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Dealing with Hair Loss

Q&A with Lynne Goldberg, MD

Lynn Goldberg

Dr. Lynne Goldberg, a world-renowned expert on hair loss, started at Boston City Hospital (now BMC) after completing a fellowship in dermatopathology at BU School of Medicine. In addition to seeing patients, Dr. Goldberg looks at slides of tissue samples in the lab to diagnose patients both locally and nationally. As director of BMC's Hair Clinic, Dr. Goldberg describes what causes hair loss and how it can be treated.

Q. What is alopecia? How common is it?

A. Alopecia is the medical term for hair loss. There are many different types of alopecia, some of which are common and some of which are rare. The most common form of hair loss in both men and women is pattern alopecia, or common baldness, which is genetic.

Q. What causes alopecia ?

A. Alopecia has a multitude of causes. They are divided into two groups – non-scarring and scarring (also called cicatricial). The most common cause of non-scarring hair loss that I see is genetic, which is due to an inherited susceptibility of certain hair follicles to normal levels of male hormone (androgen). Alopecia areata is an autoimmune disease which causes patchy and sometimes complete hair loss. Transient hair loss can follow a major stressful event, such as birth of a child, an illness or surgery. Scarring alopecias result in destruction of the hair follicle and are permanent. The exact cause of these uncommon disorders is unknown.

"I see approximately five times as many women as men, and I think that is mostly due to the prevalence of female pattern hair loss."

Q. What types of treatments are available for people with alopecia? Is normal hair growth restored or will patients continue to lose their hair?

A. This depends on the type of alopecia that a patient has. Some patients need to change their styling techniques, while others will need to use topical medications. Some require injections of steroids into the skin, while those with more severe types require oral medications. Treatments are not a cure, however, as many work to help slow symptoms and slow further loss, but do not completely stop it or reverse it.

Q. While many people think that hair loss only affects men, your practice tells another story. What percentage of your patients are women?

A. I see approximately five times as many women as men, and I think that is mostly due to the prevalence of female pattern hair loss. While male pattern hair loss is equally or even more common than female pattern hair loss, the population is generally aware of it and many men do not seek treatment. Women are often unaware of the existence of female pattern hair loss, and tend to seek care for their hair more often than men. There are other types of alopecia that are more common in women as well, which likely contributes.

Q. You also are trained in dermatopathology, which means that you diagnose skin disorders by looking at skin samples under the microscope. What made you interested in that?

A. I became interested in the dermatopathology of alopecia many years ago, when we had a visiting lecturer who, luckily for me, happened to have a home on Cape Cod. He pioneered a new way of processing skin biopsies for alopecia. After learning from him, I taught our lab to use this technique, which has revolutionized the histopathologic diagnosis of non-scarring alopecia. This technique allows pathologists to count the actual number of hair follicles in the specimen and offer a more accurate diagnosis, particularly for non-scarring alopecia. I was so excited by this that I lecture nationally, teaching others how to do it; it has now become standard practice in many dermatopathology laboratories.

In addition to diagnosing alopecia, I also examine slides of skin samples to diagnose a wide range of skin diseases and cancer. I very much enjoy the combination of clinical care and research that I get to do as a dermatopathologist.