You think you have Alopecia now what?

Losing your hair can be scary. We associate much of our physical identity with it, so when we lose it, we feel like we’re losing our identity too. Though you may not be able to control your hair loss, you can control how you respond to it.

The first thing you’ll likely do when you lose your hair is turn to the internet for answers. It is important to understand that while the internet may seem to have all the answers, it cannot replace medical advice. Most of us don’t have a medical or scientific background, so we run the risk of misinterpreting the information we find on the internet. For example, if you look up alopecia areata, you’ll likely find that it is a cytotoxic T lymphocyte-mediated autoimmune disease affecting the hair follicles. Without any knowledge of immunology, the scientific study of the immune system, you may see the word toxic and think that you’re sick with some sort of toxic hair follicle disease. What it actually means is that the immune cells responsible for killing our pathogen-infected body cells, known as cytotoxic T cells, mistakenly attack our healthy hair follicle cells, causing the hair to fall out and preventing regrowth until the attack is suppressed. This is where the support from our physicians is imperative for us to understand our hair loss.

The next thing you’ll likely do when you start losing your hair is contact your primary care provider. For many, their primary care provider is a family physician, general internist, or primary care nurse practitioner. They will be the first step in your alopecia management. In most cases, they will make the initial diagnosis and refer you to a dermatologist. They may also prescribe you some interim treatments while you wait for the dermatologist appointment. Your primary care provider may also be able to help educate you and alleviate any of your concerns.

So, what should you ask your primary care provider? Everyone is different, but below are

common questions that you should ask them to better understand your hair loss.

Do you have patients you treat with alopecia?

It is important to have a health care provider that has experience in this field as they will be equipped to manage your needs.

What do you think is causing my hair loss?

Though they may not have this answer, they may be able to provide you some sort of reassurance based on what they determine on their examination and investigations.

How much time between follow-up appointments?

Sometimes your follow-up appointments will have a gap, so it’s good to have a general idea of how long their wait list is.

Do you communicate through email?

Sometimes you may have questions or may be experiencing discomfort and want to send an image or shoot your practitioner an email, its key to know how they best communicate with their patients.

What treatments and or medications are covered by OHIP or insurance?

Treatment options often times can come with an upfront fee or cost not covered by OHIP or insurance, so request a list as to what is typically covered and what is not.

Are they any diagnostic tests I should have done?

Diagnostic tests such as blood work can help elucidate underlying hormonal, metabolic or general biochemical abnormalities that could be contributing to, or directly causing your hair loss. The results of these investigations can also be attached to the dermatologist referral, which will help them in making a diagnosis.

Is there anything we can do to alleviate my symptoms?

Symptoms associated with your hair loss, such as itching or burning may be resolved with topical corticosteroids and/or soothing compounds such as Aloe Vera. Though this may not be the solution to the hair loss, it will help keep you comfortable until a diagnosis is made and more direct treatment(s) can be prescribed.

Is there anything I should be aware of about my hair loss?

Your primary care provider’s answer to this will depend on whether or not they know what is causing your hair loss. For example, if they know you have Alopecia Areata based on their examination and medical history acquisition, they can advise you that the hair loss is unpredictable and could progress to more extensive loss or resolve itself on its own. Though it is a worrisome thought, it is important that patients are aware of all possible outcomes so that they are not surprised, as this could result in significant emotional distress. Emotional supports may be required and your primary care provider can help you obtain it if need be.

Are there any lifestyle changes I can make to improve my condition?

Some hair loss conditions may improve based on lifestyle changes - this is particularly true for hair loss caused by vitamin deficiencies or metabolic abnormalities.

Are there any specific dermatologists you recommend?