Hair problems

Many forms of hair problems require clinical care by a physician or other health care professional. If excessive hair or hair loss is impacting your quality of life, we encourage you to talk with your dermatologist about concerns. Learn more about some of the most common hair conditions we treat. 

Baldness

What is baldness?

Baldness is hair loss, or absence of hair. It’s also called alopecia. Baldness is usually most noticeable on the scalp, but it can happen anywhere on the body where hair grows.

What causes baldness?

Hair loss can occur for many reasons. Some of the more common causes include the following:

  • Aging

  • Change in hormones

  • Illness leading to shedding of hair (called telogen effluvium)

  • Family history of baldness

But hair loss is not caused by the following:

  • Poor circulation to the scalp

  • Dandruff

  • Wearing hats

Generally, the earlier hair loss starts, the more severe it will become.

What are the symptoms of baldness?

Depending on the type, the symptoms of baldness will vary. There are male and female types of baldness:

  • Male-pattern baldness. Male-pattern baldness is usually inherited. The condition may start at any age. Hair loss often starts on the front, sides, or on the crown of the head. Some men may develop a bald spot or just a receding hairline. Others may lose all of their hair.

  • Female-pattern baldness. Although less common, female-pattern baldness differs from that of male-pattern baldness in that the hair generally thins all over the head. The hairline is maintained. Usually, the first sign that women may see is a widening of the part. Female-pattern baldness rarely results in total hair loss.

Other causes of hair loss

  • Alopecia areata. This hair loss disorder is characterized by sudden loss of hair in one particular area. The hair grows back after several months. However, if all body hair is suddenly lost, regrowth may not happen. The exact cause of this type of hair loss is unknown. Researchers believe that this type of hair loss is due to an autoimmune condition. If hair loss is complete on the scalp, it is called alopecia totalis, and if all body hair is lost, it's called alopecia universalis.

  • Toxic alopecia. Toxic alopecia may happen after a high fever or severe illness. Certain medicines, especially thallium, high doses of vitamin A, retinoids, and cancer medicines may also cause it. Medical conditions, such as thyroid disease, and giving birth may also trigger toxic alopecia. The condition is marked by temporary hair loss.

  • Trichotillomania (hair pulling). Hair pulling may cause hair loss. This condition is common in young children.

  • Scarring or cicatricial alopecia. Scarred areas may prevent the hair from growing back. Scarring may happen from burns, injury, or X-ray therapy. However, other types of scarring that may cause hair loss can be caused by diseases. These include lupus, bacterial or fungal skin infections, lichen planus, sarcoidosis, tuberculosis, or skin cancer.

How is baldness diagnosed?

In addition to a medical history and physical exam, a punch biopsy of the skin may help to identify the type of baldness or its cause. In a punch biopsy, a small core of tissue is taken out. A culture may be done if infection is suspected.

How is baldness treated?

Your healthcare provider will talk with you about the treatments available and together you will decide on the best treatment for you.

Most forms of baldness have no cure. Some types of baldness will go away without treatment. Treatment may include:

  • Certain medicines to promote hair growth (such as minoxidil and finasteride)

  • Hair transplants

  • Scalp reduction

  • Skin lifts and grafts

Hair replacement surgery

The interest in hair replacement has gone up over the past several years. There are a number of hair replacement techniques available. But, hair replacement surgery can’t help those with total baldness. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are 4 primary different types of hair replacement methods, including the following:

  • Hair transplant. During a hair transplant, the surgeon removes small pieces of hair-bearing scalp from the back or sides of the head to be used as grafts. These grafts are then relocated to a bald or thinning area.

  • Scalp expansion. In this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then needed to place the newly expanded skin over the adjacent bald spot.

  • Flap surgery. Flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed on to the bald area while still attached at one end to its original blood supply.

  • Scalp reduction. Scalp reduction is done to cover the bald areas at the top and back of the head. It involves first removing the bald scalp. Then sections of the hair-bearing scalp are pulled together filling in the bald area. This can be done alone or with hair transplantation. 

What are possible complications of baldness and hair transplantation procedures?

Baldness may lower self-esteem. In addition, there are complications from hair transplantation procedures that include:

  • Patchy hair growth. Sometimes, the growth of newly placed hair has a patchy look, especially if it's placed next to a thinning area. This can often be fixed with more surgery.

  • Bleeding or wide scars. Tension on the scalp from some of the scalp reduction techniques can cause wide scars or bleeding.

  • Grafts not taking. Occasionally, there is a chance that the graft may not "take." If this is the case, surgery must be repeated.

  • Infection. As with any surgical procedure, there is the risk of infection.

Key points about baldness

  • Baldness, also known as alopecia, is hair loss, or absence of hair.

  • Baldness is usually most noticeable on the scalp, but can happen anywhere on the body where hair grows.

  • Treatment for baldness depends on the type of baldness and its underlying cause.

  • Most forms of baldness have no cure. Some types of baldness will disappear on their own.

  • It is important to talk with your healthcare provider about your baldness and how it can be treated.

Next steps

Tips to help you get the most from a visit to your healthcare provider: 

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions or develop a problem or complication.

Hirsutism in Women (Excess Body Hair Growth)

What is hirsutism?

Hirsutism is excess hair growth on the body or face. For women, the hair may grow in areas where men often have a lot of hair, but women often don’t. This includes the upper lip, chin, chest, and back. It’s caused by an excess of male hormones called androgens. All women naturally produce small amounts of androgens. But high levels of this hormone can lead to hirsutism.

What causes hirsutism?

Hirsutism can run in families. It may also be caused by:

  • Polycystic ovary syndrome (PCOS). This is the most common cause of hirsutism in women. It is a disorder that causes hormone problems.

  • Disorders of the pituitary gland, adrenal gland, or thyroid gland

  • Tumor on the ovary that makes extra androgens

  • Severe insulin resistance

  • Changes in hormones from menopause

  • Use of anabolic steroids or corticosteroids

  • Use of medicine to treat endometriosis

  • Certain other medicines

In some cases, the cause isn’t known. This is called idiopathic hirsutism.

Who is at risk for hirsutism?

You are more at risk for hirsutism if you have any of these:

  • Polycystic ovary syndrome (PCOS)

  • Parents or siblings with excess hair growth

  • Disorders of the pituitary gland, adrenal gland, or thyroid gland

  • Severe insulin resistance

  • Changes in hormones from menopause

  • Use of anabolic steroids or corticosteroids

  • Use of medicine to treat endometriosis

What are the symptoms of hirsutism?

Symptoms can occur a bit differently in each person. They include darker or thicker hairs growing on parts of the body such as:

  • Upper lip

  • Chin

  • Jawline

  • Chest

  • Back

  • Buttocks

The symptoms of hirsutism can look like other health conditions. See your healthcare provider for a diagnosis.

How is hirsutism diagnosed?

Your healthcare provider will ask about your symptoms and health history. He or she will give you a physical exam. You may also have blood tests to check for increased androgen levels. These tests can also check for other problems that may cause excess hair growth.

How is hirsutism treated?

Treatment depends on personal preference. Hair growth causes no physical harm. The decision to remove or reduce hair varies from person to person.

Methods to remove or reduce unwanted hair include:

  • Shaving. This is a way to remove hair with thin blades moved across the skin. Hair will start growing back right away, so shaving needs to be repeated often.

  • Depilatory lotion. This is a type of hair removal done with chemicals put on the skin. It softens hair above the skin so it can be wiped away.

  • Waxing. Hot or cold wax can be used to pull out hair from the root. This treatment needs to be done every 2 to 3 weeks.

  • Bleaching. Chemicals can lighten the color of the hair and make it less easy to see.

  • Electrolysis. A very thin needle is put into a hair follicle. Electricity is sent through the needle. This damages the hair follicle. This method is done over several sessions. This can reduce and remove hair for months or longer.

  • Laser hair removal. A special laser is pointed at the skin. The light from the laser is absorbed by color (pigment) in the hair and destroys the hair. This works best on darker hair. This method is done over several sessions. This can reduce and remove hair for months or longer.

  • Medicated cream. Skin cream with eflornithine can slow hair growth. Results show up in 6 to 8 weeks. The hair will regrow in about 8 weeks if you stop using the cream.

Other medicines can reduce the hormones that cause hair growth. It can take 6 months or longer for you to see results from these medicines. This is because hair grows, rests, falls out, and regrows in cycles that last for months. And not all hairs are in the same part of the cycle at the same time. Because of this, treatments that affect the hair you have now may need to be repeated over time. Medicines that can change hormones to affect hair growth include:

  • Birth control pills. These are different kinds of hormone pills that prevent pregnancy. They can reduce the amount of androgens in your body. Most women will notice a change in body hair growth when taking birth control pills.

  • Antiandrogen medicine. This type of medicine can reduce your body’s androgen levels. Or it may stop the effects of androgens on hair follicles. The most common type is spironolactone. The medicines can cause birth defects, so a woman must use birth control while taking them.

Other factors that can lessen excess hair growth include:

  • Treating another condition. Treating disorders of the pituitary gland, adrenal gland, or thyroid gland can lessen excess hair growth.

  • Weight loss. In some women, losing weight can reduce androgen levels and cause hair growth to slow.

  • Aging. Women age 30 and older have decreasing androgen levels. Hair growth may lessen over time.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.

What can I do to prevent hirsutism?

In some cases, hirsutism may be prevented by not taking a medicine that can cause excess hair growth.

How to manage hirsutism

Hirsutism is often a long-term (chronic) condition. But you can manage it by working with your healthcare provider to create a treatment plan.

When should I call my healthcare provider?

Call the healthcare provider if you have:

  • Symptoms that don’t get better, or get worse

  • New symptoms

Key points about hirsutism

  • Hirsutism is excess hair growth on the body or face. It’s caused by excess hormones called androgens.

  • For women, the hair may grow in places where men often have a lot of hair, but women often don’t. This includes the upper lip, chin, chest, and back.

  • It can run in families. It may also be caused by polycystic ovary syndrome (PCOS) or other problems. In some cases, the cause isn’t known.

  • Treatment depends on personal preference. Hair growth causes no physical harm. The decision to remove or reduce hair varies from person to person.

  • Methods to remove unwanted hair include shaving, waxing, laser hair removal, birth control pills, and other medicines.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Ingrown Hairs

What is an ingrown hair?

An ingrown hair is a hair that curls and penetrates the skin with its tip, causing inflammation. Ingrown hairs are more common among people with very curly hair. Most ingrown hairs happen in the beard area on men and the bikini or groin area on women.

What are the symptoms of an ingrown hair?

The most common symptom of an ingrown hair is redness and inflammation of the skin. This is followed by pus formation. The symptoms of an ingrown hair may seem like other skin conditions. Always talk with your healthcare provider for a diagnosis.

How is an ingrown hair diagnosed?

Diagnosis of an ingrown hair can be confirmed with a medical history and a physical exam.

Treatment for an ingrown hair

An ingrown hair often heals on its own. Warm compresses may help if you have pustules. But in the case of chronic ingrown hairs, prevention may include:

  • Letting the hair to grow longer before shaving it

  • Not shaving the area in the future. If you must trim the hair, use a clipper rather than a razor. Or try not to shave as closely. Special razors that don't shave as closely may be useful.

  • Removing the hair permanently through laser, electrolysis, or depilatory methods (liquids or creams)