Identifying broad hair thinning and possible treatments? (Photos)

Question

i’m a male in my mid thirties. i always had very thick, healthy hair, but in my early thirties i went through a period of a couple years where i was wearing it in a ponytail 24/7 while also picking at my scalp like crazy every night. last year i noticed my hair had dramatically thinned- i still have close to full coverage (a little withdrawal on my forehead but barely) but it’s much, much thinner than it used to be. when i noticed that i immediately stopped wearing a ponytail and stopped picking at my scalp. it’s now been around a year since then. a couple months ago i started using 5% topical minoxidil in hopes of bringing my hair density to where it used to be. i know it takes time for results but i don’t even see vellus hairs yet, and i’m starting to think that between the ponytail and the picking i might have scarred my scalp, which from what im reading would imply that minoxidil will not be useful and the only solution is a hair transplant. i am hoping for an assessment of if that’s the case- if i should keep trying the minoxidil, or if my scalp looks scarred. i’ve attached a few pictures of my scalp (please excuse my forehead, which is covered in moisturizer). the pictures were taken shortly after leaving the shower, so my hair is a little damp. thank you for your help.

Anna Chacon, MD, FAAD · Answer

From your description, it sounds like you've taken some positive steps by discontinuing the ponytail and scalp picking, which can contribute to hair thinning. The use of 5% topical minoxidil is a well-regarded treatment for hair regrowth, but it can take several months to see visible results, and sometimes even longer to see significant improvement.

Here are some considerations and potential next steps:

Continue Minoxidil: Since you've only been using minoxidil for a couple of months, it's worth continuing for at least 6-12 months to assess its full effect. Some individuals experience initial shedding, which can be a sign that new growth is beginning.

Scalp Assessment: To determine if there is any scarring, which could impede hair regrowth, a consultation with a dermatologist or trichologist would be beneficial. They can perform a physical examination and may use tools like a dermatoscope to assess the scalp closely.

PRP Therapy: Platelet-rich plasma (PRP) therapy is another option to consider. It involves injections of your own platelets into the scalp to stimulate hair follicles and promote regrowth.

Nutritional and Lifestyle Factors: Ensure that your diet is rich in essential nutrients that support hair health, such as proteins, vitamins (particularly biotin and vitamin D), and minerals like zinc and iron. Stress management and avoiding harsh hair treatments can also help.

Hair Transplant Consultation: If there are areas of significant thinning or scarring, and other treatments are not effective, consulting with a hair transplant specialist could provide insight into whether this is a viable option for you.

It's important to follow up with a specialist to get a personalized assessment and treatment plan tailored to your specific needs.

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