The root of the problem: Blood work-up, scalp biopsy provide important clues to hair loss origins

October 1, 2009
Lisa B. Samalonis

Hair loss can be caused by various factors, including genetics and stress. Doctors must determine the cause in order to treat the condition effectively.

Key Points

"For hair loss, there is some detective work required for both the patient and the dermatologist with regard to symptoms and timing," says Nicole Elaine Rogers, M.D., F.A.A.D., in practice in Metairie, La.

Genetic alopecia

"Up to 50 percent of men and 40 percent of women can develop androgenic alopecia. There are many different genes involved, but we don't know exactly which ones.

"This hair loss can appear as early as the teen years (in both girls and boys), or it may not show up until the person is in their 40s or 50s, depending on their DNA," Dr. Rogers says.

Medical treatments for genetic alopecia include minoxidil (Rogaine, Pfizer), the only product currently approved by the Food and Drug Administration (FDA) for women, and finasteride (Propecia, Merck).

Other options include low-level light therapy, for which data are still pending, and hair transplant surgery, a permanent solution to hair loss.

"Women can be just as good candidates as men for hair transplant surgery," Dr. Rogers says.

Physiologic stress

Telogen effluvium, which is brought on by significant physiologic stress, is another cause of hair loss.

"This is not day-to-day work stress, but major life-altering stress. This may include having a baby, a death in the family, general surgery, general anesthesia or crash dieting.

"For example, effluvium frequently occurs six and eight months after childbirth. The body's hair follicles prematurely enter the hair resting phase (telogen), and later new follicles (in the anagen stage) push them out," Dr. Rogers says. "This resolves on its own over time."

For more chronic hair loss, blood work can provide clues to the dermatologist. "It is worthwhile to check ferritin levels (an indicator of iron stores), ANA, a marker for autoimmune conditions, and thyroid levels," she adds, noting ±2 levels can also be checked.

"If the cause is not pinpointed and corrected, chronic effluvium could result," Dr. Rogers says.

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