Hair loss

Overview

Nowadays, Hair loss is a very common problem in both men and women. Almost everyone experiences hair loss at some point in their lives. Hair loss occurs in 70-80% in men and 50-60% in women. Hair loss can affect the scalp or the whole body. Hair loss is also known as alopecia or baldness. Hair loss can be temporary or long-standing, based on its identification, cause, and treatment. Moreover, the hair loss that was first temporary may become permanent as a result of incorrect diagnosis, care, and treatment. Although hair loss doesn’t cause a threat to your health or life but can cause devastating effects on your self-image and sense of well-being. Hair loss can be a prime indicator of underlying chronic or serious health issues.

Hair grows everywhere on the human skin except on the palms and soles. Hair is made up of a protein called keratin, which is produced from the hair follicles in the outer layer of the skin. As follicles produce new hair cells (new hair), old cells (old hair) are being pushed out through the surface of the skin at the rate of about six inches a year. The hair which is seen outside is actually a string of dead keratin cells.

The average adult head has about 1 to 1.5 lakh hair and loses about 100 hairs each day. This is normal hair a person loses usually, and their hair grows back. But in most men and some women lose hair as they grow older. At any one time, about 90% of the hair on a person’s scalp is in the growing stage. Each follicle has its own life cycle that can be influenced by age, disease, and a wide variety of other factors.

Normally, hair goes through a regular growth cycle. This regular growth cycle or life cycle is divided into three phases:

Anagen phase

Anagen phase: is active hair growth that lasts between two to six years, the hair grows.

Catagen phase

Catagen phase: is transitional hair growth that lasts two to three weeks

Telogen phase

Telogen phase: is a resting phase that lasts about three months; and at the end of the telogen phase, the hair falls out and replaced by new hair (and the growing cycle starts again).

With ageing the rate of hair growth slows down.

Hence, Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with invisible scar tissue.

Hair is an essential component of the human body. It works as a defensive structure to our body.

  • It regulates the body temperature
  • It helps in the process of perspiration.
  • Hair in sensitive areas like nose, ears, and around eyes protects the organs from dust and other small impurities.

  • Hair or eyelashes regulate the amount of light that our eyes should receive.

Causes Hair Loss

The average person loses about 100 hairs per day. This usually doesn’t cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss also can have other causes, including drugs or disease. The medical term for hair loss is called Alopecia; there are different causes of hair loss.

Ageing

Ageing: as a natural ageing process.

Genetics

Genetics: The most common cause of hair loss is hereditary condition affecting male or female-pattern baldness. If you have a family history or your close relatives have hair loss or thinning of hair, you are likely to suffer from hair loss. It usually occurs gradually with aging.

Hormones

Hormones: imbalance of hormones is the most common cause in females, such as pregnancy, childbirth, menopause, and thyroid problems.

Stress

Stress: excessive stress causes general thinning of hair, represents several months after a physical or emotional shock. Like any other organic cells, Hair cells too need rest. This type of hair loss is usually temporary. Three types of hair loss that occurs to stress are telogen effluvium, trichotillomania, and alopecia areata

Nutritional

Nutritional: Unhealthy or nutritionally deficient diet like iron, folic acid and B vitamins leads to hair loss

Environmental factors

Hard Water or Chemically Treated Water

Hard Water or Chemically Treated Water: Washing your hair with hard water (contains a high amount of silica, magnesium, and calcium) or chemically treated water ( swimming in chlorinated) causes dandruff and damage hair follicles or hair.

Air Pollution and smoke

Air Pollution and smoke: Hair gets interacted with contaminated air and smoke, make hair weaker and thinner.

Sun Exposure & Heat

Sun Exposure & Heat: As we all know the sun provides vitamin D in our body which is required to maintain healthy hair and skin. But prolonged sun exposure damages the hair protein structure and can cause dry, brittle hair.

Lifestyle changes

Smoking

Smoking: there is an association between smoking and hair loss or baldness in men.

Chemicals

Chemicals: Excessive and prolonged usage of Hair Shampoos, conditioners, and hair styling products, containing chemicals over long periods or OTC shampoo with high concentrated chemical also causes hair loss and hair thinning.

Certain hairstyles and treatments such as

Excessive tight hairstyles, such as braids, buns, or ponytails can cause traction alopecia or hair loss. Hot rollers, curling irons, hot oil treatments, and permanents can permanently damage hair follicles.

Compulsively twisting, rubbing, or pulling your hair. Combing, brushing or applying plastic or rubber hair ties on your wet hair.

Chronic illness and infection

Chronic illness and infection: High degree fever, Typhoid, Jaundice, for longer periods and Viral Diseases, etc. affects your immune system leading to loss and thinning of hair. Fungal infection of the scalp also causes localized hair loss.

Physiological changes

Physiological changes: During pregnancy, childbirth or menopause, can also contribute to hormonal imbalance in women which may contribute to temporary hair loss. Women are also prone to mineral deficiencies and stress during pregnancy leading to hair loss.

Medical problems

Medical problems: such as thyroid, PCOD, etc.,

Medication & treatments

Certain drugs

Certain drugs such as birth control pills, antidepressants, beta-blockers, calcium channel blockers, anticonvulsants, anabolic steroids or retinoids or chemotherapy can also cause hair thinning and extensive hair fall

Radiation therapy

Radiation therapy to the head

Dandruff

Dandruff: Dandruff can cause itching to lead to the inflammatory scaly scalp resulting in hair loss.

Hence, it is important to identify the root cause of the hair loss problem and to correct it in time.

Some signs and symptoms

of hair loss are such as:

Thinning of hair

Thinning of hair: Gradual thinning on top of the head is the most common type of hair loss, affecting both men and women as ages.

Receding hairline

Receding hairline: The most of receding hairline cases affects men, which usually starts in their late 30s. Here the hairline starts to recede in the forehead region and is recognized as male pattern baldness.

However, in men, hair often begins to recede from the forehead in a line that resembles the letter’ M’. Women typically thin throughout the top of the scalp and leaving the frontal hairline intact.

Patchy hair loss

Patchy hair loss: in some, the hair loss occurs as patches or coin-sized bald patches. This type of hair loss usually affects just the scalp, but it sometimes also occurs in beards or eyebrows. In a few cases, it may precede with itch or pain before the hair falls out.

Sudden shedding of hair

Sudden shedding of hair: A physical or emotional trauma can cause hair to loosen. Plenty of hair may come out when combing or washing your hair or even after gentle touching. This type of hair loss usually causes overall hair thinning.

Full-body hair loss

 Full-body hair loss: In some conditions and or medical treatments, such as chemotherapy for malignancy, can result in the loss of hair all over the body. In these conditions, the hair usually grows back.

Patches of scaling

Patches of scaling that spread over the scalp. This is a sign of fungal infection. It is usually associated with itching, broken hair, redness, swelling, or oozing.

The above signs and symptoms of hair loss are a matter of concern and one needs to restore their hair by consulting a dermatologist.

Psychosocial impact of hair loss

With the period of time, the symptoms of hair loss can be traumatic and the psychosocial impact of hair loss can be severe for the sufferers. Hair loss can cause dramatic and devastating emotions which can negatively impact their quality of life. The negative quality of life seems to be worse in women.

The known psychosocial complications include depression, low self-esteem or self-confidence, altered body or self-image, and unusual social engagement.

Hair loss can appear in many different ways, depending on what’s causing it. It can come on suddenly or gradually and affect just your scalp or your whole body. Some types of hair loss are temporary, and others are permanent.

Hair loss other than age-related (involutional alopecia) is further classified into two major categories: scarring and non-scarring hair loss. Most commonly it is age-related hair thinning or male or female pattern balding is common.

In general, scarring hair loss is permanent hair loss. Scarring hair loss is two types primary and secondary. Primary alopecia arises from a process that originates from the hair follicles, whereas secondary scarring alopecia is due to all other causes of underlying scalp involvement. Non-scarring hair loss which we commonly come across can include patchy hair loss or alopecia areata, telogen effluvium, and so on.

Alopecia is the medical term for excessive or abnormal hair loss.

Nonscarring Alopecia

Androgenetic alopecia (Male or Female pattern Hair loss)

Telogen effluvium

Anagen effluvium

Alopecia areata

Traction alopecia (can scar)

Trichotillomania

Tinea capitis (rarely scarring)

Scarring Alopecia

Primary:

Central centrifugal scarring alopecia

Discoid lupus erythematosus

Folliculitis decalvans

Frontal fibrosing alopecia

Secondary:

Lupus erythematosus (LE)

Dermatomyositis (DM)

Psoriasis & Lichen planus

Tinea capitis (Kerion)

Involutional alopecia (ageing)

As ages, the rate of hair growth slows, resulting in a reduction of the volume and thickness of hair. Here the hair follicles gradually enter the resting phase and the remaining hair becomes shorter and less in number, sometimes even brittle.

Male / Female pattern baldness

Male / Female pattern baldness: Permanent hair loss from the scalp, causing baldness. However, in men, hair often begins to recede from the forehead in a line that resembles the letter’ M’. Women typically thin throughout the top of the scalp and leaving the frontal hairline intact.

Telogen Effluvium

Telogen Effluvium: A reversible condition in which temporary hair falls occurs due to stressed episodes like childbirth, severe illness, fever, sudden mental stress, or weight loss. This results due to abrupt changes in the growth cycle of hair, where a large number of hairs go into the resting phase.

Anagen Effluvium

Anagen Effluvium: It is an abnormal hair loss during the first phase or growth phase of the hair lifecycle that occurs as the result of exposure to chemicals or toxins or cancer treatments.

Alopecia Areata

Alopecia Areata: There is a sudden hair loss that may start as circular or coin-sized patches on the head and or face.

Traction alopecia

Traction alopecia: Due to traction on hair because of particular hairstyles causing small, localized areas a type of hair loss, particularly involving the hairline.

Trichotillomania

Trichotillomania: This is also referred to as hair-pulling disorder. The individual with psychological disturbances has the habit of twisting or pulling their own hair from the scalp and eyelashes.

Diagnosis

A detailed medical or family history with the physical examination is a must before making a diagnosis. After which few tests may have to be performed to know the cause of hair loss such as the following:

Blood test

Blood test:This may help uncover medical conditions related to hair loss

Phototrichogram or Hair Analysis System

Phototrichogram or Hair Analysis System is an advance patented technique to measure hair loss. It is a software-based method to analyze human hair. The main purpose of this process is to identify the root cause problem and for studying pattern hair loss (PHL) or other forms of diffuse hair loss.

Pull test

Pull test: This is performed to determine the stage of the shedding. Here the physician gently pulls a few dozen hairs to see the hair fall out

Scalp biopsy to determine the cause hair loss like infection etc.

Light microscopy examination can be done to check the hair loss related to the structure of the hair shaft.

Treatment

There are various treatments available to treat hair loss. The early and right treatment during the process can slow further thinning or reverse hair loss.

Treatments for hair loss include medications, interventional therapy such as procedures like mesotherapy, platelet-rich plasma (PRP) therapy , micro-needling (derma roller) , low-level laser light therapy (LLLT)  and surgery  to promote hair growth and slow hair loss.

Changes in lifestyle and natural home remedies can help hair loss.

Prevention

There are few tips which can help to avoid preventable types of hair loss:

  • Avoid mental and physical stress
  • Avoid tight hairstyles, such as buns, braids, or ponytails.
  • Avoid compulsively twisting or pulling the hair.
  • Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments, and permanents.
  • Avoid harsh washing and brushing of hair. A wide-toothed comb or brush may help prevent pulling out hair.
  • Avoid the sunlight or sources of ultraviolet light.
  • Avoid medications and supplements that could cause hair loss.
  • Avoid smoking.

Most baldness, male or female is caused by genetics which is not preventable but early and right treatment with above preventable measures can slow down the thinning and reverse the hair loss.