Conference Coverage

Essential tips to diagnose and intervene early in hair loss



Ask patients about their hair during a general dermatology examination, recommend supplements backed by peer-reviewed studies when appropriate, and watch for a new trend – man bun traction alopecia.

These and other clinical pearls on hair loss come courtesy of Wendy E. Roberts, MD.

“Hair loss can be scary,” but if physicians diagnose the underlying cause and treat early, a number of existing and upcoming treatments can be effective, said Dr. Roberts, a dermatologist in private practice in Rancho Mirage, Calif. “Timing is very critical.”

Dr. Wendy Roberts

Dr. Wendy Roberts

A dermatology full body examination is a perfect opportunity to ask patients about their hair because “you’re checking them from head to toe,” Dr. Roberts said. She recommends asking: “How is your hair doing?” This advice prompted a bit of uproar from the ODAC audience, suggesting this may be too sensitive a subject for some to broach with patients. Dr. Roberts responded, “No, not at all. Your patients will be glad you asked.

“That simple question will open up doors of opportunity” for dermatologists, she said. The condition remains very common: About 80 million people in the United States are affected by its No. 1 cause, hereditary hair loss. An Internet search for “hair loss,” in fact, reveals an overwhelming amount of consumer interest in hair loss treatment and management, yielding approximately 35 million results.

Paying attention to hair loss is not just question of appearance or aesthetics; hair loss can also indicate declining health, Dr. Roberts said at the Orlando Dermatology Aesthetic and Clinical Conference.

Suggest supplements backed by science

Given the millions of online searches, it’s apparent that people continue to look for the latest solutions to treat or prevent further hair loss. But as with many “treatments” and “cures” touted online, caution is warranted – not every claim is backed by solid research, she said. “Go with supplements that do have peer review literature.”

For this reason, Dr. Roberts suggests considering the following three supplements for patients with hair loss:

Nutrafol – “What I like about this supplement is it has ashwagandha, an Indian herb that reduces stress,” she said.

Viviscal – This supplement has the marine extract AminoMar, which includes shark cartilage and oyster extract powder.

Vitalize Hair – Its active ingredient, Redensyl, contains two molecules, Dr. Roberts said, one to boost metabolism of the hair follicle and the other to increase hair volume over time.

Application of platelet rich plasma is another option showing promise for hair loss. It works by activating hair bulb cells. “It kind of whispers to the hair: ‘Be young again.’ Many times it comes in at the original hair color – tell your patients to be prepared to see their hair color from childhood.” Dr. Roberts said.

Man bun alert

There is a new consideration in male hair loss based on changing hairstyles. “One thing that is trending: man bun traction alopecia. We see a lot of this in Southern California where I practice,” Dr. Roberts said. She showed meeting attendees the photo of a man with a tight hair bun whose hairline was starting to recede.

Man with a hair bun EzumeImages/Thinkstock

Basics to remember: differential diagnosis

When a patient presents with hair loss, things to consider in a differential diagnosis include chemical hair treatments, hairstyles that can cause traction alopecia, and behaviors such as compulsive hair pulling. Trichotillomania is on the increase. It affects approximately 2% of the population, but 90% of those are women, Dr. Roberts said. To diagnose, “look at the scalp and lower area near the nape of neck, especially in younger patients.”

She suggested that dermatologists show male patients the Norwood Scale illustrations of hair loss. The illustrations can help them understand when their hair loss is progressing over time, she added. For female patients with hair loss, the Ludwig Scale for hair loss in women can be very illustrative.

In the work-up of the patient, conduct a physical exam and consider overall health and nutritional status. Ask about family history as well, because relatives are the best window for insight into hair loss caused by genetics and aging, Dr. Roberts said.

Review patient medications. Older patients, in particular, often take multiple medications, which increases the likelihood for interactions or side effects leading to hair loss.

In addition, she had a few specific recommendations. “When you have male patient with hair loss taking Propecia [finasteride], talk to them about the dangers of exposure to a female partner and pregnancy in particular.” Also ask patients to bring in any supplements they are taking. Watch out for keratin supplements in patients with renal disease, she added, because elevated levels can be associated with kidney problems.

In terms of laboratory testing, consider checking for thyroid function, hormonal imbalance, and anemia. “The most overlooked is hemoglobin levels,” Dr. Roberts said, although anemia can cause hair loss in some patients.

Dr. Roberts is a speaker, consultant, investigator for and/or receives honoraria from Allergan, Colorescience, Galderma, Lytera, MDRejuvena, Restorsea, SkinMedica, Theraplex, Top MD Skincare, Valeant Pharmaceutical International, and Viviscal.

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