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Hair Loss News Archives
December 2010
Hair loss during menopause treatable with right diagnosis
Female pattern is most common form of hair loss during menopause
Dec 2010
Dermatologists today have more options for treating hair loss during
menopause than ever before. But according to one expert in the field
of female hair loss, unless the right diagnosis is made, the
treatments might be less than effective.
"We know more about the mechanisms of hair loss than we did a decade
ago, and have a wide variety of pharmaceuticals and treatments to
choose from," says Theodore J. Daly, M.D., F.A.A.D., director,
Garden City Dermatology, Garden City, N.Y. "Getting the diagnosis
right can lead you to a successful solution."
Female pattern is the most common form of hair loss during
menopause, and affects approximately one in three women during this
time of their lives. While gradual hair loss is often the reason for
the office visit, getting to the root cause is crucial.
Other common reasons for hair loss in menopausal women are low
thyroid and hormone changes, according to Dr. Daly, who is
board-certified in dermatology, pediatric dermatology and
dermatopathology.
"Although hair loss during menopause is a serious cosmetic problem
for many women, its cause can be systemic or due to nutrient
deficits, and those factors aren't apparent with exam only. In fact,
a recent study of women with fluctuating hormones showed that a
significant percentage of their deficits were detected by lab only."
Diagnosis: Get it right
"Without the lab test, you can miss up to 15 percent of women who
have abnormal hormone levels," Dr. Daly says.
"Upon the initial visit, you might not be sure of the diagnosis, so
you may need to check other causes with a lab test. If the woman
tests abnormal, then it's not a cosmetic problem; it's systemic or a
nutritional deficit. Sometimes you just need to replace the missing
iron. After that, women feel better and are happy to have been
diagnosed, not to mention that their hair begins growing back.
"Sometimes a patient will come in and the diagnosis is not what they
expected," Dr. Daly says. "Unless you look at the scalp, you are
going to miss some things. Part the hair; look at the scalp and also
look at the nails. This is basic, but can change the course of
treatment. If your initial diagnosis is off, nothing you do after
that will be very effective."
Treatment choices
Once the proper diagnosis is made, treatment for hair loss typically
starts with a therapy like topical minoxidil (Rogaine, McNeil-PPC).
Other options include Aldactone (spironolactone, Pfizer),
finasteride (Propecia, Merck), dutasteride (Avodart,
GlaxoSmithKline), laser treatment and transplants.
Dr. Daly says he remembers these as "MOLT" — minoxidil, other pills,
laser and transplants.
Laser therapy can be helpful when used as adjunct treatment or when
patients can't tolerate other treatments.
"Cold laser such as Revage 670 (Apira Science) as added therapy can
result in great improvements," Dr. Daly says.
For some women, hair transplantation might be the answer. An
experienced surgeon can provide excellent results with the
follicular unit and mini-graft techniques. If all other treatments
fail, there are more aggressive treatments that are not standard of
practice, as well as wigs and other cosmetic cover-ups.
While treating hair loss is not a highly reimbursed procedure, it is
covered for most cases, especially when the cause is not pattern
loss.
Treatment not for everyone
Despite the high number of menopausal women dealing with hair loss,
many dermatologists are not interested in treating it, according to
Dr. Daly.
"Many fellow dermatologists will refer patients at the onset of
their hair loss or after they have exhausted their treatment
options. It involves a lot of mental gymnastics; it's time-consuming
and not driven by procedure," he says.
Nonetheless, dermatologists with an interest in the field should
acquire "a comprehensive viewpoint of hair loss by reading
everything on the subject, including textbooks and attending AAD
(American Academy of Dermatology) lectures on the topic," Dr. Daly
says. "The field requires a full understanding of hormones,
nutritional deficits, and various forms of hair loss, such as
central centrifugal cicatricial alopecia and chronic telogen
effluvium."
Dr. Daly currently is researching hair loss by performing biopsies
pre- and post-laser treatment. Wellman Laboratories at Harvard
Medical School, Boston, is conducting the independent histological
analysis in conjunction with Dr. Daly's study.