The hair follicle is preserved. Therefore, hair regrowth is always possible.

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Julie Stevenson
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WHAT ARE THE DIFFERENT TYPES OF HAIR THINNING? NON-SCARRING types of hair thinning are due to changes in your hair cycle, hair follicle size, hair breakage, or a combination of these changes.

1 WHAT ARE THE DIFFERENT TYPES OF HAIR THINNING? NON-SCARRING types of hair thinning are due to changes in your hair cycle, hair follicle size, hair breakage, or a combination of these changes. The hair follicle is preserved. Therefore, hair regrowth is always possible. FEMALE pattern (hereditary) hair thinning is gradual and diffuse thinning with preservation of the frontal hairline. By middle age, 40% of women show signs of pattern hair thinning, a genetically determined condition in which hair follicles gradually shrink and become less active. Nearly 75% of women taking the potassium-sparing water pill spironolactone notice stabilization or even improvement of their female pattern hair thinning (Famenini et al, 2015). Minoxidil 5% foam is applied daily while minoxidil 2% solution should be applied morning and night. Originally used as a blood-pressure medication, minoxidil dilates blood vessels, helping to stimulate and nourish hair follicles. The result is a prolonged hair growth (anagen) phase. Low Level Light Therapy (LLLT) can increase hair density and has been approved by the FDA in Our favorite is the irestore Laser Hair Growth System. The device is available over the counter. MALE pattern (hereditary) hair thinning is characterized by a receding hairline and diffuse thinning at the crown. It affects 50% of men by 50 years of age and is genetically determined. The only two medications approved by the FDA are minoxidil (Rogaine) and finasteride (Propecia) 1 mg daily (inhibits DHT). Dutasteride (Avodart) 0.5 mg daily is not FDA approved but potentially more effective than finasteride. Both medications have rare side effects such as decrease in sexual drive and performance in approximately 1% of patients. Finasteride seems to be the better choice for many patients due to the wealth of data about its long-term safety and effectiveness. Finasteride received FDA approval as a treatment for benign prostatic hyperplasia (BPH) in Dutasteride was approved for prostate enlargement in Low Level Light Therapy (LLLT) can increase hair density and has been approved by the FDA in Our favorite is the irestore Laser Hair Growth System. The device is available over the counter.

2 TELOGEN (diffuse) hair thinning presents either as an acute self-limiting form triggered by events such as surgery, childbirth or rapid weight loss; or as a chronic type that is sometimes associated with female pattern thinning. Telogen hair thinning may be triggered by stress, illness, nutritional deficiencies, or hormonal changes. Better nutrition, rest, and time may be all you need. ALOPECIA AREATA is an autoimmune condition attacking the hair follicles. This reversible spot baldness typically appears on the scalp. Beard, eyebrows, eyelashes, body and limbs may also be affected. Most people with only a few small patches will notice full regrowth within 2 years. Therapy is custom designed based on your age, expectations, disease extent, disease duration, and the results of laboratory studies. Topical onion juice is the most natural option. Success rates approach 80% after 2 months. Alternatives include minoxidil (Rogaine), steroid creams, local steroid injections, dithranol cream, and contact sensitization treatment. Janus kinase (JAK) inhibitors, including tofacitinib, baricitinib, and ruxolitinib, are immunosuppressive medications with potentially severe side effects. They may reverse alopecia areata in some patients. The website of the National Alopecia Areata Foundation (NAAF.org) provides additional information. TRACTION hair thinning is due to chronic traction from hair styling. It is reversible in the early stages but might become irreversible later on. SCARRING types of hair thinning are rare. Associations include discoid lupus, folliculitis decalvans, frontal fibrosing alopecia, and lichen planopilaris.

3 YOUR HAIR THINNING ACTION PLAN Early diagnosis and early initiation of treatment are desirable as halting progression of hair thinning is less challenging than stimulating regrowth. Although most hair thinning is due to genetic factors, many co-triggers are under your control. They include: Long-term everyday stress including lack of sleep Heat - Please avoid for hair processing and drying or at least use a hair heat protectant. Not using a wide-tooth detangle comb Lack of vitamin D3, iron, biotin, zinc, copper, vitamin B12, folate, or protein INITIAL BLOOD TESTS: Vitamin D Levels below 60 ng/ml are associated with increased risks of alopecia, cancer, etc. TSH Should be less than 2.5 mu/l; hair thinning is an early sign of an underactive thyroid Ferritin Storage form of iron, should not fall below 70 ng/ml ADDITIONAL BLOOD TESTS: Blood sugar High levels indicate inflammation, insulin resistance, and poor circulation Biotin Deficiency may trigger hair thinning Zinc High zinc levels are associated with low levels of inflammation Copper Low levels may compromise blood circulation Vitamin B12 Vegans & vegetarians tend to be deficient Testosterone High levels may accelerate hair thinning in women DHT High levels are related to hair thinning in both women and men Progesterone & estradiol Low levels of estrogen may trigger an increase in hair thinning DHEA & cortisol Low DHEAs or high levels of cortisol may contribute to hair loss Additional information:

4 HAIR THINNING QUESTIONNAIRE ( ) Do you feel you have been shedding excessive numbers of hairs daily? ( ) Do you feel that your scalp hair is slowly thinning out over the top without losing excessive numbers of hair daily? Approximately how long have you noticed hair thinning? How rapid was your hair thinning? ( ) Gradual ( ) Sudden ( ) Are you losing hair in areas other than your scalp? Are your hairs ( ) Coming out at the root ( ) Breaking off ( ) Is there a family history of ladies with thinning over the top of the scalp? ( ) Is there a family history of gentlemen with pattern thinning? ( ) Are you actively dieting? ( ) Are you a vegetarian or vegan? ( ) Have you had any recent lab work done to diagnose your hair loss? Do you have ( ) Vitamin D deficiency ( ) Anemia or low iron ( ) Thyroid disease ( ) Diabetes ( ) Lupus ( ) Rheumatoid arthritis How often is your hair colored, chemically processed, or straightened? ( ) Never ( ) Every week(s) ( ) Every month(s)

5 Within 6 months prior to the onset of hair loss: Have you been started on any new medications? If yes, please list: Have you had any hormone pills or birth control pills started ( ) or stopped ( ) ( ) Have you been experiencing any significant medical issues in your life, such as the birth of a child, surgery, illness, or hospitalization? ( ) Have you been experiencing any significant stress, such as divorce, family illness or cancer, or work issues? ( ) Have you had any recent weight loss or change in your diet? For Women: Are your periods ( ) Regular ( ) Irregular ( ) Do you have excessive hair on your face, chin, stomach, or around nipples? ( ) Have you had difficulty becoming pregnant? ( ) Are you postmenopausal? ( ) Have you had a hysterectomy? ( ) Have you ovaries been removed? Please list the names and dosages of all medications, over-the-counter pills, hormone pills, vitamins, and supplements that you are currently taking and circle the ones that you were taking when your hair began to fall out. Please list all prescription medications, supplements, shampoos, and solutions that you have tried for your hair loss Treatment When was it tried? For how long? Did it help? Minoxidil (Rogaine) Finasteride (Propecia) Spironolactone Vitamin D Biotin LLLT What do you think is the cause of your hair loss?

DON T LET HAIR LOSS TANGLE YOU UP: DERMATOLOGISTS CAN IDENTIFY COMMON HAIR DISORDERS AND OFFER SOLUTIONS

Jennifer Allyn Scott Carl Allison Sit (847) 240-1730 (847) 240-1701 (847) 240-1746 jallyn@aad.org scarl@aad.org asit@aad.org FOR IMMEDIATE RELEASE DON T LET HAIR LOSS TANGLE YOU UP: DERMATOLOGISTS CAN