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Effective Hair Loss Treatments? A Dermatologist’s View

October 10, 2017

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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 hair loss and finally, any treatments that are effective for hair loss.

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 loss 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 loss 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. Hair loss problems are best treated by an accredited dermatologist

A google search on “hair loss treatment” 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.” 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, treatment 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. Some research on forums and beauty websites which may boast causes and cures of hair loss which is 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.

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 patches of hair loss, and can be effectively treated with steroid injections and oral medications.

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.

4. Do you have other scalp symptoms?

Do you have itch, redness or pain on your scalp? An undiagnosed inflammatory scalp disease such as seborrheic dermatitis, scalp eczema or psoriasis can be responsible.

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.

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 treatment 

I had a patient who had spent over two decades on numerous hair and scalp treatments promising to treat hair loss 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 treating scalp and hair problems, including hair loss. 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 treatment.

6. What treatments are available?

When it comes to 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.

7.What is the 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 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 whereby hair follicles are destroyed, it appears as round patches of hair loss and can be treated in early stages effectively with steroid injections. 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 untreated.

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.

© 2017. Dr. Teo Wan Lin. All rights reserved.

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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 appt@twlskin.com. Alternatively, you may fill up our contact form here.

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