In a world where our appearance often plays a significant role in our confidence and self-esteem, hair loss can be a particularly distressing issue and it is a problem that affects many individuals, both men and women, young and old. Also, the term alopecia can be broken up into ‘Alo’ which means ‘hair’ and ‘Pecia’ which means ‘to fall’ but now it is being used as a general term to describe hair fall, hair, thinning or baldness.
Understanding the hair cycle
Before we dive into the world of hair loss, it is essential to grasp the fundamentals of the hair growth cycle. In an interview with HT Lifestyle, Dr Kashish Kalra, MD, Dermatologist, Head of Dept at Max Smart Hospital in New Delhi, explained, “This cycle consists of three phases: the anagen (growth) phase, the catagen (resting) phase, and the telogen (shedding) phase. Normally, 70% of your hair is in the growth phase, while 20% rests and 10% is shed. It’s considered normal to lose 50 to 100 hairs daily as new ones naturally replace them.”
Types of hair loss
Dr Kashish Kalra said, “Hair loss isn’t a one-size-fits-all issue; it manifests in various forms. Excessive hair fall and thinning are primary culprits, often working in tandem to cause hair loss. Some individuals experience excessive hair fall, while others suffer from gradual hair thinning.” Let’s explore these conditions further –
1. Excessive hair fall: Hair fall within the range of 50-100 strands daily is typically considered within the normal range. However, when the daily hair loss exceeds this range, it is categorized as excessive hair fall. Understanding this distinction is important, as excessive hair fall can be a potential indicator of underlying health issues or lifestyle factors that may need attention and intervention.
2. Hair thinning: Genetic factors largely underpin hair thinning. It manifests differently in males and females. In men, hair loss typically initiates at the temples, progresses to the hairline, and finally affects the crown. In contrast, females experience a different pattern, with central thinning and a widening parting.
Hair loss causes
Dr Kashish Kalra revealed the causes of hair loss as –
1. Nutritional factors: Imbalances in essential nutrients, hormones, and thyroid levels can contribute to hair loss. Ensuring a balanced diet and addressing nutritional deficiencies are vital.
2. Lifestyle choices: In metropolitan areas like Delhi, harsh beauty treatments such as rebonding, straightening, and coloring are commonplace. These treatments often involve the use of chemicals that can damage hair and exacerbate hair loss.
3. Stress and hormonal changes: Stress, major life events, and hormonal imbalances, such as PCOD, can lead to hair loss. Managing stress and seeking medical advice are essential steps in preventing further hair loss.
She added, “Hair loss can also be caused by conditions like alopecia areata and scarring alopecia. These conditions require specialised treatments and should be addressed promptly by a qualified dermatologist.”
Bringing her expertise to the same, Dr Nina Madnani, Consultant Dermatologist, Aesthetic Dermatologist, Hair Specialist and Vulvologist at PD Hinduja Hospital and Medical Research Centre at Mumbai’s Mahim, said, “There are many reasons for alopecia and alopecia can hit all ages right from childhood to right up to old age. We generally classify alopecia as those which are non-scarring that means there is a very good chance of recovery and those that are scarring when the entire skin has been damaged due to the inflammation. The commonest causes of non-scarring alopecia are firstly nutritional that is telogen effluvium, nutritional, post delivery. It could be post viral fever like after Covid, malaria, dengue where in we have a lot of hair fall which is among the most common reason. Secondly, iron deficiency anaemia can cause hair fall. There is another entity call alopecia areata which is an autoimmune condition where you get patches of hair loss. So these are all conditions which are treatable and one can recover.”
Highlighting that cancer patients on medications can have a sudden breakage of hair and hair fall that is called anagen effluvium, Dr Nina Madnani shared, “Once the chemo drug are stopped generally most of them have a good recovery. Scarring alopecias are due to certain inflammatory diseases like Lupus erythematosus or lichen planus. These are diseases which can give scarring or you can have burns/injury on the scalp or you can have chemical treatments which can cause scarring alopecia. Those conditions where the hair follicles gets totally destroyed by the inflammation, they don’t recover. Using very hot hair dryers very close to the scalp can also damage the hair follicles. Also, one very important cause of alopecia or baldness which we are seeing very commonly in women is called female pattern hair loss in which they get a diffuse loss on the frontal part of the hair and that is caused due to hormones or genetics but it is also concomitantly worsened if there are any deficiencies. In men, the commonest cause is male pattern baldness which is genetic.”
Treatments and prevention for hair loss
Dr Kashish Kalra said, “Hair loss, often perceived as a condition rather than a disease, affects a substantial portion of the population. Managing hair loss, and potentially delaying or reversing baldness, is a common objective for many. Understanding the stages of hair loss and available treatments is crucial for those seeking effective solutions.” She elaborated –
1. Medications and injectables: FDA-approved medications like minoxidil and finasteride can be effective in preventing hair loss. Additionally, off-label peptide treatments show promise in delaying hair loss and promoting growth.
2. Injectable therapies: 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.
3. Hair transplant: 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).
Dr Nina Madnani recommended, “First, we need to identify what sort of alopecia it is. The treatment also depends on what the causes are. If it is female pattern hair loss, we have to do investigation to see if they don’t have a deficiency of B12, iron, thyroid, D3. In men, for male pattern baldness, we usually don’t do any blood test and for patients with alopecia areata, because it is related to other autoimmune diseases, we may do a CBC or a thyroid profile. So we try to find out what is the cause, we might also need to take biopsies.”
She added, “There is an interesting instrument called the Tricoscope in which we examine the hair under high magnification. We can also see the quality of the scalp, whether the scalp has any disease which is causing follicular damage and we also see the type of hair – whether they are broken hair as in a fungal infection or certain individuals pullout their hair which is called Trichotillomania or it is a variation in hair diameter which we call male pattern baldness or female pattern hair loss. So depending on the etiology we have to tailor treatment for the patient.”
Hair loss is a multifaceted issue with various causes and solutions. Whether you’re considering preventive measures, medications, injectable therapies or even hair transplant surgery, it is essential to consult a certified dermatologist as early intervention and the right treatment can make all the difference in managing and preventing hair loss effectively. Remember, your hair’s health deserves expert care, not quick fixes from unqualified sources.