Guide | HairMD | July 1, 2021
Hair loss or alopecia is the most common complaint reported to dermatologists. Almost half of the population (both men and women) experience hair loss by the age of 50. We have around 1 lac hair strands, and we lose around 100 strands every day. This is negligible hair loss and does not cause any serious balding effect.
Now you must be wondering why hair falls off normally? It is a normal life cycle of hair. Life of hair involves 4 phases, namely Anagen, Catagen, Telogen, and Exogen. Anagen is the longest phase in which hair grows continuously. It lasts around 3-7 years. When the hair growth slows down, it is the Catagen phase indicating shrinkage of the hair follicle. This phase lasts for 2-4 months. Then hair now enters Telogen, with further growth, lasting for approximately 3 months. Thereafter, hair falls off in the Exogen phase. Daily 5-10% of hair is in its last phase, and hence we notice normal hair fall every day.
But, when we lose a bunch of hair every time we take a shower or during combing, it causes thinning of hair. When you start seeing your hair everywhere on the floor in your house, especially on the bathroom drain, it’s a serious concern. You need to consult a dermatologist to understand the cause and treatment of your hair loss.
Excessive loss of hair causes the scalp to get exposed, showing baldness. It can be a single patch or several patches. Heredity is the most common reason for baldness. It is non-scarring, however, it has a considerable impact on a patient’s quality of life, because it is chronic, relapsing, and easily visible to others. Many people feel low-esteem because of hair loss.
Hair loss causes are manifold. One or more factors may be responsible at a time. You cannot make out hair loss reasons on your own and should consult a dermatologist for proper diagnosis and treatment. Alopecia areata usually runs in families, suggesting genetics as one of the hair loss reasons. Other reasons responsible for hair loss are specified as:
– Hair loss may be occurring because of poor health. Illnesses that cause hair loss are systemic lupus erythematosus (an autoimmune disease), syphilis, and thyroid gland dysfunction like hypothyroidism or hyperthyroidism. Allergic contact dermatitis is also one of the most commonly noticed hair loss causes.
– It is the second most common cause of hair loss. It is generally observed 2-3 months after the body suffers any physical trauma or stress, like accidental blood loss, major surgery, or any serious infection. Sudden change in hormonal levels as seen during pregnancy and after childbirth also causes hair loss.
– Anticancer chemotherapy drugs like paclitaxel and doxorubicin cause sudden hair loss, affecting the entire head and even eyelashes, eyebrows, and body hair. Other medicines like amphetamine, beta blockers, levodopa, lithium, and warfarin do cause hair loss.
– Deficiency of vitamins like B6 (Pyridoxine), B7 (Biotin), B12 (Cyanocobalamin) and C (Ascorbic acid) causes hair loss. Diet deficient minerals like zinc and iron also cause hair loss. Eating a well-balanced diet and vitamin supplementation usually restores the hair loss to normal.
Several lifestyle factors like junk food, a diet deficient in essential vitamins and minerals, stress, smoking, and alcohol consumption also add to hair loss.
Food is the best medicine for any health problem; therefore, a diet complete in all nutrition will improve overall health and will keep your hair in a healthy state too. Fast food rich in saturated fat, and containing high sugar and salt is a major risk factor for lifestyle diseases like diabetes, blood pressure, and obesity. Inadequate sleep further builds stress in the body. These chronic diseases and their treatment affect the health of hair as well. Follow a healthy diet, rich in fresh fruits, green vegetables, fibres, nuts, and protein. This will help you to have healthy hair.
External factors responsible for hair loss are pollution, UV rays, harsh sunlight exposure, smoke and dust. Harmful chemicals from the atmosphere like sulphur dioxide, ammonia, heavy metals, and pesticides cause potential damage to hair health. Chlorine and bleach, usually added in swimming tank water, make your hair brittle and easily fall off. Always protect your hair with a scarf or cap when stepping outside.
Write about how certain external factors like pollution, water and air quality, and weather changes can affect hair loss.
Several medicines are available for hair loss treatment. They are either applied on the scalp, or may be taken orally. However, the best-suited treatment for your hair loss is decided by your doctor. Minoxidil and finasteride are the most commonly used first-line treatment medications for hair loss.
– It is FDA approved medicine, available in the form of 5 % foam (Once a day use) and 2% solution (Twice a day). It is available as Over the Counter (OTC) product. Minoxidil prolongs the anagen phase of the hair cycle, and shortens telogen. Miniaturised follicles are enlarged. Hair shaft diameter and linear hair growth rate also get increased.
– It is also FDA approved medicine available as cream, foam and tablet (Propecia, Proscar). However, this is a prescription medicine. Finasteride improves hair counts, increases in hair thickness and length.
Both these medications for hair loss are effective, but you need to have patience to continue a long-term treatment. Initial effects are visible after 2-3 months, and complete treatment may last for 6-7 months.
Rarely used contact immunotherapy involves use of Diphenylcyclopropenone (DPCP) and squaric acid dibutyl ester. These drugs are topical sensitisers, and used for patients with more than 50% hair loss. These drugs cause allergic contact dermatitis, and change the immune response and trigger hair regrowth. Topical corticosteroids may be used to reduce inflammation of hair follicle, e.g., Desoximetasone cream (Topicort) and clobetasol propionate foam (Olux-E Foam).
The second line of treatment involves the use of anthralin, prostaglandin derivatives, systemic corticosteroids, inosine pranobex, Excimer laser, etc. The third line of treatment includes JAK/STAT inhibitors like tofacitinib (Xeljanz), baricitinib (Olumiant) and ruxolitinib. It is always advised to consult a certified dermatologist or trichologist, before taking any medication for your hair loss.
Give a brief about the available medical procedures like hair transplant, platelet-rich plasma, mesotherapy, derma-roller, etc.
– It is a concentrate of human platelets in a small volume of plasma. It is obtained by centrifugation of the patient’s own venous blood. It is injected intradermally in the bald areas of the scalp. PRP contains several growth factors and essential biochemicals that stimulate new hair growth. It also increases hair density and hair shaft diameter.
– It is a small device having a drum with tiny needles and is rolled over the bald area. It causes micro-injuries that stimulate hair growth. When microneedling is used along with other drugs, it helps deep penetration of the drug and improves the efficacy of it. Therefore, micro-needling is successfully paired with other hair growth-promoting therapies, such as PRP, topical steroids or minoxidil.
– This is also approved by FDA. The technique involves very narrow beams of light that penetrate deep into the scalp to the depth of the hair follicles. It reduces inflammation and improves blood circulation. The fractional laser causes the secretion of proteins essential for hair growth and stimulates the anagen phase. It is frequently used in combination with topical minoxidil, and results in improved hair growth and density. A recent innovation in this field is Trichibiolight®. It is a combination technique involving application of nutrients used in mesotherapy directly on the scalp followed by a photo-biostimulation session with LED light (630nm). Residual hair gets thickened and strengthened and visibly promising results are seen.
– It is a surgery performed by a dermatologist, or a plastic surgeon. It involves movement and grafting of hair from the back or side of the head, to the front or top of the head. The procedure is carried out under general anaesthesia. The procedure improves the appearance in case of men with male pattern baldness, and females with thinning hair. The procedure is not suitable for people who have lost hair due to chemotherapy, and people who form keloid at the site of injury.
– Mesotherapy involves the injection of finasteride, minoxidil, vitamins, or plant extracts to stimulate hair growth. It delivers essential micronutrients to hair, improves blood circulation, and also balances hormonal levels around the hair follicle in the scalp.
Prevention is always better than cure. Follow some self-care procedures to avoid hair loss in future. Hair loss is a health problem that comes from bad life choices. Sooner you understand it, the better it is for your lifetime. Follow simple lifestyle changes for hair loss prevention.
A lifestyle with a healthy diet rich in vitamins and minerals, regular exercise and yoga for destressing is the best hair loss solution.
Avoid hot water showers and hair-care products containing harmful chemicals. Regular washing is necessary. But use mild shampoos and lukewarm water. Sulphates, parabens, and propylene glycol cause excessive drying and irritate your scalp. Frequent use of such chemicals on hair and scalp may lead to hair loss.
Follow gentle hair styling. Never pull your hair. Tight ponytails and braids will harm the roots and increase hair fall.
Avoid hair processing. Frequent application of hair colors or dyes and perming or straightening cause potential damage to scalp and hair.
Use a silk pillow cover while sleeping. This will allow hair to slide easily. Cotton pillow covers may absorb natural oil from your hair making them excessive dry. It may also cause friction between the hair as you turn your head on the pillow.
Follow such simple hair loss solutions routinely to avoid facing the problem!
When you feel that hair fall is increased, you can try some home remedies for hair loss at initial stages. A gentle massage of the scalp using fingertips dilates the blood vessels beneath the skin. It also increases blood circulation, helps hair follicles to regrow, and increase hair density. It also relieves stress and relaxes your mind. Massage can be done with warm medicated oils to further boost the calming effect.
Coconut oil or sesame oil is the best oil for massage as they provide nutrition and conditioning effects too. Many natural hair loss remedies offer hair protective effects and promote a healthy scalp.
Lemon or orange juice and buttermilk help restore the pH of the scalp and reduce itching and dandruff caused by alkaline shampoos. These hair loss remedies are best used as a rinse after hair wash.
Aloe vera is a traditional ayurvedic medicine. It is generally applied as a gel that acts as a natural moisturiser and prevents drying of scalp and hair. It also has antibacterial, fungicidal, and antioxidant properties. Therefore, it is commonly used as a hair conditioner after shampooing.
Onion juice is used to treat bald patches. It is scientifically proven that onion juice improves hair growth. It also has antioxidant and anti-inflammatory actions. But it has a very strong smell. So, you can mix it with aloe vera gel and lemon juice and apply on the scalp.
Flaxseed oil contains omega 3 fatty acids like alpha linoleic acid, antioxidant vitamin E and B group vitamins. All these ingredients are nutritive and anti-inflammatory in action. Flaxseed oil soothes the scalp and makes hair grow stronger and healthier. Add a few drops of flaxseed oil to any other scalp massage oil. Benefits can also be obtained by eating the crushed flaxseeds.
Amla is well-known for its hair strengthening properties. It contains dihydrotestosterone (DHT) blockers like ellagic acid, chebulagic acid, pyrogallol, and flavonoids like quercetin. It also contains a large amount of antioxidant vitamin C. Amla can be applied to the scalp as a fresh juice or can be extracted in any massage oil.
Liquorice is rich in flavonoids such as liquiritin, glabrine, and glabranine. These flavonoids directly block DHT and potentiate the hair growth. It is antioxidant, anti-inflammatory, and protects skin and hair from UV radiation-induced damage. Liquorice can be used as a mask for the hair or can be extracted in oil for scalp massaging.
Shankhpushpi contains aromatic essential oils, fatty acids, like myristic, palmitic, and linoleic acid that block DHT. Shankhpushpi also contains β-sitosterol, and kaempferol, that stimulate hair follicles and block DHT. It is a rejuvenating herb that supports hair growth and prevents hair fall.
Essential oils – Several volatile aromatic oils like lavender, rosemary, lemongrass, and peppermint, when added to carrier massage oil like pomegranate seed oil, jojoba oil, or grapeseed oil, improves hair condition.
Even after trying homemade remedies, if hair loss symptoms persist, then you should consult an expert, certified dermatologist.
Some alternative cosmetic techniques available to restore the hair loss are:
Very delicate and naturally appearing cosmetic procedures are scalp microblading and micro pigmentation. Both the techniques impart pigment into the skin. The only difference lies in the device used in the procedure. In microblading, a manual blade is used whereas, in micro pigmentation a more powerful electric tattoo machine is used. It is very similar to eyebrow microblading. It is an artistic, but skilled procedure. The cosmetic surgeon or dermatologist inserts the tattoo ink just into the dermis by scratching the skin. It creates natural-looking strokes and hides the thinning areas on the scalp. The tattoo ink strokes in the form of tiny dotted lines replicate the appearance of real hair, and create the illusion of voluminous, healthy hair.
The simplest hair loss solution is to hide it.
Change your hairstyle, and cover the thinning areas.
Use colour sprays that will colour your scalp. The colour needs to be exactly the same as that of your natural hair.
You can also opt for a hair wig or toupee. Nowadays, high quality, natural looking wigs or toupees are available. The colour and texture of hair can be customised to match your natural hair. If the top of the head is thinning, then try crown weave. Consult an expert hairdresser or hairstylist to design your wig.
Everyone has dandruff. Dandruff is the flaking of scalp or exfoliation. It gets developed normally if hair is not washed for 1-2 weeks. Dandruff does not cause hair loss immediately. Hair loss happens when dandruff becomes excessive due to infection by Malassezia fungi. This infection causes oxidative damage and inflammation of the scalp, often noticed as redness, itching, and excessive flaking. Chronic and frequent appearance of red patches, an unhealthy condition called seborrheic dermatitis, causes dandruff hair loss. Therefore, dandruff hair loss should not be overlooked. One should always consult a dermatologist to control the dandruff hair loss. Often an anti-dandruff shampoo, or a scalp lotion containing antifungal ketoconazole is prescribed by the doctor.
Excessive hair loss moves from thinning to the balding stage. The stage of hair loss is decided based on the Hamilton-Norwood scale for males, and Ludwig system for females. These systems take into consideration the pattern and severity of hair loss. Norwood classified male pattern hair loss into several stages.
Stage 1 – It is the very early stage of hair loss without any recession of the hairline.
Stage 2 – Hairline starts receding, especially around the temple regions.
Stage 3- There is a symmetrical recession of hairline in M, U, or V-shaped balding. Stage 3 vertex shows hair loss in the vertex area.
Stage 4- This stage has no hair on the vertex, and two bald areas are separated by a band of sense hair.
Stage 5- Vertex and temple region hair loss is severe. The band of hair connecting two regions of bald is now getting thinner.
Stage 6- This stage is similar to stage 5. However, hair loss has increased to a greater extent.
Stage 7- Horseshoe-shaped hair on the back and sides of the head are seen. The density of hair is thin.
Female pattern hair loss is classified by Ludwig in 3 grades.
Grade I- Crown region shows thinning of hair. This is seen approximately 1-3 cm behind the frontal line.
Grade II- Considerable thinning of hair on the crown region, and the scalp is visible.
Grade III- The crown region is completely bald.
Clinically the dermatologists use different terminologies to classify the severity of hair loss:
Alopecia areata – Hair loss occurs in patches and is frequently reported.
Alopecia totalis – Hair loss is observed over the entire scalp.
Alopecia universalis- This condition has total hair loss, including eyebrows and body.
In recent years, alopecia areata has been noticed in children as well. It is more prevalent in girls than in boys. Boys show more severe alopecia areata.
For male pattern hair loss, hormone DHT, an androgen is responsible, as it causes shrinkage of hair follicles. So DHT blockers come to rescue. Mostly, hair loss runs in families and is a genetic problem. But additionally, other factors like thyroid hormone imbalance, ringworm infection of scalp, excessive dandruff and stress also add to hair loss. Hair loss treatment for men is slightly different than women.
Minoxidil is the most common OTC product for hair loss in men. It should be rubbed on a dry scalp every day for several months. Stopping minoxidil therapy may start hair loss again. Finasteride tablets for oral use are also prescribed by dermatologists.
Lifestyle changes need to be done to avoid the bad effects of smoking and alcohol consumption. A balanced diet, supplemented with vitamins, minerals and regular exercise also help.
Female pattern hair loss is usually noticed as the shortening of ponytail or widening of the part line. Women usually experience hair loss after child birth, or during menopause. It is due to hormonal imbalance. Thyroid gland dysfunction may also be responsible for hair loss, and can be treated with hormone supplements. If hair loss is due to nutritional deficiency, it does not require medical treatment. Vitamins and minerals supplementation would help.
Minoxidil solution or foam, available as OTC product, is applied on dry scalp daily for several months. Finasteride is not recommended in women because of its side effects on the female reproductive system. Although not very common, hormone replacement therapy may be prescribed for post-menopausal women with androgenic alopecia. Topical application of vitamin A derivative, tretinoin may be used in combination with minoxidil. Dermatologists may prescribe anti-androgen spironolactone based on the hormonal condition of a woman. Excessive dandruff may be treated with ketoconazole shampoo.
If no response is observed with any of these treatments, dermatologists may advise for PRP, minimally invasive microneedling and hair transplant.
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Ans. Baldness occurs only when new hairs do not regrow for the hair that has fallen off. We daily lose 50-100 strands. It is considered as normal hair fall. That many hair regrows, restoring normal hair density. When we lose excessive hair in the form of clumps or bunch every time, we wash our hair and comb, in that case, hair loss results in baldness.
Ans. Excessive hair loss than normal hair-fall causes thinning of hair. Eventually, it leads to balding either at one spot or as several patches. The condition is called Alopecia areata. Hair loss may be hereditary, or may occur because of hair styling and treatments, skin infections, hormonal changes, vitamin deficiency, medication, or radiation therapy. These factors interfere with the growth cycle of hair, and prevent regrowth from hair follicles.
Ans. Vitamin deficiency causes hair loss. Hair loss arising from deficiency of vitamins because of poor diet is called telogen effluvium. It is temporary hair loss and can be cured naturally by taking vitamin supplements like Biotin (Vitamin B7), Niacin (Vitamin B3), Ascorbic acid (Vitamin C) and also minerals like zinc.
Ans. a major reason for hair loss in females is a changing hormonal level. It is experienced especially during menopause. Levels of female hormones like estrogen and progesterone levels fall, and therefore, the effects of the male androgenic hormones become prominent, leading to hair loss. Additional factors responsible for hair loss in females include thyroid gland diseases, stress, poor nutrition, vitamin deficiency, and heredity.
Ans. Yes. FDA approved hair loss treatments are very effective. However, such treatment should be taken under medical supervision. Dermatologists will diagnose the exact cause of hair fall and will suggest you the best hair loss treatment accordingly. Self-medication should be strictly avoided.
If you are struggling with hair loss, you are not alone. Millions of people suffer from hair loss all over the world. You just need to be alert and act fast. It is always best to prevent hair loss as soon as you notice the early signs of it, and take action to control it. If you notice that your hair loss rate is getting severe day-by-day than usual, it’s a warning to consult an expert. The reason can be anything like, a stressful life, familial history, or a nutritional deficiency. Underlying medical conditions may also be responsible for hair loss. The earlier you consult a doctor and seek assistance, the more likely it is to prevent further loss and keep your healthy hair.
If you are reading this, it means you are suffering from hair loss and are worried about it. Consult the expert dermatologist and renowned specialists at HairMD.
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July 1, 2021
Natural hair is an asset and a major factor in deciding an individual’s appearance. While some people love their hair, many fight with hair loss and other hair problems. Hair... 3007
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