Hair loss—called alopecia areata—can be upsetting. If it affects you, you may feel as if you’re the only one, but it’s more common than you think. About seven million Americans have alopecia areata, including men, women, and children of all ethnic groups.

In this Q&A, Emma Guttman-Yassky, MD, PhD, Waldman Professor and Health System Chair of Dermatology at the Icahn School of Medicine at Mount in New York and Director of the Alopecia Areata Center of Excellence at Mount Sinai, explains the condition, its risk factors, and who to contact for treatment.

What is alopecia areata?

Alopecia areata is an autoimmune disease that causes you to lose your hair, mostly on the scalp. An autoimmune condition means your body’s own immune system is attacking a certain part of your body. In this case, the system attacks healthy hair follicles. Alopecia areata often starts with one or more circular patches about the size of a quarter. Hair may disappear suddenly, over just a few days, or it may fall out slowly, over weeks or months. This condition can spread to other parts of the body, such as the eyebrows, eyelashes, beard, and extremities. The condition is not linked to food. There’s nothing you should eat—or avoid—to prevent it. If you are an alopecia patient, you can eat whatever you want.

What causes the condition? Who is most at risk?

This condition does not discriminate. It affects people of all ages, genders, and backgrounds. It often starts in childhood or adolescence but can affect those well into adulthood.

Alopecia areata can be triggered by a significant event, such as an illness or trauma, or it can arise due to genetics or a family history of eczema or another allergy. We see more alopecia areata in families of patients who have had the condition. We also see it in families that have eczema. While some people think it can be caused by stress, there is no scientific data to back that up. Alopecia is not contagious.

Can hair loss affect you emotionally?

If you’re feeling anxious or depressed over your hair loss, that’s not unusual. Hair can be an important part of our identity. And baldness—in patches or all over your head—can be devastating. It can make you feel self-conscious and unhappy about your appearance. According to the National Institute of Mental Health, people with long-term alopecia areata are at a higher risk of depression. So, if you’re feeling sad or uncomfortable about the condition, you are not alone.

Should I see a doctor if I think I have alopecia?

You should see a doctor as soon as you notice a problem. Some mild forms of the disease improve on their own, but most people need medical intervention. I recommend seeing a specialist, because many primary care physicians don’t know how to treat alopecia. At the Alopecia Areata Center of Excellence at Mount Sinai, we have special expertise in diagnosing and treating alopecia areata and cicatricial alopecia.

We have found that patients with alopecia have more systemic inflammation than patients with other skin conditions, such as psoriasis or eczema. Over a long period,  inflammation that is systemic—affecting many or all parts of the body—can cause a number of problems including heart disease, arthritis, Alzheimer’s disease, and cancer. Getting treatment early can help prevent alopecia from developing into these conditions.

How is the condition treated?

The first step is to evaluate your symptoms and the type of cells that are causing the inflammation. Dermatologists will then use a variety of treatments, including systemic (oral or biologic), topical, and injected anti-inflammatory medications. In addition, at Mount Sinai’s Alopecia Areata Center of Excellence, we are researching new treatments for the conditions, so we may be able to include you in a clinical trial.

It seems that everywhere you look, there are new skin care tips and tricks that can range from the elaborate, such as a 10-step nighttime routine, to the bizarre—like vampire facials. But not all viral trends are good, and they certainly may not be good for your skin.

Angela J. Lamb, MD, Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, explains some of the most popular trends and provides advice on how you can determine what works best for your skin.

What is one of the more overrated skin care trends?

I see a lot of videos on TikTok about the 10-step process that include two different cleansers and multiple serums and treatments. This method is overrated as it uses too many products, which is often not a good idea.

A good skin care routine is simple. I recommend using a cleanser, a ‘power product’—which can be a serum or an eye cream—and a moisturizer. You’re better off investing in a few of these high-quality products that are going to do what you want them to do, instead of using 10 different things.

What ingredients should I look for in products if I have facial hyperpigmentation and/or excessive redness?

For hyperpigmentation, look for products that have a retinol or a vitamin A derivative as this will help to brighten the skin. There are also a variety of other ingredients, including mandelic acid, kojic acid, and azelaic acid, which will help your hyperpigmentation.

If you have some redness, look for something that has acetamide as that will help to calm the skin and improve texture. Also, the product you use will depend on the reason for the redness. For example, if you have rosacea, a product that contains green tea would be best to decrease redness.

Are sheet masks effective?

Sheet masks are very effective. Most of the masks on the market have a high concentration of hyaluronic acid, which is great at hydrating skin. Other masks contain clay—which is great at drying out blemishes and minimizing the appearance of pores—or lactic or glycolic acid—which exfoliate skin. In general, sheet masks are great, a lot of fun, and feel good.

When should I see a dermatologist for my skin care?

You should see a dermatologist if you’ve tried a couple of over-the-counter solutions and you are still having skin issues.

Here are some examples:

If you have eczema and have tried a few over-the-counter cortisones, anti-itch creams, and moisturizers, and your skin is still keeping you up at night and making you feel self-conscious, then you need to see a dermatologist.

• If you’re dealing with hair loss and have tried over-the-counter shampoos and you’re still losing more hair, that’s when you need to see a dermatologist as there may be a vitamin deficiency or scalp condition that needs prescription treatment.
• If you have acne and have tried over-the-counter treatments for a few months and you’re not satisfied, see a dermatologist. Over-the-counter products are a good compliment to prescription remedies, but if you have severe acne that goes untreated, it can cause indented scars in your skin, which is hard for a dermatologist to treat. You should get treatment sooner rather than later.

This advice extends to anti-aging treatments. If the serums, potions, and masks, are not getting you to where you want to be, then that is the perfect opportunity to go to a dermatologist. We can recommend very noninvasive treatments including chemical peels and lasers. You don’t need to get Botox^®. Some people get nervous thinking that they will have to get invasive procedures, but there are all sorts of things we can do, like prescribing a retinol.

Are there any other skin care tips you would like to offer?

Prevention, prevention, prevention. Too often, people come into my office with acne scars when I really wish I had treated their acne more aggressively upfront. If I had seen them earlier, we could have gotten the acne under control and prevented facial scarring or pitting.

The same goes for wrinkles. I want to get all of my patients to their skin care goals. But when you have had damage from years of not using sunscreen, treatment is difficult. Simply wearing sunscreen will help to prevent your skin from looking more mature than you would like later on.

Use sunscreen and make sure any skin problems you have are addressed aggressively at the beginning so that you don’t have long term consequences that are very hard to treat.

Going from hot, humid summers to cold, dry winters can mean more than just a wardrobe change. Temperature fluctuations may also prompt a change to your skin. For some, winter brings dry skin and exacerbates conditions like eczema and psoriasis, while the humidity of summer can make skin look very oily.

Angela J. Lamb, MD, Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, shares what you need to know about protecting your skin and how to have healthy, glowing skin year-round.

Why does the weather have an effect on your skin?

When the weather is hot and humid outside, your skin ramps up its oil production, which can produce an oily sheen. Alternatively, when the weather is cooler, and maybe the radiators are on more, the low air humidity causes moisture in your skin to evaporate faster, making skin drier.

Should you change your skin care routine as the seasons change?

There are definitely considerations you have to take into account with seasonal change.

For the summer, you want to use a gel-based cleanser and then moisturizers that are a bit lighter—typically products that have hyaluronic acid in them—to avoid clogging your pores.

For the winter, you want to use a thicker, cream-based moisturizer, which will fuse moisture into your skin and not strip it of the oils that are being made naturally. Look for products that contain a humectant—which traps water—like glycerin or glycol. These ingredients will prevent moisture from evaporating off the skin’s surface.

Is there a general rule to a good skin care routine?

I always say that a good skincare routine is simple, simple, simple. Often people are doing far too much to their skin. They come in to my office with bags of 10 different products, and I always say: try to simplify.

I recommend having a cleanser, what I call a ‘power product’—which can be something like a serum or an eye cream—and then a moisturizer. You want to do the same thing morning and night, even if you use slightly different products.

Most people should wash their face twice a day. So, for oily or acne prone skin, you want to use a cleanser with salicylic acid or glycolic acid to help with skin cell turnover and a moisturizer that is a light oil or hyaluronic acid based. For dry skin, you want to use a cleanser that is cream based, which does not have anything in it that’s like a detergent, and a thick moisturizer. So, you should avoid products that have sulfates and look for moisturizers with oils and thick emollients like petrolatum or dimethicone.

How should I change my routine from daytime to nighttime?

Sunscreen is fundamental for a daytime routine, even if you’re not going to be outside for a long time. It is one of the main things you can do for your skin to combat advanced aging, brown spots, wrinkles—all the things people do not want to see on their skin.

A simple daytime routine includes a cleanser, a ‘power product’ for daytime could be a serum with vitamin C or a cream for around the eyes that makes them look less puffy, a sunscreen, and a moisturizer.

You want to do some things that are very similar at night, but—obviously—you will not need a sunscreen. Additionally, in the evening, you may want to use a moisturizer that absorbs oil.

A simple nighttime routine includes a cleanser, a ‘power product’ for nighttime could be a retinol or some type of vitamin A derivative, and a moisturizer.

While sunscreen is the best thing for skin cancer prevention and anti-aging, retinols can almost turn back the clock on fine lines, and wrinkles. They also help build up collagen and can even the tone and texture of skin. I think everyone should be using retinol at night.

How important is it to incorporate sunscreen in your daily routine, particularly for Black women and women of color?

Sunscreen is foundational for anti-aging. While it is true that people who have more pigment in their skin are at a decreased risk of skin cancer—which people often think of as the main reason for using sunscreen—it is also essential for preventing wrinkles. The sun’s rays increase aging. Using sunscreen daily helps to ward off that aging, regardless of your complexion.

And then, of course, the skin cancer prevention is important. It’s very difficult to prevent skin cancer if you’re not wearing sunscreen.

To sum up, use a good cleanser based on your skin type, a good moisturizer based on your skin type, and everyone should be using something—be it a serum or a moisturizer—that has retinol at night.

And, you really shouldn’t be using more than five or six products on your face. I find that people are stressing themselves out trying to do too many things which can cause problems, like irritation or allergic reactions. I encourage people to keep it simple.

Joshua Rosenberg, MD, is an Assistant Professor, Otolaryngology at the Icahn School of Medicine at Mount Sinai and Co-Chief of the Division of Facial Plastic and Reconstructive Surgery at Mount Sinai’s Department of Otolaryngology – Head and Neck Surgery. A diplomate of the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, Dr. Rosenberg is an expert in facial plastic and reconstructive surgery and microvascular reconstruction.