Am I correct that now he should see a dermatologist? I don’t think he’s stressed.

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.

Rogaine is an over-the-counter medication to slow hair loss and promote new growth for androgenic alopecia and alopecia areata. It is rubbed onto the scalp twice daily, and it may take up to 12 weeks before any progress is seen.

It is up to your son to determine whether he can adapt to early baldness or whether he is so concerned that he chooses to consider a wig, surgical implant or medication. If he is under a great deal of stress at work or in his private life, he may wish to address that issue as well.