Hair consultations last the longest as there is lot to ask patients – their original hair volume , their lifestyle and diet, hair care practices and family history – to find the reasons for hair fall.
In our skin clinic in Madurai, hair and scalp are analyzed with trichoscopy, and appropriate tests are suggested when needed. After a long counselling session with our skin specialist in Madurai, a customized treatment plan is devised based on the the numerous treatment options available.
There are instances where our skin specialist just gives reassurance, a good diet plan and hair care advice and the hair issues start resolving. But there are instances where a patient might need all the best treatment options available for getting a moderate benefit. Hair fall issues are complex. And hair fall treatment needs patience and commitment.
Hair cycle
Hair goes through growth phase (anagen), transition phase (catagen) and growth arrest (telogen). The actual shedding is exogen which happens later than telogen. By the time the hair is actually shed out new hair has already started anagen phase in that hair root. So , shedding is normal, as it paves way for a new healthier hair.
The growth phase lasts from 3 to 6 years rarely up to 10 years. This length of time is genetically programmed. The longer the phase, the lengthier the hair grows. That’s why some people can grow very long hairs.
When hair shifts to telogen the growth is arrested and all sources of nutrition is cut off. It stays that way for 3 months. By that time new hair bulb is getting formed underneath. When it grows up, the old hair is shed (exogen).
Common causes of hair fall in women and how to treat them
Normal/physiological hair shedding
Is hair fall normal? Yes, if it’s within the limit of 50 to 100 hairs per day.
Most times, especially in women with longer hair, the hair sheds from root but stays on top of scalp and only completely sheds when they wash hair. Most women wash hair twice a week on average, hence drain full of hair is mistaken as increased shedding. That’s just accumulated shedding as it is a half week worth.
And hair density and texture changes post puberty. The scalp becomes greasier, the hairs matt to one another and the hair slightly thins post hormonal changes. These reduce the volume of hair to some extent. Unless there is excess hair shedding much more than normal or thinning leading to scalp visibility there is nothing to worry about.
Solution
Greasy scalp makes hair look flat and thin. Switch to oil control shampoos, clarifying shampoos or volume enhancing shampoos. Avoid using conditioner near scalp. Avoid using dense or protein based thick conditioner and thick serums which further weighs down hair.
Use oil for massaging before hair wash, rather than daily use. If applying oil daily, then apply only to lower part of hair and not on scalp. Get treatment for dandruff to reduce greasiness. Have a nutritious and iron rich diet to compensate for excess needs due to monthly blood loss and body development.
Telogen effluvium
This is by far the commonest cause in women. It is seen as increase in hair shedding either suddenly or gradually. This usually follows an illness, stressful events, major life changes, diet changes, weight loss/gain and such. A common example is post child birth hair loss.
But does that happen immediately? No. It usually happens after 3 months. The reason is that, the major physical stress of childbirth or illness suddenly shifts many hairs to telogen/fall phase. But the actual shedding, the exogen, happens 3 months later and continues for 1 to 3 months. This is the natural body response and hair cycle.
The shedding cannot be stopped abruptly. As it is not possible to re attach a hair which has crossed to telogen. What can be done is correction of causative factors so that more hairs do not shift to telogen and new hairs are healthier.
Solution
Sometimes all that is needed is stress reduction and a good diet and hair naturally grows. Many spurious ‘oils’ and ‘miracle hair cures’ just utilise this time of natural recovery. Commercial hair care centers give intensive treatments costing thousands, during this period where only minimal supportive treatment would have given results.
If shedding does not stop in 3 to 6 months, then it is time to analyse continuous stressors like gross nutritional deficiency not corrected by diet, undiagnosed illness, thyroid disorders and others to go for more proactive treatment.
Hair supplements which contain many vitamins, minerals, antioxidants and peptides are very helpful for this type of hair loss. Correction of Iron or other gross vitamin deficiencies like vitamin D should also be added separately after checking blood levels. Peptide based hair serums and platelet rich plasma therapy help in anchoring hair to tissue and supporting hair growth. Once the cause is corrected and maintained, hair fall stops and hair starts growing back.
Female patterned hair loss
This is equivalent to male baldness seen in about 5 to 10% females. This type needs the longest treatment, multiple treatment options and maintenance. There may or may not be a period of increased shedding, but hair progressively thins. So much that at some point the scalp starts to become visible.
Temporary telogen effluvium (rapid hair fall) may sometimes unmask the underlying thinning making scalp visibility obvious. The patients get frightened by the amount of thinning they have and rush for treatment.
This is due to two major factors – genetic and hormonal. And it is difficult to influence both factors. Hence the results are slow and whatever growth occurs needs to be maintained.
Solution
In addition to hair supplements and peptides they basically need all the hair treatment options available to get decent hair growth.
Most important therapeutic back bone here is minoxidil. The one proven ingredient that can influence hair cycle considerably. Correction of hormonal factors is necessary. Thyroid and testosterone levels needs to checked and corrected if abnormal.
Other supportive options include Platelet rich plasma therapy, micro needling, stem cell therapy and LASER. These are expensive, but the investment is worth it, to arrest progressive hair thinning. Very advanced stages with excessive recession of hairline and scalp visibility will benefit from hair transplantation.
And lots of patience and commitment to treatment is very important. No point in trying and dropping out in few months.
Other causes
Alopecia areata, a common patchy hair loss condition, where there are one or more smooth bald patches over scalp. It can also happen in eyebrow and body hairs. It is treatable and hair grows back in few months. But some rarely have extensive involvement and recurrence, needing more potent treatment.
Very tight plaits and pony tails can cause prolonged tension on the hair follicles. In some people this can lead to hair loss in some areas. Repeated twisting and pulling at hairs, chemical and heat treatments can also damage hair.
Scarring scalp diseases
These are extremely rare. But if not identified early and managed appropriately, the follicles are damaged permanently. It leads to formation of scars which prevent new hair formation. The hair loss is patchy and random.
Solution
These are skin diseases affecting scalp skin and should be managed as any other skin disease with creams and tablets. Usual hair treatments are not very effective except as a maintenance therapy. Aggressive and early treatment by a dermatologist helps in saving the follicles.
So, it’s always best to consult a good dermatologist, find the key issues and get treated accordingly. Salon providers and commercial hair care centres (advertised as trichology clinics without a dermatologist) cannot understand the complex biology of hair. They are trained to improve hair texture and groom hair. Many self proclaimed ‘trichologists’ (no such qualification exists) use PRP, LASERs and many fancy gadgets very frequently, at multiple times the cost, irrespective of the cause, whether it is needed or not.
Know what your issue is and get a customised treatment plan which is effective. And importantly, follow it for a minimum of six months before switching to other options.
