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Hair Loss: Causes, Prevention, Treatment & More

Dr. Shani Francis June 16, 2014 12:00 PM This chat has ended. Thank you for participating.
Brenna (Moderator) - 11:34 AM:
Our chat--Hair Loss: Causes, Prevention, Treatment & More--will begin in 30 minutes. You can submit questions at any point during the chat. This chat is already extremely popular so we apologize in advance if we are unable to answer all submitted questions. Please only submit your question once.

Dr. Shani Francis (NorthShore) - 12:00 PM:
Good afternoon and welcome to our online chat discussing hair loss, a topic very near and dear to my heart. My name is Shani Francis and I am the Director of the Hair Disorders Center of Excellence in the Division of Dermatology at NorthShore. I look forward to answering your questions and I will try to answer as many of them as I can during this hour. Please note that while many of the questions will apply to most people, I am not your personal doctor, and as a result the responses here follow generally accepted practices and may not be appropriate for every patient. Therefore you will want to follow-up any concerns you have with your own physician or schedule an appointment with me in the future to ensure you get the best possible treatment. OK lets get started!

Ellen (Allentown, PA) - 12:00 PM:
What drugs commonly cause hair loss? I am currently on Coumadin, a beta blocker, thyroid med, and a statin. Also, what products are contraindicated when on these meds? Thank you

Dr. Shani Francis (NorthShore):
That is a great question. In general, there are different classes of medications that typically raise a concern with hair loss: some chemotherapeutics, antidepressants, seizure medications, and some blood pressure medications,including beta blockers. In fact, while many medication labels state "alopecia" or "hair loss" as a side effect, the drugs themselves rarely cause hair loss. However, the process of starting ANY new medication (especially a hormonal one - like birth control) could induce shedding in 2-3 months in a process called "telogen effluvium". This is exceptionally important in conditions like thyroid disease where the level of hormone could be changing frequently. Most topical products are usually safe to use with minimal interactions with medications. It is always best to check with the prescribing doctor with more specific questions and product interactions.

ROSIE (CHICAGO, IL) - 12:06 PM:
Wearing Wigs? Will this make your hair thinner ? Hair is dry all the time from being cover up with a wig.

Dr. Shani Francis (NorthShore):
Wearing wigs could serve as great camouflage agent when dealing with hair loss conditions. The wig itself, it usually ok. However, it is important to not put the wig on too tightly or you may cause a second cause of hair loss called "traction alopecia", which is thinning around the hairline. Wigs should be loose enough to not create an indention in scalp when wig is removed. Also, having a "wig free" period, is important to let the scalp breathe. And do not forget that when wearing wigs, you still need to take care of your hair underneath!

Harriet (Chicago, IL) - 12:11 PM:
Dr. Francis, Can you address the issue of postmenopausal (15 yrs post-hysterectomy and oophorectomy) hair thinning and hair loss when thyroid tests are normal? Are there any tests you would recommend for postmenopausal women with hair loss other than thyroid levels? Also, do you see any value in using laser helmets or laser combs to help stimulate hair growth in female pattern hair thinning and hair loss in patients who do not want to use minoxidil? Thanks.

Dr. Shani Francis (NorthShore):
This is another great question that I commonly see in my clinic. Postmenopausal hair loss is quite common. In most cases, this is a process called "Senescent alopecia" where the hair follicles have decided to permanently stay in the resting or "telogen" phase of their growing cycle. They are basically tired and no longer wish to grow. It is always important to screen for other causes before jumping to this diagnosis. If the symptoms are there: a serum iron test is important to also check. For this condition, minoxidil works well (off-label use) . It is not a hormonal problem, therefore hormone replacement or other hormonal medications, do very little. The laser comb may be helpful in this condition if you are not interested in minoxidil, but it is currently only FDA approved for pattern hair loss. These two conditions are not caused by the same genes, they are different. You are very welcome. Thank you for your question.

Heather (Chicago, IL) - 12:18 PM:
Is it completely normal to start losing clumps of hair along with additional shedding at 8.5 months postpartum?

Dr. Shani Francis (NorthShore):
It depends. Hair loss postpartum, is extremely common. Childbirth induces a large shift in hormones that can set off a process called "telogen effluvium", previously discussed. This gets further complicated by the fact that after childbirth some women chose to nurse or breast feed. This could delay the rapid hormonal shift, by as much as 3 months after discontinuation of breast feeding. So if you are nursing for 6 months, your timing fits for this scenario. There are also changes in birth control and diet, and weight variations, which can all contribute to different telogen effluvium "triggers". All of the triggers typically will cause hair loss about 2-3 months after they start. It is not instantaneous, but rather delayed. It is important to remember that each trigger can cause hair loss. So if a person is picking up new triggers throughout the year, they could be shedding for quite a while. The good news is that you will never go completely bald from this type of process.

Dr. Shani Francis (NorthShore) - 12:25 PM:
I also want to add that patchy hair loss, with smooth bald spots is not "telogen effluvium" and should be further investigated by a physician.

Karen (Chicago,Il) - 12:25 PM:
I' a 33yr old woman who use to have full, thick hair not less than a year ago. How can I determine exactly what is the cause of my hair thinning and a recurrence of raised,crusty like sores on my scalp?

Dr. Shani Francis (NorthShore):
It is best for you to be evaluated, preferably by a dermatologist (physician who specializes in hair, skin, and nails).

Dr. Shani Francis (NorthShore) - 12:27 PM:
Scales and crusts could be a sign of infection or inflammation at the minimum. Further evaluation in a medical office is needed for a specific diagnosis and plan of action.

Diane (Lindenhurst IL) - 12:27 PM:
What is the special shampoo you mention in the Spring 2014 article in Connections and how much biotin do you recommend to take? Thanks.

Dr. Shani Francis (NorthShore):
In the article, the special shampoo is: "Ketoconazole 2% shampoo". This is available over-the-counter in the 1% strength. This medication helps decrease inflammation and also blocks male hormones that could be contributing to the problem. This medication is not for everyone. I typically do not recommend biotin directly for hair, as there is limited research demonstrating its effectiveness in people without an nutritional deficiency. Biotin is usually available in "hair, skin, and nails multivitamins" as 5000 mcg (or 5 mg). Biotin is very useful for nails, however, especially if they are weakened. You are very welcome. Thank you for your question.

Fabiola (Chicago, Il) - 12:34 PM:
Can castor oil help with hair growth? I been reading so much about it but wonder if it really helps.

Dr. Shani Francis (NorthShore):
Another great question. The use of herbal or natural products is of great interest to me, especially for hair loss. Unfortunately, we are quite limited in actual research that proves that they work. On a personal note, I do believe that some may be helpful. However, as a professional, I can rarely recommend them as there is no specific research to date that addresses this question. Castor oil specifically, is helpful for maintaining moisture, and therefore, can help prevent breakage. If your hair stays the same length and "does not seem to grow", it may in fact, be breakage that is a primary concern or problem. Castor oil may be helpful in this situation.

Eileen Moriarty (Mt Prospect IL) - 12:38 PM:
Are there any effective over the counter products to treat hair loss in women? When should a woman (in her 50s, otherwise healthy) see a physician for hair loss, ie how much hair loss is too much??

Dr. Shani Francis (NorthShore):
I think minoxidil is a wonderful over the counter general product for hair loss for most women. Minoxidil helps reset the hair into the growing part of the hair cycle. There are some general considerations for its use, and if truly concerned, it is best to discuss with a hair specialist. Any hair loss that makes you concerned is too much. We are here to help you.

Renee (Chicago, iL) - 12:41 PM:
What can I do to get thicker, stronger and longer natural hair. I am a 50 year old women often wear extention braids. My hair has been thinning for a while now. Should I just stop getting my hair in braids? What do you think?

Dr. Shani Francis (NorthShore):
Great question. A common goal of many women. In general, it is important to look very closely at your hair styling practices. Hair styles which create too much pulling or tension (or cause headaches after getting them) is too traumatic to your scalp and could easily result in hair loss. Same thing for heat and chemicals. Braiding, heat and chemicals are not inherently bad, but braiding hair with added hair and extensions is usually too much. Anything that hurts is too much. Any style that causes bumps around the hairline is too much. A traumatic hair style holiday may be just what you need. Styles that embrace your natural texture and essence of your hair typically are preferred (at least by your scalp).

Alison (Chicago,IL) - 12:46 PM:
My sons are beginning to show signs of male pattern baldness which runs on grandmothers side and fathers side a bit. would you recommend an oral medication for a 23 yr old to prevent further hair loss?

Dr. Shani Francis (NorthShore):
Another great question to a common problem. They are just the right age for male pattern baldness. There are 2 FDA approved treatments: 1 is topical, minoxidil or Rogaine 5% solution or foam; 1 is an oral medication called "Propecia" or Finasteride 1 mg. Minoxidil is available over the counter without a prescription, they need to use that 2x/day for 6 months to see any improvement with full benefits at 1 year, which can be maintained as long as they continue this medication. Finasteride is a prescription and it is best to discuss this with a physician. They are more than welcome to schedule with me.

Brenna (Moderator) - 12:48 PM:
There are 15 minutes left in this chat. We will try to get through as many questions as possible in that time.

Kirsten (Chicago, IL) - 12:50 PM:
Can you discuss some of the hair changes in MS patients? Can you suggest treatments/medicines to combat hair loss and thinning for those with MS?

Dr. Shani Francis (NorthShore):
Interesting question: there are probably a few reasons to have hair loss. By MS, I assume you mean: Multiple Sclerosis. Multiple Sclerosis is an inflammatory, neurological and immunological condition. In neurologic conditions, we typically see severe seborrheic dermatitis (a type of dandruff) which could contribute to hair thinning. Treatments for this would address the scalp inflammation. Over-the counter, "anti-dandruff" shampoos are a good place to start. Prescription strength are also available, also with prescription strength topical steroids. A clinic visit is needed for prescriptions. Given the cyclical and inflammatory nature of this condition, "telogen effluvium", the increased hair shedding problem is also a possibility. Also, I would recommend regular vitamin D3 supplementation with at least 1000 (not exceeding 3000-4000 units) daily, as vitamin D levels have been shown to be lower in MS patients and also helpful to their overall disease.

Vicky (Chicago) - 12:55 PM:
My 24 year old daughter has had some hair loss, thinning and breakage. We brushed it off due to stress from college, now that she has graduated they problem still exists. Is there anything she can use to help her? She takes vitamins and has had numerous physical exams.

Dr. Shani Francis (NorthShore):
If stress-induced, the culprit could easily be "telogen effluvium". This condition is tricky because it usually starts 2-3 months after the trigger, but takes about 6-15 months for hair to return to normal. If her periods are heavy, I would look for iron deficiency as well to make sure that is not contribution. Also, a well balanced diet with protein, iron, and sufficient calories, is important for maintaining healthy hair.

Jim (Chicago, IL) - 12:58 PM:
Does daily scalp messages really prevent hair loss?

Dr. Shani Francis (NorthShore):
Daily scalp massages are wonderful for hair loss! Scalp massages help improve circulation and reduce stress (and also feel really good). I cannot say that it completely "prevents" hair loss, not all causes of hair loss are preventable.

Brenna (Moderator) - 1:00 PM:
This will be the final question of this chat. We apologize if we were unable to answer your question this afternoon. Dr. Francis will be answering a selection of the questions submitted during this chat. We will share those answers on our NorthShore Facebook page. Like us on Facebook here: www.facebook.com/northshoreweb

Brenna (Moderator) - 1:01 PM:
Thank you to everyone who submitted such wonderful questions. Check back soon for answers to more of your questions on Facebook.

Dr. Shani Francis (NorthShore) - 1:03 PM:
Thank you all for joining in on this great hair loss discussion! I know that there are many questions that were not answered, but I will make arrangements to answer every question that was submitted. Details to follow. Thank you again. Sincerely, Dr. Shani Francis
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