A dermatologist shares best practices for hair and scalp care, including how to prevent and treat hair loss.
Curious about why we lose our hair? This week on Health Matters, dermatologist Dr. Shari Lipner returns to the show to share tips on maintaining a healthy head of hair and preventing hair loss. The most common type of hair loss affect 80% of men and 50% of women. She explains various causes of hair loss and walks listeners through treatments that she recommends to her patients. She explains the studies and debunks myths around popular supplements that promote hair growth.
Dr. Shari Lipner is board certified in dermatology and has a wide range of clinical experience in the diagnosis and management of skin, hair, and nail disorders. She is one of the few experts in nail disorders in the world, and treats patients with nail psoriasis, nail fungal diseases, brittle nails, and nail cancers. She is also one of the leading researchers in dermatology. She has authored over 400 peer-reviewed publications, numerous books and book chapters, lectures nationally and internationally, and is frequently featured by the media including CNN, NPR, Self, Allure, The Washington Post, and The New York Times for her expertise.
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Dr. Shari Lipner: There's a lot we can do in terms of maintaining healthy hair, but to clarify, I don't think that just doing these things may prevent all types of hair loss. So some of it is inflammation, autoimmune conditions, infections, genetics, luck. But in terms of our daily lives, sure there's a lot of changes we can make, and there are really some great treatments out there.
Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from New York Presbyterian. I'm Courtney Allison.
Whether it’s on your hair brush or in the shower drain, it’s normal to shed hair. But as we age, our hair follicles change, and we may start to notice more hair loss than before.
This week, we talk to Dr. Shari Lipner – a dermatologist at NewYork-Presbyterian and Weill Cornell Medicine – who explains why hair loss happens, effective treatments to combat it, and if supplements for hair health actually help.
Dr. Lipner, Welcome back to Health Matters.
Dr. Shari Lipner: It is great to be here Courtney.
Courtney: We always love having you on the show, and as a dermatologist, you’ve helped explain how to keep our skin healthy. But today, we’re going to tackle another issue that so many people struggle with: hair loss. Can you explain what causes hair loss?
Dr. Shari Lipner: Hair loss is complex, right? There's many different hair loss types. There's hormonal causes. So the most common cause of hair loss is androgenetic alopecia. We think this is related to hormones, genetics, environment, and this affects 80% of men and 50% of women.
But there's other types of hair loss. So telogen effluvium is a common type of hair loss that follows a stressful event. And this could be the death of a loved one, this can be hospitalization, this can be childbirth. And what happens with telogen effluvium is the hairs, which are normally in the growing phase, they go into telogen which is the phase where they fall out. But the good news with telogen effluvium is when the stressor is gone, the hairs come back.
Lately we're seeing a lot of this with weight loss or weight gain. And so for instance, if someone has bariatric surgery, and they lose a hundred pounds, we'll often see a telogen effluvium happen. And now with a lot of the GLP drugs, we're seeing this commonly. And our group and other groups have looked at this, and mostly the GLP types of hair changes tend to be the, the telogen effluvium, but there also may be an effect of the GLP on the most common type of hair loss androgenetic alopecia. So it may be doing two things, but the jury's still out and there's still studies being done, so we're learning more about what GLP does to hair.
Courtney: That's so interesting to hear how hair loss has been associated with GLP-1s and other weight loss drugs like Ozempic and Wegovy… You also mentioned phases of hair growth. What are those phases?
Dr. Shari Lipner: So there are three phases of the hair cycle. There's anagen, which is the growing phase, and the majority of hairs are growing. But they may be in different stages or growing at different rates, especially hairs on the scalp versus let's say the eyebrows or the eyelashes, right?
So the hair on the scalp keeps growing. But for the eyebrows and the eyelashes, usually they stop after certain points. And then there's the catagen phase, which is a resting phase.
And then finally there's the telogen phase, which is a part of that telogen effluvium that we spoke about. And with telogen, the hairs will shed.
Courtney: How do you typically treat hair loss?
Dr. Shari Lipner: The first step is diagnosis, and that's why I can't stress the importance of seeing a board certified dermatologist and not just trying to diagnose yourself and trying this supplement or that supplement. Because we have so many different types of hair loss and they are all treated differently.
If we're talking about the most common type of hair loss, androgenetic alopecia, we have a lot of options. One example of a drug we use commonly to treat androgenetic alopecia is topical minoxidil, and we can use that in both men and women. Believe it or not, topical minoxidil is over the counter.
There's 2% and there's 5% formulations, and there's solutions, and there's foams. In general, the 5% works better than the 2%. So I tell patients to get the 5%, either the solution or the foam. And the indication is to apply it twice a day, but it's hard to do. So I think reasonably, I think people can apply it, you know, one time a day and still have good effects.
Courtney: Do people have to stay on it long term or is it something you can be on for a little bit, and it's treated?
Dr. Shari Lipner: So I get that question a lot and people don't always like my answer, but I think when I explain it, they're okay with it. You know, most things in medicine and most things in dermatology are chronic diseases. If we have a strep throat, we can give an antibiotic and eradicate it, right?
But if we think about things like hypertension or diabetes, generally people have to be on a daily medication. And if they stop their medication, their issue is gonna come back or it's gonna be out of control. And so with hair loss really, we want to preserve the remaining follicles. And so once those follicles die, right, there's not much we can do.
When patients think about it like that, I think they're okay with using it more long term. So, you know, yes, I, I think it has to be maintained unless the patient is switched over to a different medicine. But that goes for all the hair loss drugs. It's not like you take it for a month and you're done with it. You have to take it continuously.
Courtney: So it sounds like minoxidil is an effective medication for hair loss. And I know a lot of people also take supplements for hair, nail and skin health. Are there any scientifically proven supplements that support hair health and growth?
Dr. Shari Lipner: Probably one of the most common supplements out there is the supplement biotin. We don't synthesize biotin. However, we can get it from our normal diets, so things like meat, fish, eggs, nuts, dairy products, some vegetables. We can get plenty of biotin from that, so we don't really need to supplement it.
When we really look at the data in terms of does biotin help hair, there's very few studies that looked at this, and in general, it did not show a benefit. And there have been two FDA warnings issued about biotin, because biotin can interfere with lab tests. and give false positives and false negatives.
Courtney: Yes, we talked a bit about biotin last time you were on the show, and that fact about how it can impact lab tests really stuck with me. Another supplement I’ve read about is pumpkin seed oil. Can you explain if pumpkin seed oil might support hair growth?
Dr. Shari Lipner: Pumpkin seed oil is packed with vitamin E, Omega-3 fatty acids and linoleic acid. So because of that, it theoretically has anti-inflammatory and antioxidant properties. We also know that if there's too much of the hormone dihydrotestosterone, it can contribute to hair loss.
And so there are some studies showing that pumpkin seed oil decreases these dihydrotestosterone levels, which could theoretically prevent hair loss and promote hair growth. And in this human study they had 76 men with hair loss, and they either received a pumpkin seed oil capsule, or a placebo capsule, and they saw that there was better hair growth in the group that had the pumpkin seed oil and better patient reported satisfaction.
There probably isn't enough data to support using pumpkin seed oil. There probably isn't a great harm in doing it though, but I think better to see a board certified dermatologist to get a diagnosis for your hair loss and then get an individualized treatment plan.
Courtney: Got it, thank you for breaking down that study. So what about collagen? That's another one we hear a lot about.
Dr. Shari Lipner: Collagen has been studied pretty well for skin aging, but in terms of studies for hair, there's not too many of them. And so just to give you a background, collagen is rich in amino acids. And it's essential for the production of keratin, which is a key structural protein in hair. And there's only one study that looked at this.
And so in this study, they looked at patients with two types of hair loss, so hormonal type of hair loss, androgenetic alopecia, as well as a stress induced hair loss. Telogen effluvium, and they gave these people collagen, but they also gave them a whole series of other supplements such as taurine, cysteine, methionine, iron, and selenium.
And these patients also got their regular treatments prescribed by the dermatologist. And there did seem to be some improvement with this concoction, including collagen along with the other treatments. So again, it's not a very clean study. Probably this is not enough to go on for me to recommend it to my patients, but maybe.
Courtney: So we've talked a lot about how to treat hair health issues and I'm curious how we can best take care of our hair and hopefully help prevent these issues before they occur. What are your best practices for maintaining healthy hair?
Dr. Shari Lipner: There's a lot we can do in terms of maintaining healthy hair, but to clarify, I don't think that just doing these things may prevent all types of hair loss. So some of it is inflammation, autoimmune conditions, infections, genetics. But in terms of our daily lives, sure there's a lot of changes we can make. There's a lot of practices we can follow. So for example, when we're getting out of the shower, you may have a tendency to really rub the scalp to dry it off, but that's not necessarily the best thing for your hair.
And so it may be better to wrap a towel, uh, around the hair, to absorb the water or let your hair air dry if you have time or set the blower on a cooler setting rather than a hotter setting. If you are gonna blow out your hair, sometimes limit it, uh, try not to do it more than once a week.
Other things we have to think about are hair weaves or hair extensions. They look amazing, right? But, they're heavy. You know, go through periods where you don't have an extension in.
And then we also have to think about chemicals that touch our hair. I'm not telling people if they wanna have, you know, blonde red or brown hair or black hair to, uh, keep it white or gray, but do your best to, you know, do it a little less often if you can try to stretch the time in between treatments.
If you're brushing your hair, you may want to let it dry a little bit until it's damp, before combing it or brushing it. And typically using a wide tooth comb is healthier for your hair. You know, there’s a myth that you have to brush your hair a hundred strokes a day to keep it healthy, not true. Brush it as, as needed to untangle it or style it, but certainly I wouldn't count your a hundred strokes.
Courtney: And any just parting advice on how we can all just take care of our hair and scalp as long as we can?
Dr. Shari Lipner: I think the most important point is hair loss is common. Hair is important to the vast majority of people, and there is help for it. I don't think you should do it yourself. I don't think you should look at social media for the answer to how to treat your hair loss. But a board certified dermatologist is trained in diagnosing and treating hair, and there are really some great treatments out there.
Courtney: Dr. Lipner, thank you for coming back on the show to talk to us about hair loss and what people can do if they're concerned about it.
Dr. Shari Lipner: Courtney, it's great to be here and to help to educate the public about hair health.
Courtney: Our many thanks to Dr. Shari Lipner. I’m Courtney Allison.
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The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Lipner’s work with patients, check out the show notes.
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