17: Understanding Hair Loss with Dr. Nancy Echefu
EP. 17
For many women, hair is a big part of their identity, femininity, and confidence. When hair loss occurs, it can feel worrying, especially when the cause is unclear and the path forward is unknown. Whether it’s hormonal changes from pregnancy, perimenopause, or menopause, many women struggle to understand what’s happening and how to address it.
I recently met with Dr. Echefu, a hair transplant surgeon, who shared invaluable insights on the different types of hair loss women face, from scarring to non-scarring alopecia and shared her approach to addressing it through personalized treatment options. Keep reading to learn more about the causes of hair loss and the practical steps you can take to start addressing your hair health today.
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Understanding the Different Types of Hair Loss
When it comes to hair loss, the most important thing to understand is that not all hair loss is the same. During my recent conversation with Dr. Echefu, she used an insightful analogy to break it down—comparing hair to a tree, with roots and branches, which made the concepts easier to understand.
There are two major classifications of hair loss: scarring alopecia and non-scarring alopecia. The key difference lies in the hair’s roots. In scarring alopecia, the roots are attacked by an inflammatory process, preventing new growth. Non-scarring alopecia, on the other hand, doesn’t involve inflammation and is typically a result of natural progression, like genetics.
Non-scarring alopecia is by far the most common type, and it’s often the culprit behind what we know as male or female pattern hair loss. Dr. Echefu shared that most patients she sees are dealing with genetic hair loss, something that tends to run in families. This is something that many women, like myself, might dismiss as just stress or aging, but it’s usually hereditary.
On the other hand, scarring alopecia is far more concerning as it indicates that the hair roots are being damaged beyond repair. Types of scarring alopecia, such as CCCA (central centrifugal cicatricial alopecia), are often linked to inflammation in the scalp, and unfortunately, once the roots are damaged, there’s little chance for regeneration. This makes scarring alopecia much more challenging to treat.
Understanding the distinction between these two categories is crucial. If you're experiencing hair loss, recognizing the type you're dealing with can help determine the appropriate treatment path. For many, the journey starts with identifying whether the issue is related to genetics or inflammation, which is where professional guidance comes in.
Understanding CCCA (Central Centrifugal Cicatricial Alopecia) and Its Diagnosis
What is CCCA?
CCCA is a type of scarring alopecia, meaning that the hair loss occurs as a result of inflammation that damages the hair follicles. This damage can prevent hair from growing back. CCCA typically starts in the central part of the scalp and spreads outwards, which is why it's referred to as “centrifugal.” It’s closely associated with hairstyles that cause tension on the scalp, such as tight braids or weaves.
How is CCCA Diagnosed?
Differentiating CCCA from other types of hair loss begins with a thorough consultation. The key is to ask specific questions about symptoms such as itching, burning, redness, or tingling sensations on the scalp. These are indicators that something more serious than just genetic hair loss could be at play. A physical exam is then conducted to assess where the alopecia is located—CCCA is typically centralized on the scalp.
But is a scalp biopsy always necessary? Not necessarily. While a biopsy can confirm a suspected diagnosis, it’s not always required. Experienced practitioners can often recognize the signs through physical exams and patient history alone. For example, if a patient reports inflammation-related symptoms, a biopsy may be used to confirm the diagnosis, but in many cases, it’s simply a way to document what the clinician already suspects.
Hair Loss vs. Hair Shedding: What's the Difference?
When it comes to understanding hair loss, it's also important to distinguish between hair loss and hair shedding, two terms that are often confused. Hair shedding can be a natural part of the hair cycle, but hair loss usually refers to a more progressive condition where the roots are permanently damaged.
What is Hair Shedding?
Hair shedding happens when hair moves into the resting phase of the growth cycle, which can be triggered by factors such as stress, pregnancy, or even medical conditions. Unlike hair loss, shedding doesn’t involve permanent damage to the hair follicles, so there is a possibility that the hair can grow back once the trigger (like stress or illness) is removed. A key point here is that shedding typically involves the loss of the hair shaft (the "branches" of the tree), while hair loss involves the roots (the “tree” itself).
What is Normal Hair Shedding?
On average, people lose about 50 to 100 hairs a day. Anything beyond that could indicate excessive shedding, which might be linked to an external trigger, such as stress or medication. The important thing to remember is that the roots are still intact during shedding, so the hair can eventually grow back once the trigger is addressed.
The Hair Growth Cycle and How It Relates to Shedding
The hair growth cycle involves three main phases:
Anagen (growth phase): This phase can last anywhere from 2 to 8 years, depending on the area of the scalp and the individual.
Catagen (transitional phase): This phase is short-lived, lasting about 2 to 3 weeks.
Telogen (resting phase): This phase lasts anywhere from 2 to 6 months, during which hair stops growing and can be shed.
When a person experiences hair shedding, it means that their hair has entered the resting phase prematurely, often triggered by an external factor. However, the important thing to note is that hair shedding doesn’t necessarily indicate permanent hair loss, as the roots are still intact, and the hair can regrow once the cycle normalizes.
Patience Is Key
Whether you’re dealing with hair loss or shedding, one thing is certain: patience is essential. Hair growth takes time, and treatments often require several months to show visible results. For people undergoing hair restoration or treatment for conditions like CCCA, it may take 4 to 6 months to see any significant improvement.
Understanding the difference between hair loss and shedding—and recognizing the stages of the hair growth cycle—can help you better manage your expectations and approach treatment more effectively.
A Comprehensive Approach to Treating Hair Loss
Dr. Echefu combines medical science with tailored treatment protocols to address hair loss. Her approach includes:
Standard Treatments: Minoxidil, canasteride, and spironolactone are core treatments for non-scarring alopecia. PRP (Platelet-Rich Plasma) and micro-needling are often added for better results.
Hair Restoration Options: PRP uses growth factors to promote hair growth, while micro-needling stimulates the scalp. Dr. Echefu also offers third-hair restoration and laser cap therapy, with laser devices carefully selected to avoid scalp damage.
Medical Support: Medical treatments are combined with other therapies to ensure faster, healthier hair regrowth. Hair transplants offer a more permanent solution for some patients.
Patient-Specific Solutions: For those averse to needles, Dr. Echefu ensures needle-free treatments. Her methods respect each patient’s preferences and emotional responses, especially in the case of sensitive conditions like trichotillomania.
Holistic Care: Dr. Echefu works closely with primary care physicians and specialists when needed, especially if conditions like PCOS or mental health factors (e.g., depression, body dysmorphia) are suspected.
Trichotillomania and Hair Loss
Trichotillomania, a compulsive hair-pulling disorder, is more common in women and is often linked to anxiety or other mental health conditions. While it can affect people of any age, it is most commonly associated with anxiety.
Many people deny their hair-pulling behavior, which complicates treatment, as hair transplants are ineffective if the person continues to pull their hair. Even mild hair manipulation, such as twisting or clenching hair, can contribute to hair loss. Dr. Echefu emphasizes the need to address both the physical and psychological aspects of hair loss for successful treatment.
Advice for Managing Hair Loss Before Seeing a Doctor
Dr. Echefu recommends these steps for individuals experiencing hair loss:
Track Your Hair Practices: Be mindful of how you care for your hair, including washing, products used, and any treatments. Note how your hair reacts, especially after washing, to identify patterns or irritants.
Stop and Reset: Evaluate and adjust your hair care routine. If necessary, pause any heavy treatments and start fresh with simpler practices to observe changes.
Minoxidil: Start using over-the-counter 5% minoxidil, but be cautious of irritation. If you experience burning or itching, stop and consult a professional.
Derma Roller: Incorporate a 0.5mm derma roller into your routine, gently rolling over the affected areas once a week. This can enhance the effectiveness of treatments like minoxidil. Start slow and build up to using it twice or three times a week.
Follow Protocol: While there’s no need to follow a strict regimen, having a basic guide can help ensure you’re using these treatments effectively without overuse.
Dealing with hair loss takes a holistic approach—it's about treating both the physical side and any underlying issues like stress or habits. Dr. Echefu stresses the importance of understanding and managing behaviors like hair manipulation, while also exploring effective medical treatments for optimal results.
More About Dr. Echefu
Dr. Echefu is the CEO of Havilah Hair Restoration, specializing in hair restoration treatments, including those for Afro-textured hair loss. With over a decade of experience, she’s led hair loss exhibitions and owns DRECH, a company producing hair and facial aesthetic products.
She holds a medical degree from Avalon University and trained at Morehouse School of Medicine and Grady Hospital in Atlanta. Dr. Echefu is a fellowship-trained Aesthetic Physician with expertise in scalp and facial aesthetics, trichology, and scalp diseases, particularly burned scalp and face.
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