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Hair loss isn't just for middle aged med

Illustration by Rachelle Maynard

Hair loss isn't just for middle-aged men – just ask Keylin Haar.

The 25-year-old college student in Belleville started losing her hair when she was 15. She has patches of baldness on the top of her head and around her ears, which she covers up by styling her hair a specific way. "It feels really bad," she says in a phone interview during a summer heat wave. "It is so hot out and I can't put my hair up. I have to wear certain hair styles so you can't see the thinning. It's frustrating."

There are 100 different types of hair loss that can affect anyone – girls, women, boys, men and older people. Like so many of these patients, Keylin was initially misdiagnosed. When her hair started falling out, a doctor assumed she had a common autoimmune condition called alopecia areata, which causes patchy or, in rare cases, total hair loss. She was subjected to steroid injections for 10 years, but they did not help. She also took a strong topical medicine called diphencyprone (also known as DPCP), which was applied to the affected areas of her scalp. The medication exacerbated a rare genetic skin condition Keylin has, causing blisters, itching and scabs.

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Keylin was finally referred to the Hair Loss Clinic at Sunnybrook, run by dermatologist Dr. Jeff Donovan. He specializes entirely in hair loss problems and has directed the clinic since 2010. The clinic has one of the largest practices dedicated to hair loss conditions in the country. Last year, 600 to 900 new patients were evaluated and treated here by Dr. Donovan in addition to the many hundreds of patients already on the clinic's list.

"Many dermatologists evaluate patients with hair loss, but only a few doctors around the country have clinics dedicated to evaluating patients with these complex hair loss conditions," says Dr. Donovan. "There are dozens and dozens of conditions with hard-to-pronounce names for which modern science is only just beginning to unravel the underlying causes. It is a fascinating area of medicine."

The clinic also has the most up-to-date technology to aid in diagnosis, and nurses who work specifically in this field. This is extremely helpful for people with hair loss because while many of the conditions look the same, they are very different, and require different treatments. "A typical patient might think they have one type of hair loss condition. We sometimes diagnose it as a completely different hair loss condition and we get them on the right medication," explains Dr. Donovan.

"There are lots of mimickers," he says. "For instance, genetic hair loss in women causes hair thinning  in the middle of the scalp, but suppose the woman also has itching, burning or pain in that area. That could be the sign of a group of hair loss conditions known as scarring alopecia. We are equipped to biopsy the scalp if necessary to confirm exactly what it is. Treatment could be drastically different."

Dr. Donovan tells the story of a recent patient losing hair at her hairline at the front. She assumed it was early genetic baldness, like her father had. "Within seconds of her describing her situation, I knew her hair loss could not be attributed to genetic hair loss," says Dr. Donovan. Her condition turned out to be a condition called frontal fibrosing alopecia, for which treatments are drastically different than those for genetic hair loss.

"Hair grows slowly, about 1 centimetre per month. If you are not on the right treatment, you might be wasting a lot of time. The sooner you get the proper diagnosis the better," he says.

Sunnybrook's clinic also hooks people up with resources that can help them, including patient networks, information about their condition, and links to wig salon. Dr. Donovan attends conferences all over the world, and brings back cutting-edge knowledge. "If a new treatment is coming out or has just been shown to be helpful, we'll be able to offer it to patients." Dr. Donovan also performs hair transplant surgery in Sunnybrook's Dermatology Centre.

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In Keylin's case, Dr. Donovan did a scalp biopsy and discovered her condition is not alopecia areata. He is combing the world's literature for cases like hers and speaking to other hair loss specialists around the world to see if her hair loss might be caused by her skin condition, or something else. "It is quite a relief to find him," she says. "I went through 10 years of needles. I'm glad to have him working on my behalf."

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