Unsure of What the Next Step Should Be

[Quelaag]

Hello! 26 year old and female. Recently over the past 6-8 months I noticed thinning around my hair part and bangs to where you can see more scalp through my hair.

I was in a bit of denial at first due to people claiming that it wasn't balding and that I was overreacting. Well I scheduled with a dermatologist on March 28th after it seemed to get worse and the fact I've been dealing unsuccessfully with psoriasis on the left side on my scalp and the back near the base; he initially wanted to test for alopecia but the thought of getting a scalp biopsy at that moment scared me so I opted for bloodwork to be done instead.

Bloodwork showed I am very low in vitamin D and a bit low in iron levels. I'm not sure if these things can affect hair loss, but I started taking Vitamin D supplements twice a day and hair, skin, and nails biotin vitamins once a day. Also using a biotin based shampoo and plan on trying to get more sun.

So I guess I'm wondering if I should go back for the scalp biopsy or if I should see if supplements for vitamin D can help and if clearing up my psoriasis may help? 

Can a lack of vitamin D really cause hair loss in any way? 

And for the psoriasis I'm skeptical because it doesn't occur near my hair part or bangs, though I am currently putting medicine there just in case. Could that still affect hair loss away from the affected area?

I guess I'm just scared that if it's alopecia then it's out of my hands to my understanding? 

Also not sure if pictures need to be provided? I can if need be but honestly seeing pictures of my scalp stresses me out.

Thank you all in advance and sorry if this is in the wrong forum. Also let me know if I need to provide more info.

[harry_potter1]

Vitamin D deficiency is one of the most debated arguments in the medical fields right now, with many "pointing fingers" from sides too. I don't think we will have a concrete honest answer before a decade or two. 

Some thinks it the devil, it is the reason for almost everything out there, other think that this is a fraud and over-exaggeration of its effect, answer is probably in-between 

But yes, there is an argument it can contribute to hair loss, or hair weakness/fragility. Zinc plays a role too btw and I am suffered from its deficiency and seen its effect (I've Vit D insufficiency too) . Vit.D an cause other  problems like Hyperparathyroidism 

A note ,it takes time to compensate for this deficiency, reaching blood level doesn't mean you don't have deficiency anymore as it gets to its level sooner than the rest of the body. 

 

I am a dentist, not a dermatologist so I can't tell you if biopsy is a must. My honest advice is take a 2nd opinion and if it was also to get a biopsy, do it. Also ask thoroughly about side effects of taking the biopsy, it might be minimal and you are overreacting, or may be you are right to be skeptical 

Hope I was helpful, although not sure about that.

[DrTBarghouthi]

Hi Queelag. I just read your post but I think some details are missing:

1) Is there any female pattern hair loss in the family? Any sisters, mother, aunts, grandmothers with a similar or even more advanced thinning?

2) What blood work did you have apart from Vit D and iron? Generally, since genetic female hair loss accounts for only 40% of female hairloss, then it is usually advised to test thyroid function, zinc, magnesium, B12, Complete blood count and according to the case DHEA-S (androgens testing), ANA (autoimmune test) and prolactin (if other symptoms exist such as an irregular cycle).

 

3. Scalp biopsy is the only definitive test to check for scarring (Cicatricial) Alopecias which is a certain type of hairloss that causes scarring of the scalp. It has several sub-types but is mostly suspected clinically first and has certain characteristics on a magnifying dermascope. If these findings are present, then a biopsy is advised. Did someone check the scalp with a magnifying camera?

It will be great if you can post some photos, as It certainly sounds like androgenetic alopecia from the pattern of loss you described, especially if it runs in some family members too.

[pkipling]

I highly recommend getting a second opinion. If they also recommend getting a biopsy in order to better diagnose you, I would personally move forward with it. I'm not sure if your fear is associated with the procedure itself, or if it's more geared towards what the results of the procedure might be. Regardless, in order to properly treat this and come up with the most effective game plan, you want to have as much information as possible - and a biopsy would provide that for you.  

[Quelaag]

5 hours ago, pkipling said:

I highly recommend getting a second opinion. If they also recommend getting a biopsy in order to better diagnose you, I would personally move forward with it. I'm not sure if your fear is associated with the procedure itself, or if it's more geared towards what the results of the procedure might be. Regardless, in order to properly treat this and come up with the most effective game plan, you want to have as much information as possible - and a biopsy would provide that for you.  

I think for me I fear the results. I don't know what to do if it ends up being something out of my control. I know others have it way worse than me but I still don't know how I'll handle it since ky self esteem is already pretty low, lol. I'm going to schedule an appointment with a different dermatologist tomorrow for a second opinion and if they suggest a biopsy then I'll do it then and there I guess.

[Quelaag]

5 hours ago, DrTBarghouthi said:

Hi Queelag. I just read your post but I think some details are missing:

1) Is there any female pattern hair loss in the family? Any sisters, mother, aunts, grandmothers with a similar or even more advanced thinning?

2) What blood work did you have apart from Vit D and iron? Generally, since genetic female hair loss accounts for only 40% of female hairloss, then it is usually advised to test thyroid function, zinc, magnesium, B12, Complete blood count and according to the case DHEA-S (androgens testing), ANA (autoimmune test) and prolactin (if other symptoms exist such as an irregular cycle).

 

3. Scalp biopsy is the only definitive test to check for scarring (Cicatricial) Alopecias which is a certain type of hairloss that causes scarring of the scalp. It has several sub-types but is mostly suspected clinically first and has certain characteristics on a magnifying dermascope. If these findings are present, then a biopsy is advised. Did someone check the scalp with a magnifying camera?

It will be great if you can post some photos, as It certainly sounds like androgenetic alopecia from the pattern of loss you described, especially if it runs in some family members too.

1) It runs in the men of my dads family but I have not noticed it on either parents side in women. Not saying it couldn't pass down from my dad I guess. 

2) I think the labcorp took the paperwork that had testing but there was a thyroid test and some hormone testing done as well. I assume they would have mentioned if either of those turned up positive. Though I would like a second opinion on the hormone part? There are some other issues I have that I feel may be hormone related that may have not been noticed so I might see a primary care for that soon too. But maybe I'm just being hopeful that something like that is the cause. Denial I guess.

3) The dermatologist I went to kind of rushed me so I'm going to definitely going to see a second one for another opinion/hopefully more careful observation. He just kind of briefly went through my hair and rushed through options. Granted he was more focused on my scalp psoriasis so maybe that's why? Which that's clearing up since starting perscription stuff so I'm hopeful for better results there. 

If the second doctor wants to do a biopsy I'm going to do it then and there even though the thought of it scares me.

[DrTBarghouthi]

Thank you for the answers. 

Yes I agree that a second opinion is a good idea. Keep us updated. The biopsy as a process is very straightforward. Nothing to worry about there. It mainly is to outrule a specific type of hairloss. 

Let us know what happens and best of luck! 

[pkipling]

14 hours ago, Quelaag said:

I think for me I fear the results. I don't know what to do if it ends up being something out of my control. I know others have it way worse than me but I still don't know how I'll handle it since ky self esteem is already pretty low, lol. I'm going to schedule an appointment with a different dermatologist tomorrow for a second opinion and if they suggest a biopsy then I'll do it then and there I guess.

I understand the desire to look the other way and not deal with anything that could potentially come up with a biopsy. However, it's much better to have all the information and face it head on so that you can act accordingly. It will also really serve to support your emotional state, particularly if the results come back negative. 

One of my female friends has alopecia, and while it may not be "ideal", she has used it in her life in a really beautiful, powerful way. She uses her platform to speak out about image, self worth, empowerment, and acceptance, and is the source of inspiration for so many people - particularly others who also have alopecia. No matter what happens to any of us in life, we get to choose how to respond - and trust that you have everything inside you to handle whatever life throws at you, alopecia or not. 

[Quelaag]

So it's been two months but I finally got in and got a scalp biopsy done. Unfortunately it came back androgenetic alopecia so I'm just now taking that in. The letter I got with my results seemed pretty unsure though as they're confused about my age. I'm going to schedule with an endocrinologist because I'd like more detailed labs on my hormones just to be safe and maybe it can bring to light something that a dermatologist could not find. I don't know. I'm not expecting a miracle, but I have other health issues that could really indicate a hormonal problem (ie. Feeling tired all the time, depression, anxiety, mood inbalances etcetc) so regardless of if it can affect my hair growth I need to find a cause to those things.

As for treatment; I'm looking into doing viviscal supplements/treatments. Minoxidil was shoved in my face as being the number one option, but I am wary of it, I'd rather take a pill daily than completely change my routine, but if minoxidil is the be all end all I suppose I can suck it up. 

[Dazed]

On 4/18/2019 at 9:56 PM, Quelaag said:

I think for me I fear the results. I don't know what to do if it ends up being something out of my control. I know others have it way worse than me but I still don't know how I'll handle it since ky self esteem is already pretty low, lol. I'm going to schedule an appointment with a different dermatologist tomorrow for a second opinion and if they suggest a biopsy then I'll do it then and there I guess.

“Imagination frames events unknown,
In wild, fantastic shapes of hideous ruin,
And what it fears creates.”

― Hannah More