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.
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.