Hair Care

Hair Fall

04 Sep

INDICATION – BRIEF

Hair fall, or alopecia, can be caused by a variety of clinical and non-clinical factors. Clinically, it can be due to conditions like androgenetic alopecia, alopecia areata, telogen effluvium, tinea capitis, hormonal changes, or certain medications. Non-clinical causes can include nutritional deficiencies, physical or emotional stress, damaging hair treatments or hairstyles, smoking, or natural aging. Treatment is dependent on the root cause and may involve medical treatment, lifestyle changes, or surgical interventions. In cases where hair loss is due to an underlying condition, treating that often resolves the hair fall.

INDICATION – DEFINITION

Hair fall, also known as hair loss or alopecia, is a common issue encountered by many individuals, both men and women. It is normal for a person to lose about 50-100 hairs per day as part of the normal hair growth cycle, but when the loss exceeds this range, it becomes a cause for concern.

  1. Clinical Causes
    • Androgenetic alopecia: This is the most common cause of hair loss and is usually genetically determined. It’s often referred to as male pattern baldness or female pattern baldness.
    • Alopecia areata: This is an autoimmune disease where the body’s immune system attacks the hair follicles, leading to hair loss.
    • Telogen effluvium: This is a temporary hair loss condition usually caused by a significant physical or emotional stress event that disturbs the normal hair cycle.
    • Tinea capitis: A fungal infection of the scalp, causing patches of hair loss.
    • Hormonal changes: Conditions such as pregnancy, childbirth, menopause, and thyroid disorders can cause temporary or permanent hair loss.
    • Medications and treatments: Certain medications such as chemotherapy, radiation therapy, and medications for heart disease, depression, high blood pressure, and arthritis can cause hair loss.
  2. Non-clinical Causes
    • Nutritional deficiencies: Lack of necessary nutrients such as iron, zinc, vitamin D, and protein in the diet can cause hair loss.
    • Physical or emotional stress: Major surgery, a high fever, severe infection, or even emotional stress can lead to hair loss.
    • Hairstyling and treatments: Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause a type of hair loss called traction alopecia. Hot oil hair treatments and permanents can cause inflammation of hair follicles leading to hair loss.
    • Smoking: Some studies have shown an association between smoking and baldness in men.
    • Age: As you age, hair often becomes finer and thinner, and hair loss becomes more common.

The treatment and management of hair fall greatly depend on the underlying cause, hence a thorough investigation is necessary. It might involve medical treatment, lifestyle modifications, or in some cases, surgical intervention like hair transplantation. If hair loss is caused by an underlying disease or condition, treating that disease or condition often resolves the hair loss.

SYMPTOMS AND DIAGNOSIS

Hair fall, medically known as alopecia, can present in a variety of ways, depending on the underlying cause.

Symptoms:

  1. Gradual thinning on top of the head: This is the most common type of hair loss, affecting both men and women as they age. In men, hair often begins to recede at the hairline on the forehead. Women typically have a broadening of the part in their hair.
  2. Circular or patchy bald spots: Some people may experience smooth, coin-sized bald spots. This kind of hair loss usually affects just the scalp, but it can also occur in beards or eyebrows.
  3. Sudden loosening of hair: Physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging.
  4. Full-body hair loss: Some conditions and medical treatments, like chemotherapy for cancer, can result in the loss of hair all over the body.
  5. Patches of scaling that spread over the scalp: This could be a sign of ringworm (tinea capitis). Accompanied with broken hair, redness, swelling, or oozing, this may indicate a severe form of the disorder.

Diagnosis:

To determine the cause of hair loss, a dermatologist usually begins by taking a detailed medical history and asking about family history of hair loss. Following that:

  1. Physical examination: Your doctor will examine your scalp to see the pattern of hair loss.
  2. Blood tests: They might be done to rule out underlying conditions such as thyroid disorders or hormonal imbalances.
  3. Pull test: Your doctor may gently pull several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
  4. Scalp biopsy: In some cases, a small piece of scalp skin may be taken for examination under the microscope. This helps to determine if the hair follicles are normal or if there’s any infection or scarring.
  5. Light microscopy: A special instrument is used to examine hairs trimmed at their bases. This can help uncover possible disorders of the hair shaft.

After all these tests, your doctor can usually determine the cause of your hair loss and suggest appropriate treatment strategies.

Prognosis and Impact

Prognosis:

The prognosis of hair loss or alopecia largely depends on its underlying cause.

  1. Androgenetic alopecia is a progressive condition, meaning it tends to worsen over time. However, the progression is very slow, and individuals can have periods of stability. The hair loss is usually permanent.
  2. For alopecia areata, the hair often grows back but may fall out again. The extent of hair loss and regrowth varies greatly from person to person.
  3. Telogen effluvium usually resolves within six months, once the underlying cause is addressed.
  4. Hair loss from tinea capitis or scalp ringworm will improve once the infection is treated, though in severe cases, there can be some permanent scarring and hair loss.
  5. Chemotherapy-induced hair loss is generally temporary, and hair usually regrows after the completion of treatment.

Impact:

The impact of hair loss is largely psychological and affects the quality of life, as hair is often associated with an individual’s identity and attractiveness. It can lead to a range of emotional issues, from day-to-day embarrassment to a severe psychological toll, including anxiety and depression.

  1. Self-esteem: Many people with hair loss suffer from low self-esteem and may feel unattractive or embarrassed about their appearance.
  2. Social function: Hair loss can affect social functioning. Individuals may avoid certain social situations and activities, which can lead to feelings of isolation and loneliness.
  3. Depression and anxiety: Hair loss can contribute to depression and anxiety, particularly if it is persistent or severe.

However, support and counseling can significantly help individuals to cope with hair loss. Various treatments are also available that can help to manage hair loss and its impact on the quality of life. It’s crucial to consult with a dermatologist to discuss these options and find a treatment that suits the individual’s specific needs and lifestyle.

Treatment Options

Treatment for hair loss or alopecia depends on the underlying cause. Below are the most common treatment options:

  1. Medications:
    • Minoxidil (Rogaine): Available over the counter, this medication is applied to the scalp to stimulate hair follicles. It’s used in cases of androgenetic alopecia and alopecia areata.
    • Finasteride (Propecia, Proscar): This is a prescription pill used in men to slow hair loss and stimulate new growth. It works by inhibiting the hormone dihydrotestosterone (DHT), which leads to hair loss in men.
    • Corticosteroids: In cases of inflammatory conditions like alopecia areata, corticosteroids may be used. They can be given as an injection into the scalp or other areas, orally, or as a topical cream or ointment.
  2. Hair Transplant Surgery: This involves moving small plugs of skin, each with a few hairs, to bald parts of your scalp. This works well for people with inherited baldness.
  3. Laser Therapy: Low-level laser therapy is a safe form of light/heat treatment used to stimulate hair growth and slow hair loss. However, the long-term effectiveness is still a subject of ongoing research.
  4. Scalp Micropigmentation (SMP): A non-surgical treatment, it involves the application of natural pigments at the epidermal level of the scalp to replicate the natural appearance of real hair follicles.
  5. Anthralin (Dritho-Scalp): This is a topical medication used to treat alopecia areata. It’s applied to the skin for a short time and then washed off to help stimulate new hair growth.
  6. Lifestyle Modifications: This includes a balanced diet rich in protein, iron, and other nutrients, regular physical activity, and avoiding hairstyles or treatments that can damage hair.

Each treatment has benefits and risks, and the right choice varies from person to person. It’s also important to remember that not all treatments may work for everyone, and it may take several months to see results. Always consult with a dermatologist to discuss these options and find a treatment that suits your specific needs and lifestyle.

Risks and Side Effects

Each treatment option for hair loss comes with its own potential risks and side effects.

  1. Medications:
    • Minoxidil (Rogaine): Potential side effects include scalp irritation, unwanted hair growth on adjacent areas like the face and hands, and rapid heart rate.
    • Finasteride (Propecia, Proscar): Side effects can include decreased sex drive, sexual function issues, and increased risk of prostate cancer. Pregnant women should not handle crushed or broken tablets due to potential risk to male fetuses.
    • Corticosteroids: Side effects of oral corticosteroids include increased appetite, weight gain, poor wound healing, mood swings, and trouble sleeping. Injected corticosteroids can cause temporary thinning of the skin at the injection site.
  2. Hair Transplant Surgery: Risks include infection, scarring, unnatural-looking tufts of new hair growth, and the anesthesia risks associated with any surgical procedure.
  3. Laser Therapy: The most common side effects include redness, itchiness, and warm feeling on the scalp. Long-term effects are still not thoroughly known.
  4. Scalp Micropigmentation (SMP): Risks include potential allergic reactions to the pigments used and dissatisfaction with the cosmetic result.
  5. Anthralin (Dritho-Scalp): Anthralin can irritate the skin and cause temporary skin discoloration.
  6. Lifestyle Modifications: There are generally no risks or side effects to having a healthy lifestyle, although rapid weight loss or a diet deficient in protein, iron, and other nutrients can lead to hair loss.

Remember that these side effects don’t occur in all individuals and might vary in intensity for those who do experience them. It’s crucial to consult with your dermatologist and discuss these potential side effects before starting any treatment for hair loss.

FAQ Section

What causes hair fall? 

Hair fall can be caused by a variety of factors, including genetic predisposition (androgenetic alopecia), hormonal changes, nutritional deficiencies, certain medical conditions, medications, and stress. Even hairstyles and treatments that damage hair can lead to hair fall.

 

Is hair fall normal as we age? 

Yes, some degree of hair loss is normal with aging. Hair generally grows less dense, and the hair shafts get smaller, producing thinner strands.

 

Can dietary changes help reduce hair fall? 

Yes, a well-balanced diet rich in proteins, iron, vitamins (especially vitamin D), and omega-3 fatty acids can help maintain healthy hair and may reduce hair fall.

 

Can hair fall be a sign of a more serious condition? 

While hair fall is usually not associated with a life-threatening disease, it can be a symptom of underlying conditions like thyroid disease or anemia. If hair fall is accompanied by other concerning symptoms, it should be evaluated by a healthcare professional.

 

Is hair fall permanent or can it be reversed? 

It depends on the cause. In some cases like androgenetic alopecia, hair fall can be permanent. However, in cases of nutritional deficiencies or certain medical conditions, treating the underlying cause can reverse the hair fall.

 

How effective are over-the-counter treatments like minoxidil? 

Minoxidil can be effective for both men and women suffering from hair fall. However, it’s important to remember that results vary, and it may take several months before you notice any improvement.

 

Are hair transplants a good solution for hair fall? 

Hair transplants can be an effective treatment for certain types of hair loss, but they’re not suitable for everyone. They are usually used in cases of androgenetic alopecia where the hair loss is permanent. The procedure should be discussed in detail with a dermatologist or a hair transplant surgeon.

 

Can stress cause hair fall? 

Yes, severe physical or emotional stress can cause a type of hair fall known as telogen effluvium, which is usually temporary. Once the stress is managed, hair typically grows back.

Reference

  1. American Academy of Dermatology Association’s resources on hair loss: https://www.aad.org/public/diseases/hair-loss
  2. Mayo Clinic’s resources on hair loss: https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926
  3. National Health Service (NHS) information on hair loss: https://www.nhs.uk/conditions/hair-loss/
  4. MedlinePlus resources on hair loss: https://medlineplus.gov/hairloss.html
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