Hair loss

Words by Dr Saroj Poudel

 

“Hair loss is a fairly common occurrence, affecting people of all ages, including children.” – Hair loss can happen to anyone, regardless of age, and it’s essential to recognize its potential causes and treatment options.

“Depending on the type of hair loss, it can be the result of genetics, internal causes, or external causes.” – Understanding the underlying factors contributing to hair loss is crucial for effective treatment and management.

“The body needs nutrients to create new hair strands and maintain healthy hair follicles.” – A balanced diet rich in essential nutrients is essential for promoting healthy hair growth and minimizing the risk of hair loss.

“There’s a range of treatment options for hair loss, but the best option for you will depend on what’s causing your hair loss.” – Treatment approaches vary depending on the type and underlying cause of hair loss, highlighting the importance of personalized care.

“Seeking medical attention from your primary care doctor or a dermatologist can help you identify underlying causes and determine the most appropriate treatment plan.” – Consulting a healthcare professional is essential for accurate diagnosis and tailored management of hair loss, ensuring the best possible outcomes.

 

Hair loss (alopecia) is a fairly common occurrence. While it’s more prevalent in older adults, anyone can experience it, including children. It’s typical to lose between 50 and 100 strands of hair a day, according to the American Academy of Dermatology (AAD). With about 100,000 hairs on your head, that small loss isn’t noticeable. New hair normally replaces the lost hair, but this doesn’t always happen. Hair loss can develop gradually over years or happen abruptly. Depending on the underlying cause, it may be temporary or permanent.

Hair growth cycle- 3 Stages 

1) Anagen: In the first stage, hair grows at half an inch every month. The rate increases in summer and reduces in winter. On an average, it takes place in 3 to 5 years, with Asians undergoing maximum tenure of anagen, which is for 7 years. Where full length hair average is about 18 to 30 inches, for Asians it’s up to 1m. This is the active hair growth phase.

2) Catagen: The second stage is the shortest phase in this cycle, spanning for only 10 days. It is basically a transitional phase from anagen to telogen.

3) Telogen: By now, active hair have become old and about to fall off. The telogen stage is a resting phase. In this phase hair follicles remain inactive for approximately 3 months, after which the entire process is repeated. Since each hair follicle functions independently, hence, it has its own growth cycle. Had this not happened, then sudden loss of huge quantity of hair would have been natural. In healthy hair cycle, about 80 hairs are lost by an individual every day.

It is only due to some causes that one experiences gradual or rapid hair loss. When it happens, the normal hair growth cycle gets disrupted.

 

Hair loss symptoms:

The main symptom of alopecia is losing more hair than usual, but this can be harder to identify than you might think.

The following symptoms can provide some clues:

  • Widening part: If you part your hair, you might start to notice your part getting wider, which can be a sign of thinning hair.
  • Receding hairline: Similarly, if you notice your hairline looking higher than usual, it may be a sign of thinning hair.
  • Loose hair: Check your brush or comb after using it. Is it collecting more hair than usual? If so, this may be a sign of hair loss.
  • Bald patches: These can range in size and can grow over time.
  • Clogged drains: You might find that your sink or shower drains are clogged with hair.
  • Pain or itching: If you have an underlying skin condition causing your hair loss, you might also feel pain or experience itching on your scalp.

 

What causes hair loss?

There are several types of hair loss, some are common and some are rarer, and each with different underlying causes.

Depending on the type of hair loss, it can be the result of genetics, internal causes, or external causes. Here’s a look at a few different types of hair loss:

  • Androgenic alopecia:

Androgenic alopecia refers to hereditary hair loss, like male pattern baldness or female pattern baldness, and is also known as “pattern alopecia” because it can happen to both males and females.

It’s also the most common cause of hair loss, affecting up to 50% of people.

Hair loss related to androgenic alopecia tends to happen gradually. While some people might experience hair loss as early as puberty, others might not notice symptoms until their middle ages.

Female pattern baldness often results in thinning all over the scalp and might look like widening or thinning around the part. It typically occurs after age 65 but, for some females, it can begin early in their lives.

Male pattern baldness typically involves progressive hair loss above the temples and thinning at the crown of the head, creating an “M” shape.

  • Alopecia areata:

Alopecia areata is an autoimmune condition that causes your immune system to attack hair follicles, resulting in bald patches that can range from small to large. In some cases, it might lead to total hair loss.

In addition to losing hair on the scalp, some people with alopecia areata lose hair from their eyebrows, eyelashes, or other parts of the body.

  • Anagen effluvium:

Anagen effluvium involves a rapid loss of hair. This usually happens because of radiation treatment or chemotherapy.

Hair will usually regrow after the treatment stops.

  • Telogen effluvium:

Telogen effluvium is a type of sudden hair loss that results from emotional or physical shock, like a traumatic event, period of extreme stress, or a serious illness.

It can also happen because of hormonal changes, like those that happen in:

  • childbirth
  • postpartum
  • menopause
  • Polycystic Ovary Syndrome (PCOS)

Other potential causes of telogen effluvium include:

  • malnutrition including vitamin or mineral deficiency
  • certain endocrine disorders
  • starting or stopping hormonal birth control
  • post-surgery as a result of the anesthesia
  • acute illnesses or severe infections like COVID-19

Several types of medications can also cause it, including:

  • anticoagulants
  • anticonvulsants
  • oral retinoids
  • beta-blockers
  • thyroid medications

This type of hair loss typically resolves on its own once the underlying cause is addressed.

  • Tinea capitis:

Tinea capitis, also called ringworm of the scalp, is a fungal infection that can affect the scalp and hair shaft. It causes small bald patches that are scaly and itchy. Over time, if not treated early, the size of the patch or patches will increase and fill with pus.

These patches, sometimes called a kerion, can cause scarring as well.

Other symptoms include:

  • brittle hair that breaks easily
  • scalp tenderness
  • scaly patches of skin that look grey or red

It’s treatable with antifungal medication.

  • Traction alopecia:

Traction alopecia results from too much pressure and tension on the hair, often from wearing it in tight styles, like braids, ponytails, or buns.

  • Diet:

The body needs nutrients to create new hair strands and maintain healthy hair follicles. Malnutrition, low protein levels, and vitamin deficiencies can increase the risk of hair loss.

Scientists have found low levels of the following nutrients in people with hair loss and other hair changes:

  • protein
  • iron
  • zinc
  • vitamin B3, or niacin
  • fatty acids
  • selenium
  • vitamin D
  • biotin

A dietary deficiency may also cause:

  • brittle hair shafts
  • a dull appearance to hair
  • skin and scalp dryness
  • sparse, light-colored hair in children

A balanced diet may help promote strong, healthy hair. In some cases, a doctor may prescribe supplements.

How is hair loss diagnosed?

Because so many things can cause hair loss, it’s best to schedule an appointment with a medical professional if you notice any changes in your hair.

They’ll likely use a combination of your health history — including any recent illnesses, surgeries, life stressors, and family history — and a physical exam to help narrow down the causes.

If they suspect an autoimmune or skin condition, they might take a biopsy of the skin on your scalp. This involves carefully removing several small sections of skin for laboratory testing.

It’s important to keep in mind that hair growth is a complex process and multiple tests may be needed to understand what is causing your hair loss. A biopsy may also be taken if it is initially very unclear what the root causes may be.

They may also order blood tests to check for any nutrient deficiencies or signs of an underlying condition.

 

What are the treatment options for hair loss?

There’s a range of treatment options for hair loss, but the best option for you will depend on what’s causing your hair loss.

Typically, the most common types of hair loss are treated with topical or oral medications, which will likely be the first course of treatment.

Over-the-counter (OTC) medications generally consist of topical creams, gels, solutions, or foams that you apply directly to the scalp. The most common products contain an ingredient called Minoxidil.

  • Minoxidil:

Minoxidil comes in strengths of 2% or 5%. People apply the product directly to the areas of thinning hair.

Hair growth may take 6–12 months to improve, but if a person stops using the treatment, hair loss will recur.

Possible side effects include:

  • contact dermatitis
  • skin irritation
  • excessive hair growth on the face and other areas of the body

  • Finasteride

Prescription medications, like Finasteride, may help prevent further androgenetic hair loss, especially for male pattern baldness. People take this medication daily to slow hair loss, though some experience new hair growth when taking Finasteride. Finasteride is an oral medication taken in 1 milligram daily dose. Doctors prescribe this drug for males and females between puberty and menopause if in case they do not see an improvement after using minoxidil.

Possible side effects include:

  • erectile dysfunction
  • decreased libido
  • gynecomastia, or growth of breast tissue

Your clinician might prescribe anti-inflammatory medications, like corticosteroids, if hair loss seems related to an autoimmune condition.

  • Injectable therapies: 

Newer treatments that are also being explored include some forms of laser therapy, microneedling with PRP, as well as other oral medications. 

Procedures such as mesotherapy and Platelet-Rich Plasma (PRP) therapy are gaining popularity. Mesotherapy involves injecting nutrients into the scalp, while PRP therapy uses the patient’s blood to stimulate hair follicles, promoting growth and thickness.

Hair transplant surgery

In advanced cases of hair loss, surgical intervention may be necessary. Hair transplant surgery involves taking hair from the donor area and transplanting it to thinning or bald areas. This is considered a permanent solution and is performed using various techniques, such as Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE).

How can I prevent hair loss?

There are a few things you can do to minimize hair loss:

  • Keep hairstyles loose. If you regularly style your hair into braids, buns, or ponytails, try to keep them loose so they don’t put too much pressure on your hair.
  • Avoid touching your hair. As much as possible, try not to pull, twist, or rub your hair.
  • Pat hair dry. After washing, use a towel to gently pat your hair dry. Avoid rubbing your hair with the towel or twisting it within the towel.
  • Aim for a nutrient-rich balanced diet. Try to incorporate plenty of iron and protein into snacks and meals.

Styling products and tools are also common culprits in hair loss. Examples of products or tools that can affect hair loss include:

  • blow dryers
  • heated combs
  • hair straighteners
  • coloring products
  • bleaching agents

If you decide to style your hair with heated tools, only do so when your hair is dry and use the lowest settings possible.

If you’re currently losing hair, use a gentle baby shampoo to wash your hair. Unless you have extremely oily hair, consider washing your hair only every other day or less.

When to contact a doctor?

In most cases, thinning hair does not result from overall health issues. If a person is concerned about hair loss or if it affects their mental well-being, they may wish to consult a doctor.

Individuals should also seek guidance from a healthcare professional if they notice:

  • sudden or unexpected hair loss
  • hair that falls out in clumps
  • the appearance of bald patches
  • hair loss with itching and burning

A person may need treatment for an underlying condition. A dermatologist can also help find a suitable treatment option.

Frequently asked questions about hair loss

  • Which vitamin can help with hair loss?

Hair loss is a complicated topic and the role of nutrition in preventing or treating hair loss can be somewhat controversial.

While nutrition and specific nutrients are vital to the hair growth process, increasing your intake of these nutrients may not help you, especially if you have a certain type of hair loss, such as scarring alopecia or cicatricial alopecia.

Element and vitamins to incorporate into your nutrition plan that may promote hair growth include:

  • B vitamins, specifically riboflavin, biotin, folate, and vitamin B12
  • iron
  • vitamin C
  • vitamin D

Some research connects excess intake of vitamin A or selenium with an increased risk for hair loss.

  • Why is my hair suddenly thinning?

Sudden hair loss can happen for various reasons, including stress, an underlying condition, and some medical treatments. Anyone who notices sudden, unexpected hair loss should seek medical advice.

  • Can thinning hair grow back?

It depends on the reason for hair thinning. Hair that falls out due to cancer treatment, for example, usually starts growing back 3–6 months after treatment.

Hair that falls out after childbirth usually returns 6–9 months later. If hair loss occurs with aging, some medical treatments may help restore growth.

  1. What illness causes hair loss?

An increased risk of hair loss is connected with certain illnesses. These include:

  • polycystic ovary syndrome (PCOS)
  • scalp psoriasis
  • sexually transmitted infections, such as syphilis
  • thyroid disease

Hair loss can also be a side effect of some medications, especially chemotherapy medications to treat cancers.

  • Is it possible to stop hair loss indefinitely?

Stopping hair loss indefinitely depends upon the underlying cause. As a general rule, the sooner you treat hair loss, the more likely you will be able to reverse or reduce the rate of hair loss.

Some hair loss causes can’t be reversed. This is true for damaged hair follicles from too-tight hairstyles, damaged hair follicles from chemicals applied to the hair, and damages caused by certain autoimmune diseases.

  • What shampoo is best for thinning hair?

Shampoos cannot prevent hair loss or bring hair back, but a moisturizing shampoo can help the hair retain moisture, making it look thicker and fuller. It may also help slow thinning by reducing the risk of breakage.

Final Thoughts:

Whatever the cause of your hair loss, seeking medical attention from your primary care doctor or a dermatologist can help you identify underlying causes. Treatments for hair loss are more likely to be successful if started early.

Treatments may include changes to how you care for your hair, improvements to your diet, and medical treatments that may be topically applied or taken in orally. Even if your hair loss is hereditary, there are treatments that exist that can help slow or reverse hair loss. If possible, talk to your doctor to address your concerns and rule out any serious underlying medical concerns that may be causing your hair loss.

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