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October 16, 2018

How to treat alopecia

SOCAH Center

When you search for someone who treats alopecia, the medical term for hair loss, you may find different names for providers, including dermatologist, alopecia specialist, hair loss specialist, or trichologist. Dr. Nikki D. Hill is a board-certified dermatologist (medical doctor) who has undergone additional training to specialize in the diagnosis and management of scalp conditions leading to alopecia. Not all dermatologists are comfortable treating alopecia or want to treat patients with alopecia. It takes time, patience, and a great understanding on the patient’s and physician’s part to nurse the scalp back to health. Additionally, those who say they are alopecia specialist typically treat the hair-meaning creating a hair care regimen to maintain moisture, health, and selecting the right products for your hair. When it comes to alopecia- real alopecia or hair thinning, you should speak with a dermatologist who is familiar with scalp conditions to determine the type of alopecia you may be suffering from.

Let’s to begin by defining alopecia. Alopecia is a condition of the scalp that leads to partial or complete hair loss. There are over 20 different types of alopecia. Alopecia is primarily broken into 2 classifications- scarring alopecia and non scarring alopecia. Scarring alopecia results in inflammation that leads to scar tissue replacing follicle. Non-scarring alopecia can be caused by many different factors that may lead to hair shedding out of the follicle but the follicle remains intact and healthy. Typically after correcting the medical concern or treating the scalp, the hair can regrow normally.

The most important thing to remember when you are experiencing alopecia is early diagnosis and treatment. I always convey how important it is to be diagnosed by a dermatologist (medical doctor of hair, nails, and skin) the correct type of alopecia as soon as you start noticing changes. The time taken to cover up alopecia with new hairstyles and seek treatments from non-dermatology providers can be the difference between saving inflamed follicles and allowing permanent scarring alopecia-meaning the hair will not regrow. Sadly, I encounter women for the first time after experiencing signs and symptoms of alopecia for over 10 or 15 years. These ladies typically are dependent on wigs or a scalp prosthesis to feel comfortable in public. Even possibly reversible non scarring alopecias, if allowed to progress too long without treatment, can allow that follicle to shrink and become a permanent alopecia.

There is no way to look at a pore opening on the scalpor and know whether it is a “live follicle” or “dead follicle.” Dermatologists use a few diagnostic tools to determine whether there are signs of scarring or nonscarring alopecia and if there is permanent damage-meaning scar tissue. Even by looking at the scalp with a tool called a dermatoscope which shows signs a fraction below the surface of the skin isn’t adequate enough to determine if an alopecia process is actively progressing. Sometimes a scalp biopsy is needed to give a specific alopecia diagnosis. A biopsy is where the scalp is numbed using a small injection of numbing medicine. Next, a tiny cookie-cutter like tool is used to take out a small core (smaller than a pencil eraser) and a stitch is placed to close the small circle into a short line on the scalp. The stitch is removed in 1 week and biopsy results are typically available at the time of follow up. A biopsy along with a medical scalp examination is the most effective to know the correct alopecia diagnosis. I always say, alopecia is not a specific diagnosis and don’t settle for that as the final answer. Alopecia is the umbrella term used in medicine that includes all of the different types of alopecias, whether they are scarring or non scarring alopecias.

A specific alopecia diagnosis is important because each type of alopecia can have a different treatment. This is also important for your dermatologist to understand the difference between the alopecias. If you have scarring alopecia, common procedures such as platelet rich plasma (PRP) stem cell therapy only causes more inflammation of the scalp and can accelerate the inflammatory alopecia process. If you are experiencing an autoimmune type alopecia, red light laser therapy or LLLT/low level light therapy will not be beneficial to the ongoing deep immune response.

Common knowledge about alopecia is vague and difficult to come by. When looking for a dermatologist to assist in the diagnosis and management of your alopecia, ask if they are experienced and comfortable in treating different types of alopecia. Being assessed for 3 minutes and being recommended Rogaine is not effective for majority of alopecia patients. Along the same line, there are other options to the common steroid injections into the scalp, which are sometimes painful and can have side effects such as thinning of the skin, stretch marks, and lightening of the skin color at the injection site. Depending on your demographics, you may be more prone to certain types of alopecias and obtaining a specific diagnosis is key. With appropriate early treatment, the goal is to shut down the inflammation occurring in the scalp so the follicles can grow perform their job which is grow hair.

For more information about alopecias or to schedule your initial consultation with Dr. Nikki D. Hill, MD Board-certified dermatologist who specializes in alopecia conditions, please call our office or schedule your hour consultation online!

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October 16, 2018