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Dr.Rassman, you have written that it is common to lose between 100-150 hairs per day. You have also stated that it is common to see a lot of these hairs when showering as you loosen dead hair follicles and hairs trapped with styling products. In a recent post (Oct.27th) an individual wrote in regarding his shed high shed count. You asked if he had noticed area specific shedding - ie. top of the head as opposed to the sides or back as this could be an indication of genetic balding. I wonder if you could elaborate on this for me.

I too have high shed counts and have for years now, I would say on average I lose between 60-80 hairs per shampoo session - over 100 if I go days without washing my hair. I also use a heavy, sticky texturing salon product and frequently wear a hat all day long if I haven’t kept up on the shower regimen. So whenever the alarm bells sound as I get the old hairy palms in the shower I chalk it up to those factors and try to accept my precious follicles washing down the drain. This is difficult because you’re never quite sure if this is “normal” or early signs of hair loss.

When you spoke of area specific loss this got me interested. I have noticed when shampooing that the vast majority of the hair that comes off on my hands originates from the front/top of my scalp. Assuming that shedding is within the normal range does this area specific loss still suggest pattern balding? Could there be other factors at play that would make hair loss appear greater in that area? Is it normal to shed more on top than the back/sides? Your insight on this issue would be greatly appreciated.

I concur, it can be difficult to determine whether you’re seeing just normal cycling or early signs of hair loss, but I really do not know the answer to your question. Your hair should shed evenly throughout your scalp, but it could be that you apply more of the sticky hair product to the top of your head for styling purposes and it traps the normal cycled hairs from falling. Couple that with not washing your hair for days,and you’ll notice the shed hairs will accumulate on your head. Then, of course, washing the hair will show the accumulation since the last wash. Wearing a hat will also increase the accumulation of shed hairs, which normally would blow away on their own.

Snippet from the article:

A Chicago-based company that claims its combination of laser therapy and scalp treatments can regrow hair is being sued for allegedly making false statements based on unsubstantiated scientific claims.

Atty. Gen.Lisa Madigan filed a lawsuit Tuesday in Cook County Circuit Court against Natural Hair Growth Institute, claiming the company has failed to provide consumers with full refunds for services that average between $8,000 and $12,000.

Read the full article — Lawsuit alleges hair growth firm’s claims are bald

From what I gather, a hair laser and snake oil sales clinic promised results in 6 months and offered a full money-back guarantee, of which they decided to conveniently disregard. They also falsely claimed that their laser was FDA Approved (in fact, none of the hair lasers are “Approved”). Now they’re being sued for the cost of the services plus $50,000 for each violation of the Illinois Consumer Fraud Act.

My scalp is very wrinkly, almost like a shar pei dog. What is this and how can I fix it?

This is called cutis verticis gyrata (CVG). The cause is unknown and there’s no known cure (though cosmetic surgery might be an option).

Basically, the condition is when a great deal of skin, far more than is needed to cover the skull, is generated by the body. I have seen a few mild cases of this condition and have written briefly about it a couple years ago. Look at Google for more examples.

Dr. Rassman,

We are repeatedly warned that traction alopecia results from pulling hair too tightly. What exactly constitutes “too tight?”

I have thick, long hair (to just above mid-back) and I use a hair-tie at about neck-level to keep it in a ponytail. With a hair tie, only the outer portion of the ponytail hair contacts the actual tie and thus supports the weight of the entire ponytail. For example, the hair at the front of my head and base of my neck often feel the brunt of the weight. Could this be this too much weight? I wonder how much of my thinning is due to years of wearing my hair like this in professional settings.

I assume that “too tight” refers to only to VERY tight hairstyles such as braids, dreadlocks and cornrows. Should I have reason to worry?

Are you losing hair along the outer rim of the pony tail area? If not, then don’t worry. It’s all a matter of perspective. I can’t put a number to it. If you feel excessive pulling, then don’t keep the hair that tightly pulled.

Hey Doc,

Since you live and work in Los Angeles, I’m pretty sure that you’re familar with the local sports scene. Having said that, I was wondering if you could comment on how many grafts it might take to fix Laker nemesis Manu Ginobili’s bald spot. He has balding in his crown area.

Above is a photo of NBA star and Olympic gold medalist Manu Ginobili playing his game for the San Antonio Spurs, and on the right is a shot of the crown area that you mentioned. If he is willing to use Propecia and his hair density is at least average, he may be a candidate for a hair transplant with 1000-1300 or so follicular units. It’s tough to give a better estimate since I’ve never met the man and the larger photos I’ve found don’t exactly zoom in on his hair. Considering that he keeps his hair shorter these days, FUE may be a good option for him.

I guess you weren’t alone in noticing his thinning crown, as I found this site.

Dear Dr Rassman:

I’m a 27 year old who has long suffered from Fibrous Dysplasia (I’m not sure if you are familiar with this disease). Due to my ailment, I have incurred over 30 medical surgeries over my lifetime. My hair was thick up untl high school, and then it really began to thin. The only ancestors of mine that have been bald were only two of my great-grandfathers. I was wondering if all of the major surgery I have had would have caused my hair loss. Also, I have been on propecia since November of last year and am having some back surgery next week. Would the shock of surgery or the medications used cause my hair loss to increase? Also, because I may be missing a couple of days of propecia doses would this affect the progress of the drug in combating my hair loss?

I’m familiar with fibrous dysplasia (it is a very rare bone disease), but I do not know what surgery you have had or what medications you take. Your question is very general and it is not something I can give you an answer to in this format. You need to see a physician and have a complete history and examination.

In most cases, hair loss in men is caused by genetics. If you have an autoimmune disease like a form of a scarring alopecia, surgery done in these conditions can be dangerous and produce failures of the grafts and further scarring of the scalp. Any medical illness or surgery that is a stress to your body can cause hair loss (sometimes permanent). But to distinguish that from genetic causes is something that only a thorough examination with a physician can provide. You are looking for a cause and effect type of relationship and I really cannot help you with the limited information I have.

I had cancer a couple years ago and it has left my hair much thinner then it used to be. where its has got thin the most is on the top of my head. the top of my head used to be the thickest part. Ive heard that going through chemo causes scarring. Is there anything out there i can take or apply to help with the scarring and/or maybe get my hair back to the way it used to be? or should i just do some minoxidil and hope for the best?

Chemotherapy does not cause scarring. What happens when the hair falls out secondary to the chemotherapy, is that as the hair population decreases, so does the blood supply. When we transplant those people who are balding, the blood supply is often lower than on those people who have a thick head of hair, but with transplants, for example, the blood supply comes back as the hair grows. I would have to examine you if you wanted an opinion on the status of your scalp and hair.

i have scalp acne or pimples its scattered all over specially the back of the head…im losing hair and im really depressed…i really don’t know what should i do ? and is there a chance that i could have my hair back ?? thanks

You need a doctor to make a diagnosis and then treat your problem. Hair loss associated with infections of the scalp is not uncommon, but this is when you need a good dermatologist to take charge of the problem. I don’t know enough about your case to provide any real comfort here. Sorry.

what is the normal eyebrow hair loss per day? what does alopecia areata look like in the eyebrow area? is it a sudden hair loss?

The eyebrow telogen cycle lasts about 9 months, so for hairs that fall out, it would take up to 9 months for them to return. I suspect that the growth phase is also shorter than scalp hair, possibly 3-6 months, which means that the growth of eyebrow hair occurs in short periods of time. We see the same with body and leg hair (long telogen cycles and short growth cycles). For more about hair cycles, see here.

The appearance of alopecia areata may occur in spotty areas or parts of the eyebrow. A biopsy of the edge of such spots of balding is the way to make the diagnosis. These patchy areas often start small and then enlarge.

Dear Doctor,

Are any parasites/worms connected with hair loss? If so, which ones?

Not that I know of, but the association of malnutrition with worms and parasites could cause hair loss or accelerate genetic balding.