Maggie McKay: When you think of someone losing their hair, usually we think of men, but women do as well for a variety of reasons, and it's concerning, but there are things to know about it and ways to lessen the anxiety that comes with it. I am so excited to welcome dermatologist, Dr. Tamar Zapolanski, who will fill us in on alopecia, preventing hair loss and so much more as we talk about the fact that women lose their hair. Welcome to Conversations like No Other presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children.

We think you'll enjoy our fresh take. Thanks for listening. I'm Maggie McKay. Thank you so much for being here. The timing couldn't be better because I have to tell you, Doctor, I actually am experiencing this very topic and I'm beside myself. My hairdresser can't explain it. I did not have Covid, and I'm thinking, does hair loss and women just come with age? So how much hair shedding is considered normal?

Dr. Tamar Zapolanski: Thanks so much for having me. So in response to your question about a normal amount of hair shedding there's actually a number that we turn to in dermatology, and it's somewhere around a hundred hairs per day for the scalp, I should specify. So the hair moves through different phases of growth, and as the hair goes through these both growth and resting phases. It is normal to shed around a hundred, on average hairs per day from the scalp.

Maggie McKay: And do hair treatments like coloring or straightening affect hair growth?

Dr. Tamar Zapolanski: So the answer to that is that if the treatment doesn't injure the scalp, hair treatments do not directly affect hair growth. Hair treatments like coloring the hair or even straightening the hair, it doesn't affect the root. Which is where the growing happens. It is true that too many hair, treatments and chemicals, which can maybe hurt the scalp itself, can result in a problem with the hair growth.

And the other thing to consider is that sometimes the treatment may damage, the longer dead part of the hair and can result in breakage. So this is important because the scalp hair, Peer thinner overall, even if it's not the actual growth that's being affected. So it is safe to do treatments to the hair, but it's a good idea to minimize the frequency to basically as little as is necessary to achieve the result that you want.

Maggie McKay: And what causes hair loss in women?

Dr. Tamar Zapolanski: So that's a great question because it's obviously not a simple answer. There are many different types of hair loss and the first thing to mention here is that for this reason, if you're experiencing hair loss, it's important to see a dermatologist so that you can be properly diagnosed before coming up with a treatment plan. Especially since there's so many, different over the counter treatment options available.

Hair loss can be, of course, genetic. But it can also be related to a medical problem or a medication that you may be taking. Very commonly we think of chemotherapy or cancer treatments as causing, hair issues. But even regularly taking medications can result in changes to the hair. It can be a result of a nutritional deficiency or there could be an autoimmune process going on. So we do have a wide variety of causes for changes in the hair.

Maggie McKay: How is hair loss type diagnosed? Do they do tests? Do they just look at it?

Dr. Tamar Zapolanski: So, there's a few different sort of tools in the armamentarium of dermatologists for diagnosing hair loss. And sometimes we require a comprehensive approach. So we need, to use more than one tool. We always start with a physical exam. So we look at the scalp, we see the pattern of hair. We also look at the condition of the scalp, and we take all that in when we're evaluating a patient with hair loss.

And sometimes there may even be other skin exam findings findings we may see on the face or other parts of the body that can also help us with the diagnosis. And then in addition to the physical exam, we always take a thorough clinical. We wanna know all the details about the hair loss, including time course when it started, what else was going on for the patient at the time the hair loss started?

Of course we take a medical history, we wanna know about medical problems, medications, as I mentioned before, and we may even check some blood work. And in some cases a biopsy of the scalp is necessary and a biopsy is actually not a complicated procedure. Dermatologists are skilled in taking samples of the skin of the scalp, and sometimes we do need this to help us diagnose the cause of hair loss.

Maggie McKay: Dr. Can Covid cause hair loss? Because I've read that and I've heard it from a lot of friends who had Covid.

Dr. Tamar Zapolanski: So that is a great question and this is a question that has come up very frequently in my practice since the pandemic started. The answer is absolutely yes. We have seen an increased incidence of a type of hair loss called Telogen Afluvium since the Covid Pandemic came to be. And Telogen Afluvium is, this type of hair shedding that occurs after the body undergoes either a physical or a psychological stressor.

And basically it sort of shocks the body in, in, in a sense, and causes a couple of months of shedding after that initial sort of insult to the hair follicles. This Telogen Afluvium tends to happen in the weeks to months after a person has Covid and the good news is, is that with time this does tend to resolve.

Maggie McKay: So your hair grows back and you stop losing it as much?

Dr. Tamar Zapolanski: Yes, exactly. Telogen Afluvium sort of lasts for anywhere between three to six months, and it does then take another three to six months on average for things to start to normalize.

Maggie McKay: What are the treatments available to treat hair loss in women?

Dr. Tamar Zapolanski: So there's many treatments available for hair loss in women, and some of them are over the counter. Some of them do require a prescription. We have topical medications such as Minoxidil, which many people are familiar with, the brand name, Rogan. And we also have oral medication. There are even some medical devices that are available over the counter, such as low level light therapy, which may be helpful. And then in addition, there are cosmetic treatments available such as PRP injections or even surgery if needed.

It's also super important, of course, to treat any underlying medical problems that could be contributing to the hair loss. That's why it's so important to be evaluated by a dermatologist and so other specialists need to be involved as well.

Maggie McKay: Does biotin help treat hair?

Dr. Tamar Zapolanski: This is a great question because biotin has received a fair amount of, media attention in recent years. While it is true that biotin and other vitamins, are essential for hair loss, the reality is that true biotin deficiency is very rare with a Western diet. There is some published data that biotin supplementation can be helpful, but real data for hair is still lacking. Some of the original data was exciting and it was mainly focusing on the growth of nails.

And this is, I think, what sort of perpetuated this explosion of many of the skin, hair, and nail vitamins that are available out there. But this has created a little bit of a problem because they are providing very high levels of biotin in this supplement and we now know that this can be problematic. So specifically taking too much biotin can interfere with blood work and different lab tests Can be incorrectly reported if a person is taking too much biotin.

So much so that in 2017 the FDA actually issued a warning and then they reiterated it in 2019, warning about the risk of biotin affecting these lab tests. So there's basically two important points here. The first is that we do not need these mega doses that are usually included in these skin, hair, and nail vitamins, such as 5,000 or 10,000 micrograms, of biotin. We can usually get enough biotin from our diets, and if you're interested in supplementing with biotin, the small amount in a multivitamin or even in some of the combination hair supplements is usually enough. The second important point here is that if you are taking a product with biotin, it's very important to stop it about one week before you get any blood work done.

Maggie McKay: You're kidding.

Dr. Tamar Zapolanski: Absolutely.

Maggie McKay: I've never heard that. Okay. Good to know.

Dr. Tamar Zapolanski: So if you have, for example, a thyroid abnormality, it can interfere with a thyroid function results. So that's very important to recognize. And of course, like with all supplements, you want to inform all medical providers of everything that you're taking anytime you're seeking medical care. So it's important to realize that these supplements can affect your body in similar ways that, traditional medications can.

Maggie McKay: And what is too much for biotin? What would you say is a good daily amount?

Dr. Tamar Zapolanski: Sure, so as I was saying, the skin, hair and nail gummies usually provide anywhere upwards of 5,000 to 10,000 micrograms. We definitely know that's too much. The original studies that were done with nail growth, were in the 2,500 microgram range. So I always recommend that if somebody wants to supplement with biotin, they take 2,500 micrograms or less. And some of the combination hair supplements that are available, some of which I do recommend.

There's even less biotin present in those, a couple hundred might be more than enough. Ultimately, we do need more studies. there has to be more stronger studies done with respect to biotin and hair before we can make any definitive statements.

Maggie McKay: And remember, I don't know if it's still popular, but lattise for your eyelashes, which was actually created for glaucoma, but they found that it was a side effect that people's eyelashes grew like crazy. I always wondered why didn't they use part of it to come up with something for hair growth, like on your scalp?

Dr. Tamar Zapolanski: So that's an interesting question. Of course, and it is true that Latisse can work well to grow eyelashes. I can tell you from personal experience that sometimes when I am compounding a special topical medication for my patients to use topically on their scalp, if I want to add Lattise to the topical medication, the cost of the product, increases exponentially. So we use, compounded Minoxidil and Finasteride and Spironolactone.

We have, a variety of ingredients that we do sometimes sort of mix up into potions for people to apply to their scallops. Usually when we add Lenapro the cost of the product, Just becomes prohibitive. so I can't tell you for certain because I'm not a chemist, but it must be a difficult product to produce.

Maggie McKay: It must be. Yeah, it does work though. It's pretty amazing, or at least it did for a lot of people I know and myself. So this is the first time I've ever heard this and I, I was surprised that I've never heard it before, but is it accurate. That when you're washing your hair, you're only supposed to do the scalp and let's say you have long hair, you don't do the rest of your hair, and then when you're doing conditioner, just the ends because apparently the conditioner can clog your hair folicles?

Dr. Tamar Zapolanski: So I think a lot of that comes down to personal preference and hair type. I am not familiar with any data that shows that using something too moisturizing on the scalp would have any direct effect on hair growth. I will say that in general the purpose of shampoo is really to wash the scalp, not necessarily the hair. And so many of my patients, who are concerned about the appearance of their hair being too dry or difficult to manage, or whatnot, or we do say, keep the shampoo close to the scalp because what we're trying to clean is the scalp.

And then with respect to the conditioner, I think it's more of a cosmetic issue that putting too much moisturizing product close to the scalp for certain hair types might result in like a greasy appearance. But the flip side of that is that for other hair types, moisturizing products are very helpful. If somebody has very curly, dry hair, then it's very common to apply, moisturizing products throughout the whole Hair and scalp.

Maggie McKay: Dr. Zapolanski, do you have any tips for women to keep their scallops and hair healthy?

Dr. Tamar Zapolanski: So I think that the most important thing for keeping the scalp and the hair healthy is to overall be as gentle as possible. I think as women, our hair and our hair styles are a form of self-expression and of our cultures. And this is all wonderful of course, but sometimes too much change and too much manipulation can be stressful for the hair and the scalp. So minimizing that when possible, I think is a good. I also think that it is important to remember that our overall health is important for our scalp and our hair health.

So all the things that we know are beneficial for our overall health. They're also gonna benefit our scalp. And then hair growth. We need to have a healthy diet, get good sleep, exercise, and stay up to date with routine medical care because routine screenings, routine medical care can diagnose problems that may, ultimately result in hair changes as well.

Maggie McKay: Thank you so much for sharing this helpful information. We appreciate you. You should see this long list of notes I've taken and learned from you just in this short time. I'm so grateful, and I'm sure a lot of other people are too.

Dr. Tamar Zapolanski: Absolutely.

Maggie McKay: For more information about dermatology at Valley, please visit valley health.com/services/dermatology or call 201-689-2103 to schedule an appointment. That's 201-689-2103. If you found this podcast helpful, please share it on your socials and check out our entire podcast library for topics of interest to you. Thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-291-6 090 or email Valleypodcast@valleyhealth.com. I'm Maggie McKay. Be well