Ask the experts…alopecia and hair loss

According to the Belgravia Centre, 94% of women are worried about hair loss. Alopecia Areata affects two in every 1,000 people in the UK, while 6.5 million men live with male pattern baldness and around 50% of women aged over 65 have some balding.  

It's incredibly common - but that doesn't mean it's not alarming when it happens to you. Lots of our members live with hair loss and we know just how detrimental it can be to confidence and body image. 

That's why we teamed up with the British Skin Foundation for a clinic on hair loss and alopecia. We were joined by consultant dermatologists Dr Anton Alexandroff, Dr Kapil BhargavaDr Nevianna Bordet, and Dr Sharon Wong.

Below are some of the best questions and answers from the clinic:

Will the hair on top of my head ever grow back? I was told to stop using my pregabalin medication by fibromyalgia specialist as she thought this was the cause, but five years later, it’s not grown back.

Dr Bordet: Hair loss can be a side-effect of some medication and typically recovers within a few months of stopping the medication if this is responsible. If, after five years, you still have hair loss, it may be due to another cause. I would recommend you see you doctor so that a thorough history and examination can be performed to determine the cause and nature of your hair loss. Without this, it is impossible to say if it will ever grow back.

I have frontal fibrosing alopecia and my hair is very thin and still coming out. I’m also on HRT. I’ve tried Etrivex shampoo that the doctor prescribed for a short while - are there any other over-the-counter shampoos you recommend trying? And is it safe to colour my hair if I use a dye without ammonia, or will it exacerbate my hair loss?

Dr Wong: If you have been diagnosed with frontal fibrosing alopecia (FFA), I would advise that you are referred to a dermatologist for ongoing care. As this is a form of scarring alopecia, usually long-term maintenance medical (rather than over-the-counter) treatment is required to stabilise the condition and prevent further hair loss. Sometimes this may simply be topicals but occasionally treatment needs to be escalated and injections or oral medications may be required to keep the inflammation under control.

In terms of hair colouring, if your scalp is not reacting to the product there should be no issues and it shouldn't exacerbate the FFA. However, repeated use of chemicals/dyes can gradually weaken and damage the hair fibres. Purely from an aesthetic/hair fibre health perspective, it would be better to reduce the frequency of use of chemicals as much as possible.

I’m 59 and have had baby fine hair all my life. The top of my head has less hair than the rest of my head and a bit of a bald patch. For years, I suffered from PCOS and for the past few years, I have had type 2 diabetes and B12 problems which I take medication for. What can I do about my hair loss?

Dr Wong: It sounds like the pattern of hair loss you have would fit with female pattern hair loss FPHL (the female version of male pattern balding) which is prevalent in women from the 4th decade onwards and is slowly progressive. The menopause and a history of PCOS may also exacerbate this pattern of hair thinning.

Whilst hair fibres are great as a cosmetic camouflage, there are medical treatment options that may help to slow down the progression of thinning and in some cases can improve hair growth with long term treatment. At its simplest, this may be daily use of topical minoxidil; in other cases, oral medication may be required as well. If this is something you wish to pursue then I would advise you to arrange an appointment with your GP in the first instance +/- referral onto a dermatologist. Hair transplantation is also an option for FPHL but usually, surgeons would still recommend being on medical therapies to stabilise the condition in the long term.

From a cosmetic and hair care perspective, the choice of shampoos and conditioners may make a difference. Choosing "thickening" or "volumising" products which are typically amino acid-rich can help to bulk up fine hair. Try to avoid products that contain silicones that can weight down fine hair.

I was diagnosed with this type of alopecia in December last year, having lost my eyebrows a few years earlier. I was given Dermovate cream to put on my hairline once a day which I think has helped, but I am still losing hair. All my follow-up appointments this year have been cancelled. The hair at the front is very weak and I am very conscious of this and am finding it very difficult to get my hair to look good. Are wigs my only option?

Dr Wong: The priority with any scarring alopecia such as FFA is to ensure the condition is stabilised and progression is halted. This will usually require ongoing medical treatment. Depending on the severity, this may range from topicals to steroid injections and oral medications, and should be discussed with you by your overseeing dermatologist.

You are absolutely right to think about cosmetic solutions which I often recommend alongside medical treatments. As FFA mainly affects the frontal hairline, options will vary depending on how far the hairline has receded. They may include bespoke hair systems that cover only the frontal section, wigs or with many patients who have very mild hairline recession, having a fringe cut.

I've been suffering from hair loss for a number of years. It's most noticeable on the sides at the front, sort of above the outer edge of eyes and I've tried a couple of well-known products but neither has made any difference. I do have an underactive thyroid for which I take Levothyroxine but my doctor says this isn't the cause. Help!

Dr Bordet: If your thyroid tests show that the Levothyroxine tablets you are on are providing the correct amount of replacement for you, it is unlikely to be causing your hair thinning. Thinning over the parietal scalp (above your ears) and/or frontal hairline is common with age but can also be caused by Androgenic Alopecia. Although it can be seen at any age, it is more common after menopause as oestrogen levels decline and the hair follicle is sensitive to testosterone. Women start to thin in the areas on the scalp that usually present in balding men. Topical minoxidil can slow down this process. However, it is best that you are examined first as there can be another cause for the hair thinning in this area, such as Frontal Fibrosing Alopecia.

How can I reduce age-related hair thinning? My mother’s hair became very sparse and semi-bald. I'm 10 years postmenopausal and have thinning in the front of my hair.

Dr Alexandroff: It would be helpful to make sure that you are not iron deficient (your ferritin should be 70mcg/L or higher). Also, ask your GP for a thyroid function blood test from time-to-time.

About 20 years ago, I had breast cancer and chemotherapy. The regime I was on meant I didn't lose all my hair but only suffered a little thinning. However, over the past five years or so, I have noticed a considerable loss in the crown. Is there any treatment that will prevent further loss or even generate some regrowth?

Dr Alexandroff: Minoxidil (Regain) lotion and foam can both prevent further age-related hair loss and can even make hair thicker.

Every time I brush my hair there is a lot of hair on my brush. The left side of my hairline seems a lot thinner than on my right side. Is this something that I should be worried about?

Dr Wong: If this change in your hairline and the amount of hair shedding you are experiencing is new, then I would advise you to see your GP for an initial assessment and preliminary investigations e.g. blood tests to look for any underlying contributory factors like nutritional deficiencies or hormone imbalances. If this does not reveal any abnormality, I would then advise seeing a dermatologist who can assess your hair and scalp more formally and under magnification.

Which are the best vitamins to help slow down hair loss?

Dr Wong: In general, there is very little evidence to support that taking vitamins/supplements without having a deficiency in the first place is going to have any positive impact on hair growth. It would be best to arrange a blood test with your GP to include common deficiencies related to hair loss/thinning such as iron (ferritin), vitamin D and zinc and to only supplement where necessary.

A few clinical studies involving specific hair supplements such as Viviscal and Nourkrin which contain marine complexes have shown some benefit in helping patients by supporting a healthy hair growth cycle. These can certainly be tried if you have no allergies to fish/shellfish but if it does not improve your hair symptoms after 6 months, I would then advise discontinuing.

Are the use of dermarollers on the scalp recommended to enhance treatments?

Dr Wong: Dermaroller can improve the penetration of some topical therapies and is commonly used alongside minoxidil to enhance its effectiveness (although some patients also describe a higher risk of facial hair growth due to the enhanced absorption).

There is also some suggestion that dermaroller can potentially improve hair growth due to the micro-injuries caused by the dermaroller stimulating the skin's healing response. However, this does require more formal research.

I've suffered from hair loss for about 14 years, starting after the birth of my first daughter. My hair eventually stopped falling but never grew back. A few weeks ago I woke up with a bald patch on one side of my head and I'm really freaking out. I had a full blood test done last month, thyroid and anaemia included and all came back good. Can alopecia come and go?

Dr Bordet: You are describing two different kinds of Alopecia. The hair loss you experienced after pregnancy sounds like telogen effluvium and is quite common. However, it usually recovers within a few months. The recent bald patch would fit more with Alopecia Areata, an autoimmune condition that is not related to your previous episode of hair loss. Patients with Alopecia Areata often experience recurrent patches of hair loss that spontaneously grow back within a few months. Blood tests are usually normal as in your case. Treatment with a potent topical steroid preparation can help to speed up the hair growing back so it is worth seeing your GP or a dermatologist if the hair is not growing back.

My daughter has atopic eczema and since lockdown, her hair has been falling out. The eczema is so itchy at times that she’s lost her eyebrows through rubbing. She’s very self-conscious about starting college in September. She was diagnosed with a vitamin D deficiency three months ago - could that be causing the issue?

Dr Alexandroff: It happens in eczema due to rubbing. The best option is to control eczema and in such case hair usually grows back. Ask your dermatologist or GP if she can have Etrivex shampoo and for eyebrows - tacrolimus ointment - to control eczema.

Is there a reason for hair loss around the forehead and above the ears? This has happened in the last three months and there is no sign of new hair growth in this region. Could it be the result of hair colour? I have also lost my eyebrows and eyelashes. Is there a remedy available?

Dr Alexandroff: There are a couple of possibilities such as alopecia areata and frontal fibrosing alopecia. It would be helpful to see your dermatologist to make a correct diagnosis.

What options are available other than minoxidil for CCCA* which can be used at home?

Dr Alexandroff: I would start with a dermovate scalp application and if necessary, try tacrolimus ointment next. Oral medications can also be helpful (e.g. hydroxychloroquine, roacutane, ciclosporin and so on).

*Central Centrifugal Cicatricial Alopecia

I’m a type two insulin-dependent diabetic. I used to have thick hair now it hardly covers the scalp. What can I do to stop hair shedding?

Hair shedding is very common I am afraid. Common causes of hair shedding are low iron (ferritin below 70 mcg/L), abnormal thyroid function, stress, crash diets, new medications (within 6 months before hair shedding started), illnesses, contraceptive pills, pregnancy. Sometimes there is no cause found. I think a good start would be ask your GP to do your ferritin and thyroid blood tests.

Many thanks to our experts. You can visit the clinic here.

Information contained in this Articles page has been written by talkhealth based on available medical evidence. The content however should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands or treatments.

Information written by the talkhealth team

Last revised: 18 August 2020
Next review: 18 August 2023