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.
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?
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.
By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
In the third instalment of my series on dealing with hair loss in Singapore as a dermatologist, I’m going to discuss dandruff and scalp sensitivity. This is one of the commonest scalp complaints that my patients have in conjunction with hair loss symptoms and leaves many of them wondering if it is the cause of their hair loss problem.
1. What is dandruff and what causes it?
Flaking on the scalp and white scales found on one’s clothes are one of the first symptoms of dandruff. This is lay speak for any form of scalp inflammation that causes the cell turnover rate on the scalp to increase abnormally. Dead skin cells, which are rapidly shed from the cell turnover, in turn constitute the white scales observed as the primary symptom of dandruff. There are several medical conditions that can result in this, the commonest being the following: scalp psoriasis, seborrheic dermatitis and scalp eczema.
2. Do I have a sensitive scalp or is it a symptom of another condition?
Do you have 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 malessezia furfur in an individual with excess production of oil. It is also commoner in tropical and humid climates such as Singapore, as it encourages this yeast to grow.
Otherwise, malessezia is an 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. Dandruff is observed as a result. If you have scalp flaking which does not respond to over the counter anti-dandruff shampoos, such as those containing zinc pyrithone which is anti-fungal, promptly seek the care of an accredited dermatologist rather than self medicate or DIY.
Other causes of scalp inflammation would be scalp eczema, which is due to an excessively dry scalp/skin condition. For example, scalp psoriasis, which may be the case especially if one has a family history of psoriasis or rashes on the body. If you have been in contact with a ringworm infected cat or dog, also do have your scalp and skin checked by a dermatologist as these infections are contagious and could also cause a form of scalp inflammation presenting as a red, scaly and itchy patch with hair loss.
3. Is my sensitive scalp and dandruff 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.
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 inflammed 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.
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). These work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals, Dr.TWL Dermaceuticals, which include sensitive scalp and hair loss treatments.
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.
By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
One of my patients who came to my clinic for hair loss treatments once remarked that “Why is it that everyone thinks of seeing hair loss treatment centres, hair spas and their hair salons offering anti hair loss treatments before consulting a dermatologist for their hair and scalp problems?” Hence in part 2 of my article, I will be using this as a case-study in point in my discussion on hair loss.
However, before that, I would like to qualify what exactly counts as hair loss. It’s normal to lose about 60–100 strands of hair a day, however, anything more than what you are used to losing should be monitored carefully. Here are some symptoms: more hair in your shower drain, on the floor, your combs and pillow, having a wider parting and thinner ponytail for girls. If you have a family member with hair loss, also be alert to early symptoms of hair loss.
1. Who do you see for hair loss treatments?
My patient spoke from experience, having gone a merry-go-round with numerous hair and scalp treatments promising to treat hair loss for over two decades, emerged none-the-better nor wiser until a good friend of hers recommended her to see a dermatologist instead. She had, at that time already resigned to her fate of having a troubled scalp and also lost 40 to 50% of her natural hair at the age of 35, blaming it on bad genetics and oily scalp.
She wasn’t even aware that dermatologists are the specialists in treating scalp and hair problems, including hair loss. Do a google search of “hair loss treatments Singapore” and one is instantly inundated with a multitude of trichologist, herbal remedies, centres specialising in anti hair loss treatments, salon listings, aesthetic centres run by general practitioners and with that a few listings of dermatologists which seems buried under all the other ads. So, if you have a true hair loss problem, stop self-medicating or visiting spas or salons and instead find an accredited dermatologist here.
2.What causes hair loss?
In my dermatological 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 need to conduct a thorough history taking, medical evaluation/examination and may recommend some blood tests and microscopic 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. Do hair loss treatments actually work?
The good news is, my patient’s hair loss did get better, she turned out to be suffering from a combination of telogen effluvium, scalp inflammation from seborrheic dermatitis as well as underlying genetic hair loss, known as female pattern hair loss. The bad news? Her treatment took a while, while her hair loss was controlled, a lot of her hair follicles had become miniaturised (think the shiny glossy scalp that you’ve seen in older men with androgenetic alopecia, which is hair loss influenced by genetics and the male hormone testosterone).
What this means is that it is a more advanced stage of hair loss which could mean a slower or less optimised outcome with treatment. The take home point is, while there are multiple evidence-based methods of encouraging hair growth (for cosmetic reasons in age or genetics influenced hair loss i.e. androgenetic alopecia) such as light treatments, in combination with active ingredients such as minoxidil and more recently, copper peptides which I prescribe in my practice.
The real issue is that more severe underlying medical conditions like lupus (an autoimmune disease), chronic undiagnosed illnesses, thyroid disease, anemia — these have serious underlying health implications which need to be treated on top of the hair loss problem. In addition, a trained dermatologist can pick up causes of both non-scarring and scarring alopecia. The latter is irreversible hair loss that can be promptly diagnosed and requires medical hair loss treatments.
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@example.com. Alternatively, you may fill up our contact form here.