Hair loss can look different in women, dermatologists can help

Hair loss in women is surprisingly common, and it appears to be on the rise. With more people experiencing hair loss since the start of the COVID-19 pandemic, some have wondered if the virus is to blame. To answer that question, and to learn more about how hair loss may look different in women, we spoke with Dr. Noelle Teske, a dermatologist at OHSU.

Although Dr. Teske has noted the pandemic has brought in more hair loss patients than in the years prior, she cautions there are many causes to consider beyond the virus itself.

“Really, what’s needed is an in-person examination,” she says, “Just recognizing hair is falling out is not enough to make a diagnosis of what's causing it.”

A detailed patient history

Dr. Teske usually begins with a patient history. She may ask questions about how long the hair loss has been happening, where it is occurring, and if there is any scalp itching, flaking or pain. She does a review of medications, including any recent changes, and she talks with the patient about any family history of hair loss.

She also asks if there have been any recent stressors, either physical or emotional. Examples of physical stressors are pregnancy, major surgery or severe illness. While COVID-19 is part of that last category, it includes many common ailments, such as the flu.

Physical examination

After the patient history, there is a physical examination of the scalp and hair.

“As dermatologists, we look with our eyes, and we look with our hands,” says Dr. Teske. Typically, she  reviews the scalp for signs of inflammation or infection. She notes the overall hair loss pattern. Sometimes, she may look at a strand of hair under a microscope. In other cases, a small biopsy of the scalp may be indicated.

“All of those things can end up being part of the visit or not,” says Dr. Teske, “But if we can make a diagnosis that day of what we think the cause is, then we can make some treatment recommendations.”

Telogen effluvium: the body's response

There are many different types of hair loss. One common type that Dr. Teske considers when thinking about pandemic-related hair loss is called telogen effluvium.

“This is the shedding that happens when you have a major stressor going on in your body or your life,” she says. For example, it is common to experience this type of hair loss after pregnancy and childbirth.

According to Dr. Teske, every hair follicle normally goes through three major cycles: a growing cycle, a transition cycle, and a resting cycle. Normally most of your hairs on your scalp are in the growing phase.  When telogen effluvium occurs, the body signals more hair follicles to transfer to the resting phase, much more than it normally would. At the end of resting phase, hair sheds.

“While this is a simplification, the metaphor I give people is that you are undergoing something major, and your body is conserving resources,” says Dr. Teske, “Your body is saying, ‘growing hair isn’t a priority right now; we’re caring for a loved one, recovering from surgery, or trying to survive during a pandemic.’”

Losing hair can be very distressing. While there is no specific cure for telogen effluvium, the good news is that this type of hair loss is usually not permanent. Patients may notice shedding for several months - sometimes even 6-12 months after the initial stressor - but the hair will gradually begin to grow back. In the meantime, there are some treatment options that can help encourage growth.

Female pattern baldness may look different

Another common diagnosis is androgenetic alopecia, a genetic form of hair loss. In men, it is commonly known as male pattern baldness, but there is a female pattern as well. Male pattern baldness has historically received a lot of media and medical attention. After seeing a family member lose their hair, many men will not be surprised as their hair begins to thin or fall out. That is not always the case for women.

“The female ‘equivalent’ of thinning hair is not always thinning at the temples,” says Dr. Teske, “It’s often thinning at the part line, so the part becomes wider. It could also manifest as diffuse thinning all over.” Ultimately, women may not recognize female pattern baldness because it is less familiar. Although it can be upsetting, once diagnosed, treatments such as Minoxidil (Rogaine) can help.

“Emotionally, I think hair loss tends to be a lot more distressing for patients who identify as female, just because hair can be such an important cultural symbol,” says Dr. Teske, “You’re used to how you look in the mirror, and hair is a big part of that.”

Many other less common types of hair loss exist. For example, alopecia areata is an autoimmune condition which causes hair to fall out in coin-sized patches. Some hair loss can be related to other illnesses, or a side effect of certain medications. Whatever the cause, it is important to see a medical provider to make a diagnosis and develop a treatment plan.

“If you are having hair loss that you think is unusual, make an appointment with a dermatologist,” says Dr. Teske, “We will do a history, we will do an exam, and there are things that we can offer to combat it.”