The FOUR "S's" of hair loss


The fascinating thing about hair loss is that every single piece of information from the patient is 'potentially' relevant to their hair loss. That's a lot of 'potentially' - and potentially a great deal of frustration ..... unless one is prepared with a strategy to decipher all the information being given to them!


Is the fact that a patient's hair got worse after starting a job in the bank relevant? Maybe. Maybe not. 

Is the fact that a patient's hair got worse after starting a new vitamin relevant? Maybe. Maybe not. 

Is the fact that a patient's hair got worse after changing shampoos relevant? Maybe. Maybe not.


The Four S's of Hair Loss

I use the 4 S's of hair loss every day. It's an extremely important tool to keep track of what is important and what is less important when acquiring information about a patient's hair loss. The four 's stand for SPEED, SYMPTOMS, SHEDDING AND SUPPLEMENTS.

Everything piece of information about hair loss is potentially important to gather from patients.



How fast is the hair loss occurring (speed)? A patient who looks different month to month does not have genetic hair loss as the main issue!  A patient who looses massive (near total) amounts of hair in 3 days likely has alopecia areata or has had chemotherapy.  The speed of hair loss is important. 



Does the patient have itching, burning or pain in your scalp (symptoms)? I never get too concerned about a bit of itching; however burning and pain raise alarm for something inflammatory and concerning. I generally perform a scalp biopsy in patients with significant itching, burning and pain.



Is the patient shedding more than your normal? Is there hair on the pillow in the morning? Is their hair in the patient's food? Hair shedding is a normal thing but once it becomes excessive a patient notices. If shedding patterns are different for a given patient than they once were, this is abnormal shedding. plain and simple!  We get too hung up on counting hairs - Is it less than 100? Is it more than 100? This is important I agree. But the most important question is : Is the patient's daily shedding patterns different than they used to be!



Finally, what pills or supplements does the patient take (supplements)? Many pills have the potential to cause hair loss but so do all supplements - including those for treating hair loss, blood pressure, weight loss, body building, depression.


I ask about the four S's - everytime !

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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