Hair loss makes you feel powerless and honestly, scared. It’s an awful thing to have to experience, but luckily there are things you can do to keep your hair from shedding and begin the journey to regrowth. One treatment that dermatologists swear by is cortisone shots. We checked in with Dr. Michelle Henry, board certified dermatologist who specializes in Mohs micrographic surgery, laser surgery, and cosmetic dermatology, on why the shots work and a breakdown on hair breakage.
View this post on Instagram
Breakage v. Shedding
Probably the most important thing to determine if you’re experiencing abnormal hair fall is where the hair is breaking from. If you can see a white bulb at the start of the hair follicle that means the hair is falling out from the scalp, at the root. This means there’s an internal issue going on, and there could be many reasons causing it. If you don’t see that bulb, chances are you damaged your hair (either though a chemical process or even through stress on the hair, like pulling it into a high pony). While this is far from ideal, hair breakage is external, which means you can treat it with an external solution (such as Olaplex, regular trims, and taking it easy on the heat styling).
If it’s internal, you have to determine the cause. Doctors will routinely begin by performing a blood test to find out if you are lacking a vitamin, suffering from a hormonal issue, or if an autoimmune disease is potentially to blame. A dermatologist can also study the hair under the microscope to determine where the hair is in the cycle of growth (there are three primary phases, one of development, growth and then hair fall). The amount you shed is also crucial to determining if there’s truly an issue—losing more than 150 hairs in one day is considered irregular. It may sound gross, but Dr. Henry recommends collecting the hair over two days to really quantify it. “It may be tedious, but collect each hair so you can determine how rapidly you’re shedding,” she advises.
If it’s shedding (falling out at the root) versus breaking that’s something called telogen effluvium, explains Dr. Henry. “It’s a type of hair loss that can be triggered by anything, from stress, new medication, not sleeping enough—anything that’s a metabolic stress on your body can cause your hair to shed,” she continues. If it’s breakage you can expect to just see fragments of the hair, as chemical processing can “destroy the bonds of the hair, making it less prone to hydration, which is why it might snap and become too dry,” Dr. Henry says.
View this post on Instagram
Treating Telogen Effluvium
What do you do if it’s telogen effluvium? Dr. Henry notes that ultimately, the best option is to just wait it out. In the meantime, she recommends vitamins like Nurtrafol: $79/month. Nutrafol contains ingredients called adaptogens, which can reduce stress.
Cortisone Shots for Regrowth
Sometimes, Dr. Henry will opt for cortisone steroid injections, but this is actually not that common. “Usually, I will use them for conditions with inflammation like traction alopecia or pulling, where the hair is falling out from pulling. Or with Central Centrifugal Cicatricial Alopecia, where there’s inflammation at the top of the scalp, that’s where we would inject to reduce inflammation,” she notes, adding that it can sometimes help with telogen effluvium.
Cortisone works by reducing inflammation. When there’s inflammation, there are immune cells, and these immune cells are disturbing the hair follicle and preventing it from focusing on growth. “So, if you can get rid of that inflammation than the hair follicle can do what it’s meant to do, and that is grow. That’s an option,” she continues.
If scalp inflammation is not an issue, again, there are many things that can contribute to hair loss, from a thyroid issue to low iron and vitamin D. “There are a lot of metabolic conditions that can cause it, and we even check for infections such as syphilis, which can cause hair loss,” Dr. Henry explains, noting that there could be metabolic, nutritional, infectious and hormonal reasons for hair loss.
“We’re more invested in our hair than our body is,” she says. “For our body biologically, hair is superfluous. So whenever we’re under excess stress, the body is not going to save our hair because it needs to save all that other energy for more important organs—and it’s just growing quickly. Anything that is regenerating so rapidly is going to have more loss than something we need over the course of our entire lives,” she explains.
If cortisone injections are used for hair loss, Dr. Henry recommends them monthly. Red light therapy can also be helpful for hair regrowth. Otherwise, she recommends shampoo and conditioning with Ducray Anaphase: $26 each and beginning a Minoxidil treatment, which is the leading compound in Rogaine: $44.97.
If you suspect abnormal hair loss, speak to your derm and get to the root of it.