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and joined the MJH Life Sciences team in February 2023. She attended Kent State University and earned a Bachelor of Science degree in journalism with minors in public relations and creative writing. She enjoys making and listening to music, reading, and spending time with her cats, Astrid and Marceline.

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Keep up with the latest headlines in dermatology from the past week, including anti-racism training for dermatology residents, the creation of artificial "smart skin," and more.

Derm In The News: September 29-October 5

Kaitlyn Bader is the assistant managing editor of 

 and joined the MJH Life Sciences team in June 2022. She attended Otterbein University in Westerville, Ohio, and earned a Bachelor of Arts degree in literary studies with minors in creative writing and film studies. Prior to health care news, Kaitlyn worked in industrial marketing. She enjoys cooking, reading, and tending to her house plants.

In case you missed it, this week we had news about bimekizumab's 2-year efficacy data in hidradenitis suppurativa, new long-term results for ESK-001 in psoriasis, late-breaking 40-week efficacy and safety data for povorcitinib for prurigo nodularis, and more.

The Weekly Roundup: September 30-October 4

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and joined the MJH Life Sciences team in May 2024. She attended Baldwin Wallace University, studying Media Production and Film, and is now finishing her Masters in Digital Media through Ohio University. When she's not writing, Maddi loves to read, attend concerts and spend time with her family.

While researchers found both therapies effective in long-term use, they stated secukinumab showed quicker improvements in QoL.

GPP Therapies: Comparing Efficacy and Safety of Secukinumab and Ustekinumab

Eric Simpson, MD, MCR, FAAD, lead author of a recently-published article highlighting roflumilast cream 0.15%, joined us for a Q+A interview.

 Q+A: Roflumilast cream 0.15% for AD with Eric Simpson, MD, MCR, FAAD

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Brella received FDA clearance last week for improving excessive underarm sweating.  

Doris Day, MD, Discusses Primary Axillary Hyperhidrosis and Brella SweatControl Patch 

Final Thoughts: The Importance of Comparative Studies in AD

Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

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Hair loss is a common problem that affects women, with more than 50% of postmenopausal women and up to 40% of healthy women experiencing frontal/parietal hair loss often beginning around reproductive age.

 The most common type of female hair loss is androgenetic alopecia (AGA), or female pattern hair loss (FPHL). Other forms of alopecia affecting women include alopecia areata (AA), telogen effluvium (TE), lichen planopilaris (LPP), central centrifugal cicatricial alopecia (CCCA), frontal fibrosing alopecia (FFA), and traction alopecia. It has also been shown that female hair loss can have a psychosocial impact, contributing to a lower self-image, anxiety, and depression.

Currently, there are limited FDA-approved medications to address female hair loss. These include topical minoxidil for FPHL and 3 oral Janus kinase inhibitors indicated for the treatment of AA.

 With the dearth of options, supplements and nonprescription therapies could play a beneficial role in filling a gap in the management of all females experiencing hair loss.

When discussing the pathophysiology of female hair loss disorders, it is helpful to consolidate etiologies into a few broad categories. These include hormone imbalance, systemic and localized inflammation, nutrient and vitamin deficiencies, aging and cellular senescence, and oxidative stress. The origins of hair loss vary across the board, and each cause has interventions that may serve as mediators impacting disease progression and reversal.

Hair loss in women is often influenced by hormonal factors, such as the production of dihydrotestosterone (DHT), polycystic ovary syndrome (PCOS), thyroid disorders, menopause, pregnancy, and hormone replacement therapy (HRT). While the role of DHT, a potent androgen, is established in male pattern baldness, DHT may also contribute to FPHL by miniaturizing hair follicles, particularly in genetically predisposed individuals.

 In PCOS, hormone dysregulation and elevated androgen levels lead to scalp hair thinning. Thyroid imbalances, both hyper- and hypothyroidism, can disrupt the hair growth cycle, leading to diffuse hair loss.

 During menopause, estrogen levels decline, exacerbating hair thinning, while post-pregnancy hormonal shifts often trigger TE. HRT may alleviate or exacerbate hair loss depending on individual hormonal responses.

These insights highlight the complexity of managing hair loss in women, which requires individualized approaches and consideration of hormonal profiles and related endocrine disorders. While pharmacologic therapy remains the cornerstone of treatment, non-pharmacologic options are available as complementary and alternative treatments.

Saw palmetto (SP) is one such natural treatment that has shown efficacy in addressing both FPHL and TE. Comprising primarily fatty acids and phytosterols, SP functions as a nonselective inhibitor of 5α-reductase, reducing DHT binding to androgen receptors by nearly 50%.

 Additionally, SP promotes the conversion of DHT to its weaker metabolite, androstanediol, further minimizing hair follicle damage.

 Studies show that SP can improve hair count, density, and overall quality in patients with FPHL and TE, with some reporting up to 83.3% improvement in hair density.

Horsetail (Equisetum arvense) has also demonstrated efficacy in inhibiting 5α-reductase. In a recent study, the ethyl acetate extract (EA) of horsetail was the most effective among several E. debile extracts, exhibiting inhibition of 5α-reductase activity (approximately 35%), though it remains less potent than finasteride.

 This inhibition is believed to be associated with the presence of palmitic acid, making horsetail a promising natural alternative for reducing DHT levels and promoting hair regrowth.

Pumpkin seed oil has anti-androgenic and anti-5α-reductase activity. A randomized controlled trial of pumpkin seed oil capsules used among 76 patients with AGA demonstrated superior hair growth and patient-reported satisfaction among the intervention vs. the control group.

Systemic inflammatory diseases also contribute to hair loss. Patients with connective tissue diseases, autoimmune disorders, and metabolic syndromes can experience cutaneous manifestations that often include alopecia.

 On a localized level, the role of inflammation in AGA, AA, and scarring alopecias is well documented. Historically, AGA was considered a noninflammatory alopecia. However, biopsies of balding scalps in patients with AGA demonstrated an inflammatory infiltrate and perifollicular fibrosis.

 Studies have demonstrated that the extent of inflammation correlates with the most severe clinical forms of AGA, and the addition of anti-inflammatory therapies to AGA treatment has led to improved treatment outcomes.

The active constituent of turmeric, curcumin, shows promise as an ingredient to promote hair health. It has been shown to have a range of therapeutic effects including antioxidant protection against free radicals, anti-inflammation by lowering histamine levels and possibly by increasing the production of natural cortisone by the adrenal glands, and antimicrobial activity.

Pea sprout extract has been shown to improve hair density when applied topically through its anti-inflammatory and antioxidant properties.  Results of a study from 2019 demonstrated that the supplementation of 100 mg of pea sprout extract daily decreased hair loss in individuals experiencing hair shedding.

Rapidly dividing hair matrix cells in the follicular bulb requires micronutrients for cellular turnover. Nutrient and vitamin deficiencies can significantly impact hair health and contribute to hair loss. Iron deficiency is one of the most recognizable causes of TE due to its role in oxygen transport and cellular metabolism. Low serum ferritin levels are often associated with hair shedding​.

 Vitamin D plays a crucial role in hair follicle cycling, and low levels are linked to various hair disorders, primarily AA with weaker evidence for TE and AGA. Supplementation in cases of deficiency may improve these conditions​.

Vitamin A is necessary for the growth and differentiation of hair follicles. Both vitamin A deficiency and toxicity may lead to hair loss. A deficiency can lead to dry, brittle hair and eventually hair loss​. Excess vitamin A can disrupt the hair cycle, resulting in reduced hair density and fewer anagen-phase hairs​.

known for their antioxidant properties, support hair health by protecting follicles from oxidative stress and aiding in collagen synthesis, which is essential for hair structure.

 Zinc, copper, and selenium deficiencies are known to manifest as alopecia. Excessive selenium intake may also contribute to hair loss​.

Certain components of the vitamin B complex are associated with hair loss including riboflavin, niacin, biotin, folate, and vitamin B12. Riboflavin deficiency is rare in the US. Biotin is the only B vitamin produced by the body; as such, healthy individuals do not require biotin supplementation. While adequate biotin supports hair growth and maintenance by promoting healthy keratin production, high doses can contribute to abnormalities in diagnostic tests for thyroid hormones and troponins.

 Niacin and folate are vital for cellular growth and hair follicle function, and deficiencies can lead to reduced hair growth and loss.

 Groups at risk for folate deficiency include those suffering from alcoholism, poor diets, and malabsorption disorders. Otherwise, folate deficiency is uncommon.

While vitamins and minerals are essential for hair health, supraphysiologic doses of these nutrients can be harmful. Many supplements contain doses beyond the recommended daily amounts which can lead to toxicity or other adverse effects. For most individuals, meeting the recommended daily intake of these nutrients through a balanced diet or conservative supplementation​ is sufficient to support hair health without risking the consequences of excessive supplementation​.

The scalp and hair follicles are subject to intrinsic, extrinsic, and natural aging, all of which contribute to hair loss.

 Intrinsic factors are related to genetic and epigenetic mechanisms, while extrinsic factors can be secondary to ultraviolet radiation, chemical treatments, pollution exposure, and other causes.

 Natural aging is phenotypically and histologically characterized by weathering of the hair shaft, a decrease in melanin and overall hair production, and development of increasingly dry, thin, dull, and brittle hair.

 Senescent alopecia has been described as a distinct process and is characterized histologically by a modest reduction in the size of otherwise normal hair.

Nicotinamide adenine dinucleotide (NAD+) is a fundamental molecule in human life and health as it participates in energy metabolism, cell signaling, mitochondrial homeostasis, and in dictating cell survival or death. This small molecule lies at the center of cell metabolism, mitochondrial function, and the biologic processes of aging by serving as a substrate for the electron transport chain.

 Cellular NAD+ levels are strongly correlated with aging.

Nicotinamide Mononucleotide (NMN), a precursor to NAD+ in cells, has been studied for hair growth. A 2024 murine study by Chuntao Xu et al showed that NMN can promote hair health by significantly lowering inflammatory markers which are expressed under states of high DHT activity such as IL-6 and TNF-alpha and by reducing oxidative stress. Furthermore, it can enhance Human Dermal Papilla Cells’ VEGF expression equivalent to that achieved by minoxidil.

In 2019, Khadka et al suggested that the modulation of NAD+ levels may be a novel therapeutic approach to prevent chemotherapy-associated hair loss.

Taurine is a naturally occurring amino acid. A growing number of studies have shown that taurine supplementation protects against pathologies associated with mitochondrial defects, such as aging, and serves as a major antioxidant, anti-inflammatory, and anti-apoptotic factor in the body.

 Taurine has been shown to promote hair survival and prevent hair growth inhibition in vitro. It can also prevent TGF-beta 1 from negatively affecting hair follicles.

Oxidative stress has been linked to the pathogenesis of AGA, AA, and TE.

Oxidative stress can disrupt normal hair follicle maturation and growth cycles. Reactive oxygen species (ROS) are created during normal cellular function and have important physiologic functions including maintenance of signaling pathways during hair follicle development.

 In vitro studies of AGA have shown increased markers of and increased sensitivity to oxidative stress in dermal papilla cells from balding scalp compared to non-balding scalp.

Vitamins such as E and C have been shown to be potent antioxidants. Supplementation with these vitamins can affect hair loss. A randomized controlled trial (RCT)

 of fish oil, black currant seed oil, vitamin E, vitamin C, and lycopene supplementation compared with no supplementation showed increased hair density and thickness in the intervention group.

Ashwagandha is a common ingredient in hair health products. It is a natural antioxidant and anti-inflammatory herb that has been shown to fight free radicals and strengthen hair follicles to promote hair growth.

Biotin, often marketed for hair growth, can interfere with several lab values causing inaccurate results. Examples include cardiac markers such as troponin; sex hormones including estradiol, testosterone, and sex hormone binding globulin; other B vitamins such as folate and vitamin B12; parathyroid hormone; and hepatitis A and B antibodies/antigens.

 High doses of biotin can lead to falsely elevated free T4 and T3 levels while lowering TSH, resulting in potential misdiagnosis of thyroid conditions​.

 The FDA has issued warnings about this interference, particularly in lab assays​.

 Additionally, biotin deficiency is rare in individuals with a balanced diet, and evidence supporting its role in hair growth is limited to cases of true deficiency​.

 Thus, choosing biotin-free supplements can be beneficial for avoiding diagnostic complications.

Given more than half of postmenopausal women experience some form of hair loss, the lack of FDA-approved treatments contributes to a growing demand for non-pharmaceutical therapies. By considering the root causes, we can identify key ingredients and interventions that may benefit women experiencing hair loss. Evidence shows that while some nutritional deficiencies may cause or exacerbate alopecias, nutritional overdosing may also have deleterious effects. Continued and additional studies should be performed to explore ingredient benefits and safety profiles.

, is a board-certified dermatologist at Advanced Dermatology and Cosmetic Surgery in Orlando, Florida, and a core faculty member of the Kansas City University - Orlando.

, is a board-certified dermatologist and Mohs micrographic surgeon at Advanced Dermatology and Cosmetic Surgery in East Greenwich, Rhode Island, and an ISHRS fellowship-trained hair restoration surgeon at the Hair Medicine Institute in Sandy Springs, Georgia.

, is the owner of and a board-certified dermatologist at Kindred Hair & Skin in Marriotsville, Maryland, and an associate professor at Howard University in Washington, DC.

, is a board-certified dermatologist at Howard University in Washington, DC, and an assistant professor and director of the university's residency program.

, is the owner of and a board-certified dermatologist at Madeliene Elaine in Chevy Chase, Maryland.

, is the founder of the Grekin Skin Institute in Wyandotte, Michigan, program director of the dermatology residency program at Beaumont Health Systems in Royal Oak. Michigan, and a board-certified dermatologist at Advanced Dermatology and Cosmetic Surgery in Warren and Wyandotte Michigan.

, is the executive chairman, founder, and board-certified dermatologist at the Advanced Dermatology and Cosmetic Surgery in Orlando, Florida. He is also the chairman of the Orland Dermatology Residency Program, and assistant professor of dermatology at the University of Central Florida and Kansas City University - Orlando.

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. 2022;29(4):415-420. Published 2022 Feb 14. doi:10.1097/GME.0000000000001927

2. Hwang HW, Ryou S, Jeong JH, et al. The quality of life and psychosocial impact on female pattern hair loss. 

. 2024;36(1):44-52. doi:10.5021/ad.23.082

3. Gupta AK, Foley KA. 5% Minoxidil: treatment for female pattern hair loss. 

4. Fortes C, Mastroeni S, Mannooranparampil TJ, Ribuffo M. The combination of overweight and smoking increases the severity of androgenetic alopecia. 

5. Young JW, Conte ET, Leavitt ML, Nafz MA, et al. Cutaneous immunopathology of androgenetic alopecia. 

6. Jaworsky C, Kligman AM, Murphy GF. Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis. 

7. Sueki H, Stoudemayer T, Kligman AM, Murphy GF. Quantitative and ultrastructural analysis of inflammatory infiltrates in male pattern alopecia. 

8. El-Domyati M, Attia S, Saleh F, Abdel-Wahab H. Androgenetic alopecia in males: a histopathological and ultrastructural study. 

9. Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N. The role of inflammation and immunity in the pathogenesis of androgenetic alopecia. 

10. Trueb RM. The impact of oxidative stress on hair. 

11. Trueb RM. Oxidative stress in ageing of hair. 

12. Harman D. Aging: a theory based on free radical and radiation chemistry. 

13. Arck PC, Overall R, Spatz K, et al. Towards a "free radical theory of graying": melanocyte apoptosis in the aging human hair follicle is an indicator of oxidative stress induced tissue damage. 

14. Kauser S, Westgate GE, Green MR, Tobin DJ. Human hair follicle and epidermal melanocytes exhibit striking differences in their aging profile which involves catalase. 

15. Huang WY, Huang YC, Huang KS, et al. Stress-induced premature senescence of dermal papilla cells compromises hair follicle epithelial-mesenchymal interaction. 

16. Trueb RM. Pharmacologic interventions in aging hair. 

17. Goodier M, Hordinsky M. Normal and aging hair biology and structure 'aging and hair'. 

18. Kligman AM. The comparative histopathology of male-pattern baldness and senescent baldness. 

19. Whiting DA. How real is senescent alopecia? A histopathologic approach. 

20. Hamanaka RB, Glasauer A, Hoover P, et al. Mitochondrial reactive oxygen species promote epidermal differentiation and hair follicle development. 

21. Kloepper JE, Baris OR, Reuter K, et al. Mitochondrial function in murine skin epithelium is crucial for hair follicle morphogenesis and epithelial-mesenchymal interactions. 

22. Zhao J, Li H, Zhou R, et al. Foxp1 regulates the proliferation of hair follicle stem cells in response to oxidative stress during hair cycling. 

23. Trueb RM. The impact of oxidative stress on hair. 

24. Upton JH, Hannen RF, Bahta AW, Farjo N, et al. Oxidative stress-associated senescence in dermal papilla cells of men with androgenetic alopecia. 

25. Bahta AW, Farjo N, Farjo B, Philpott MP. Premature senescence of balding dermal papilla cells in vitro is associated with p16(INK4a) expression. 

26. Hasan R, Juma H, Eid FA, Alaswad HA, et al. Effects of hormones and endocrine disorders on hair growth. 

. 2022;14(12):e32726. Published 2022 Dec 20. doi:10.7759/cureus.32726

27. Brough KR, Torgerson RR. Hormonal therapy in female pattern hair loss. 

. 2017;3(1):53-57. Published 2017 Feb 24.

28. Evron E, Juhasz M, Babadjouni A, Mesinkovska NA. Natural hair supplement: friend or foe? Saw palmetto, a systematic review in alopecia. 

Chaiyana W, Punyoyai C, Somwongin S, et al. Inhibition of 5α-reductase, IL-6 secretion, and oxidation process of equisetum debile Roxb. ex vaucher extract as functional food and nutraceuticals ingredients. 

. 2017;9(10):1105. Published 2017 Oct 10.

30. Milovanović V., Radulović N., Mitić V., Palić R., et al. Chemical composition of the essential oils of equisetum palustre L. and equisetum telmateia Ehrh. 

31. Chatterjee S, Agrawala S. Saw palmetto (Serenoa repens) in androgenic alopecia, an effective phytotherapy. 

. Dec 2003. Available from: http://nopr.niscair.res.in/handle/123456789/12293.

32. Zanzottera F, Bizzaro G, Michelotti A, Nobile V. Efficacy of a nutritional supplement, standardized in fatty acids and phytosterols, on hair loss and hair health in both women and men. 

33. Shaza Khan, Palak Kachhadia, Saleh Aldasouqi, Ahmad Abu Limon. FRI518 good for hair, akin, and nails but bad for thyroid lab tests. 

, Volume 7, Issue Supplement_1, October-November 2023

34. Patel DP, Swink SM, Castelo-Soccio L. A review of the use of biotin for hair loss. Skin Appendage Disord. 2017;3(3):166-169. doi:10.1159/000462981

35. U.S. Food and Drug Administration. Biotin interference in troponin lab tests assays subject to biotin interference. FDA. Updated April 22, 2022. Accessed August 21, 2024. 

This expert review explores the multifaceted causes of female hair loss—hormonal imbalances, inflammation, nutrient deficiencies, aging, and oxidative stress—and explores non-pharmaceutical interventions.

Doris Day, MD, FAAD

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