Questions about hair loss can start when you notice more hair than usual in your hair brush or shower drain trap – or the “shedding” you’ve been attributing to a change in seasons continues and/or increases. Is it just your imagination, or reason for concern? Dr. Marco Barusco – founder and Chief Medical Officer of Tempus Hair Restoration – notes that shedding 100 to 150 hairs per day is part of the normal hair cycling process. Losing a significant amount beyond that could indicate an issue that needs to be evaluated by a hair restoration surgeon before the condition progresses.
The most frequent concern that patients bring to Dr. Barusco is an increase in shedding hair, but without scalp symptoms, such as itching or burning.
“I see patients every day here at the office with different types of hair loss and some very common symptoms that happen to everyone,” says Dr. Barusco. “It may be happening to you or someone you know, and a lot of times they can be a little deceiving. You’re just dismissing it as, ‘Well, I know it’s going to get better,’ or ‘It’s just a simple hair loss issue.’ In reality, that could be the sign and symptom of something more serious that needs to be treated so you can preserve your hair.”
Healthy hair has growth and resting phases, which accounts for typical shedding. But there can be certain situations in which shedding occurs more rapidly. The medical term for this condition is telogen effluvium. Women are more susceptible after surgery, undergoing general anesthesia, or experiencing a stressful event or trauma – as well as the hormonal changes of menopause, or discontinuing birth control pills. Thyroid disease is another possible cause. Returning to hormone-induced causes, new mothers may experience hair loss two months after giving birth. This shedding usually peaks after four months, and is normal and temporary. Dr. Barusco’s video on the topic of pregnancy and hair loss for his YouTube channel, Hair Loss Medical Advice, provides additional helpful information.
How to Recognize Signs of Excessive Hair Shedding
Evaluating the rate of your own hair loss isn’t as easy as you may think. In his informative YouTube video, Dr. Barusco notes that the apparent amount of shedding can fool the eye. For example, a bundle of 50 hairs of thick, curly texture will look more voluminous than a bundle of 50 thin, straight texture hairs. The same holds true for long hairs versus shorter hairs. For this reason, Dr. Barusco often instructs his patients to save their shed hairs in self-sealing plastic bags.
“Sometimes, you just have to sit down and count the hairs of the patient. Many times, we are between the 100 to 150 hairs that they would shed every day. But it’s important for us to have that parameter.”
From Hair Shedding to Noticeable Areas of Hair Loss on the Scalp
Even more alarming is when the situation shifts from excessive shedding to visible areas of hair loss on the scalp. “There are different stages of thinning,” says Dr. Barusco. “You can go very easily from a mild scalp see-through to a little bit more area, to then many areas.
“Another clinical presentation that I see many times is when the hairline and temples get thinner. This is much more common in African-American women. It’s called traction hair loss, or traction alopecia – and it happens because of tightly pulled hairstyles and weaves. This causes a good deal of trauma to the hair follicles – particularly around the frontal scalp at the temples and the hairline. Over time, these stressed-out follicles become weaker, and they’ll become thinner and thinner. Eventually, you may see balding spots. However, it is my job to evaluate each patient to rule out other causes, because there are other conditions that can mimic this.”
What You Need to Know About Alopecia
“Alopecia” is a general term for hair loss. There are many types of alopecia, each with its own pathology and set of symptoms. Androgenetic alopecia is a common form of hair loss in both men and women. In men, this condition is also known as male-pattern baldness.
Alopecia areata is an autoimmune disorder that causes hair loss on the scalp and elsewhere on the body. Males and females of every age and ethnic group can develop alopecia areata. It often first appears during childhood and can be different for everyone who has it. According to the American Academy of Dermatology (AAD), alopecia areata can cause different types of hair loss: alopecia areata (hair loss in patches), alopecia totalis (total hair loss on the scalp) and alopecia universalis (hair loss on the entire body).
Alopecia areata is characterized as a superficial inflammation. The hair follicles – the “bulbs” below the skin surface – remain protected, so hair loss typically isn’t permanent. Our blog post – “Advanced Treatments for Non-Pattern Hair Loss” – provides additional information.
“These types of lesions are very common, characterized by a pretty much completely bald spot that can start small and grow,” says Dr. Barusco. “It can also occur in the beard, eyebrows, eyelashes and armpits – any area of the body that has hair.”
Other types of alopecia include the following:
Central centrifugal cicatricial alopecia (CCCA) – This is a form of scarring alopecia that results in permanent hair loss in the crown region of the scalp. According to the Journal of the American Medical Association (JAMA) Network, it is the most common form of scarring hair loss in black women over age 30. However, it may be seen in men and among persons of all races and hair color – although rarely.
Frontal fibrosing alopecia (FFA) – This is a form of lichen planopilaris that is characterized primarily by slowly progressive hair loss and scarring on the scalp near the forehead. In some cases, the eyebrows, eyelashes and/or other parts of the body may be involved, as well.
Lichen planopilaris (LPP) – This affects the scalp and hair. It is a form of lichen planus, an inflammatory condition affecting the skin and mucous membranes. Symptoms may include scaly skin and redness around hair follicles, and bald patches – as well as pain, burning or itching on the scalp. Tiny, red bumps (papules) may appear around hair clusters. LLP can result in scarring that leads to permanent hair loss.
A fungal infection in the scalp can also cause hair loss. For example, in the case of ringworm – which is actually a fungus – the fungus targets the hair shaft, which causes the hair to shed. The outside ring is red and inflamed, and as it expands, the center will heal. “Sometimes, the hair can start going back to the center of the lesion – so that’s how we got the name of ringworm, because there’s a circle of red, then the central areas will start to heal and look less red,” says Dr. Barusco. “This can be treated with antifungals, and the hair can be grown back. But it needs to be addressed, so don’t just look at this and let it go.”
Don’t Take a Wait-and-See Attitude Toward Shedding Hair
If you’re concerned that you’re losing more hair than usual – yet hesitant to schedule a consultation with a hair replacement specialist – you also may be losing valuable time in getting a diagnosis that can treat the cause of your hair loss and prevent or delay future loss. As you’re familiar with your hair, any changes you notice are worth investigating. Just as you shouldn’t ignore troubling symptoms regarding your overall health, paying attention to warning signs about the health of your hair and scalp is also important. Consulting a hair restoration surgeon who – like Dr. Barusco – is also a physician will give you the best opportunity for an accurate diagnosis, appropriate treatment plan and good outcome.
Ultimately, choose your surgeon based on experience, results and integrity. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice. Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device.
Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!