Fashion & Beauty: Skin Sense Fashion & Beauty
Fighting Hair Loss
BY RACHEL HERSCHENFELD, M.D. - DERMATOLOGIST

Most of my patients come to see me about problems with their skin, but many of them bring up concerns about their hair during their visits. By far the most frequent hair problem I encounter is hair thinning. It may be surprising to know that I hear about this from women almost as frequently as I hear about it from men. Although there are no magical cures, in many cases there are treatments that can help. To choose the appropriate one, it's important first to identify the cause of the hair loss.

The most common cause of hair loss in men and women is called androgenetic alopecia. This type of hair loss is inherited, and may be related to levels of androgens. Men with androgenetic alopecia develop a receding hair line at the temples along with thinning of hair on the crown of the scalp; while women develop thinning of the hair over the central scalp and usually have normal hair thickness at the periphery.

Another common type of hair loss is telogen effluvium, which occurs when the growth cycles of many hairs become synchronized, and more hair than usual falls out at once. It can be caused by abrupt shifts in hormonal status, such as from starting or stopping oral contraceptives, after pregnancy or after a serious illness or hospitalization.

Telogen effluvium will often resolve on its own after about six months. Androgentic alopecia, on the other hand, inevitably progresses unless it is treated. Hair transplantation is a good option for some people. For patients who prefer to avoid surgery, there are effective medications, and research is ongoing into new treatment options. Topical minoxidil, or Rogaine, can prevent progression of hair loss for many people, and can produce regrowth of hair in both men and women. It takes some time, though, and consistent use for six to 12 months may be needed in order to see a benefit. When it does help, it is important to continue using minoxidil, or the hairs that regrew will be lost again. Minoxidil comes in two strengths: 2 percent and 5 percent. The higher concentration may produce results a little more quickly, although it doesn't ultimately result in more growth of hair on the scalp and may occasionally lead to hair growth on the face.

Finasteride or Propecia is a pill that can also promote regrowth of hair over time, and it can be used in combination with minoxidil. Since this medication blocks androgens, it can cause birth defects if taken during pregnancy and it is approved by the FDA only for use in men.

New research is focusing on potential light treatments for hair loss. Lasers have been used successfully for years to remove hair, and now the focus is shifting to light therapies to regrow hair. One device, the HairMax comb, was approved by the FDA in February for the treatment of male pattern hair loss. This comb, which emits red light, is unlikely to produce more than a modest increase in hair density, and it certainly cannot replace the use of minoxidil and finasteride. However, studies of higher energy light based devices are in progress, and may provide better treatments some day.

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More About Doctor Herschenfeld, M.D.

Dr. Rachel Herschenfeld's practice is based in Wellesley, Massachusetts. After graduating from Harvard Medical School, she completed residencies in Internal Medicine and Dermatology, then joined two other dermatologists to found Dermatology Partners, Inc. Dr. Herschenfeld is board certified in Dermatology, and is a Fellow of the American Academy of Dermatology. Dr. Herschenfeld performs cosmetic procedures including Botox, Restylane, collagen, Sculptra, and laser treatments for many conditions.
Dr. Rachael Herschenfeld is a practicing dermatologist. Her answers here should not replace medical advice. To submit a question, e-mail skincare@washingtonpost.com. We reserve the right to edit submitted questions for length and clarity and cannot guarantee that all questions will be answered.

Doctor Q&A

I am a 45-year-old woman. I have very large pores on my nose, cheeks and chin and they are always congested. I steam my face, and I also use masks or a scrub about twice a week and apply an oil-free moisturizer. I don't seem to be getting anywhere. Can you please offer me any suggestions? Thank you.
- G.Z.
Many people are troubled by the appearance of large pores on their face, and by the debris that accumulates in the pores. It is normal for skin to secrete oils, and for skin cells to slowly slough off of the skin surface, and these processes combine to produce clogs in pores. There are several products that can help to slow this process down or help to clean out the pores. Cleansers containing salicylic acid, such as Neutrogena Acne Wash, or peels with salicylic acid can help to dissolve some of the debris from pores. In addition, topical retinoids such as RetinA, Differin and Tazorac can help prevent the accumulation of oil in pores. In addition, there is some data that Tazorac may actually help to shrink pore size.
I've been accustomed to staying out of the sun, and to using SPF15 sunscreens. Lately, I've been reading that one needs 20 minutes of sun daily on face, neck and arms to be sure of getting enough Vitamin D. One, is this true and, second, if so, does wearing a sunscreen block out the Vitamin D that one should be getting? Thanks!
- D.W.
Vitamin D in our bodies comes from two main sources: We absorb it from our diet, and our skin can synthesize it when exposed to UV rays in sunlight. Using sunscreen definitely decreases the amount of UV light that reaches the skin, and therefore decreases synthesis of Vitamin D. However, it is possible to compensate for this by getting enough Vitamin D in our diet. Vitamin D is present in dairy products, but most of us don't drink enough milk to get adequate amounts of the vitamin this way. The USRDA for Vitamin D is 400 IU daily, which may not even be enough for many people, so it is worth discussing this issue with your doctor. Vitamin D can easily be obtained by taking over- the-counter supplements containing Vitamin D3 (or cholecalciferol), the more active form of this vitamin.

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