Dr. Lynne Goldberg, a member of the Dermatology faculty at Boston University School of Medicine and Associate Professor at the institution, divides her time evenly between the practices of dermatopathology and clinical dermatology. She has a special interest in alopecia, or hair loss, and runs the Hair Clinic at Boston Medical Center. Below, Dr. Goldberg lends her expertise to address some commonly asked patient questions regarding hair loss, and to shed light on a topic that is both perplexing and distressing for many men and women.
DermHub: What is normal hair loss and when should I be concerned about excessive hair loss?
Dr. Goldberg: It is estimated that people lose up to 100 hairs daily. This is most evident when brushing and in the shower. Hairs grow in a cycle, and periodic shedding of the hair shaft is normal. If the amount of shedding is persistently increased, one should consider seeking an evaluation.
DermHub: What are the most common causes of hair loss?
Dr. Goldberg:The most common cause of hair loss is genetic, and is called male and female pattern alopecia. This can be inherited from either side of the family, and not all affected individuals have a positive family history. There are many other causes of hair loss. Some are temporary, such as telogen effluvium, a shedding state following a major event such as pregnancy, illness, etc. Others are permanent, the so called “scarring alopecias”, such as discoid lupus erythematous.
DermHub: Can the pattern of hair loss clue you in as to why it is occurring?
Dr. Goldberg:Absolutely. A doctor experienced in the evaluation of hair loss will take a detailed history and examine the scalp, looking for the pattern of hair loss and presence or absence of inflammation. Hair loss can be scarring or nonscarring, diffuse or patchy. Unfortunately some types of alopecia have overlapping clinical features, so the exam is not always diagnostic.
DermHub: Will I continue to lose my hair until I am bald?
Dr. Goldberg:It is difficult to predict the outcome of alopecia. Male and female pattern alopecia progresses over time, and is usually worse in men. Women typically become thin, but do not go bald. Certain types of alopecia, such as alopecia areata, cause patchy hair loss, and, when severe, can progress to total baldness.
DermHub: I have made an appointment with a dermatologist to discuss my hair loss. What questions might my doctor ask me during the first visit?
Dr. Goldberg:Your doctor will want to know about timing [when did your hair loss begin? how fast has it progressed?], quality [does it fall out in clumps? from where are you losing most of your hair?, and duration of the hair loss [how long have you been losing your hair?]. Your doctor will also want to know about your general health, diet, medications, family history of hair loss, and recent potential precipitating events.
DermHub: What treatment is available to stop the progression of hair loss?
Dr. Goldberg:Hair loss itself is a symptom, not a diagnosis. Treatment is individualized to the specific type of hair loss and can be aimed at slowing the hair loss, re-growing the hair, or preventing further loss, depending on the diagnosis.
More about Dr. Lynne Goldberg: Dr. Goldberg completed medical school at Downstate Medical Center in NY, and then went on to complete residencies in both Internal Medicine at New York University and Dermatology at the Albert Einstein College of Medicine. She relocated to Boston in 1992 to train in Dermatopathology at Boston University under Dr. Jag Bhawan. Following her fellowship, she joined the Dermatology faculty at Boston University School of Medicine, where she is currently an Associate Professor. She divides her time evenly between the practices of dermatopathology and clinical dermatology. She has a special interest in alopecia, and runs the Hair Clinic at Boston Medical Center.
Dr. Lynne Goldberg
Associate Professor of Dermatology and Pathology and Laboratory Medicine
Boston University School of Medicine
Director, Hair Clinic
Boston Medical Center