Hair loss

Signs and symptoms of hair loss can present in many ways as follows:

• Gradual loss or thinning of hair on the top of the head.
• Receding hairline (frontal fibrosing alopecia). If the hairline starts looking higher than the usual position.
• Widening part. If someone parts their hair, they might notice the part getting wider over time.
• Circular or bald patches. Some people develop circular or bald patches on their scalp, beard, or eyebrows.
• Loosening of hair. Clumps of hair might come out while combing or washing hair.
• Thinner ponytail.
• Scalp becomes visible through the hair.
• Full-body hair loss. Some health conditions and treatments, such as chemotherapy for cancer, can cause loss of hair from all over the body.

Hair loss can be gradual or rapid. The symptoms for gradual hair loss include:

• Hair thinning
• Widening of part
• Receding hairline

The symptoms for rapid hair loss include:

• Clumps of hair in comb or drain
• A bald patch that appeared recently
• Severe hair fall

Note: Gradual hair loss is more common and tends to affect everyone at least once in their lifetime. The signs of gradual hair loss are subtle and may take a long time before you even notice your hair fall!

Apart from the obvious signs of hair fall, some other symptoms may also be present:

• Intense itching and redness in the scalp: This could occur due to an underlying infection in the scalp.
• Scaly bald patches, often with sores: This can be a sign of a fungal infection like ringworm or due to a chronic disease like psoriasis.
• Burning and tingling on the scalp: Some people who have alopecia areata might experience burning and stinging prior to sudden hair loss.
• Pus-filled sores on the scalp: Some conditions, such as folliculitis, can cause pus-filled blisters on the scalp resulting in temporary hair loss.

Before knowing about the causes of hair loss, it is essential to understand the hair growth and hair loss cycle. Ideally, each hair follicle goes through three phases:

• Anagen phase: This is the active phase of hair growth that usually lasts for about two to six years. Around 85-90% of the hair on the scalp is in this stage at any given time.
• Catagen phase: This is the transitional phase that lasts a few weeks (2-3 weeks). Only 1% of hair is in this stage.
• Telogen phase: This is the end phase of hair growth, which is the resting phase. Around 13% of our hair is in this stage.

At the end of the telogen phase, hair follicles are shed, which is replaced by new hair, and the cycle continues. However, the hair growth cycle can be influenced by an individual’s age, diseases, hair care routine, and diet.

Common causes of hair loss include:

• Age: With age, it is common to notice some amount of hair fall. Both men and women may experience a receding hairline as well as thinning of hair.
• Genetics: Hereditary causes are the most common reason for hair loss worldwide, affecting both men and women. Known as androgenic alopecia, male-pattern baldness, and female-pattern baldness, it appears as a receding hairline and bald spots in men, and thinning hair along the crown and widening part in women.
• Childbirth and other stressors: Recent childbirth or chronic illness can lead to hair fall. Stress or any traumatic event may also trigger hair loss.
• Ongoing treatment/medications: Treatments for cancer, arthritis, depression, heart problems, gout, and high blood pressure can trigger hair fall within a few days or weeks of starting radiation or chemotherapy.
• Tight hairstyles: Hairstyles such as braids can lead to hair fall over time, resulting in permanent hair loss known as traction alopecia.
• Scalp infections: A scalp infection, which may appear scaly and inflamed, can result in hair loss.
• Hormonal imbalance: Certain women experience hair loss due to hormonal imbalances, such as in PCOS (polycystic ovarian syndrome). Birth control pills, which are hormonal preparations, can also trigger hair fall.
• Nutritional deficiencies: A diet lacking protein, zinc, biotin, iron, or other essential nutrients may lead to hair fall and thinning.
• Disease: Conditions such as hyperthyroidism, hypothyroidism, diabetes, lupus, and sexually transmitted infections (STIs) can lead to hair fall as well as bald patches on the eyebrows, lashes, and other body parts.
• Pulling your own hair: Known as Trichotillomania, this habit of pulling one’s own hair may lead to permanent hair loss over time.

There are many risk factors for developing hair loss. Some of these risk factors can be avoided, while others cannot. The following are some of the risk factors:

• Hereditary: If you have a family history of hair loss, there is a good chance that you will experience it as well. Hereditary hair loss can affect both men and women.
• Stress: Frequent stress can be a risk factor for hair loss. Various types of stress can negatively impact the body and may cause hair to stop growing.
• Hormonal changes: Hormonal changes that occur during pregnancy, childbirth, the initiation or cessation of hormonal birth control pills, or menopause can increase the risk of hair loss.
• Medications: Certain medications may lead to hair loss. If you notice hair loss after starting a medication, consult your doctor to determine if it is a side effect.
• Chemotherapy: During cancer treatment, there is a significant chance of hair loss. Hair typically begins to regrow after completing the series of chemotherapy treatments.
• Significant weight loss
• Medical conditions: Conditions such as hypothyroidism, hyperthyroidism, diabetes, lupus, and STDs can also contribute to hair loss.

Does initial hair fall lead to hair loss in the long run? Read to know!

Diagnosis for hair loss includes a detailed history and a physical examination with a focused evaluation of the hair and scalp. Other diagnostic measures include:

• Fungal screening of the scalp
• Hair pull and tug test
• Light microscopy and/or trichoscopy

Diagnostic Tests

1. Pull test: In this test, also known as the traction test, 20-60 hair strands are grasped between your thumb and index and middle fingers, held firmly from the hair shaft, and tugged away from the scalp. If the hair shedding is more than 10% of the total hair grasped, it is called a ‘positive pull test’ and indicates active hair shedding.
2. Light microscopic examination: The hair collected during the pull test is examined under a microscope for fractures, irregularities, coiling, and other hair shaft disorders.
3. Scalp biopsy: Scalp biopsies are performed in cases of cicatricial hair loss and undiagnosed cases of non-cicatricial alopecia.
4. Blood tests: Your doctor may request a thyroid profile, as low levels of thyroid hormone can lead to hair loss. Additionally, blood tests may be recommended to check the levels of various nutrients, as deficiencies can contribute to hair loss. The following are usually tested:
   • Iron: Iron deficiency in premenopausal women is a major cause of hair loss. Iron is essential for hemoglobin production, which delivers nutrients and oxygen to hair follicles. Inadequate iron levels can result in progressively thinner hair.
   • Zinc: Zinc deficiency can also impact hair growth and cause hair thinning.
   • Biotin: Also known as Vitamin B7, biotin stimulates keratin production in hair and can promote follicle growth. A deficiency in biotin can lead to hair loss.

If you are already experiencing hair loss, making a few changes in your hair care routine and following these simple tips can help alleviate the problem:

• Limit the use of hair styling products and tools such as hot rollers, curling irons, and hot oil treatments, as they can cause hair breakage and lead to hair fall.
• Avoid tight hairstyles and unnecessary twisting, rubbing, or pulling of your hair. Do not rub wet hair with a dry towel; instead, wrap a towel around your hair to soak up water and allow it to dry naturally.
• Avoid aggressive combing, as it can cause split ends and hair breakage. Instead, use a wide-toothed comb.
• Apply oil regularly to prevent dirt and toxins from entering the follicle. Gently massage the scalp to promote blood circulation in the area.
• Eat a diet rich in essential nutrients such as vitamins, minerals, and antioxidants, especially iron, biotin, and zinc, along with proteins, fats, and carbohydrates to prevent hair damage.
• Avoid crash diets, as rigorous dieting can impair the supply of nutrients to the hair follicles.
• Quit smoking, as it can cause premature aging of the hair cells, making the follicles brittle and thin, which can lead to hair breakage.
• Manage your stress, as it can lead to hormonal imbalances in the body, contributing to hair loss.
• Consult a trichologist or dermatologist to determine the exact cause of hair loss and receive proper treatment. Avoid self-medicating with supplements or hair care products for hair growth.

Save your hair this monsoon by following these simple steps.

There are many treatment options for hair loss, ranging from medications to hair transplantation. These are:

A. Medications

1. Oral supplements
   • Vitamin B12 (Cobalamin): This vitamin is responsible for the production of red blood cells, which deliver oxygen and essential nutrients to all parts of your body, including hair follicles.
   • Vitamin B7 (Biotin): This vitamin is known to stimulate keratin production in hair and can increase the rate of follicle growth. Supplements of Vitamin B12 are beneficial for regrowing hair in people with its deficiency.
   • Zinc: Zinc is an essential mineral that’s involved in several biological processes within your body. It plays a key role in making proteins in your hair and other cells.
   • Iron: The best way to treat hair loss associated with low ferritin is to increase your iron levels. Hair loss due to low iron is not permanent and can be treated with supplements and foods rich in iron.
2. Minoxidil: An over-the-counter medication that is FDA approved for use in both men and women. Administered topically, the 5% concentration is used to treat male pattern baldness, whereas 2% is approved only for female pattern baldness treatment. It stops the thinning of hair and is known to stimulate hair growth.
3. Finasteride: An FDA-approved drug for the medical management of hair loss, but only in men. It is a prescription drug commonly used to treat an enlarged prostate, with a higher dose used for hair loss. It stops the production of the hormone 5-dihydrotestosterone (DHT), which is known to cause hair loss.
4. Topical corticosteroids or steroid injections: These steroids help to stop inflammation and treat hair loss. They usually come in the form of topical cream or injections that are administered into the scalp to promote hair growth. These injections are typically given every 4 to 8 weeks as needed. Consult your dermatologist for more information.

B. Platelet Rich Plasma (PRP) Therapy

PRP is a process in which the patient's own blood is processed and injected into various points in the scalp. PRP, rich in growth factors, aids in hair growth. The following steps are followed:

1. Blood is drawn, usually from the arm, and processed in a centrifuge (a machine that spins and separates fluids of different densities).
2. After about 10 minutes in the centrifuge, the blood separates into three layers:
   • Platelet-poor plasma
   • Platelet-rich plasma
   • Red blood cells
3. The scalp is locally anesthetized. The platelet-rich plasma is drawn into a syringe and injected into areas of the scalp that require more hair growth.

C. Hair Transplantation

During a hair transplant procedure, a dermatologist or cosmetic surgeon removes hair from a part of the head that has hair and transplants it to a bald spot. Possible risks include bleeding, bruising, swelling, and infection. The two most common techniques for hair transplants are:

1. Follicular Unit Transplantation (FUT): The older of the two methods, FUT uses strips of skin with hair from your scalp to be transplanted to a bald spot. The scarring left behind on the donor site is covered up with new hair. This technique requires significant aftercare and can be cumbersome.
2. Follicular Unit Extraction (FUE): A newer technique that utilizes advanced technology. In this method, incisions are made around each follicle unit, which is then transplanted to the balding area. This method results in minimal scarring, and the recovery process is quicker compared to FUT.

D. Laser Treatment

There are numerous laser devices available in the market claiming to stimulate hair growth and treat hair fall. These include brushes, combs, and other electronic devices; however, the efficiency and safety of these devices are not well established.

1. Onion (pyaaz) juice

Onions contain sulfur, which is essential for the production of amino acids, proteins, and collagen, all of which are necessary for hair growth and preventing hair loss. Applying onion juice to the scalp is known to increase blood supply to hair follicles, thus preventing hair fall due to thinning and promoting hair growth.

2. Eggs

Eating eggs can be beneficial for hair growth and preventing hair loss because they are rich in nutrients like biotin, Vitamin A, Vitamin E, and folate, which have been proven to aid in hair growth and prevent hair loss caused by nutritional deficiencies.

3. Aloe vera

This traditional home remedy is known to soothe the scalp, condition dry hair, and reduce dandruff while nourishing hair follicles and improving overall hair health when applied to the scalp and hair length.

4. Coconut (nariyal) oil

Coconut oil enhances hair health and luster due to its lauric acid content, which easily penetrates the hair shaft, reducing protein loss from both damaged and undamaged hair when used as a pre- and post-wash treatment.

5. Fenugreek (methi) seeds

Fenugreek seeds contain phytoestrogens (plant hormones) believed to enhance hair growth.

6. Bhringraj

Eclipta alba (bhringraj) is a popular traditional remedy for hair fall. The methanolic extract of E. alba in water can promote hair growth by increasing the anagen phase (the active growth phase of hair follicles).

7. Tea tree oil

Tea tree oil is one of the few essential oils known to prevent hair fall and promote hair growth due to its powerful cleaning, antimicrobial, and anti-inflammatory properties. When applied topically, it can improve nutrient absorption by the follicles, thus enhancing hair growth.

Hair loss or alopecia does not have any harmful physical effects; however, the psychological impact of hair loss cannot be denied. The psychological consequences of alopecia affect both genders and include:

• Anxiety
• Depression

Interestingly, high levels of stress and anxiety further exacerbate hair fall. Additionally, failure of treatment or its ineffectiveness contributes to these psychological conditions.

• Aromatherapy: A compound in sandalwood, rosemary, and thyme oils is used to boost hair growth. Rubbing one or more of these oils into your scalp for at least 2 minutes every night can promote hair growth.
• Acupuncture: Acupuncture is known to reduce hair loss and promote hair regrowth for patients with hair loss by improving cerebral blood circulation. However, more scientific research and backing are required to prove this.
• Microneedling: Microneedling can help stimulate and induce stem cells in the hair follicles, leading to hair growth. It may also improve the absorption of products used to treat hair loss, such as minoxidil, platelet-rich plasma, and topical steroids.

Living with hair loss can be challenging. For many individuals, hair is inherently connected to self-image. When hair looks good, confidence is boosted; however, hair loss can lead to diminished self-esteem and feelings of aging. If you notice thinning hair, you don't have to simply accept it. Consider exploring various treatment options for hair loss. If these treatments prove ineffective, you can explore alternatives such as:

• Wearing scarves or bandanas: A silk or cotton scarf or a bandana can be a stylish option that masks hair thinning. Choose soft fabrics to avoid irritating the scalp.
• Exploring hair extensions or wigs: If you're experiencing hair loss, consider adding hair extensions. For those who have lost all their hair due to alopecia or chemotherapy, a wig may be a suitable option for covering the head.
• Wearing hats: Hats can also be a good option for dealing with hair loss. You might combine this with other solutions, such as wearing a wig to work and a hat during leisure time.
• Considering counseling: While some individuals may feel comfortable with their appearance after hair loss, others may experience low confidence and depression. If this is the case, don't hesitate to consult a counselor or therapist. Sharing your feelings can aid in coping.
• Joining a support group: Talking to someone experiencing similar feelings can be beneficial. Consider joining a support group or interacting online if you prefer the comfort of home.
• Embracing baldness: This approach is not for everyone, but some individuals find empowerment in embracing their baldness. Rather than hiding it, they feel liberated to showcase it to the world.