Dr. Lynne Goldberg
Lynne Goldberg, MD is an Associate Professor of Dermatology and Pathology at Boston University School of Medicine. She is an Alpha Omega Alpha graduate from Downstate Medical Center in New York. She completed a Residency in Internal Medicine at New York University Medical Center prior to her Dermatology Residency at Albert Einstein College of Medicine. Dr. Goldberg subsequently completed a Fellowship in Dermatopathology at Boston University. Dr. Goldberg is Board Certified in Internal Medicine, Dermatology and Dermatopathology and has a special interest in hair disorders. She practices as a dermatopathologist and dermatologist at Boston Medical Center, where she runs the hair loss clinic.
Hair loss, or alopecia as it is called in the medical community, is a distressing problem to most that are affected. Sometimes one will notice increased hair shedding, causing clogging of shower drains and strands of hair seemingly everywhere. Others do not appreciate any shedding, but are told by friends or relatives that their hair looks thinner. Sometimes it is the hairdresser who first notices a bald spot. Some will have itching or other symptoms, while others will have none. Whichever way it presents, once discovered, hair loss often evokes feelings of fear and uncertainty.
There are actually many different reasons for hair loss. Most alopecia is genetic, causing typical male and female pattern hair loss. It is estimated that up to 50% of women over the age of 40 will experience this form of hair loss, which tends to worsen or become more apparent at the time of menopause. Some types of hair loss are related to medical conditions, such as endocrine disease, autoimmune disease, or iron deficiency. Some are related to inflammatory diseases of the skin. There is a type of hair loss that abruptly follows a significant stressful event such as hospitalization, birth of a child, or death of a loved one. Certain medications can cause hair loss. Hair loss can sometimes be caused by fungal and other infections. Because there are so many disparate causes of hair loss, there are several classification systems in place. Hair loss is divided into those that are patchy, causing bald areas, or those that are diffuse, causing thinning but no bald spots. These are further subdivided into those that cause permanent hair loss, called scarring or cicatricial alopecia, and those that are potentially reversible, known as non-scarring alopecia.
Sounds complicated? It is! This is why a visit to the doctor is often helpful in sorting out the cause of your hair loss. An evaluation for hair loss typically starts with a detailed history, including questions about your general health as well as hair care practices. The scalp examination includes estimates of hair density at different scalp locations, checks the hairline and scalp surface, looks for breakage and hair loss from the root, and checks for bald patches. To complete the evaluation, blood testing is often required, although keep in mind that there are few specific tests for hair loss. Sometimes your doctor will discuss a scalp biopsy. This office based procedure involves removing a small cylinder of scalp for examination under the microscope to help establish the correct diagnosis.
If you are diagnosed with alopecia, don’t panic! Most types of hair loss do not lead to baldness. You might think that if your hair is shedding at a rapid rate that you will soon be left with no hair. This is rarely the case. Your hair actually grows in a cycle. Each hair follicle on the scalp produces a hair shaft that grows for a period of years, and is then shed normally. The same follicle then produces a new hair shaft.
Treatment of your hair loss will obviously depend on the diagnosis. There are medical options, surgical options, and a variety of products that greatly enhance the appearance of one’s hair. It is important to keep your expectations realistic. Advanced hair loss may be best covered by a partial hair piece or cranial prosthesis (wig). For some, changing a medication is all that is needed to stop the loss of hair. Other times a topical preparation applied to the scalp daily may be indicated. Oral medications are sometimes necessary. One type of patchy hair loss called alopecia areata responds well to steroid injections. In many instances there are different treatment options. You and your doctor can decide on an individualized treatment plan that works best for you.