“Is Your Hairline Raising As A Woman? You Need To Intervene Quickly”: Dermatologist And Hair Surgeon On Hair Loss In Women And What Can Work

In this short series of articles, HLN investigates what you can do about hair loss. They answer questions that readers have sent in themselves. Last week it was their male readers, this week they answer the questions of their female readers.

“We also get quite a few questions about hair loss from women,” says dermatologist Stefanie Bracke, whose patients include Gert Verhulst. “While men usually have genetic hair loss, women have different types of conditions. There are solutions for most types, but people sometimes have difficulty getting to a dermatologist because of the long waiting lists. We are also seeing more and more so-called aesthetic hair practices springing up, often with doctors from other disciplines who also want to make money from the urgent demand for help with hair loss. Prescribing medication doesn’t earn them much, which means they have to promote other commercial matters such as expensive hair fillers or laser therapy. Unfortunately, these kinds of things are not always based on scientific research and don’t help the patient any further. That’s why my advice is still to contact a certified dermatologist.”

What is the best treatment to slow or stop frontal fibrosing alopecia? (Hilde)
“First of all, it is important to explain what FFA or frontal fibrosing alopecia is,” says Bracke. “This is a hair disease in which the hair falls out at the hairline. The hairline slowly recedes as a result, giving you an increasingly large forehead. A typical symptom here is redness and flaking in the hairline. We do not know the cause of the condition very well. We do know that it is the body's own immune system that attacks the hair follicles, but we have no idea what the exact trigger is.

“The most efficient way to treat FFA is often with cortisone. We usually prescribe a lotion that can stabilize the hair loss. We can also prescribe anti-malaria medication. That may sound strange, but we know that medication such as plaquenil or hydroxychloroquine can counteract immune-related disorders. Please note that with medication we can only slow down or stabilize the hair loss. It is not possible to get the hair back. In those places, the FFA has caused scar tissue and hair can no longer grow back. So it is important to act quickly.”

I am 47 years old and in perimenopause. Could that be the reason I am losing so much hair? (Bella)
“That is certainly possible. You should know that the hormone estrogen extends the growth phase of your hair and strengthens your hair follicles. During and around the menopause, however, the amount of estrogen decreases. In people who are sensitive to this, the hair can suddenly fall out a lot. In addition, you can also get hair in unwanted places, such as your chin, because at the same time the male hormones or androgens become relatively more dominant. If you really suffer from this, I advise you to discuss it with your dermatologist or gynecologist. It is possible to do estrogen replacement. We then give estrogen in the form of a pill or gel to reduce the symptoms.”

I have been using minoxidil spray for a while now, but it doesn't seem to work. Are the pills better? (Isabelle)
“Minoxidil is a medicine that we use for various types of hair loss in both women and men. It improves the blood flow to the hair follicles and thus stimulates growth. It does not work on the real cause of the hair loss – usually something additional is needed – but it can give your hair growth a little extra. Some studies show that the spray and pills would work equally well, but in practice I see a clear difference. The pills usually work much better. That is because your body has to make a little more effort to absorb the spray. You need the enzyme sulfotransferase for it. Not everyone has enough of that enzyme in their scalp, which sometimes makes absorption difficult. We also notice that compliance with a pill is often higher than with a spray, which could also explain the difference. A pill can have side effects more quickly. Think of hair in unwanted places, a drop in blood pressure and palpitations. But if we build up the dose very gradually, we see that the latter two hardly occur.”

Is it true that taking collagen powder together with vitamin C helps against hair loss? (Nathalie)
“Collagen is often promoted as the cure-all for stronger hair and nails, but there is very little scientific evidence for this. It may give your hair a little boost, but it will never address the entire cause. The same goes for vitamin C. It is not dangerous in normal doses, but it will not have a major impact on your hair either. What is more important is that you have a diet with sufficient protein, iron and zinc. I believe this will give your hair growth a bigger boost than all those supplements.”

"Women with hair transplants are becoming more common. These are women with receding hairlines, or women who naturally have a higher forehead."
Bijan Feriduni, Hair Surgeon

I am currently taking a course of Cystiphane on the advice of my gynaecologist, but I do not notice much difference. What else can I do? (Sharon)
“Cystiphane is another nutritional supplement. It contains the amino acid cystine, vitamin B6 and zinc. If you have a deficiency of these, this supplement can help to restore your hair. If that is not the case, it will be of little use. That is why it is so important to have a diagnosis made by your dermatologist. He or she can perform a blood test to see if there is a deficiency or perform a trichoscopy (an examination with a digital magnifying glass with built-in (polarized) light, to get a good view of the scalp and the base of the hair, ed.) to study your scalp in detail. If we know exactly what is going on, we can start a targeted treatment. Otherwise you are treating haphazardly.”

Can I also get a hair transplant if my hair loss gets worse? (Viviane)
“That is certainly possible, and it is also happening more and more often,” says doctor Bijan Feriduni. He specializes in hair transplants and has helped ex-cyclist Niels Albert and actor Rik Verheye, among others. “We are talking about women with receding hairlines, or women who naturally have a higher forehead. In men, we have to implant the hair over a large part of the skull. In women, this is done much more subtly. We have to lower the hairline ‘only’ two to four centimeters. We take the facial balance into account. After all, the new hairline has to continue to look natural. The cost depends on the number of grafts we have to use. A graft is a piece of skin tissue with one or more hair follicles. In Belgium, the price is on average between 4,000 and 12,000 euros, excluding VAT. This usually includes the intake interview, the treatment itself and the follow-up.”

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