My hair is thinning!

“I can see through my hair.” I often hear this as a dermatologist. The first question I always ask is whether short hairs versus long hairs are found on the pillows, on the bathroom floor, in the shower, or in the brush/comb. I ask this question primarily because short hairs equal breakage and if someone is experiencing breakage, I further ask about the hair care regimen and products.  A guide to infusing moisture back into the hair can be found here.


Hair grows at an average set rate and length is inevitable while retention of length depends on moisture content of hair and daily care. If your hair is processed, with color, perms, relaxers, texturizers, etc, this changes the inherent pH of the hair and can allow for dehydration and a dry, fragile hair shaft. Daily wear and tear on fragile hairs further lead to breakage and split ends. If enough hairs involved, the ends of your hair will appear uneven and the density will become thinner the further down the hair you travel. A quick way to test for breakage at home is to grab a strand of hair and do a quick bend and tug. If the hair snaps, there is a fragility factor. Also look at the entire length and at the end to assess for splitting and frayed areas. Lastly, place a sheet of white paper behind your hair and have someone take a photo. If you can see a large portion of white paper through your hair, that is breakage. The more breakage, the more visible the paper until it starts tracking up higher in the hair.


If long hairs are found on the brush, floor, pillow, clothing, etc, there may be a concern for a shedding condition called, telogen effluvium (learn about the natural hair cycle here). Telogen effluvium is an excessive shedding phase that is reversible and does not destroy the follicles (non-scarring). Triggers include starting and stopping medications especially hormones and supplements, health conditions (anemia, thyroid, malnutrition, pregnancy, birth), and sudden stressors (illnesses, surgeries, crash diets, stressful event).  My patients will report diffuse shedding and thinning hair all over the scalp. The solution is to find the stressor and remove it. If it was a one-time event, when the stressor has finished, the telogen effluvium must run its course and fade out. I always counsel patients it is an unknown amount of time when the hairs exit out of this effluvium and enter back into their normal cycles. If the shedding is occurring for a long time or if the patient feels more than 50% of the hair density has been lost,  I can intervene with medicine to stop or slow down the natural process and help prevent further shedding.

A similar story of long hairs shedding rapidly can also occur from another shedding condition called anagen effluvium, commonly seen with medications that stop rapid cell growth, such as chemotherapy and particular medications. This condition is also non-scarring and is reversible.  Interestingly, with regrowth after these medicines the hair may return a different color or have a new curl pattern.


Lastly, I evaluate for age, nutritional status, and family history. Male and female pattern baldness is prevalent and I not only ask about hair loss in male family members but also among female members.  I check hormone levels to make sure there are no internal factors driving this condition. There are a few topical and systemic (oral pills) regimens that will help. Often these regimens regrows hair and thickens the hair and holds the patient for years as long as they continue the treatment regimen.

Other reasons:

A close look at the scalp is necessary as all hair thinning is not due to breakage, shedding, or genetics.  There are inflammatory, scarring (follicles turn to scar tissue and cannot grow a hair) permanent hair loss conditions that do warrant medications to slow or stop the process and I specialize in diagnosing and treating these conditions. Early assessment and diagnosis is important to prevent diffuse permanent hair loss. Other permanent hair loss disorders can occur from tight braids, removing glue-in weaves, wraps or headbands around the edges, and chemical burns.  We will talk about these conditions and how to prevent them in future articles.

In conclusion, hair thinning is very common either through medical or cosmetic reasons.  If you’re experiencing hair thinning, seek guidance from your local cosmetologist and dermatologist for treatment of any medical conditions and to help correct moisture imbalance so you can regain your thick healthy hair.



Winterize your hair- treating dry hair

This is the season to winterize your hair.  Dry frizzy hair happens during the winter due to the constant change from cold outdoors to heated indoors. We will discuss preparing a winter regimen and ways to maintain moisture in the hair without causing excessive drying which may lead to split ends, breakage, and loss of length.

  1. Drink plenty of water.  Water evaporates from your skin and hair at an increased rate during the winter due to heat/furnaces.
  2. Wash hair weekly or biweekly to remove debris and product build up which can lock out moisture.
  3. After washing hair, seal in moisture with a light oil, such as argan or coconut oil. Make sure to pay special attention to the ends which have received the most wear and tear on the entire length of your hair.
  4. Apply a light cream or light-weight non-oily hair lotion daily to add moisture back into the hair. Lotions and cream contain a higher water content compared to oil and grease. Also avoid alcohol-based products during the winter which can further pull water out of the hair.
  5. Take a chemical vacation (from coloring and other chemical processes) if possible (relaxers should be continued every 6-9 weeks to prevent increased breakage at the line of transition). Chemically-treated hair deserves extra TLC as the pH and chemical structure of the hair has changed.  Bleaches, alcohols, peroxides are ingredients to avoid during the winter as they can make the hair brittle and cause split ends.
  6. Performing deep conditioners under hooded caps bimonthly or protein treatments once monthly are optimal and will help baseline moisture.
  7. Add water back to the hair. If you don’t want to add product that will leave residue on the hair try spraying plain water (can add lavender and a drop of your favorite oil or a drop of glycerin which helps with slippage and prevents tangles) on the hair. This is also a nice way to put moisture (which plainly is water) back into the hair midweek without having to wash.
  8. Try to not add products to the scalp which can coat the scalp and allow a yeast, Malasezzia, to flourish and cause dandruff. If you find yourself having to co-wash more often to retain moisture, it may mean you have to incorporate moisture using a daily regimen to maintain moisture from wash to wash.
  9. Your salon may offer the service of steaming the hair which can help open the cuticles and allow moisture back into the hair prior to adding products and styling. If you’re low on funds you can just sit in a bathroom with the shower steaming or hold your head over a sink or tub of hot water. There are also home steamers you can purchase for use.
  10. Wear protective styles such as ponytails, buns, braids, pinups, etc to prevent the ends from being traumatized and subsequently forming split ends.
  11. Protect thermally-treated styles by apply leave-in conditioners, use thermal protectant sprays (allow it to dry first), and try to curl, press, or straighten hair once weekly. The frequent use of heat further dries hair out further (think of it like making a grilled cheese without butter. If you throw the butter-less sandwich back on the grill it will burn). Also try to run as few passes through the hair with the iron as possible.
  12. You can pin-curl or re-twist between heated treatments to help maintain curly styles or wrap the hair to prolong straight styles.
  13. Sleep on a satin/silk pillowcase or use a satin bonnet or hair wrap. This keeps the moisture in the hair and prevents hairs from snagging on the fibers in pillowcases.
  14. If you are wear hats, try to find ones with a liner or wear a satin bonnet or scarf to prevent the hat material from pulling out moisture from the hair.
  15. Seal split ends that may occur with a thicker hair balm to allow the pieces to adhere to one another until you can get a trim. You can trim individual ends if you have a few.  Otherwise, rely on your hair professional for routine trims.

Protect your strands from the elements of nature.  Maintaining the moisture content at an equilibrium during the winter will allow you a smooth transition of healthy shiny hair into the summer.

Have you found any regimens that help keep winter dryness from your tresses? Share below.