What are the common causes of hair loss?
Hair loss, also known as alopecia, can be divided into two major categories. The first category of hair loss is temporary.  Medical causes of temporary hair loss can include:
• Changes in hormone levels caused by birth control, pregnancy or menopause
• Anemia or low iron
• Thyroid conditions
• Anesthesia
• Severe infection
• Crash dieting
• Seborrhea (seen as excessive flaking or dandruff of the scalp)
• Alopecia areata (a disorder where the immune system attacks hair follicles)
• Medications
•  Certain ways of styling and caring for your hair

Most non-scarring hair loss is reversible if the underlying problem is addressed and treated appropriately.
The second major category of hair loss is permanent. Causes of permanent hair loss can include:
• Genetic and/or hormonal predisposition called androgenetic alopecia (female pattern baldness)
• Systemic diseases such a lupus, lichen planus, and sarcoidosis
• Browlifts and facelifts
• Certain styling techniques like tight braids, ponytails, updo’s, tight buns or tract weaves
• Blow drying, excessive combing or brushing, use of curling irons or chemical relaxers or straighteners can also damage hair follicles

Long term tension on hair will eventually lead to breakage on the sides of hair strands.  Also be aware that tight ponytails on infants or young children over time can lead to damage of the hair follicles.  Permanent hair loss is caused by irreversible damage to the hair follicle.

Commercials and advertisements seem to warn us that our hair is constantly being damaged.  What degree of damage is irreversible?

Hair is not like grass.  If the follicles are permanently destroyed, they typically do not regenerate.  Harsh ingredients found in styling gels and sprays, as well as chemicals in treatments such as colorants, straighteners and perms can potentially damage the hair follicle and promote hair loss.  Abrasive ingredients like sulfates and sodium contained in thick gels and strong sprays may dry out and damage hair, prompting it to break when heat and styling tools are used.

Follicular Degeneration Syndrome (centroparietal scarring alopecia) commonly seen in the crown of black women is not clearly understood.  Once thought to be caused by overuse of hot combs, the syndrome was discovered in patients who had never pressed their hair.  One theory that persists is that constant damage to the hair and scalp over time may eventually lead to thinning, scarring and permanent hair loss in certain ethnic groups predisposed to hair loss.

If one of your patients experiences an inordinate amount of shedding and breakage, or notices bald spots, what type of professional help should he or she seek?

Because the causes of hair losses can be tricky to diagnose, I would recommend an initial visit to a dermatologist.  A thorough history will be obtained to rule out medical conditions that could contribute to hair loss, like recent surgery, metabolic diseases such as hypothyroidism, anemia, or underlying illnesses like ringworm, or lupus.  Your dermatologist will ask numerous questions about how you normally treat your hair and she might suggest a biopsy of a particularly affected area.

Provided the damage isn’t permanent, what can men and women do to alleviate hair loss?

Prevention is the number one key for avoiding hair loss.  Choose a stylist who emphasizes healthy hair over the latest fad or style.  Eat a balanced and nutritious diet rich in antioxidants (leafy green vegetables like bok choy, spinach, arugula, and broccoli), drink milk and eat other foods that are rich in calcium.

Many women who straighten or chemically relax their hair may have several textures of hair on the scalp.  A good stylist will recognize this and may opt to relax different areas of the scalp on different schedules.  Insist that solutions used for straighteners or perms are thoroughly rinsed.  Also consider opting to sit under the dryer for a longer duration at a lower heat setting, avoid excessive blow drying, curling with an iron or “bumping edges.”  Remember that as we age, we lose density in our hair.

To give your hair periodic breaks, regularly try to go a whole day without combing or manipulating the hair. Instead use the fingers or loose clips to style for the day.

Is the incidence of hair loss on the rise, specifically among black women?
Yes and for a variety of reasons.  The current trend of using straighteners and perms at an early age (some as early at 5-6 years old) is placing many young women in jeopardy for future hair loss.  Also, our culture’s obsession with tract, weave/’quick’ weave, sew or glue in, and extensions can place our healthy hair at great risk for breakage, especially during application and removal.

Remember:  Good hair is healthy hair.