Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The course of typical alopecia areata is not predictable with a high likelihood of spontaneous remission. The longer the period of time of hair loss and the larger the area involved, the less likely the hair will regrow spontaneously. Therefore, there are a variety of treatments, but none of these can confidently be predicted to impact the course of this disease. Local steroid injections intracutaneously may be very helpful in restarting the hair growth cycle in treated areas. Steroid creams, lotions, and shampoos have been used for many years but are of limited benefit at best. Although oral systemic steroids are known to induce hair growth in affected patients, their long-term use is contraindicated because of the likelihood of undesirable side effects.

Evaluating and treating hair loss (alopecia) is an important part of primary care, yet many physicians find it complex and confusing. Hair loss affects men and women of all ages and frequently has significant social and psychologic consequences. This article reviews the physiology of normal hair growth, common causes of hair loss, and treatments currently available for alopecia.
Why? Unwanted hair growth (sideburns, for example) is a reported side effect of minoxidil. The belief is that a higher concentration of minoxidil would result in more unwanted hair, which is why women are instructed to use it less often. However, the study in Skin Therapy Letter reports that unwanted hair was more common in 2 percent minoxidil solutions than 5 percent, and women are instructed to use Rogaine’s 2 percent solution twice daily — so what gives?
While hair loss can be very distressing, alopecia by itself isn't harmful - the damage is cosmetic. But there's always a chance that alopecia might be a secondary effect or symptom of some other illness. To be sure, only medical tests and a full discussion with your doctor can ensure the right diagnosis. Always see a doctor if you start to lose hair.
I am on Arava and my hair has become extremely coarse, frizzy, and tight tight curls in the back. The sides of my hair are pure frizz and the top is straight, with frizz. It used to be smooth and so easy to manage. Now it takes so long and it looks awful. Anyone find the same thing and anything that helps? I have tried so very many hair products, so has my beautician. She says it is like I have 3 completely different textures on my head.
The follicles on the sides of the scalp are more genetically resistant to DHT, which is why male pattern baldness often results in a “crown” of hair. But its downsides are serious. “With women, finasteride is not an option,” says Dr. Wolfeld. “It’s not FDA-approved for women to take, so we don’t prescribe it.” In fact, due to the drug’s effect on hormone levels, pregnant women are advised to not even touch broken or crushed tablets.
A bathroom covered with loose strands or an ever-scrawnier ponytail can be startling but doesn't necessarily mean anything's wrong. By age 50, half of women will complain of hair loss. "As we age, overall hair density changes and individual strands become finer," says dermatologist Doris J. Day, MD. But just because thinning is natural doesn't mean you have to accept it. Here are 13 solutions to help you keep the hair out of your brush and on your head.
Some of the skin disorders like lupus and sarcoidosis can cause hair loss. In case of lupus, the hair tends to get brittle and may fall out in patches. Lupus hairs or short, broken hairs usually appear above the forehead. Hair loss is not permanent in general here. Some individuals with lupus also develop a form of lupus known as discoid or cutaneous lupus that affects the skin. Scars that sometimes develop on the skin of the scalp may lead to hair loss.
Some other autoimmune diseases can also lead to hair loss. Lupus, which affects many different systems of the body, is one of them. Symptoms include fatigue, headache, painful joints, anemia, abnormal blood clotting, and hair loss, according to the website LiveStrong. The disease is usually triggered by environmental factors like exposure to the sun. Hashimoto’s disease, which occurs when the immune system attacks the thyroid gland causing an underactive thyroid, can also result in hair loss.

For the first time in my life also, I have been experiencing a lot of scalp pain. I think it is because this time, it is not slow and diffuse like it was in my teenage years, at the onset of PCOS. Quitting the pill after 5 years of dependency meant a major hormonal shock to the system which provoked both a mix of both Telogen Effluvium (shock loss), and Androgenic Alopecia (the testosterone from the PCOS back in full form, killing hair follicles).

Furthermore, Penn dermatopathologists developed an even more advanced method called the HoVert technique for diagnosing hair loss and other disorders from a scalp biopsy. The technique uses a unique horizontal and vertical testing approach that provides a greater amount of information to the referring dermatologist than standard industry longitudinal scalp biopsies.
My story is little different it seems. My fiancé was dionosed with Rocky Mountain Spotted Fever from a tick bite. And after test after test almost losing her and so many blood drawings then blood transfusions along with dialysis. Fighting depression trying to stay possitive is getting harder everyday. We ask all her doctors about why her nails break so easy, skin changing and hair falling out handfulls at a time…..then being looked at like we’re crazy has took my faith out of their hands.
I too have been having bad hair loss. I am 25 years old and since the birth of my second child 2 1/2 years ago, it has not stopped. It is normal for it to fall out for a few months after child birth so I wasn’t too worried at first. After about 6 months it started to slow down then all of a sudden started up again. And has been falling out ever since. I am really thin in the front and around the temples and just recently, has become really unhealthy. It breaks and is very course. I have been to 3 derms. and 2 PCP’s. All my lab work has always come back normal. And they just tell me to use Rogain. The past 6 months I have been trying to get pregnant again and haven’t been able to. I got pregnant with my last 2 very easy and feel that my hair loss and not being able to get pregnant are intertwined. I also have gained about 15 pounds. I don’t want to use the Rogain because I am trying to get pregnant and don’t know the effects it will have if I did get pregnant. I don’t know what to do next. I am in the Phoenix area so if anyone know of any good docs around here please let me know.

Harklinikken does not advertise, but the 25-year-old multinational company is beginning an aggressive expansion into the $3.6 billion hair-loss market in the United States, meaning you’re likely to hear a lot more about it. A New York clinic opened in June inside the Core Club in Midtown (you don’t need to be a member to get an appointment); and in August, Harklinikken consultations became available at some 70 Women’s Care Florida obstetrics and gynecology clinics. (Roughly 75 percent of the company’s 50,000 active users are female.)


I heard about DR. REDMOND from a couple support sites, but thought his prices were outrageous…until I had the breakdown and confronted the truth of my many bald spots and the way it had controlled my self-esteem/psyche for so long. I went. I continue to go. It is THE BEST investment for yourself. As females, we equivocate taking care of ourselves with selfishness. This is simply not true. THINK ABOUT IT. if your mother/daughter/best friend/lover/sister had this problem, would you call her selfish if she wanted to fix it?!?!?! INVEST in YOURSELF. Please, go to DR. REDMOND. He CAN HELP!!!!
Honestly, for female pattern baldness (what I have) I don’t think there really is any effective treatment — the only hope is learning to cope psychologically. (Just my humble opinion) So I don’t totally “hate” him for not being able to help me medically regarding the hair — but he was such a let down. I really expected more. (he’s an excellent dermatologist, for skin things at least)
Bald spots, thinning, and breakage can be symptoms of a serious underlying health condition such as alopecia, lupus, thyroid issues, and other common types of disease that cause hair loss. If you have noticed a dramatic increase in shedding or other change in the appearance of your hair, Drs. Robert J. Dorin and Robert H. True can help. During an evaluation at one of our offices in New York, New Jersey, or Boston, we can discuss your options and provide you with solutions to restore your appearance and confidence.
Thank you for all your post. My daughter had extremely thick hair about eight years ago. It was so thick you could barely put it in a scrunchie. Her hair has been continuously thinning to the point that you can see through it. All the women in my family on both sides have extremely thick hair. We live in the north east and have seen several GP and a Dermatologist who act like there is nothing wrong. I work in the medical field and when I hear this I get so mad because I feel like they want to just brush of like no big deal. It is a big deal to all women no matter what ages. I have written done some of the post advise and will continue to look for an endocrinologist for her. Please keep me postes on any new developements.
Hair changes about as fast as grass grows, which is to say it’s extraordinarily slow and not visible to anyone checking impatiently in the mirror every day. But during regular follow-up appointments, Harklinikken uses high-tech equipment to photograph and magnify the scalp and count new hairs and active follicles, which motivates users to adhere to the regimen. Too many people give up on treatments like Rogaine and low-level-light devices before they’ve had a chance to work, Dr. Senna said.
It is perfectly normal for people to shed 50 to 100 hairs per day. This generally doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time that hair is shedding. However, hair loss occurs when this hair growth cycle and shedding is disrupted or when the hair follicle becomes destroyed and replaced with scar tissue. Female pattern hair loss (androgenetic alopecia) is the most common form of hair loss in women. This occurs gradually and is caused by genetics (from either side of the family), age, and the action of a specific male hormone, dihydrotestosterone (DHT). This hormone is found in lesser amounts in women and it preys on the hair follicles, preventing them from receiving vital nutrients for proper hair follicle growth, leading to the hairs shrinking, and resulting in a shorter lifespan. Interestingly, DHT does not need to be elevated to generate hair loss. Estrogen, when lowered as commonly seen in menopause, creates a change in the ratio of male to female hormones, giving an edge to these male hormones. Compounded with the sensitivity of DHT to the hair follicles, heredity can affect the age at which a woman begins to lose her hair, as well as the rate of hair loss and the extent of baldness. 
Treatment options for AGA (Table 3)6 focus on decreasing androgen activity. Minoxidil (Rogaine) and finasteride (Propecia) are the only medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of AGA (Figure 4).6 Minoxidil is available without a prescription as a 2-percent topical solution that can be used by both men and women and as a 5-percent solution (Rogaine Extra Strength) that should be used by men only. The mechanism of action by which minoxidil promotes hair growth is unknown, but it appears to act at the level of the hair follicle. Minoxidil is an effective treatment for male and female AGA and is recommended as first-line treatment by the American Academy of Dermatology guidelines.5
The Provider Directory is provided on an "AS-IS" basis. WebMD disclaims all warranties, either express or implied, including but not limited to the implied warranties of merchantability and fitness for particular purpose. Without limiting the foregoing, WebMD does not warrant or represent that the Provider Directory or any part thereof is accurate or complete. You assume full responsibility for the communications with any Provider you contact through the Provider Directory. WebMD shall in no event be liable to you or to anyone for any decision made or action taken by you in the reliance on information provided in the Provider Directory.
Telogen effluvium occurs when the normal balance of hairs in growth and rest phases is disrupted, and the telogen phase predominates. The disproportionate shedding leads to a decrease in the total number of hairs. Axillary and pubic areas often are involved, as well as the scalp.2 The hair-pluck test usually shows that up to 50 percent of hairs are in the telogen phase (in contrast to the normal 10 to 15 percent), although these results can vary in persons with advanced disease.4  The patient often is found to have had inciting events in the three to four months before the hair loss (Table 4).1,4 If 70 to 80 percent of hairs are in the telogen phase, the physician should look for causes of severe metabolic derangements, toxic exposures, or chemotherapy.1,4 No specific treatment for hair loss is required because normal hair regrowth usually occurs with time and resolution of underlying causes. Lack of significant historical events and a delay in regrowth should raise suspicion for syphilitic alopecia.1
in between all these years, i also tried some homeopathic methods. i read dr. andrew weil’s book on health and used to take 2000mg of alpha-linolenic acid either by evening primrose oil, grapeseed oil or borage oil. it didn’t regrow my hair but i do feel that it helped stall it. only problem is that after a year or so it stopped working for me, but it may help some of you out. there’s a connection, according to dr. weil, between alpha-linolenic acid and hair. i’ve also used homemade rosemary water and washed my hair with it, but it only helps with making me smell like the bush it comes from.
Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.

^ Lenane P, Pope E, Krafchik B (February 2005). "Congenital alopecia areata". Journal of the American Academy of Dermatology (Case Reports. Review). 52 (2 Suppl 1): 8–11. doi:10.1016/j.jaad.2004.06.024. PMID 15692503. We believe AA should be classified not only as an acquired but also a congenital form of nonscarring hair loss. It may well be more common than is thought because of lack of recognition


About one-third of women experience hair loss (alopecia) at some time in their lives; among postmenopausal women, as many as two-thirds suffer hair thinning or bald spots. Hair loss in women often has a greater impact than hair loss does on men w, because it's less socially acceptable for them. Alopecia can severely affect a woman's emotional well-being and quality of life.
In contrast to trichotillomania, traction alopecia involves unintentional hair loss secondary to grooming styles. It often occurs in persons who wear tight braids (especially “cornrows”) that lead to high tension and breakage in the outermost hairs (Figure 10). Traction alopecia also occurs commonly in female athletes who pull their hair tightly in ponytails. The hair loss usually occurs in the frontal and temporal areas but depends on the hairstyle used. Treatment involves a change in styling techniques. Other hair-growth promoters may be needed in end-stage disease, in which the hair loss can be permanent even if further trauma is avoided.1
The Strategist is designed to surface the most useful, expert recommendations for things to buy across the vast e-commerce landscape. Some of our latest conquests include the best women’s jeans, rolling luggage, pillows for side sleepers, ultraflattering pants, and bath towels. We update links when possible, but note that deals can expire and all prices are subject to change.
It may take some time to find the right dosage of thyroid hormone to get your thyroid under control. If you're uncomfortable with the look of your hair while treatment is underway, there are options to consider. Wearing a hair piece or wig or getting a new hairstyle can help camouflage hair loss as you wait for the results of thyroid treatment to begin. Ask your doctor if it makes sense to try a topical medication that helps spur hair growth like mixoxidil (Rogaine).
If you find yourself snacking at night before bed, it may be because you're bored or anxious — not truly hungry — and eating makes you feel better. Try eating a healthy dinner a bit later in the evening. If your stomach is truly growling before bed, try a protein-based snack like a hard-boiled egg or a slice of cheese. A few spoonfuls of yogurt or some fruit is another good option. 

Side effects of JAK inhibitors identified so far include stomach upset, an increase in chest and skin infections and transaminaitis (an alteration in liver function identified by blood testing). Mild skin and upper respiratory tract infections have been reported in 25% of patients. Very few patients with alopecia areata elect to stop the medication as a result of side effects. Nevertheless patients receiving these medications require close medical supervision.
The Rogaine rep we spoke to explained that the different packaging (and therefore different prices) has to do with the FDA-approval process: “We discovered in clinical trials that the hair loss patterns between men and women are different,” she said by way of explanation. “Men typically have that bald spot on the crown of their head, where women generally have a general thinning throughout, but concentrated more on the top of the head. So for FDA approval, we had to come up with two different, gender-specific products, so the directions were more explanatory.”
Each day the scalp hair grows approximately 0.35 mm (6 inches per year), while the scalp sheds approximately 100 hairs per day, and more with shampooing.1 Because each follicle passes independently through the three stages of growth, the normal process of hair loss usually is unnoticeable. At any one time, approximately 85 to 90 percent of scalp follicles are in the anagen phase of hair growth. Follicles remain in this phase for an average of three years (range, two to six years).1 The transitional, or catagen, phase of follicular regression follows, usually affecting 2 to 3 percent of hair follicles. Finally, the telogen phase occurs, during which 10 to 15 percent of hair follicles undergo a rest period for about three months. At the conclusion of this phase, the inactive or dead hair is ejected from the skin, leaving a solid, hard, white nodule at its proximal shaft.2 The cycle is then repeated.
Hair transplants will likely lead to better results in the long run (you are introducing new hairs to the balding areas), but you’ll still need to use minoxidil or finasteride after surgery to maintain the results. Like all hair loss treatments, hair transplants are best when combined with other methods, and you’ll want to speak with your doctor to see what combination is best for you.
The only nonchemical option offered up by the dermatologists I spoke with — short of a surgical hair transplant or platelet-rich plasma therapy, which is like Kim Kardashian’s vampire facial but for your scalp — was the laser comb. First cleared by the FDA in 2009, the HairMax LaserComb is a handheld laser device that is designed to promote hair growth. As the manufacturer explains in a letter to the FDA, “The device provides distributed laser light to the scalp while the comb teeth simultaneously part the user’s hair to ensure the laser light reaches the user’s scalp,” which, in turn, stimulates the hair follicles.
There is no cure for the condition.[2] Efforts may be used to try to speed hair regrowth such as cortisone injections.[1][2] Sunscreen, head coverings to protect from cold and sun, and glasses if the eyelashes are missing is recommended.[2] In some cases the hair regrows and the condition does not reoccur.[2] In others hair loss and regrowth occurs over years.[2] Among those in whom all body hair is lost less than 10% recover.[5]
Greetings ladies, I am so happy I found this website. I have a 19 year old daughter who has been experiencing hair loss for the past 5 years. Throughout high school, she wore hair weave to camouflage what was going on. She is now a sophomore in college and wants to wear her natural hair. It is frustrating her because we don’t know why its happening. Does anybody know of a good endocrinologist in Chicago? Do you think treatments varies depending on ethnicity? She is African American.
The main type of hair loss in women is the same as it is men. It's called androgenetic alopecia, or female (or male) pattern hair loss. In men, hair loss usually begins above the temples, and the receding hairline eventually forms a characteristic "M" shape; hair at the top of the head also thins, often progressing to baldness. In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman's hairline rarely recedes, and women rarely become bald. 

Oral immunosuppressants, like methotrexate and cyclosporine, are another option you can try. They work by blocking the immune system’s response, but they can’t be used for a long period of time due to the risk of side effects, such as high blood pressure, liver and kidney damage, and an increased risk of serious infections and a type of cancer called lymphoma.
Onion - A study published in the Journal of Dermatology examined the results when onion juice was used in people with alopecia areata. Twenty-three people applied onion juice directly to the scalp twice daily for two months. Participants began to experience hair growth after just two weeks of treatment. At four weeks, hair regrowth was seen in 17 people and at six weeks, hair growth was apparent in 20 people.
About one-third of women experience hair loss (alopecia) at some time in their lives; among postmenopausal women, as many as two-thirds suffer hair thinning or bald spots. Hair loss in women often has a greater impact than hair loss does on men w, because it's less socially acceptable for them. Alopecia can severely affect a woman's emotional well-being and quality of life.
Men may also experience some sexual and emotional side effects while taking it: In a study published in the June 2011 issue of The Journal of Sexual Medicine, Dr. Michael Irwig of George Washington University found as many as 92 percent of test subjects reporting problems in the bedroom. The study also reported that “the mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months,” meaning that side effects lingered long after subjects stopped taking the pill.
I have recently noticed my hair thinning about a year ago. I was 19 when it stated and I am now 20. I have seen well over 10 different doctors including dermatologist, gynecologist and your normal everyday doctor. They have done thousands of dollars worth of blood work on me and they have yet to figure out what is going on. I went from loosing 20 hairs a day to 100 and talk about wanting to cry every night. I have lost over 50% of my hair and everyone including my parents blow me off like it completely normal. My doctors have strung me out in every medicine and when that didn’t work they thought it was all in my head. They told me that it’s normal to lose hair and that it will eventually stop. I’ve had doctors laugh and blow me off, I’ve had doctor to prescribe me depression medicine and a psych. I feel like I’m alone and no one understands what I’m going through. I went from being the funny outgoing person who didn’t care what people think to a self conscious and antisocial person I don’t know. It’s been the worst year of my life, sometimes it feels like a nightmare. I just hope the next doctor I see will give me hope that one day I’ll have my think pretty long hair that I use to have.

I have been amazed and appreciate alot of peoples’ comments and experiences on hair loss. I recently found out that i have PCOS through an endocrinologist. I went in for an infertility consultation. Still working through that. I do have thinning hair on the top of my head and my hair has become really dry in general. I have type 4b/4c hair (kinky/tightly coiled). With PCOS you have to treat each symptom. I am wondering, if i am focused on infertility right now, am i also able to check in with a dermatologist and treat both? It seems likely that the answer is no. Just curious if anyone is going through this or has gone through this and can give any helpful advice.

Hello Ladies. I love this site. I will be brief. I have only been to 1 Endo and they told me my glucose was pre diabetic but that my TESTOSTERONE was too high. Not over the line but right there. He put me on the cure all of metformin but I haven’t taken it yet. I am trying to lower my testosterone by diet and exercise and also watching everything I eat. Its not doing much but I have been doing this for about a month now. The holidays kill me with wine, coffee, and sweets. I have read the reviews and will probably pick up that book but also hit another endo and a dermo. You guys keep the faith. PS In Houston. Any suggestions on a dermo or endo you like, shoot them my way.

Aside from the falling hair, I’m also experiencing bouts of arrhythmia. There are instances when my heart would beat slowly and it feels like it’s going to break my ribcage. It’s hard to breathe and I get dizzy. Do you think these are related? I don’t want to go to another doctor yet because I haven’t researched yet and because of my many disappointing experiences with them, I would never dare to consult with one without knowing anything.


PCOS or Polycystic ovary syndrome is an imbalance in male and female sex hormones. An excess of androgens can cause ovarian cysts, higher risk of diabetes, weight gain, changes in menstrual period infertility and also hair thinning. Because male hormones are over-represented in polycystic ovary syndrome, women may also experience more hair on their body and face.
Oops forgot to mention also went to Dermatologist who said it is probably just stress related but I really don’t stress ever. I am going back for a scalp biopsy just to be sure nothing going on there. I did lose 12 kg over a 15 week period last year (ending about May – hair loss started in July) but it was done properly eating well and just increasing my exercise level so not sure if this is related other than that I am totally lost as to why I am BALD.
Eva if you can look at some of Pilar’s post she mentions in one of them a dr she sees in NYC. She loves her and the dr has done a lot for her. I would say there is no doubt it is the Retin A that has caused your loss, but it is probably Telogen Efflivium which is temporary and the recovery is nothing like they say it is. Especially if your scalp is miserable because there is a lot of inflammation that will need to calm down before everything can reset itself. Please try to find her post where she list the derm she sees. She loves her.
A separate study, published in Skin Therapy Letter — a professional reference site for dermatologists — found that women also benefit from using the more potent 5 percent minoxidil treatment. “Patient-reported improvement in hair volume and coverage appears to be greater with 5 percent minoxidil foam,” reads the report. Plus, because the 5 percent treatment is stronger, women only have to apply it once a day to get the same results as they would with the 2 percent treatment applied twice daily.
Mistakenly thought of as a male disease, around 40% percent of women will suffer from some form of hair loss by the age of 50. A woman’s hair is an important part of her aesthetic make-up. It represents her style and taste, and frames her face while accentuating her best features. Unfortunately, most physicians don’t have answers or solutions for women who begin to lose their hair.  Plano, TX hair restoration surgeon, Dr. Joseph Yaker, understands that this can be extremely catastrophic to a woman’s self-confidence, body image and quality of life. Clinical studies have shown that psychiatric disorders such as depression and anxiety are more common in people with hair loss, especially women.
×