Author: Dr. William Rassman

I’ve have consistent diffuse hairloss universally around my head for about a year and a half, to the point where I believe I’ve lost about 60-70% of my hair. Many of the hairs that fall have large white plugs attached to them (see pictures), which I believe may be sebum.

Is this in fact sebum? Can these plugs cause diffuse hairloss? Any idea what may cause them or what might treat them? So far, I’ve tried zinc, ketoconazole, salicylic acid, coal tar, and other “sebum reducing” shampoos. I have also been on propecia for 6 months, but with no noticeable reduction in the pace of my loss.

Sebum is a waxy substance from the production of oil from your sebaceous glands. It can be seen on ends of hair follicles that fall out but this does not mean you have a hair loss condition or disease process (because of the sebum). There are products that claim better control of sebum and Internet posts that claim the sebum is the cause of hair loss. It generally makes for great marketing campaign to sell a product to those who are looking for a hair loss cure. Sebum does not cause hair loss, if it did, the many men and women on skid-row would be balding as they often do not shampoo their hair and reduce their sebum buildup. If you are experiencing diffuse hair loss, I doubt sebum is the root cause (no pun intended). You need to see a doctor for your hair loss condition to establish a good diagnosis.

In a recent question you write: “A 25 year old man already showing thinning in the Norwood Class 7 pattern will not benefit from Propecia unless it is caught early and still it may not do much more than stop the loss from occurring.”

Is there any difference between “thinning in the Norwood Class 7 pattern” and “diffuse pattern alopecia?”

And what’s a good way to determine if you are catching your thinning early? If you have hair all over your head, but your scalp is starting to be seen in the mirror, is that early? Or ?

Let me clarify things a bit. If you are 25 years old and already a Norwood class 7 (it does happen), you will not benefit from Propecia because there is no hair left to save. If you still have some hair, and show signs of Norwood 7 with significant miniaturization present in that pattern, then Propecia would help hold on to the hair longer. Norwood 7 has a definite pattern to thinning of hair loss. A diffuse pattern is just as it states — you are thinning all over (even in the sides and back of the scalp).

A good way to determine if you are thinning early is to have your scalp hair examined for signs of miniaturization. Get the scalp mapped, then have it done again in 6 months to compare the results.

Do fin or min+fin work well for diffused thinners? Also please give advice on regimens that have worked for you if you’re a diffused thinner. I am 18 years old.

Diffuse thinning has many causes. You need a good examination by a hair doctor that understands hair loss and hair thinning. If it is part of the genetic hair loss that you inherited, then finasteride and minoxidil are the staples of treatment.

Hair transplant for diffuse hair loss from tressless

hi doctor, i’d like to apologize’ first because i dont have good progress pics to post but i’d still like to get some advice

i’m a diffuse thinner and i’ve been using minox for 9 months and finasteride for about 7 month. was losing 100+ strands of hair daily when i shower but since last month the hair loss has gone down to around 50+ strands, should be a good thing right? but the problem is that my hair density and volume are way below baseline and it worries me a lot

what should i do, are there any other options? keep it up and just wait and see how it goes? i’m worried that my hair loss didn’t actually “improve” and i’m losing fewer hairs simply because i dont have as much hair to lose now compared to before, if you get what i mean.

There are thickening agents you can buy which will make your hair look much better. These medications will hold the hair you have and not regrow new hair. You need to see a doctor and get a Personalized Master Plan for your hair both short term and long term, knowing where you are going will be helpful for your future planning.

Does diffuse thinning only happen at the crown? Or can it happen all over the head (sides and back)? Also, if you are diffuse thinning or balding in general, can the sides and back become softer (individual hair becoming weaker and not as thick)? Or should the back and sides not be affected at all (at all as in should be as thick as when you were a kid/ teen)?

For men, thinning and balding occurs in patterns. For some men, crown thinning and balding is a pattern of hair loss, one that I personally had and transplanted it. If it is diffuse (all over the scalp) then there is a condition called Diffuse Unpatterned Alopecia (DUPA) something we originally defined in the medical literature in the 1990s which is a real problem for those who have it and these men are never candidates for hair transplantation. Diffuse hair thinning occurs in women but it does not occur in pattern and the causes for this are too many to list here.

This is a problem when the direction was placed in the wrong angle. You may have to get FUE on those hairs that are misplaced and then re-implant them in the proper direction. ?

Note that in this photo, the neck hair in this man has already started to disappear. This is a genetic trait that is different from general Male Patterned Genetic Balding. For this reason, I never transplant the neck hair into the recipient area because this hair, in some men, is not permanent hair. Note the transition between the neck hair and the scalp hair at are about the occipital notch (base of the skull).