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Dear Dr. Gott: My son has a bald spot on the back of his head. His doctor said it was stress-related alopecia. His hair grew back and his scalp was normal, but the bald spot reappeared, bigger, and is lasting much longer. So his doctor told him to buy Rogaine.  Am I correct that now he should see a dermatologist?

Dear Reader: I'm not all that sure your son suffers from alopecia, an autoimmune disorder in which the immune system attacks hair follicles. In most cases, with the various types of alopecia, hair falls out in small patches about the size of a quarter. It can regrow in the same areas but may fall out again, repeating the pattern. Severe cases result in complete loss of hair over the entire body. Treatment to promote hair growth may include minoxidil (Rogaine), topical creams and corticosteroids.

An individual suffering from alopecia will not ordinarily have other autoimmune difficulties but could have an increased incidence of nasal allergies, atopic eczema, asthma and thyroid disorder.

Most people shed up to 100 hairs every day and don't bald. And thinning hair is often a part of the aging process that occurs because of hormonal changes. Balding occurs when the rate hair sheds surpasses the rate it grows. Causes can include having diabetes or lupus; scalp infection such as ringworm; a hair-pulling disorder, such as exhibited with mental illness; medical treatment, such as chemotherapy and radiation for cancer; use of specific medications for arthritis, high blood pressure, some cardiac conditions or gout; several forms of alopecia; and still more. A specific diagnosis can be made through scalp scrapings and other methods. Your son may have a hormonal or medical disorder. I would defer to his primary-care physician regarding involving a dermatologist.

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