Hair Loss Myths

Hair loss is a common complaint seen in dermatology clinics. Studies show that by age 50, approximately half of men and women will experience hair loss.¹ Hair loss can be very distressing to patients and can cause poor self-esteem.² From frustration and attempts at self-help, patients with hair loss may present to the dermatologist with false beliefs about the causes of their condition and what treatments are effective. These false beliefs are often acquired from the Internet or conversations with family and friends. If patients are allowed to continue with their incorrect beliefs about hair loss, it can hamper their compliance with medical treatment, their expectations of improvement, and their ultimate outcome. Thus, it is important for dermatologists to address patients’ ideas about hair loss and to provide them with accurate information. Other groups have organized resources to make this task easier with one group investigating the validity of claims for hair growth products and ultimately producing a “consumer report” for healthcare providers to discuss with patients.³ This review will take the idea of validity further by presenting common myths about hair loss and review the literature on these opinions. We intend to provide dermatologists with information that will help address the most commonly held false beliefs about the etiology of and treatment options for alopecia. We will discuss four main categories of myths, including myths related to minoxidil treatment, vitamin and mineral supplements, natural topical treatments, and hair care practices (Table 1).

Minoxidil is one of only two FDA-approved pharmaceutical therapies for hair loss, and the only medical therapy approved for treatment of hair loss in women.⁴ Currently minoxidil 2% solution twice daily and 5% foam once daily are approved by the FDA for use in female pattern hair loss (FPHL). Evidence suggested for some time that the 5% formulation was likely effective, and pivotal trials using the drug once daily in women ultimately showed equivalence of 5% foam with twice daily 2% solution and led to the approval of the foam version in February 2014 for use in women for FPHL.^5,6 While the mechanism of action of minoxidil in treating hair loss has not yet been fully elucidated, there are several theories about how it affects hair growth. It is thought to increase hair growth rate, hair follicle diameter, and to increase the length of the anagen phase of the hair cycle.⁷

Increased hair loss has been reported in some studies during the first two to eight weeks after initiating treatment with minoxidil.⁸ This is likely a result of hair follicles transitioning from telogen to anagen phase, resulting in the release of telogen hairs,⁹ something akin to synchronization of hair growth. It is important to warn patients about this temporary shedding process and to encourage continued use of minoxidil treatment through this short-term apparent worsening of hair loss in the application area. It is also important to note that not everyone will experience this shedding phenomenon. If shedding does