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 hair loss shampoo is an important part of making sure your hair stays healthy and voluminous. To help you navigate the world of shampoo products, we introduce you to the basics you need to know.
How should a hair loss shampoo function?
A shampoo is a viscous liquid (liquid with texture that tends to be thick). Its primary purpose is cleansing the scalp and hair of dirt, sebum, sweat, dead skin cells and environmental pollutants. It does so by dissolving oil-soluble dirt, which is water-insoluble and hence, cannot be removed by solely rinsing with water. A shampoo should also remove greasy residues from hair care products such as oils, gels and sprays. The overall effect is that of cleansing to maintain a good hygiene level to reduce the chance of scalp irritation, inflammation and odour.
While most shampoos 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. Certain types of shampoos also treat the scalp with medicated ingredients, such as those targeting dandruff, a common scalp disorder caused by a yeast known as Malassezia.
The Copper Peptide Hair Regrowth Shampoo is a hair loss shampoo formulated for hair loss and sensitive scalps. It contains amino acid surfactant that performs gentle action for sensitive scalps, is pH-Adjusted for deep-cleansing. It also includes actives such as zinc pyrithione for anti-dandruff, and copper peptide for healthy hair growth.
Ingredients In A Shampoo
Typical shampoos contain 10 to 30 ingredients. These include: cleansing agents (surfactants), conditioning agents, special care ingredients, and additives. Surfactants essentially cause a lathering effect via a process known as emulsification. For example, a surfactant emulsifies sebum and grime on the hair and scalp which can then be easily rinsed off with water. They 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 hair loss shampoos is classified according to their hydrophilic polar group. The four common categories of shampoo surfactants are anionics, cationics, non-ionics and amphoterics. Most shampoo 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 surfactants 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. Examples include sodium laureth sulfate, ammonium laureth sulfate, sodium lauryl sulfate, and ammonium lauryl sulfate.
In contrast to anionic surfactants, cationic surfactants 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. They help with the formation of micellar emulsion, improving the lathering ability of the shampoo, resulting in a thick liquid which is efficient to use. 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 cocamidopropyl betaine, sulfonate betaine, amphoteric acetate/diacetate.
Nonionic surfactants do not have a charged group and hence are compatible with any surfactant. Nonionic surfactants are the mildest type of surfactant. Such surfactants are often used in baby shampoos. Examples are fatty alcohol ethoxylates, cocamide MEA, sorbitan ether esters, and alkyl polyglucosides.
Conditioners In Shampoo
The purpose of conditioning is to increase hair manageability by smoothening and softening the hair shaft and to enable easy detangling. 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.
What are 2 in 1 shampoos?
They are conditioning shampoos that can wash off dirt and at the same time disperse conditioners onto the hair shaft. 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.
What is the technology behind 2 in 1 shampoo?
Silicones and conditioning oils help smoothen out the hair shaft. They need to be regularly dispersed upon application to the hair shaft to condition the hair. 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. The lathering components help to cleanse off the oil, dirt and dead skin cells of the scalp.
What is the science behind wet and dry hair conditioning?
The science behind conditioning hair while wet is based on a compound known as coacervate. It is best understood as something with positive and negative ions reacting in the presence of water.
On the other hand, the end goal of dry hair conditioning is to deposit smoothening silicones and hair conditioning oils on the hair surface. The commonest hair oils contain silicones such as dimethicone, dimethiconol, and amodimethicone.
Why should we avoid silicone-containing hair conditioners?
Scientific studies show that when the hair shaft surface is coated with silicone it becomes instantly smoother and it is covered with a protective layer. However, this is merely a temporary illusion of healthy hair. Silicone continues to build up layer by layer and eventually your hair gets weighed down. Instead of appearing smooth and shiny, hair may appear greasy and dull.
What are the other alternatives available?
In my development of the hair mask bar system for my patients with dry, brittle and unmanageable hair, I have incorporated natural proteins such as hydrolysed wheat, silk and milk proteins that directly penetrate and repair the hair shaft. These natural proteins are effective cuticle moisturizers that ensure detangled, well-nourished locks.
The Hair Mask Vials Bundle includes the Keratin Hair Mask for hair strengthening, the Silk Hair Mask for hair smoothness and frizz, and the Milk Hair Mask for hair softness.
Another important way to smoothen and condition your hair is through the use of plant oils. The bioactive substances present in plant oils contribute to their moisturizing, conditioning, anti-inflammatory and antioxidant properties.
The LipiGro Serum is enriched with 5a-reductase inhibitor to reverse hormonal hair loss, and the purified seed oil of ethanolic extract of Carthamus tinctorius.
The LipiShine Serum should be used with the CutisCool™ Biological Gel Hair Cap in the Hot Oil Treatment. Enriched with Oleic acid that acts as a cuticle softener, Linoleic acid that smooths hair, and the Purified seed oil of ethanolic extract of Carthamus tinctorius.
The LipiSilk Serum is used to treat damaged hair, chemically treated hair, and split ends. It contains actives such as Linoleic acid for deep repair of the hair shaft, Vitamin E, a bioactive antioxidant, and purified seed oil of Hippophae rhanoides (Sea Buckthorn Oil).
Do I have a sensitive scalp or is it a symptom of another condition?
Do you have an itch, redness or pain on your scalp? You may have an undiagnosed inflammatory scalp disease. Scalp “sensitivity” without any underlying scalp condition is a very rare condition attributed to abnormal nerve sensations known as scalp dysaesthesia.
It is far more common to have an underlying cause such as seborrheic dermatitis, which is due to proliferation of a yeast known as malassezia furfur in an individual with excess production of oil. It is also more common in tropical and humid climates such as Singapore, as such climates encourage this yeast to grow. Otherwise, malassezia is an ordinary inhabitant of one’s skin and scalp.
Under normal conditions, it does not cause any issues. However, under humid and sweaty environments, this yeast can proliferate to cause scalp inflammation and flaking. If you have scalp flaking which does not respond to over the counter anti-dandruff shampoos, usually contain zinc pyrithione as an antifungal agent, promptly seek the care of an accredited dermatologist rather than self medicate or DIY.
Other causes of scalp inflammation would be scalp eczema due to excessively dry scalp/skin conditions, scalp psoriasis which may be the case especially if one has a family history of psoriasis or rashes on one’s body. If you have been in contact with a ringworm infected cat or dog, do have your scalp and skin checked by a dermatologist as these infections are contagious. They could also cause a form of scalp inflammation presenting as a red, scaly and itchy patches with hair loss.
The CUTISCOOL Hair Cap has specifically engineered thermal and cold therapy capacities that allows comfortable home use of effective heat treatment for sensitive scalps. When heated, it can increase absorption of cosmeceuticals. When chilled, the Hair Cap has an anti-inflammatory effect on the scalp.
Is my sensitive scalp causing hair loss?
Most cases of scalp inflammation due to eczema, seborrheic dermatitis, scalp folliculitis or psoriasis should not cause hair loss. However, severe inflammation can push the hair growth cycle into a stage of telogen effluvium which is when hair reaches the end of its cycle and falls out, similar to hair loss that occurs after a major illness or post-pregnancy. In addition, if one picks and peels off crusted areas over the scalp, this can also cause damage to the hair root and lead to hair loss.
The ORZAT4 InfusionTreatment Comb is impregnated with Sandalore® which has been scientifically proven to stimulate hair regrowth. This comb is designed to stimulate and support vigorous, healthy hair growth when used regularly.
There are other causes of hair loss such as alopecia areata, which is an autoimmune disorder causing one’s immune system to attack hair follicles, leading to hair loss. This usually has no symptoms other than the appearance of round patches of hair loss over one’s scalp. Scarring causes of hair loss include folliculitis decalvans, which is the end-stage of a type of scalp folliculitis, whereby the hair follicles themselves are constantly inflamed and infected. Children may be more susceptible to tinea capitis, which is a fungal scalp infection that can lead to scarring hair loss if untreated.
The Copper Peptide Hair Regrowth Serum contains copper tripeptide for hair regrowth, root strengthening, and hair shaft thickening.
Suspect suffering from a hair inflammatory disorder; scalp folliculitis? Scalp folliculitis is an inflammatory disorder of the hair follicles in the scalp, also known as “acne necrotica miliaris” or “Proprionibacterium folliculitis”.
It is characterised by small, very itchy pustules on the scalp, often most troublesome on the frontal hairline. Depending on the severity, there may be only a small number or may appear as very numerous lesions. Due to the itch, they are hard to leave alone and overtime often become sore and crusted.
Causes of Scalp Folliculitis
Although the cause of scalp folliculitis is not well understood, it is generally considered to be an inflammatory reaction to components of the hair follicle, particularly the micro-organisms. These include:
● Bacteria (especially Cutibacterium acnes, but in severe cases, also Staphylococcus aureus)
● Mites (Demodex folliculorum)
● Yeasts (Malassezia species)
Treatment for Scalp Folliculitis
Treatment plan includes washing the folliculitis affected scalp with a mild normal shampoo as often as desired. In some cases, antidandruff shampoos containing anti-fungal agents such as ketoconazole or ciclopirox are helpful in mitigating scalp folliculitis. If patients desire, hair conditioner can be used.
● Oral antibiotics, such as the consumption of tetracycline in the long-term
● Oral isotretinoin, as a long-term, low dose treatment option
Severe Forms of Scalp Folliculitis
One such severe form of scalp folliculitis is acne necrotica. It is also known as “acne varioliformis” or “acne frontalis”. In this condition, first, the larger follicular spots (papules) become inflamed then secondly they tend to develop blackened crusts, finally leaving permanent pox-like scars. It is to be noted that acne necrotica may affect the face, scalp or other areas.
Another rare and severe form of scalp folliculitis, sometimes associated with hidradenitis suppurativa, acne conglobata and spinal arthritis (spondyloarthropathy), is perifolliculitis capitis abscedens et suffodiens. It is also known as “dissecting cellulitis” or folliculitis, or “perifolliculitis capitis”. It rarely occurs in white-skinned individuals, females and children and most often affects black adult men. In this case, large nodules and cysts accompany smaller follicular papules and pustules, from which purulent material can be expressed. Temporary hair loss over the lesions eventually results in permanent scarring and bald patches.
Because dissecting cellulitis is very resistant to treatment, the severity of the condition can be reduced with oral treatment such as isotretinoin, antibiotics, dapsone and injectables such as systemic steroids. If you have been diagnosed with dissecting cellulitis, you will need to be on long term treatment and followup with an accredited dermatologist to prevent scarring.
The Raser™ Hair Regrowth Comb is a multi-functional 5 in 1 comb that incorporates Diode Laser + Radiofrequency+ Red Photon + EMS + Massage with Ozone Sterilization. It is beneficial for hair follicle stimulation, hair regrowth, scalp serum absorption, and increases hair elasticity/anti-frizz/shine.
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.
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 [email protected]. Alternatively, you may fill up our contact form here.