212.644.6454        New York Dermatology              
   30 East 60th Street  (Park/Madison)               8th Floor Suite 805 New York, NY      Contact
derm blog
          
Loading
                               
                
                                                                        
                                     

 

 


Loading

 

Loading
Your Subtitle text

Hair Loss NYC Treatment Center



Hair Loss  - Hair Loss Treatment - Hair Replacement 

Get the flash player here: http://www.adobe.com/flashplayer



Hair Loss; Alopecia; Baldness 

Hair Restoration Treatment                                                    

Partial or complete loss of hair is called alopecia.

According to Dr. Rothfeld at the Hair Loss NYC Treatment Center, hair loss usually develops gradually and may be patchy or diffuse (all over).  Roughly 100 hairs are lost from your head every day. The average scalp contains about 100,000 hairs.

Each individual hair survives for an average of 4-1/2 years, during which time it grows about half an inch a month. Usually in its 5th year, the hair falls out and is replaced within 6 months by a new one. Genetic baldness is caused by the body's failure to produce new hairs and not by excessive hair loss.

Both men and women tend to lose hair thickness and amount as they age. Inherited or "pattern baldness" affects many more men than women. About 25% of men begin to bald by the time they are 30 years old, and about two-thirds are either bald or have a balding pattern by age 60.

Typical male pattern baldness involves a receding hairline and thinning around the crown with eventual bald spots. Ultimately, you may have only a horseshoe ring of hair around the sides. In addition to genes, male-pattern baldness seems to require the presence of the male hormone testosterone. Men who do not produce testosterone (because of genetic abnormalities or castration) do not develop this pattern of baldness.

HAIR LOSS

ABOUT HAIR LOSS IN MEN


 

 

According to Dr. Gary Rothfeld, a board 

certified dermatologsit at the NYC Hair Loss Center male hair loss is the most common type of hair loss. It is caused by increased sensitivity to


 male sex hormones (androgens) in certain parts of the scalp, and is passed on from generation to generation.

Some men have areas on the scalp that are very sensitive to the male sex hormones that circulate in men's blood. The hormones make the hair follicles - from which hair grows - shrink. Eventually, they become so small that they cannot replace lost hairs. The follicles are still alive, but are no longer able to perform their task.

The condition usually starts in men aged 20 to 30 and follows a typical pattern. First, a receding hairline develops, and gradually the hair on top of the head also begins to thin. Eventually, the two balding areas meet to form a typical U-shape around the back and sides of the head. The hair that remains is often finer, and does not grow as quickly as it used to.

 

 

Some women also develop a particular pattern of hair loss due to genetics, age, and male hormones that tend to increase in women after menopause. The pattern is different from that of men. Female pattern baldness involves a thinning throughout the scalp while the frontal hairline generally remains intact.

ABOUT HAIR LOSS IN WOMEN

 

 

Unlike hair loss in men according to Dr. Gary Rothfeld at NYC Cosmetic Dermatology and Hair Loss Center female scalp hair loss may commonly begin at any age through 50 or later, may not have any obvious hereditary association, and may not occur in a recognizable "female-pattern alopecia" of diffuse thinning over the top of the scalp. Woman who notice the beginning of hair loss may not be sure if the loss is going to be temporary or permanent—for example, if there has been a recent event such as pregnancy or illness that may be associated with temporary hair thinning.

In women as in men, the most likely cause of scalp hair loss is androgenetic alopecia—an inherited sensitivity to the effects of androgens (male hormones) on scalp hair follicles. However, women with hair loss due to this cause usually do not develop true baldness in the patterns that occur in men—for example, women rarely develop the "cue-ball" appearance often seen in male-pattern androgenetic alopecia.

Patterns of female androgenetic alopecia can vary considerably in appearance. Patterns that may occur include:

-Diffuse thinning of hair over the entire scalp, often with more noticeable thinning toward the back of the scalp.

-Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp but not involving the frontal hairline.

-Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp, involving and sometimes breaching the frontal hairline.

Unlike the case for men, thinning scalp hair in women due to androgenetic alopecia does not uniformly grow smaller in diameter (miniaturize). Women with hair loss due to androgenetic alopecia tend to have miniaturizing hairs of variable diameter over all affected areas of the scalp. While miniaturizing hairs are a feature of androgenetic alopecia, miniaturization may also be associated with other causes and is not in itself a diagnostic feature of androgenetic alopecia. In post-menopausal women, for example, hair may begin to miniaturize and become difficult to style. The precise diagnosis should be made by a physician hair restoration specialist.

It is important to note that female pattern hair loss can begin as early as the late teens to early 20s in women who have experienced early puberty. If left untreated, this hair loss associated with early puberty can progress to more advanced hair loss if it is left untreated

Common Causes   

Hair Loss and Its Causes

 

What is the normal cycle of hair growth and loss?

The normal cycle of hair growth lasts for 2 to 6 years. Each hair grows approximately 1 centimeter (less than half an inch) per month during this phase. About 90 percent of the hair on your scalp is growing at any one time. About 10 percent of the hair on your scalp, at any one time, is in a resting phase. After 2 to 3 months, the resting hair falls out and new hair starts to grow in its place.

It is normal to shed some hair each day as part of this cycle. However, some people may experience excessive (more than normal) hair loss. Hair loss of this type can affect men, women and children.

What causes excessive hair loss?

A number of things can cause excessive hair loss. For example, about 3 or 4 months after an illness or a major surgery, you may suddenly lose a large amount of hair. This hair loss is related to the stress of the illness and is temporary. 

Hormonal problems may cause hair loss. If your thyroid gland is overactive or underactive, your hair may fall out. This hair loss usually can be helped by treatment thyroid disease. Hair loss may occur if male or female hormones, known as androgens and estrogens, are out of balance. Correcting the hormone imbalance may stop your hair loss.

Many women notice hair loss about 3 months after they've had a baby. This loss is also related to hormones. During pregnancy, high levels of certain hormones cause the body to keep hair that would normally fall out. When the hormones return to pre-pregnancy levels, that hair falls out and the normal cycle of growth and loss starts again. 

Some medicines can cause hair loss. This type of hair loss improves when you stop taking the medicine. Medicines that can cause hair loss include blood thinners (also called anticoagulants), medicines used for gout, medicines used in chemotherapy to treat cancer, vitamin A (if too much is taken), birth control pills and antidepressants.

Certain infections can cause hair loss. Fungal infections of the scalp can cause hair loss in children. The infection is easily treated with antifungal medicines.

Finally, hair loss may occur as part of an underlying disease, such as lupus or diabetes. Since hair loss may be an early sign of a disease, it is important to find the cause so that it
 

Can improper care of my hair cause hair loss?

Yes. If you wear pigtails or cornrows or use tight hair rollers, the pull on your hair can cause a type of hair loss called traction alopecia (say: al-oh-pee-sha). If the pulling is stopped before scarring of the scalp develops, your hair will grow back normally. However, scarring can cause permanent hair loss. Hot oil hair treatments or chemicals used in permanents (also called "perms") may cause inflammation (swelling) of the hair follicle, which can result in scarring and hair loss.
 

What is common baldness?

The term "common baldness" usually means male-pattern baldness, or permanent-pattern baldness. Male-pattern baldness is the most common cause of hair loss in men. Men who have this type of hair loss usually have inherited the trait. Men who start losing their hair at an early age tend to develop more extensive baldness. In male-pattern baldness, hair loss typically results in a receding hair line and baldness on the top of the head.

Women may develop female-pattern baldness. In this form of hair loss, the hair can become thin over the entire scalp.

 

Can my doctor do something to stop hair loss?

Perhaps. Your doctor will probably ask you some questions about your diet, any medicines you're taking, whether you've had a recent illness and how you take care of your hair. If you're a woman, your doctor may ask questions about your menstrual cycle, pregnancies and menopause. Your doctor may want to do a physical exam to look for other causes of hair loss. Finally, blood tests or a biopsy (taking a small sample of cells to examine under a microscope) of your scalp may be needed.

 

Is there any treatment for hair loss?

Depending on your type of hair loss, treatments are available. If a medicine is causing your hair loss, your doctor may be able to prescribe a different medicine. Recognizing and treating an infection may help stop the hair loss. Correcting a hormone imbalance may prevent further hair loss.

Medicines may also help slow or prevent the development of common baldness. One medicine, minoxidil (brand name: Rogaine), is available without a prescription. It is applied to the scalp. Both men and women can use it. Another medicine, finasteride (brand name: Propecia) is available with a prescription. It comes in pills and is only for men. It may take up to 6 months before you can tell if one of these medicines is working.

If adequate treatment is not available for your type of hair loss, you may consider trying different hairstyles or wigs, hairpieces, hair weaves or artificial hair replacement.

Baldness is not usually caused by a disease, but is related to aging, heredity, and testosterone. In addition to the common male and female patterns from a combination of these factors, other possible causes of hair loss, especially if in an unusual pattern, include:

  • Hormonal changes (for example, thyroid disease, childbirth, or use of the birth control pill)
  • A serious illness (like a tumor of the ovary or adrenal glands) or fever
  • Medication such as cancer chemotherapy
  • Excessive shampooing and blow-drying
  • Emotional or physical stress
  • Nervous habits such as continual hair pulling or scalp rubbing
  • Burns or radiation therapy
  • Alopecia areata -- bald patches that develop on the scalp, beard, and, possibly, eyebrows. Eyelashes may fall out as well. This is thought to be an immune disorder.
  • Tinea capitis (ringworm of the scalp)

 

Home Care

 

Hair loss from menopause or childbirth often returns to normal 6 months to 2 years later.

For hair loss caused by illness (such as fever), radiation therapy, or medication use, no treatment is necessary. The hair will usually grow back when the illness has ended or the therapy is finished. A wig, hat, or other covering may be desired until the hair grows back.

For hair loss due to heredity, age, and hormones, the topical medication Rogaine (minoxidil) can be helpful for both male and female pattern baldness. Expect to wait 6 months before you see results. The oral medication Propecia (finasteride) is effective in some men. This medicine can decrease sex drive. When either medication is stopped, the former baldness pattern returns.

Hair transplants performed by a physician is a surgical approach to transferring growing hair from one part of the head to another. It is somewhat painful and expensive, but usually permanent.

Hair weaves, hair pieces, or changes of hair style may disguise hair loss. This is generally the least expensive and safest approach to hair loss. Hair pieces should not be sutured to the scalp because of the risk of scars and infection.

 

Call your Board Certified Dermatologist if    

 

  • You are losing hair in an atypical pattern.
  • You are losing hair rapidly or at an early age (for example, teens or twenties).
  • You have any pain or itching associated with the hair loss.
  • The skin on your scalp under the involved area is red, scaly, or otherwise abnormal.
  • You have acne, facial hair, or menstrual irregularities.
  • You are a woman and have male pattern baldness.
  • You have bald spots on your beard or eyebrows.
  • You have been gaining weight or have muscle weakness, intolerance to cold temperatures, or fatigue.

 

What to expect at the office of Board Certified Dermatologist  Dr. Gary Rothfeld at NYC Dermatology Center

 

A careful medical history and examination of the hair and scalp are usually enough to diagnose the nature of your hair loss.

Your doctor will ask detailed questions such as:

  • Are you losing hair only from your scalp or from other parts of your body as well?
  • Is there a pattern to the hair loss like a receding hair line, thinning or bald areas on the crown, or is the hair loss throughout your head?
  • Have you had a recent illness or high fever?
  • Do you dye your hair?
  • Do you blow dry your hair? How often?
  • How often do you shampoo your hair?
  • What kind of shampoo, hair spray, gel, or other product do you put on your hair?
  • Have you been under unusual stress lately?
  • Do you have nervous habits that include hair pulling or scalp rubbing?
  • Do you have any other symptoms like itching, flaking, or redness of your scalp?
  • What medications do you take, including over the counter drugs?

Diagnostic tests that may be performed (but are rarely needed) include:

  • Microscopic examination of a plucked hair
  • Skin biopsy (if skin changes are present)

Ringworm on the scalp may require the use of an oral drug, such as griseofulvin, because creams and lotions applied to the affected area may not get into the hair follicles to kill the fungus.

Treatment of alopecia areata may require topical or injectable steroids or ultraviolet light.

Dr. Gary Rothfeld at NYC Dermatology has over 25 years of experience in Hair Loss. He is one of the pioneers of medical hair transplantation. He has performed over 10000 hair transplants in his career.

Any questions or to make an appointment click here 

Dr Gary sees every patient himself and  believes in personalized care. The Doctor does not employ any physician assistants, nurse practitioners, or other physician substitutes to do his treatment. He sees every patient himself at every visit.

A significant percentage of my  Dermatology Conditions are diagnosed  on listening to medical history of the patient alone, a further percentage on examination and the remainder on further investigation and my patients teach me the rest. It is clear to me that history and examination skills remain at the very core of my dermatology practice. Older Dermatologists like myself rely on history and physical to a greater degree than the younger dermatologists.  I think that the pendulum has swung too far towards all these cosmetic procedures where the younger dermatologists are just doing cosmetic procedures and not listening to their patients.  This is an important point because if the Dermatologist does not spend enough time with the patient the cosmetic procedures will not work.


 
Synonyms

hair loss, effluvium, alopecia, baldness

Related terms

androgenic alopecia, androgenetic alopecia, alopecia areata, cicatricial alopecia

Abstract

Hair loss is a normal process (45 to 60 hairs/day), the hair that falls out is continuously replaced by newly grown hair. We lose more hair towards the end of summer and in spring. Hair loss of more than 60 hairs/day is considered abnormal.

Hair loss has very diverse causes.

Diffuse hair loss is mostly encountered in common baldness (male-pattern and female-pattern alopecia) or telogen effluvium (high fever, pregnancy, medication or severe diet). Anagen effluvium causes rapid hair loss after cancer chemotherapy or during alopecia areata. Genetic hair loss can be observed in newborns but mostly appears during childhood (monilethrix, loose anagen hair syndrome, ectodermal dysplasia).

Localized hair loss occurs in male-pattern androgenetic alopecia (in various patterns), fungal infections (tinea), alopecia areata, cicatricial alopecia (lupus erythematosus, lichen plano pilaris, folliculitis decalvans, central centrifugal cicatricial alopecia, postmenopausal frontal fibrosing alopecia, etc.) or can be due to traction alopecia (trichotillomania, braiding and hair straightening). Tumours and skin outgrowths also induce localized baldness (sebaceous nevus, basal cell carcinoma, squamous cell carcinoma).

Stress has often been pointed at as causing hair loss but this has never been confirmed by scientific studies. However, anyone can experience stress and its role should not be neglected when faced with a sizeable hair loss in the weeks following an intense emotional upheaval.

Effective treatment of hair loss is based on finding the cause of the disorder.

• Telogen effluvium can be induced by an iron or vitamin B12 deficiency or a thyroid gland disorder which need to be treated. However, it often resolves spontaneously within 3 or 4 months (after pregnancy, fever, surgery, etc.). In the case of medication-induced telogen effluvium (isotretinoin, cholesterol-lowering drugs, anticoagulants), the causative treatment must be discontinued and replaced with an alternative whenever possible.

• Chemotherapy-induced anagen effluvium can be somewhat minimized by the use of preventive measures (cooling caps).

• Skin diseases and systemic disorders leading to hair loss must be treated in the appropriate manner and according to each case. Tinea infections require oral antifungal therapy. Topical, intralesional or systemic corticosteroids are indicated in the treatment of lichen, synthetic antimalarials (Plaquenil) can also sometimes be useful. Cicatricial alopecia is difficult to treat and requires the intervention a scalp specialist. Once the pathologic process has been stabilized, hair transplantation can sometimes be considered.

• Hair transplantation or a hairpiece can sometimes be helpful in congenital alopecia.

• Alopecia areata in small patches often resolves quickly without treatment (although there may be relapses), whereas more severe alopecia areata must be treated as soon as possible with topical (lotion), intralesional (scalp injections) or more rarely systemic corticosteroids. PUVAtherapy, dithranol (anthralin) and immunotherapy with diphencyprone are often useful.

•  Male-pattern androgenetic alopecia improves with finasteride (Propecia®) and minoxidil 5%; dutasteride is still being tested in this indication and only temporary results are available. Hair transplantation remains the sole means of recovering natural hair, the current follicular unit transplant techniques give excellent results when performed by specialist teams. Female-pattern androgenetic alopecia is a common condition, its treatment includes minoxidil 2% and antiandrogens (cyproterone acetate) in case of obvious hyerandrogenism; finasteride is not currently approved in women, it is however being tested in postmenopausal women. 

DIFFUSE HAIR LOSS Children Women Men
Fast or progressive
• Congenital alopecia 
• Hair dysplasia
• Telogen effluvium

• Androgenetic alopecia
• Telogen effluvium

• Androgenetic alopecia
• Telogen effluvium
Brutal
• Chemotherapy
• Alopecia areata 
• Chemotherapy
• Alopecia areata
• Chemotherapy
• Alopecia areata 

LOCALIZED HAIR LOSS 
Children Women Men
From birth
• Benign congenital alopecia
• Neonatal occipital alopecia
• Congenital alopecia
• Congenital alopecia
Progressive
• Hair dysplasia
• Endocrine disorder
• Androgenetic alopecia
Brutal
• Alopecia areata
• Radiotherapy
• Alopecia areata
• Radiotherapy
• Alopecia areata
• Radiotherapy
Hair breakage
• Tinea infection 
• Trichotillomania
• Hair dressing and hair care
• Trichotillomania
• Hair dressing and hair care
 
Scalp involvement
• Tinea infection 
• Cicatricial alopecia 
 • Cicatricial alopecia
• Cicatricial alopecia


line
Photographs
line

 

line
Female-pattern baldness
line
Male-pattern baldness
Female-pattern baldness
Female-pattern baldness

line
line
Alopecia areata-patchy pattern
Alopecia areata-ophiasis pattern
Alopecia areata totalis pattern

line
line
Cicatricial alopecia from braids
Central centrifugal cicatricial 
alopecia
Pseudopelade of Brocq

line
lichen-plan-pilaire.jpg frontalfibrosingalopecia.jpg
line
Lichen planopilaris
Frontal fibrosing alopecia
Lupus erythematosus


Definitions


Anagen: 
The anagen or growth phase of the hair cycle involves 80 to 90% of the hair and lasts from 2 to 6 years (3 years/1000 days in men and 5 years in women). The duration of this phase determines the final length of the hair, which grows at a speed of 0.4 mm/day (i.e. 1 cm/month). 

Anagen effluvium:>Abnormal hair loss during the anagen or growth phase. Anagen effluvium is the least common type of hair loss and mostly occurs following a course of medication interfering with the hair formation process (e.g. chemotherapy), or in alopecia areata. 

Androgenetic alopecia (AGA):>Male or female-pattern androgenetic alopecia is also known as common baldness or androgenogenetic alopecia. This type of hair loss is due to aging and is characterized in males by progressive balding of the crown of the head and the forehead, whereas in women hair loss mostly affects the crown. Nevertheless, diffuse hair loss can also occur in male-pattern androgenetic alopecia whereas female-pattern alopecia can sometimes induce hair loss on the sides of the forehead. 

Catagen:>The catagen phase is the intermediate or "resting" phase of the hair cycle, lasting for 3 weeks and involving 0 to 2% of the hair mass. This phase is intermediate between the anagen or growth phase and the telogen “shedding” phase of the hair cycle. 

Cicatricial alopecia:>Permanent hair loss; can be due to congenital malformation (congenital aplasia, angioma), trauma (wound, burn or surgery), scalp disease (lupus erythematosus, lichen planus) or scalp tumour (basal cell carcinoma, squamous cell carcinoma) leading to the formation of abnormal scar-like tissue.

Congenital:>Present at birth.

Diffuse alopecia:>Overall decrease in hair density. 

Exogen:>The exogen phase is a subphase of the telogen phase, during which the hair falls out. Roughly 1% of the hair in the telogen phase falls out every day.

Hair dysplasia:>Abnormality of hair structure.

Hair cycle:>The different stages of evolution of human hair. The anagen or growth phase involves 80 to 90% of the hair and lasts for 2 to 6 years. During the catagen phase the hair stops growing; this phase lasts for 2 to 3 weeks and involves 0 to 2% of the hair mass. Lastly, the telogen or shedding phase involves 10 to 20% of the hair and lasts for about 2 to 3 months, after which the cycle starts again. All abnormal hair loss is characterized by an alteration in the hair cycle pattern.

hair cycle
From Price VH, Treatment of Hair Loss. Review Article. N Eng J Med 1999; 341:964-973

 


Hair follicle: 
All the elements forming a hair. Hair follicles are made up of a hair shaft (the hair itself) and a sebaceous gland and arrector pili muscle attached to it. Hair follicles are grouped together in follicular units containing 1 to 4 hair shafts. 

Localized alopecia: Localized decrease in hair density. 

Normal hair loss: 
Hair shedding is a continuous and normal process. Normal hair loss is characterized by the shedding of 45 to 60 hairs a day, it reaches its climax at the end of summer and in spring.

Scalp:> Skin covering the skull and containing hair follicles.

Telogen: 
The telogen phase of the hair cycle is characterized by the involution and shedding of the hair, it involves 10 to 20% of the hair and lasts for around 3 months (100 days). Roughly 1% of the hair in the telogen phase of the cycle fall out each day (exogen phase).

Telogen effluvium:> The growing or involuting hair is rushed into shedding (exogen phase) or the growing hair is rushed into involution followed by shedding. Telogen effluvium can occur a few weeks after childbirth, surgery, high fever or certain medical treatments, it is also encountered during attacks of androgenetic alopecia.

Tinea: 
Tinea or ringworm is an infection of the hair or facial hair (sycosis) due to dermatophytic fungi.

Traction test:> Test during which the health practitioner pulls out gently but firmly on a strand of 25 to 30 hairs. The shedding of more than 5 hairs is considered abnormal.

Trichogram: 
Diagnostic test aiming at quantifying hair loss, establishing which type of hair loss is present (telogen or anagen effluvium) in order to refer the patient or to diagnose their condition. A strand of hair is taken from the forehead, temples and neck using tweezers. The hair is examined microscopically and classified according to its type (anagen, catagen, telogen). The rate of shrinking of the hair can also be assessed, as well as the occurrence of dystrophic bulbs, which are found in alopecia areata or anagen effluvium.

Trichotillomania: Irrepressible need of pulling or twisting one's hair leading to hair breakage and hair loss. This tic is considered as being part of obsessive compulsive disorder (OCD). 



Dr. Rothfeld, recognized by the by the entertainment industry of America as one of the best dermatologists in Manhattan, has organized a comprehensive skin care center offering personalized state of the art services including medical,pediatric, and cosmetic dermatology. 

New York Dermatology serves the following neighborhoods within New York (NY), which are in close proximity to our office:
Upper East Side Dermatology, Fifth Avenue Dermatology, Park Avenue Dermatology, Madison Avenue Dermatology, Upper West Side Dermatology, Midtown Dermatology, Lower East Side Dermatology,Chelsea Dermatology, Gramercy Park Dermatology, Murray Hill Dermatology,  Greenwich Village Dermatology, East Village Dermatology, West Village Dermatology, Soho Dermatology, Tribeca Dermatology, Meat Packing District Dermatology, Sutton Place Dermatology, Wall Street Dermatology, Hells Kitchen Dermatology, and the burroughs of Brooklyn Dermatology , Bronx Dermatology, Queens Dermatology and Staten Island Dermatology.
Dr. Gary Rothfeld is recognized as one of the best Dermatologist in New York, NY, Manhattan, NYC, New York City and the nation by the entertainment industry in the United States of America. At New York Dermatology headed by board certified Dermatologist Dr. Rothfeld, sees patients  7 days a week including Saturday and Sunday.

                  We accept all credit cards  as well as debit cards for payment of services.

Open 7 Days A Week — Se Habla Español

 New York Dermatology
Board Certified Dermatologist 
30 E. 60th St. Ste. 805 (Park Avenue)
New York, NY 10022

212.644.6454

                         We accept the credit cards below as well as debit cards for payment of services.

 

 

 

Thank you for reading our Disclaimer:
The purpose of this website is to both educate current patients and to attract new patients. Please note that the information on this website is not intended as medical advice. For questions about how to treat your illnesses, please consult your dermatologist or physician. In addition, please note that, unless you are a current patient, our office cannot, by law, give medical advice over t