Hair Loss

2024/05/20

What is Hair Loss?

Hair loss may be abnormal if you are losing more than 100 hairs a day. This may result in a general thinning of hair or in a patchy loss of hair over the scalp or other hair-bearing areas such as the beard or eyebrows.

Symptoms

Androgenetic Alopecia

Androgenetic Alopecia (commonly known as male or female pattern baldness) is the most common cause of hair loss in both men and women. It is caused by a combination of factors, including hormones (Testosterone), age and genetic predisposition. It usually affects women later in life than men.

Alopecia Areata

Alopecia Areata is an auto-immune disease in which immune cells of the body attack and damage its own hair follicles. This usually results in a patchy loss of hair.

Telogen Effluvium

Telogen Effluvium is a disruption of the normal hair cycle resulting in diffuse loss of hair. This commonly occurs two to four months following situations such as childbirth, acute illness, surgery, physical or emotional stress and crash dieting.

Chronic Illness and nutritional deficiencies

Chronic Illness (thyroid diseases, connective tissue disease and chronic kidney or liver disease) and nutritional deficiencies (such as a lack of iron, vitamin D and Zinc) can also cause hair loss.

Scalp Diseases

Fungal and bacterial infection, and other local scalp inflammatory disorders such as seborrheic dermatitis may result in patchy or focal hair loss with accompanying scaliness.

Trichotillomania

Trichotillomania is an obsessive, uncontrolled self-plucking of one's hair. This results in patchy hair loss in bizarre shapes and patterns, broken hair shafts and scalp excoriations.

When to seek medical advice

See your doctor if:

You're so uncomfortable with the condition that it affects your quality of life
There is widespread distribution

Treatment and drugs

Treatment for hair loss depends on the type and severity. Your doctor will take a detailed history and perform a thorough examination. He or she may also conduct certain investigations such as blood tests, hair microscopy and even perform a scalp biopsy.

Androgenetic Alopecia

First line treatment involves applying topical solutions such as Minoxidil (2%/5%). Oral Finasteride tablets can also be used in men. Oral medications are not routinely prescribed for women because of possible side effects and risks of teratogenicity (damage to the fetus). You should discuss this with your doctor. In patients for whom other therapies have not proven effective, hair transplant surgery can be an option.

Alopecia Areata

First line treatment involves either injecting steroid solutions into the scalp or applying potent topical steroids on the scalp. In more severe cases, topical immunotherapy can be performed. This involves a weekly application of a solution over the bald patches to induce an inflammatory reaction, thereby stimulating hair growth. Oral medications such as prednisolone, methotrexate and ciclosporin are sometimes also used for severe cases; it is best to discuss this with your doctor.

Telogen Effluvium

This is condition is usually self-limiting once the inciting factor is over eg. Childbirth, emotional stress.

Chronic Illness and nutritional deficiencies such as iron, vitamin D and Zinc

Nutritional deficiencies should be treated either with improved diet or vitamin supplements. Chronic illness should be managed and treated adequately.

Scalp Diseases

Topical or oral antimicrobial therapy can be used to treat scalp infections. Topical steroids and medicated shampoos such as coal tar, cetrimide and ketoconazole are often used to treat scalp inflammation.

Trichotillomania

Counselling and behavioural modification is important. Medications such as Tricyclic anti-depressants and Selective Serotonin reuptake inhibitors can also be used, often in consultation with psychiatrists.

Doctors