be affected. Women and men are affected equally. Alopecia Areata affects approximately two percent of the population. The damage to the follicle is usually not permanent. Experts do not know why the immune system attacks the follicles. After a comprehensive laboratory work-up at Dr. Michele Green, a series of intralesional cortisone injections (injected every few weeks) and other topical or oral therapies may be used to treat and control the progression of the disease. Severe cases may be treated with other modalities such as Rogaine or Tacrolimus.
Female Pattern Baldness
Each strand of hair sits in a tiny place in the skin called a follicle. In general, baldness occurs when the hair follicle shrinks over time, resulting in shorter and finer hair. Eventually, the follicle does not grow new hair. The follicles remain alive, which suggests that it is still possible to grow new hair. The reason for female pattern baldness is not well understood, but may be related to aging, changes in the levels of androgens (male hormones). For example, after reaching menopause, many women find that the hair on their head is thinner, while the hair on their face is coarser. There may be a family history of male or female pattern baldness as well.
Hair thinning is different from that of male pattern baldness. In female pattern baldness hair thins mainly on the top and crown of the scalp. It usually starts with a widening through the center hair part. The front hairline remains unaffected except for normal recession, which happens to everyone as time passes. The hair loss rarely progresses to total or near total baldness, as it may in men.
Male Pattern Baldness
Male pattern baldness is related to your genes and male sex hormones. It usually follows a pattern of receding hairline and hair thinning on the crown, and is caused by hormones and genetic predisposition. The typical pattern of male baldness begins at the hairline. The hairline gradually moves backward (recedes) and forms an “M” shape. Eventually the hair becomes finer, shorter, and thinner, and creates a U-shaped (or horseshoe) pattern of hair around the sides of the head. Dr. Green offers several treatments including PRP, Minoxidil, Propecia, and other medications that can activate hair growth.
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP) is a popular new and exciting non-surgical method of treating hair loss for both women and men. What PRP does is use your own blood cells in a way that only the enriched cells that contain various types of proteins remain. The blood is spun in a centrifuge and the PRP is separated and then removed from the rest of the blood. These platelets are then concentrated to 3x the normal blood value. This is then followed by an injection of the blood cells into your scalp area. No medications are required pre or post procedure. PRP contains many growth factors that stimulate hair follicles and can be performed up to every month based on how much hair growth is required.
PRP is a great solution for both men and women, especially when hair transplant surgery is not an option. PRP injections can stimulate new hair growth in men who suffer from androgenetic alopecia (known as male/female pattern baldness) and women who suffer from female pattern baldness. The procedure requires just a few injections into the scalp area where the hair is currently thinning. The procedure will take approximately 30 minutes from the time your blood is drawn until the PRP is injected into your scalp.
Another factor in why PRP has become so popular for patients looking to restore hair is that it is a “natural” way to restore hair. Most medications used to restore hair, such as Propecia, can have side effects in men. These medications are also contraindicated in women of child-bearing age. PRP treatments can also be used in tandem with hair transplantation to help accelerate hair growth. PRP treatments should be performed on average, every 4 for three sessions. Further treatments will be evaluated by the end of the fourth month. It is recommended that you discuss all hair treatments including PRP at the time of the initial consultation with Dr. Michele Green.
If indicated, Dr. Green will do a comprehensive analysis of both hair and blood to determine the cause of your hair loss. Some women suffer from hormonal changes such as hypothryroidism or premature menopause which can accelerate hair loss.
The second type of hair loss is defined as a scarring alopecia and it is the result of the active destruction of the hair follicle. Causes may include such diverse diseases as Lupus, Lichen Planus, and Acne Keloidalis Nuchae. Scarring alopecia, also known as cicatricial alopecia, refers to a collection of hair loss disorders that may be diagnosed in up to 3% of hair loss patients. It occurs worldwide in otherwise healthy men and women of all ages.
While there are many forms of scarring alopecia, the common theme is a potentially permanent and irreversible destruction of hair follicles and their replacement with scar tissue. Most forms of scarring alopecia first occur as small patches of hair loss that may expand with time. In some cases the hair loss is gradual, without noticeable symptoms, and may go unnoticed for a long time. In other instances, the hair loss is associated with severe itching, burning, and pain, and is rapidly progressive.
Male patient treated with steroid injections for Alopecia Areata (after 8 treatments)
Treatment Options for Scarring Alopecia
Scarring alopecia can involve a lot of damage and permanent hair loss. For this reason treatment of scarring alopecia should be quite aggressive. The nature of treatment varies depending on the particular diagnosis. Scarring alopecias that involve mostly lymphocyte inflammation of hair follicles, such as lichen planopilaris and pseudopelade, are generally treated with corticosteroids in topical creams and by injection into the affected skin. In addition, antimalarial and isotretinoin drugs may be used. For scarring alopecias with inflammation of mostly neutrophils or a mixture of cells, the typical treatment involves antibiotics and isotretinoin. More experimentally, drugs like Methotrexate, Tacrolimus, Cyclosporin, and even Thalidomide have been used to treat some forms. Once a scarring alopecia has reached the burnt-out stage and there has been no more hair loss for a few years, bald areas can be either surgically removed if they are not too big or the bald patches can be transplanted with hair follicles taken from unaffected areas
3 month Before and After Cortisone Injection for Hairloss (Under chin)
If you’re ready to learn more about our hair loss treatments, please don’t hesitate to contact us online today or call 212-535-3088. Dr. Michele S. Green, a board certified NYC dermatologist, practices the latest techniques at the forefront of hair loss to help diagnose, treat, and re-grow your hair.