Does itchy oily scalp cause hair loss? How about dandruff? It is pertinent to recognise the condition of your scalp to effectively treat and prevent hair loss.
What causes dandruff and scalp inflammation?
Dandruff is a lay person’s term for a medical condition called seborrheic dermatitis. The term dermatitis itself was first to an inflammatory scalp disease. In this case, it is a combination of excess sebum or oily scalp, as well as the overgrowth of a yeast organism known as Malassezia furfur that is otherwise a commensal of the scalp. So healthy people also have Malassezia furfur on their skin and scalp, but in individuals who develop dandruff, there usually is an overgrowth of these organisms that leads to an imbalance of the microbiome, which is the balance of good bacteria, pathogenic bacteria, and the various yeast organisms.
What are the symptoms of dandruff?
1. Excess production of oil or oily scalp. If you do not wash their hair, say for more than 24 hours, there can be significant itch associated with dandruff.
2. Scalp sensitivity and redness. Individuals who have dandruff, as well as scalp pimples, may actually have a concomitant disease known as scalp folliculitis. Scalp folliculitis can be caused by the same yeast organism Malassezia, or it can be due to secondary bacterial infections as well.
What factors can exacerbate dandruff?
Excess sebum production, i.e. oily scalp
The proliferation of Malassezia, a yeast that causes seborrheic dermatitis. There are specific genetic differences in the oil content. An individual who is prone to getting seborrheic dermatitis may have a slightly different what we call a physiochemical composition of their sebum, which seems to be more favorable for the yeast to proliferate.
High humidity. In terms of environment, it is also very critical to appreciate that tropical climate, such as Singapore where you have high humidity, there is a predisposition to the development of seborrheic dermatitis. The reason is because of increased moisture such as from sweating, as well as raised temperatures from heat. These factors increase the growth of microorganisms, which includes yeast.
Excessive sun exposure, exposure to environmental pollutants, and in the case of a poor diet and lifestyle can increase the amount of free radical damage that occurs on the scalp, and that leads to inflammatory processes.
What causes oily scalp, beyond genetics? What role does diet, lifestyle play?
One’s diet has not been proven definitively to influence the development of seborrheic dermatitis. What we do know in acne is if you are taking high-fat diets, in terms of trans-fat for example, such as taking a lot of deep-fried saturated fats in your diet, it increases your production of sebum and exacerbates oily scalp conditions. If we were to postulate that the same process could be happening for the scalp, then certainly this is also a valid statement. What’s more important to appreciate is the role of a poor diet, as well as a sedentary lifestyle, in terms of one’s physiology.
The skin and the scalp have to deal with a lot of inflammation on a daily basis because it is exposed to the external environment. Sun exposure, UV exposure which is considered an immunosuppressant and environmental pollutant can cause free radical damage to the scalp. In an individual who is consuming a lot of antioxidants in their diet which tend to be plant-derived, versus an individual who does not incorporate antioxidant-rich food in their diet, the former will be better equipped to fight off these external aggressors.
Can oily scalp lead to hair loss?
Oily scalp on its own does not cause hair loss. However, oily scalp is often in association with seborrheic dermatitis. In seborrheic dermatitis, the process of inflammation in the scalp does cause a disruption in the hair cycle. The hair cycle can be broadly thought of as having a growth phase, which is specifically known as the anagen phase, and the falling out phase, which is the telogen phase.
When you have active inflammation on your scalp, you are accelerating the cycles. Consequently, you may be having more hair in the falling out phase, as opposed to the growing phase. This, in turn, can lead to an imbalance in the amount of hair fall, so you probably have less hair growing and more hair falling out. In that situation, you may also experience hair thinning.
Do you have male or female pattern hair loss?
In a second scenario where you get oily scalp, it is because you are already having hair fall. This is very specific to individuals who are suffering from male or female pattern hair loss. If you have seen images of men who have the classical male pattern hair loss, you notice that the scalp has a little bit of a shiny tone to that. The reason is not that their hair follicles are dead, they are alive. However, the hair follicles over time have become miniature, in a process we call miniaturization.
The hair follicles are associated with oil glands. While the hair shaft itself is now very tiny and almost invisible towards the end stage of male pattern hair loss, the oil glands are still equally active. Hence, the original amount of oil that the body was producing in order to lubricate the hair shaft is now in excess because there is hardly any hair left for the oil to lubricate. That can lead to a phenomenon where you have excess oil production and hence the oily scalp.
Does nutrient deficiency lead to hair loss?
Whether one can eat your way to a healthy scalp, I think it’s important to address firstly, does nutrient deficiency lead to hair loss? It is extremely rare in the developed world that one’s diet is specifically lacking in what we call micronutrients. As it is, hair loss supplements are actually not evidence-based, unless there is a documented deficiency.
Right now, supplementation folic acid and vitamin D are only recommended for high-risk groups, such as during pregnancy or in infancy. However, it is a very widespread practice for many dermatologists and non-dermatologist doctors who are treating hair loss to prescribe supplements. The important thing to note here is that there is really no solid evidence that micronutrient deficiency is in a large proportion of our cases of hair loss. If you’re talking about scalp disease, there is no evidence at all.
Can you eat your way to a healthier scalp?
Our skin and scalp are very much dependent on, first of all, your biological age, as well as external environmental effects that cause this chronological aging. Having a diet that’s rich in antioxidants can help to combat and slow down this aging process. If you do suffer from a scalp disease or have hair fall, modifying your diet is not going to help. For patients who are thinking of taking biotin supplements or other natural supplements in hope of achieving some remedy for the scalp and their hair problems, it’s very important to note that while generally supplements are considered harmless, HSA and in the U.S. the FDA, are often not involved in reviewing supplements for either safety or efficacy.
There have also been reports of inadequate active ingredients, bacterial contamination, heavy metal, and toxin contamination of supplements. It is important to highlight that one should not be focusing on a dietary modification to achieve a healthy scalp and healthy hair, but it is certainly important to include antioxidant-rich food in your diet for purposes of general wellbeing, as well as organ function.
What are the common scalp problems in Singapore/Malaysia?
People living in the tropics tend to suffer from seborrheic dermatitis, and scalp folliculitis, which is essentially pimples on the scalp. Scalp folliculitis can be caused by the same yeast organism Malassezia, or it can be due to bacteria on the surface of the scalp. The common scalp problems seen in Singapore and Malaysia are due to our climate. Our climate is tropical, which means that it creates a very specific skin and scalp microenvironment.
There is increased retention of sweat because of the low evaporation rates owing to the environmental humidity. Young people who tend to be more active or say athletes or individuals involved in outdoor work may find that they sweat more. For scalp problems or the conditions associated with microorganism growth, these are much more prevalent in tropical regions and in susceptible individuals.
What would you recommend for individuals who are living in the tropics for healthy scalp and hair?
What I would recommend is to wash their hair daily. Scalp hygiene isn’t about going to a spa or having a hair treatment. But it’s really on a daily basis,you need an efficient way to cleanse your scalp. So the function of a cleanser is to emulsify dirt, oil, grime on the surface of your skin, on your scalp in this case, and physically rinse it off with water. Individuals or high-risk groups who are prone to scalp conditions include, for example, athletes, manual laborers who are working outdoors in the humidity. For them, it may be wise to incorporate active ingredients that prevent fungal or bacterial infections in their shampoo.
In the treatment of seborrheic dermatitis, we often use the active ingredients zinc pyrithione, salicylic acid in over the counter antidandruff shampoos. The concentration of active ingredients is also very important for efficacy. For individuals who have a history of recurrent seborrheic dermatitis, prescription shampoo that contains an antifungal agent, such as ketoconazole, may be required for longterm use and maintenance.
In this article, we shall dispel some common myths about excessive hair fall or hair loss. Below, we use an excerpt from the Haircare Bible which talks about the common misconceptions about hair fall. Stay tuned for more in this series.
Dr. Teo Wan Lin is one of Singapore’s prominent dermatologists and is also an expert in cosmeceutical research and development, having written the Skincare Bible – Dermatologist Tips for Cosmeceutical Skincare. She is the founder of Dr.TWL Dermaceuticals, one of the top dermatologist-formulated cosmeceutical skincare and haircare lines in Asia. As an expert in cosmeceutical formulation and with her background in dermatological research, Dr. Teo is widely consulted as an expert medical and cosmetic dermatologist for various media collaborations.
Dr. Teo’s second book, the Haircare Bible is catered to both beauty aficionados as well as sufferers of hair conditions such as hair loss, sensitive scalp, and dandruff for tips on home hair and scalp care. Chemists who seek to understand the perspective of a dermatologist in haircare formulas and individuals with an interest in hair care formulations will also find this a thorough and helpful read. Hair cosmeceuticals – for both the scalp and hair shaft, as well as best grooming practices are shared in a friendly FAQ format.
Myth #1: I have just moved to a different country and I think my hair loss started only after that. I suspect it is the water that I use to shampoo my hair with!
Potable water compliant with international guidelines for drinking water will not influence hair growth. It is sometimes a red herring, as a major move to a different country can cause a certain amount of mental and emotional stress, which will manifest 2-3 months after the move, as a form of hair loss known as telogen effluvium. It could also be the change in the climate, for example from a temperate climate to tropical weather, which causes the scalp to get inflamed. A common scenario is a flare-up of the condition seborrheic dermatitis, known to laypersons as dandruff. Seborrheic dermatitis is worsened by humid weather and can cause some hair shedding to occur as it triggers off scalp inflammation.
Myth #2: I just changed my shampoo before having excessive hair fall, could this be the culprit?
The answer is no, there is usually no impact of change in shampoo on hair fall. However, if you suffer from dandruff, start to use an over the counter anti-dandruff shampoo containing active ingredients such as selenium sulfide, zinc pyrithone and salicylic acid, your condition should improve.
Myth #3: Since developing hair loss, I switched to organic mild shampoo, that should help?
There is no such thing as organic shampoo, by way of classification via the FDA or Singapore’s HSA. Organic refers to food produce grown without pesticides, and as shampoo is not ingested, it does not apply. The key features of an effective shampoo is to be able to perform the following functions: removing oil, dirt and hair products from the scalp and hair shaft and be gentle enough on the scalp so as not to trigger off dryness and sensitivity.
Lastly, it should contain active ingredients that can help stimulate hair growth, such as a copper peptide. The differences between the lathering abilities of different types of shampoos can be traced back to the type of surfactant used. Specifically, a shampoo that lathers strongly is likely to be high in laureth sulfates, and this can cause scalp dryness as well.
Myth #4: Can I see a trichologist or an aesthetic doctor instead of a dermatologist for my hair loss?
Excessive hair fall can be indicative of medical conditions such as autoimmune disease, thyroid or anemia — these can be serious health conditions if ignored. A trichologist is not legally recognized as a medical practitioner, neither can they be held accountable in any way for your health.
Aesthetic doctors are general practitioners with a medical license. They are not specialists in skin hair or scalp as recognized by the governing medical bodies. Only accredited dermatologists (check your doctor’s license at your local Ministry of Health or board accreditation facility – it should explicitly state specialist qualifications) are legally recognized as the correct specialist to treat your scalp and hair problem.
Myth #5: Do herbal scalp treatments for unclogging scalp pores work?
Here’s the dealbreaker, those machines used by trichologists to scan your scalp? These are all marketing gimmicks and are not used in dermatologists’ offices as they offer no clue to the diagnosis. When the clinical examination is insufficient, dermatologists will order scalp biopsies to rule out rare causes of hair loss which are scarring, such as frontal fibrosing alopecia.
The scalp does not have “clogged pores” per se. If you notice bumps on your scalp, this is not a sign of clogging. It is an inflammatory condition known as scalp folliculitis, which can be due to bacteria or a yeast infection. These will not respond to herbal or deep cleansing treatments and will require oral medication in combination with a medicated shampoo for effective treatment.
Treatment – What can I do to prevent excessive hair fall?
If you are in the early to moderate stages of hair loss and thinning, or have a family history of hair loss, get started on a home-based hair diode laser/radiofrequency device such as the Raser™ Hair Comb.
How does laser light therapy prevent excessive hair fall?
The Raser™ Hair Comb diode laser treatments work through the process of photobiostimulation, delivering low-level laser light to your hair follicles. This helps to activate them for stronger hair growth. In addition, the boost of nourishing light energizes hair follicles at a cellular level to stimulate growth factors.
As a result, it becomes possible to reverse hair thinning, and restore your hair’s natural growth cycle. This will help your hair grow fuller, denser, longer, and stronger. Laser light therapy is recommended by dermatologists to their patients with hereditary hair loss. The comb is also FDA Approved for laser device usage in the fields of dermatology and hair restoration.
What is a radiofrequency device?
Radiofrequency devices are used on the scalp to produce the rejuvenating effect of the wound healing process. Hair follicles undergo the same process of wound healing in order to stimulate hair growth. Hence, using radio frequency technology can help in treatment of hair loss. This is especially relevant for hair loss due to genetic causes such as female pattern and male pattern hair loss. This strengthens the hair follicles, preventing excessive hair fall and promoting hair growth.
The Raser™ Hair Regrowth Comb is most effective for people in early to moderate stages of hair loss and thinning. This comb is a multi-functional 5 in 1 comb, encompassing diode laser, radiofrequency, red photon, electric muscle stimulation, and massage with ozone sterilization. These functions are helpful in the prevention of excessive hair fall as it addresses the causes of hair loss holistically and stimulates the hair follicle via 4 main modalities – Laser diodes, radiofrequency, red photon light therapy as well as scalp massage which stimulate blood flow to the hair follicles. The teeth and shape of the Raser™ Hair Regrowth Comb help to separate the hair parting to efficiently deliver light energy to scalp follicles for optimal results.
Overall, light therapy/radiofrequency devices are recommended as part of comprehensive hair loss treatment. The Raser™ Hair Regrowth Comb, in particular, stimulates hair follicles, enhances absorption of hair growth serums by the scalp, restores hair elasticity, and add shine to the hair shaft with anti-frizz features.
Acne occurs when the oil glands under the skin, scientifically known as sebaceous glands, become clogged with sebum, an oily substance. This process is known as inflammation, and it is often genetically determined. Hence, if you have a family history of acne, you are at high risk.
A normal amount of sebum usually keeps the skin healthy. Your oil glands become active once you reach adolescence due to hormones and this is when acne usually starts. When clogged, bacteria grows in the glands. This leads to swelling, bumps and visible blackheads and whiteheads on the skin’s surface.
Acne can still affect adults. In fact, many adult females suffer from acne breakouts around the chin, especially during certain times of their menstrual cycle. This should be differentiated from other conditions such as perioral dermatitis, which may look similar but is treated differently.
Under proper dermatologist care, acne can be fully treated with the correct medications, creams and light treatments. For patients who prefer not to be on oral medications, some forms of laser therapies are safe and effective acne treatment methods too. Blue light, a type of light therapy is designed to treat acne when it is active by killing Propionebacterium Acnes on the skin, which causes acne inflammation. Non ablative and ablative resurfacing lasers can treat subsequent acne scarring after it subsides.
In addition to treatment, prevention against future acne breakouts are also crucial. Diet and proper skincare are also important factors in contributing to one’s acne condition. Therefore, holistic counselling with specific advice about how to manage your condition is important.
For mild to moderate acne, you may consider over the counter dermatologist formulated cosmeceuticals such as the Anti-Acne Bundle here.
2. Use hair regrowth products
Originally prescribed only in my dermatologist practice, the Copper Peptide Hair Regrowth Serum uniquely contains Copper tripeptide, a novel molecule that stimulates hair growth. Clinically proven to have similar efficacy to that of 5% minoxidil, stimulating growth without irritation side effects or toxicity. Studies show collagen production is increased, strengthening existing hair and thickening the hair shaft.
In conjunction with the hair serum, one can consider cosmetic camouflage for a quick fix. I often recommend the Kerabuilt Follicle Hair Fibres, integrated with Biomimetic Hair Technology for natural-looking, instant results. In addition, it is chemical-free and hypoallergenic, recommended even for those with hair loss and sensitive scalps.
In my dermatology practice, almost all patients suffering from hair loss had also done their due research online about possible causes of hair loss before seeing me. The real problem though, medical websites are not written for the layperson and the lists of diagnoses of conditions that lead to hair loss simply leave the hair loss sufferer worried and fearful. Those that do their research on forums and beauty websites are none the wiser, as they suggest many non-evidenced backed methods of hair growth or causes of hair loss which is simply unscientific and wrong information.
There are many different causes of hair loss, which can occur at the same time or individually, and dermatologists are best positioned conduct a thorough history taking, medical evaluation/examination and may recommend blood tests and other tests before diagnosing the cause of hair loss. For some rare causes of hair loss, especially of what is termed scarring alopecia, a scalp biopsy, which is where samples of the scalp are taken for microscopic examination may be required.
3. Consult a dermatologist for scarring on the skin
Treatment of scars on one’s skin can be in the form of chemical peels or lasers, which can be both ablative and non-ablative. Your dermatologist will advise which treatment option is best suited for your skin. In the meantime, a good concealer consists of a colour corrector. Orange is well suited to conceal dark scars and pigmentation whereas green conceals redness. Follow up with a CC cream with cosmeceutical active ingredients to treat and conceal your blemishes at the same time – achieving an overall even complexion.
Since ancient times, plant extracts have been widely used for hair growth promotion in the traditional Ayurveda, Chinese and Unani systems of medicine. One of the most potent sources of these plant extracts would be the oil extract of safflower (Carthamus tinctorius L.).
Historically, safflower has mainly been used in traditional medicine to treat different medical conditions and as dyes for flavouring and colouring in Italian, French and British cuisines.
Interesting fact? Safflower seeds and garlands have also constantly made their appearance in the presence of mummies across ancient Egypt. In the treatment of skin conditions, safflower can be used to treat skin patches and baldness based on Iranian traditional medicine.
Use of safflower oil in the prevention and treatment of hair loss
In a 2011 study published in the Journal of Ethnopharmacology by Naphatsorn Kumar, the mechanisms involved and the effectiveness of hair loss treatment using plants were examined by determining the relationship between the activities of the 5α-reductase enzyme inhibition and hair growth promoting activities. When tested for 5α-reductase inhibition using enzymes from rat livers and hair growth promoting activity in mice, safflower extract was found to be the most potent inhibitor of the enzyme and the strongest hair growth promoter among 17 Thai plants traditionally used for hair treatment.
“Our team worked on this basis to incorporate Safflower Oil into our existing haircare and scalp care routine to stimulate hair follicles and also to heal the hair shaft.” Accredited Dermatologist, Dr. Teo Wan Lin
How does safflower oil promote hair growth and fight hair loss?
Safflower florets have traditionally been used for hair growth promotion. In the study by Naphatsorn Kumar, the potential of safflower extract on hair growth was examined both in vitro and in vivo.
It was found that safflower oil encourages hair growth by promoting the proliferation of both dermal papilla cells and HaCaT and by stimulating hair growth-promoting genes such as the vascular endothelial growth factor and keratinocyte growth factor. At the same time, it suppresses the expression of the hair loss-related gene, the transforming growth factor‐β1. As a result, the treatment of hair using safflower extract significantly increased the length of cultured hair follicles and stimulated the growth of hair.
Are there any side effects?
There are no known side effects except for allergic contact dermatitis which is extremely rare.
How can it be incorporated in your haircare regimen?
Caring for one’s hair is just as important as caring for one’s face, but often gets less attention. Understanding what constitutes a good shampoo is an important part of making sure your hair stays healthy and voluminous.
To help you navigate the world of hair care products, we introduce you to the basics you need to know.
How should a shampoo function?
A shampoo is expected to cleanse the scalp and hair of dirt, sebum, sweat, dead skin cells and environmental pollutants. It also should remove greasy residues from hair care products such as oils, gels and sprays.
While most products can accomplish a thorough cleanse, the real challenge lies in removing just enough sebum to allow the hair to be clean without drying it out.
This explains why most shampoo formulations have a secondary function of smoothing the hair’s surface and imparting lustre, smoothness, buoyancy and volume.
Typical shampoos contain 10 to 30 ingredients. These include: cleansing agents (surfactants), conditioning agents, special care ingredients, and additives. The surfactants are responsible for cleansing hair while the conditioners and other ingredients do the rest.
Types of surfactants
A surfactant is often amphiphilic, meaning its molecules contain both lipophilic (oil-attracting) and hydrophilic (water-attracting) parts. The oil-attracting parts bind to sebum while the water-loving sites parts to water. Such a mechanism allows sebum to be removed when in contact with water.
The type of surfactants used in shampoos is classified according to their hydrophilic polar group. The four common categories of shampoo surfactants are anionics, cationics, non-ionics and amphoterics. Most formulas rely on two types of surfactants.
The surfactant listed first in a shampoo’s ingredient list denotes the primary cleanser and also the ingredient in the highest concentration. The surfactant listed second is the secondary cleanser; this is often added to offset the weaknesses of the first surfactant.
Anionic sufactants are named for their negatively charged hydrophilic (water-loving) parts. Derived from fatty alcohols, they are good at removing sebum from the scalp. However, excessive cleansing with anionic surfactants leaves the hair harsh, rough, dull, frizzy and prone to tangling.
In contrast to anionic surfactants, cationic sufactants have a positively charged element. Cationic surfactants are poor cleansers and do not lather well. They are also not compatible with anionic surfactants. However, they are excellent at keeping chemically damaged hair soft and manageable. As a result, shampoos for damaged or coloured hair often include cationic surfactants. Examples include long-chain amino esters, ammonioesters, and cetyltrimethylammonium chloride.
With both positively and negatively charged groups, amphoteric surfactants foam well and condition the hair. In addition, they do not cause stinging in the eyes and are gentle on the skin/scalp barrier, making them ideal for mild shampoos. Examples are betaine, sulfonate betaine, amphoteric acetate/diacetate.
Nonionic sufactants do not have a charged group and hence are compatible with any surfactant. Nonionic surfactants are the mildest type of surfactant but lather poorly. Such surfactants are often used in baby shampoos. Examples are fatty alcohol ethoxylates, sorbitan ether esters, and alkyl polyglucosides.
Conditioners (in shampoo formulations)
Shampoo formulations tend to add hair-conditioning ingredients to impart manageability, gloss and antistatic properties to the hair. Many are noted as ‘2 in 1’ to indicate the presence of both cleansing and conditioning benefits.
Examples of conditioning ingredients are fatty substances such as vegetable oils, wax, lecithin and lanolin derivatives, protein by-products (collagen, silk, animal proteins) and silicones.
Silicones add lubricity to the hair and reduce friction that arises from combing. They make it easier to comb through and detangle strands and prevent them from becoming frizzy.
Protein substances found in conditioners function by temporarily mending split ends and holding the hair fragments together until the next shampooing takes place.
To stand out in the market, certain shampoos may offer other attractive ingredients such as panthenol, pro-vitamins or botanicals such as tea tree oil. However, given that the contact time of the product with the scalp and hair is brief, it is unlikely that these provide significant clinical benefits. Such additives function more as a marketing tools.
Shampoos for special conditions
For shampoos that target conditions such as dandruff or seborrhea (oily scalp), active ingredients are added.
Dandruff is often due to the overgrowth of a yeast called Malassezia spp. Anti-dandruff shampoos rely on ingredients that can inhibit the overproduction of yeast cells. Such ingredients include zinc pyrithione, ketoconazole and selenium disulphide.
For patients with oily scalps, coal tar can be an effective ingredient in reducing sebum production.
For deep cleansing of the scalp with pharmaceutical grade ingredients, consider Deep Cleanse Shampoo. It degreases oily scalps, calms irritated or sensitive scalp problems and improves hair loss control, This shampoo also contains zinc pyrithione to target dandruff, thus suitable for many hair types.
Male pattern hair loss, or androgenetic alopecia, is exceedingly common. Hair thinning and hair loss can begin as early as late adolescence and progress with age. Understanding why it happens, including its strong genetic element, can help men counter its effects.
Characteristics of male pattern hair loss (MPHL)
MPHL typically begins first with bitemporal recession – triangular, usually symmetrical, areas of recession at the frontal hairline. Thinning starts in the temples as well as the crown/vertex and slowly progresses to encompass the entire top of the scalp.
The disease onset and progression vary from person to person. Initial signs of male pattern hair loss usually develop during teenage years and lead to progressive hair loss and thinning of the hair across the scalp.
Causes of male pattern hair loss
A genetic predisposition is considered a major risk factor for male pattern hair loss, as genetics determine the activity level of the androgenic hormones that lead to MPHL. However, this condition can also be present even in individuals without a family history.
In the hair follicle cells, a male hormone called testosterone converts into an active form and binds to the androgenic receptors in the hair follicle. Individuals with male pattern hair loss have abnormal sensitivity of hair follicles, allowing easier binding to receptors.
This specific bonding triggers cellular processes that cut short the anagen phase of the hair cycle, the stage where hair follicles grow. For this reason, the hair follicles enter the telogen phase earlier where programmed cell death happens.
In normal hair follicles, the duration of the anagen phase lasts from two to seven years. Individuals with male pattern hair loss have an anagen phase that ranges from a few years to just weeks.
With the decreased duration of the anagen phase, more hair follicles enter the telogen phase. Telogen hairs are more easily plucked than anagen hairs. Thus, individuals will notice increased hair shedding as they comb their hair.
An increased amount of androgen also causes hair follicles to be transformed into thin, vellus-like hairs. As a result, hairs are finer and lack pigmentation.
Topical and oral treatments
Topical and systemic drugs are often used in treating MPHL. The most common topical drug is minoxidil. Originally developed as an oral medication for hypertension, its common side effect of excessive hair growth has led to its use as a treatment. Minoxidil 2% or 5% solution is often used in topical application to prolong the anagen phase.
Other anti-androgen drugs include fluridil and finasteride. A topical application of fluridil helps suppress androgen receptors in hair follicles. Finasteride is available as oral medication and reduces the conversion of testosterone into its active form. Finasteride has also shown to reverse the effects of follicle miniaturization.
Copper peptide is another ingredient that stimulates hair regrowth. Made up of amino acids, copper peptides have regenerative properties that work to increase hair follicle size and reduce hair loss. By fighting inflammation and free radicals, copper peptides also protect the hair follicles from being damaged.
All treatments for MPHL are for long-term use, which means stopping the treatment will cause your hair loss condition to return. Before committing to any topical treatment, it is recommended to consult an accredited dermatologist for professional advice.
Light therapy as treatment
Low light, intense pulsed light, and red light treatment can initiate hair regrowth. Red light treatment, with wavelengths between 630 to 670 nm, stimulates an enzyme called cytochrome C. This enzyme encourages our genes to produce more hair and lowers the cell death of hair follicles.
Using a laser comb for 15 minutes, three times a week, also increases the number of hair follicles in the anagen phase, the stage in which our hair grows. The comb is available as a stand-alone or adjunctive therapy.
We may experience changes to our hair such as hair loss or thinning as we age, so be sure to distinguish the difference between normal changes and alopecia. 100-150 hair strands lost in a day is normal and they usually show up when you brush your comb through or after washing your hair.
Bald patches on your scalp or more than 150 strands a day can be classified as abnormal hair loss.
The hair cycle
Normal hair grows through a hair cycle that has three stages. The growth phase, or the anagen phase, is the longest phase of the hair cycle, with 80 to 90% of the hair on our scalp in this phase. In the next stage called the catagen phase, the hair bulb detaches from the blood supply and is pushed from the scalp. In the last stage, the telogen phase, shedding occurs as the hair is released, leaving behind an empty follicle.
Each hair follicle is independent, going through the cycle at different stages as the other hairs. Hair problems occur when there is a disruption in the hair cycle.
How do I diagnose alopecia?
According to Dr Teo Wan Lin, accredited dermatologist at TWL Specialist Skin and Laser Centre, she says: “There are two major forms of hair loss – scarring or non-scarring alopecia. If follicular orifices are absent on the scalp, and the underlying scalp has a shiny white color, the hair loss is scarring. Follicular orifice is the opening of a hair follicle on the surface of the skin. If follicular orifices are present, it is a form of non-scarring alopecia.”
Non-scarring hair loss is the loss of hair without any presence of scarring in the scalp. Scarring alopecia leaves scar tissues on the scalp and may show signs of inflammation, redness or swelling.
Another common type of hair fall problem is androgenetic alopecia, or female/male pattern hair loss. Patients with androgenetic alopecia have high levels of androgen, a type of steroid hormone. Effects of androgen include miniaturisation of hair follicles by increasing the rate of cell division, shortening the hair cycle and increasing the duration of the telogen phase.
How can I treat my hair loss problem?
A multifaceted approach is recommended, as there are likely to be multiple factors that cause your hair condition.
For topical agents, either a minoxidil solution or ketoconazole shampoo can counter female/male pattern hair loss. Oral ketoconazole has anti-androgen effects, while topical ketoconazole can suppress androgen activity. Minoxidil shortens the telogen phase, and increases the duration of growth phase.
Low-level light treatments, in combination with active ingredients such as minoxidil and copper peptide can encourage hair growth by triggering inactive follicles or increasing blood flow to follicles.
Avoid combing your hair when it is wet, as wet hair is most subject to trauma. Hair should only be combed when mostly dried with a wide-toothed comb. Also, the less that is done to thinning hair, the better. Stay away from bleaching, rebonding or perming your hair to reduce damage done.
Shampoo your hair and scalp daily, and do dry your hair thoroughly as the humid tropical climate in Singapore makes the scalp a perfect breeding ground for microbes such as yeast. Yeast is naturally found on human skin, but excessive proliferation can cause dandruff and worsening of hair loss conditions. Use a shampoo containing fungistatic and bacteriostatic bioactive ingredients such as Zinc Pyrithione to impede the growth of microbes. The Deep Cleanse Shampoo is infused Zinc Pyrithione to arrest the proliferation of fungi and bacteria, whilst also containing Copper Peptide to stimulate healthy hair growth.
Accredited dermatologists specialize in treating scalp and hair problems. Do head to your dermatologist should the hair condition deteriorate and for comprehensive management of any hair loss issues.
Hair loss, or excessive hair fall, is also known medically as alopecia can be defined by shedding of hair, leading to an overall thinning that causes the scalp to be visible, or “balding”. Some people may also experience hair problems such as a change in the quality of hair or breakage of the hair shaft, which also results in an overall altered appearance of hair. Excessive hair fall can happen to anyone and everyone under the sun. Everyone, male or female, elderly, middle aged-adults or children is considered susceptible when it comes to hair fall although at each age group, there are different underlying causes that results in the loss of one’s crowning glory.
What causes excessive hair fall?
Excessive hair fall can be caused either by an isolated problem or a combination of factors such as genetics, chronic medical diseases such as a thyroid problem or underlying anemia (low blood count), poor nutrition, etc. Chemical treatments performed in hair salons, such as hair dyes, bleaching, perming and rebonding hair, can cause a form of hair fall from breakage of the hair shaft. In the hospital setting, patients undergoing chemotherapy usually suffer from a form of temporary hair loss, caused by the hair follicles entering into the resting phase whereby they are shed.
Namely, as a our hair growth cycle goes through 3 main phases — active growth caused by anagen, transitional growth caused by catagen and inactive growth and shedding caused by telogen — an impact in any of these stages caused by the abovementioned factors can lead to loss in hair density due to less hair on the scalp present in the growth or anagen phase. Here is a comprehensive list of some of the commonest causes of hair loss:
Hormones, abnormally high levels of male hormones in females
Genes, from both parents in male or female pattern baldness
Childbirth, emotional stress, illness, and are causes of temporary/reversible hair fall known as telogen effluvium
Fungal infections such as Ringworm, Tinea capitis caused by dermatophyte infections i.e. microsporum canis and trichophyton rubrum.
Medications such as chemotherapy medications in cancer treatment, birth control pills
An underlying autoimmune disease which attacks the hair follicles, known as alopecia areata. This is genetically influenced and those with a family history of such a condition will have a high risk of getting this condition. It is also linked to conditions such as Graves Disease and Hashimoto’s thyroiditis.
A form of scarring alopecia from traumatic injuries, burns, X-rays.
Chemical procedures such as perms, bleaching, and dyeing hair can cause hair breakage.
Trichotillomania,a psychological disorder affecting children, teenagers and young adult females, a condition in which the affected person compulsively pulls out his own hair.
Telogen effluvium is a temporary, reversible reaction to stressors such as an acute severe illness or to pregnancy or emotional/psychological trauma. This is due to changes in the growth cycle of hair. A proportionately increased number of hairs enter the resting phase known as telogen at the same time, as opposed to normal hair which forms 90% of scalp hair in the active growth phase, causing increased hair shedding and subsequent thinning.
Tight hairstyles and using instruments like rollers or hot curlers. Tightly braided hair and hot combs can also result in permanent hair loss by trauma.
Anemia,thyroid illnesses, autoimmune diseases such as lupus, diabetes,iron deficiency,eating disorders can lead to hair fall.
Poor Diet. An or extreme severely calorie-restricted diet or a low-protein diet can also cause temporary hair fall.
Involutional alopecia is a natural degenerative condition whereby hair thins with age. Proportionately increased hair follicles go into a resting phase, and existing hairs become shorter and fewer in number.
Androgenetic alopecia is a genetically influenced condition that affects both men and women. For males with androgenetic alopecia, they can even begin suffering hair fall from their teens or early 20s. Some signs of this condition are a receding hairline and thinning of hair from the crown and frontal scalp. Women generally experience this later in life. With a general thinning over the entire scalp, often with the worst hair loss at the crown.
Alopecia areata is a rare condition which may start suddenly and lead to patchy hair fall in children and young adults. Although rare, this may progress to complete baldness (alopecia totalis), whereby a person loses 100% of scalp hair. Hair regrows within a few years in about 90% of people with the condition. The most severe form of this condition is known as Alopecia universalis, which causes all body hair to fall out, including the eyebrows, eyelashes, and pubic hair.
Scarring hair loss can be picked up by a trained dermatologist as the hair follicles have been permanently damaged and it may be impossible for the hair to regrow over the same areas again. This is comparatively rare but medical conditions such as scalp cellulitis, dissecting cellulitis, folliculitis, folliculitis decalvans, if left untreated, can lead to severe scarring alopecia. Some forms of lupus, such as discoid lupus erythematosus on the scalp, results in discolored bald patches on the scalp. Lichen planus is another inflammatory scalp condition that can destroy the follicle leaving hair unable to grow again.
Can hair fall be prevented?
Excessive hair fall is scary and traumatic. The most important thing to know is that you are not alone and that there are specific causes to any type of hair fall which should be diagnosed early and treated appropriately by a trained dermatologist. See an accredited dermatologist as soon as you pick up any signs of hair loss to identify and treat any underlying disease. If you have a family history of hair loss, you may wish to consult a dermatologist to discuss treatment options for prevention.
Treatments such as red and yellow light, together with active ingredients in certain medications like minoxidil and copper peptide can increase hair growth. However, if you have active inflammation on the scalp or an underlying more serious health condition you will need medical treatment to stop hair fall before treatments to cause hair re-growth. If you don’t have hair loss, do take good care of your hair by avoiding chemical treatments such as hair colouring, bleaching and perming processes. Sleek high ponytails or bun might look chic in the short term, but for healthier hair in the long run opt for loose hairstyles to avoid traction injury resulting in hair fall along the hairline.
Seborrhoeic or seborrheic dermatitis is a common, chronic or relapsing form of eczema/dermatitis. The condition mainly affects the sebaceous, gland-rich regions of the scalp, face, and trunk. There are infantile and adult forms of seborrheic dermatitis. It is sometimes associated with psoriasis (sebopsoriasis). Seborrheic dermatitis is also known as seborrheic eczema.
Dandruffalso known as pityriasis capitis is considered to be an uninflamed form of seborrheic dermatitis. Scattering within hair-bearing areas of the scalp, dandruff of such presents as itself as bran-like scaly patches.
Although the cause of seborrheic dermatitis is not completely understood, it is associated with proliferation of various species of the skin commensal Malassezia, in its yeast, non-pathogenic form. Its metabolites (such as the fatty acids oleic acid, malssezin, and indole-3-carbaldehyde) may cause an inflammatory reaction. Differences in skin barrier lipid fuction and content may account for individual presentations.
Adult seborrheic dermatitis tends to begin in late adolescence. It is less common in females than in males and most common amongst young adults and in the elderly.
Factors sometimes associated with severe adult seborrheic dermatitis:
A family history of psoriasis or familial tendency to seborrheic dermatitis
Oily skin (seborrhoea)
Lack of sleep, and stressful events.
Immunosuppression: organ transplant recipient, human immunodeficiency virus (HIV) infection and patients with lymphoma
Neurological and psychiatric diseases: congenital disorders such as Down syndrome, depression, epilepsy, facial nerve palsy, tardive dyskinesia, parkinson disease, spinal cord injury
Psoralen and ultraviolet A (PUVA) therapy used in treatments for psoriasis
Infantile seborrheic dermatitis is the type of seborrhoeic dermatitis that affects babies under the age of 3 months and usually resolves by 6–12 months of age. It causes cradle cap, the diffuse greasy scaling on scalp. The rash may spread to affect armpit and groin folds resulting in a type of napkin dermatitis. They are characterised by their flaky or peeling salmon-pink patches. Since it is not itchy, babies often appear undisturbed by the rash, even when generalised.
Typical featuresof seborrheic dermatitis
Often affects the upper trunk, facial areas such as within eyebrows, around the nose and behind ears and scalp
Winter flares, improving in summer following sun exposure
Minimal itch most of the time
Combination oily and dry mid-facial skin
Ill-defined localised scaly patches or diffuse scale in the scalp
Blepharitis: scaly red eyelid margins
Ill-defined, thin, scaly and salmon-pink plaques in skin folds on both sides of the face
Ring-shaped or petal-shaped flaky patches on anterior chest or hair-line
Rash in armpits, under the breasts, in the groin folds and genital creases
Superficial folliculitis (inflamed hair follicles) on cheeks and upper trunk
Pityriasiform seborrhoeide is a form of extensive sebrrhoeic dermatitis that affects the scalp, neck and trunk.
Seborrheic dermatitis is often diagnosed by its clinical appearance and behaviour. This is because Malassezia is a normal component of skin flora. Due to this, their presence on microscopy of skin scrapings is often not diagnostic.
Histological findings specific to seborrheic dermatitis are as follows:
Although skin biopsy may be helpful, it is rarely indicative.
superficial perivascular and perifollicular inflammatory infiltrates
parakeratosis around follicular openings.
Treatment of seborrheic dermatitis often involves several of the following options:
Keratolytics can be used to remove scale when necessary, eg salicylic acid, lactic acid, urea, propylene glycol
To reduce Malassezia, topical antifungal agents such as ketoconazole, or ciclopirox shampoo or and/or cream are applied. It is important to note that some strains of Malassezia are resistant to azole antifungals. In such cases, it is advised to try zinc pyrithione or selenium sulphide, under a dermatologist supervision.
Mild topical corticosteroids are prescribed for 1–3 weeks to reduce the inflammation of an acute flare
Topical calcineurin inhibitors (pimecrolimus cream, tacrolimus ointment) are indicated if topical corticosteroids are often needed, as they have fewer adverse effects on facial skin
In resistant cases in adults, oral itraconazole, tetracycline antibiotics or phototherapy may be recommended. Low dose oral isotretinoin has also been shown to be effective for severe or moderate seborrheic dermatitis.
Anti-dandruff shampoos containing zinc pyrithione and salicylic acid such as the Deep Cleanse Shampoo should be used daily.
Other medicated shampoos containing selenium sulfide, coal tar, ciclopirox and ketoconazole should be used twice weekly for at least a month.
Steroid scalp applications are seen to reduce itching. These should be applied daily for a few days every so often.
Calcineurin inhibitors such as tacrolimus can be used as steroid alternatives.
Coal tar cream can be applied to scaling areas and removed several hours later by shampooing.
Combination therapy is often advisable.
Treatment for face, ears, chest and back
Using a non-soap cleanser, cleanse the affected skin thoroughly once or twice each day.
Apply ciclopirox cream or ketoconazole once daily for 2 to 4 weeks, repeated as necessary.
Hydrocortisone cream can also be used, applied up to twice daily for 1 or 2 weeks. Occasionally a more potent topical steroid may be prescribed.
Topical calcineurin inhibitors such as pimecrolimus cream or tacrolimus ointment may be used instead of topical steroids.
A variety of herbal remedies are commonly used, but their efficacy is uncertain.
Regular washing of the scalp with baby shampoo or aqueous cream is followed by gentle brushing to clear the scales.
White petrolatum may be useful.
Depending on the extent of the rash, topical antifungals are often prescribed.
Hair loss at any age affects one’s self confidence and esteem. It may also lead to depression and anxiety, conditions that affect work productivity and fitness. Unfortunately, way too many hair loss sufferers go an entire merry-go-round of trichologists, medi-spas, scalp treatments by aestheticians, hair salons before deciding to see a dermatologist, by which time a lot of their hair (and money) has already been lost. In this article, I start by tackling the commonest misconceptions of hair loss, what causes it and finally, any hair loss treatments that are effective for the condition.
If you are an expatriate that’s recently found yourself losing hair after moving to a new city, you are not alone. I have met many patients who are convinced that since moving to hot and humid Singapore they have started losing their crowning glory. Some attribute this to work stress, or the stress of relocation overall. Many report similar experiences from online forums and friends who have developed hair fall since moving to Singapore, with all sorts of speculations including water supply issues. So if you’ve moved to a new city recently, started experiencing hair fall, fret not because I hope to debunk some myths from a dermatologist viewpoint on hair loss happening to many mid-life career professionals.
1. Commonest Misconceptions of Hair Loss
It’s not in the water, the wrong shampoo or hair care
Hair loss is not linked to using an inappropriate shampoo. Using organic or baby shampoos doesn’t help hair fall problems either. How shampoos work is by means of lathering agents, like sodium or ammonium-laureth sulfate which grab dirt, grime, bacteria and oil from scalp and hair, and the foam is then rinsed off with water. The so-called degreasing shampoos are those that contain higher amounts of Sodium Laureth Sulfate (SLS). Water, as long as it is potable, should not affect the condition of your scalp or hair. Unsanitary water not complying with WHO guidelines could be teeming with bacteria which is a different case.
Chemical hair treatments causes hair loss by breakage only – not from the roots
Bleaching, perming, rebonding and dyeing hair all count as chemical treatments that alter the structure and the bonds of the hair to change its appearance. Essentially, these chemical processes damage the hair shaft, leading to parts of the hair shaft being broken off and causing hair fall by breakage. If you have bleached or permed hair, you should adopt grooming practices such as a wide-toothed comb and soft bristled brush using gentle detangling motions rather than harsh combing which can result in even more breakage.
2. Accredited dermatologists are specialists in Hair Loss Treatments
A google search on “hair loss treatments” throws up myriad trichology, herbal aesthetic and medi-spa centres offering solutions to treat all scalp and hair problems. As a patient once remarked “ I wish I had known to see a dermatologist earlier for my hair loss treatments.” Before I go on, lets first qualify what counts as hair loss.
Anything between 60–100 strands of hair a day falls within the normal range but if you are used to losing say 30–50 strands usually and suddenly notice an increase in hair fall, that’s something to be alert to. Some symptoms: more hair in the drain, floor, on combs and the pillowcase. Ladies may notice having a wider parting and a thinner ponytail. Do you have a family member suffering from hair loss? Be alert to early symptoms of hair loss and seek a dermatologist’s advice for prompt diagnosis, hair loss treatments and prevention.
3. It’s not always the stress – Some other causes of hair loss
In my practice, some of my hair loss patients come to me with their own lists of diagnoses of medical conditions that lead to hair loss, usually from a medical website that isn’t written for the layperson. This also may include some research on forums and beauty websites which may boast hair loss treatments and causes that are simply unscientific.
If you’ve just had a stressful period such as relocation or adjusting to a new job, you may be experiencing telogen effluvium, which is when scalp hair is pushed to the end of the growth cycle and falls out, typically 3 months after the stressful event. Illnesses such as high fever, viral infections and crash dieting can cause telogen effluvium.
Male and Female Pattern Hair loss is one of the commonest causes of genetic hair loss, due to the hormone testosterone, and is also known as androgenetic alopecia. This is likely if you have a family member with hair loss, especially at an early age. Male pattern hair loss tends to develop as a receding hair line and appearance of bald spots. On the other hand, female pattern hair loss may manifest as widening parting and general thinning of hair.
Alopecia areata is an autoimmune condition, the cause of it is unknown although there is some evidence that it is influenced by one’s genetics as well. This is a non-scarring type of hair loss that results in multiple bald patches. Hair loss treatments for such conditions include steroid injections and oral medications which can effectively manage the symptoms experienced.
Bacterial infections of the scalp, such as scalp folliculitis, more severe forms known as dissecting cellulitis and folliculitis decalvans cause scarring hair loss if left untreated.
Excessively tight hairstyles on the hair such as corn-braiding and tight pony-tails can cause a form of hair loss known as traction alopecia.
Some medications can also cause hair loss, for example, anti-cancer drugs and anticoagulants can cause hair loss.
Seborrheic dermatitis is caused by a yeast known as malessezia furfur in an individual with excess production of oil and can be worse in tropical and humid climates such as Singapore. Malessezia under normal conditions does not cause disease of the skin or scalp.
Under humid environments, it can cause moderate to severe scalp inflammation and flaking and when it is severe, even hair loss. If you have tried over the counter anti-dandruff shampoos and are not better, promptly seek the care of an accredited dermatologist rather than self medicate or DIY with scalp and hair loss treatments.
Scalp eczema, an excessively dry scalp/skin condition is another cause of scalp inflammation. If one has a family history of psoriasis, scalp psoriasis can also cause scaling on the scalp similar to dandruff.
If you had contact with a cat or dog with ringworm -infection, have your scalp and skin checked by a dermatologist. Animals carry a type of fungal infection known as dermatophyte infections which are contagious. This type of scalp inflammation is commoner in children and presents as a red, scaly and itchy patch with hair loss.
Hair loss can occur due to one or more of these factors. Dermatologists evaluate by taking a thorough history, a physical examination and may recommend laboratory tests and microscopic tests before diagnosis. They also are trained to distinguish between scarring alopecia, a permanent type of hair loss, and may also offer a scalp biopsy, for a microscopic samples of the scalp.
5. Risks of not getting prompt medical hair loss treatment
I had a patient who had spent over two decades on numerous scalp and hair loss treatments promising to treat her hair fall until a colleague recommended her to see a dermatologist instead. By the time she had come to see me, she had lost about 50% of her natural hair (she was only in her mid-thirties).
A lot of people are not even aware that dermatologists are the specialists in scalp and hair problems, including hair loss treatments. In the case of the patient above, while her hair loss did get better, she turned out to be having a combination of telogen effluvium, scalp inflammation from seborrheic dermatitis as well as underlying genetic hair loss, known as female pattern hair loss. Her treatment was gradual, as over such a long period of time her hair follicles had undergone miniaturisation, meaning that she had an advanced stage of hair loss. Compared to if she had sought appropriate medical treatment, which could mean overall a slower, or less optimised outcome with specialised hair loss treatments.
6. What hair loss treatments are available?
When it comes to hair loss treatments and hair regrowth treatments, it is important to follow evidence-based methods of encouraging hair growth. Light treatments, such as red light and yellow light, used in combination with active ingredients such as minoxidil and copper peptides, have evidence that supports hair re-growth.
However, the more important issue is not to dismiss hair loss as a cosmetic concern as severe underlying medical conditions like lupus (an autoimmune disease), chronic illnesses, thyroid disease, anemia are causes of hair loss and needs to be medically treated. A trained dermatologist differentiates both non-scarring and scarring alopecia, the latter is irreversible hair loss that can be promptly diagnosed and requires medical treatment to address the hair loss.
7. What is hair loss treatment outcome like?
Most cases of hair loss are age-related and due to androgenetic alopecia (influenced by the hormone testosterone). Such cases have a strong genetic component and early detection, prevention measures can help treat and retard hair loss. Discuss with your dermatologist what options are available, especially if you are aware of a strong family history of hair loss at an early age.
Mild scalp inflammation caused by scalp folliculitis, psoriasis, eczema and seborrheic dermatitis do not cause hair loss. However, if uncontrolled, it can force the hair growth cycle into telogen effluvium which is the cause of hair loss that occurs after a major illness. These conditions are all fully treatable with medications and should be diagnosed promptly to prevent worsening which may eventually lead to hair loss.
For other causes of hair loss such as alopecia areata, an autoimmune disorder affecting the immune system, hair follicles are destroyed and may manifest as round patches of baldness. Such conditions can be treated effectively using steroid injections with early stage hair loss treatment intervention. Left ignored, such may progress and require oral steroids for control.
Some causes of hair loss result in scarring, whereby the hair follicle is destroyed and may not regrow. Such cases when treated early have better prognosis and outcome. Examples include folliculitis decalvans, which is a severe form of type of scalp folliculitis, leading to constant inflammation and infection. Tinea capitis is a contagious fungal scalp infection generally affecting younger children that can lead to scarring hair loss if there is no intervention from medical and hair loss treatments.
If you have an underlying more serious health problem such as hyper or hypothyroidism, an autoimmune disorder or anemia, hair loss may sometimes be the first presenting symptom. Your dermatologist will evaluate if a blood test is necessary to detect such conditions.
Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email firstname.lastname@example.org. Alternatively, you may fill up our contact form here.