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Hair lossAlso known as hair fall, baldness, alopecia.
Generally, people shed around 50 to 100 single hair per day. Hair shedding is a natural process in which some hair sheds while new hair start to grow in. Hair loss or alopecia occurs when this balance is disrupted and more hair begin to fall than the new hair growing.
Hair loss affects men, women, and sometimes even children. One may notice hair loss in the form of hair thinning, receding hairline, part widening, and bald patches. Age, genetics, nutritional deficiencies, hormonal imbalances, certain diseases and medications could be some of the causes of hair fall. However stress, tight hairstyles, chemical hair treatments and overuse of styling products, are also known to trigger hair fall.
Hair loss does not have any harmful physical effects as such, but its psychological impact cannot be denied. For most people, their hair is inherently connected to their confidence. If their hair looks good, they feel good about themselves. But if they start losing hair, their self esteem begins to dwindle. In such a case, one can try one or many treatment options available for dealing with hair loss.
Home remedies and oral hair supplements are usually the first line of action for hair loss. However, it is always advisable to visit a dermatologist or trichologist to get a proper diagnosis and treatment. Various treatment options include topical agents like Minoxidil, injections, oral treatments, Platelet rich plasma (PRP) therapy and hair transplantation.
- Adults above 30 years of age.
- Children below 18 years of age
- Both men and women but more common in women
- Blood tests: thyroid profile & vitamin profile
- Pull test
- Light microscopic examination
- Scalp biopsy
- Oral supplements for nutritional deficiencies: Vitamin B12 (Cobalamin), Vitamin B7 (Biotin), Zinc & Iron
- Topical corticosteroids or steroid injections
- Platelet rich plasma (PRP) therapy
- Hair transplantation: Follicular Unit Transplantation or FUT, Follicular Unit Extraction or FUE
- Laser treatment
- General physician
Causes Of Hair Loss
Before knowing about the causes of hair loss, let’s know about the hair growth and hair loss cycle.
Ideally, each hair follicle goes through three phases:
1. Anagen phase is the active phase of hair growth that usually lasts for about two to six years. Around 85-90% of the hair on the scalp is in this stage at a given point in time.
2. Catagen phase is the transitional phase that lasts a few weeks (2-3 weeks). Only 1% of hair is in this stage.
3. Telogen phase is the end phase of hair growth, which is the resting phase. Around 13% of our hair is in this stage.
At the end of the telogen phase, hair follicles are shed, which is replaced by new hair and the cycle continues. However, the hair growth cycle can be influenced by an individual’s age, diseases, hair care routine, and diet.
Common causes of hair loss include:
Age: With age, it is common to notice some amount of hair fall. Men and women both notice receding hairline as well as thinning of hair.
Genetics: Hereditary causes are the most common cause of hair loss all over the world and both men and women are affected. It is also known as androgenic alopecia, male-pattern baldness and female-pattern baldness. It appears as a receding hairline and bald spots in men and thinning hair along the crown and a widening part in women.
Childbirth and other stressors: If you have recently given birth, or have had a chronic illness it can lead to hair fall. Stress or any kind of traumatic event may also trigger hair loss.
Ongoing treatment/medications: Certain undergoing treatment such as treatment for cancer, arthritis, depression, heart problems, gout and high blood pressure can trigger hair fall within a few days or weeks of starting the radiation or chemotherapy.
Tight hairstyles: Tight hairstyles such as braids can lead to hair fall over time. This is permanent hair loss and is known as traction alopecia.
Scalp infections: A scalp infection, which appears as scaly and inflamed results in hair loss.
Hormonal imbalance: Certain women experience hair loss due to hormonal imbalances in conditions such as PCOS (polycystic ovarian syndrome). Birth control pills, which are hormonal preparations, can also trigger hair fall.
Nutritional deficiencies: If your diet lacks protein, zinc, biotin, iron or any other essential nutrient then you may notice hair fall and thinning of hair.
Disease: Diseases such as hyperthyroidism, hypothyroidism, diabetes, lupus and STI’s (sexually transmitted infections) can lead to hair fall as well as bald patches on the eyebrows, lashes, and other parts of the body.
Pulling your own hair: Also known as Trichotillomania, it is the habit of pulling one’s own hair that may lead to permanent hair loss over time.
Symptoms Of Hair Loss
Signs and symptoms of hair loss can present in many ways as the following:
Gradual loss or thinning of hair on top of head.
Receding hairline(frontal fibrosing alopecia). If the hairline starts looking higher than the usual position.
Widening partition. If someone parts their hair, they might notice the part getting wider over time.
Circular or bald patches. Some people develop circular or bald patches on their scalp, beard or eyebrows.
Loosening of hair. Clumps of hair might come out while combing or washing hair.
Scalp starts getting visible through the hair.
Full-body hair loss. Some health conditions and treatments such as chemotherapy for cancer, can cause loss of hair from all over the body.
Hair loss can be gradual or rapid. The symptoms for gradual hair loss include hair thinning, widening of part, receding hairline. The symptoms for rapid hair loss include clumps of hair in comb or drain, a bald patch that appeared recently and severe hair fall.
Note: Gradual hair loss is more common and tends to affect everybody at least once in their lifetime. The signs of gradual hair loss are subtle and may take a long time before you even notice your hair fall!
Apart from the obvious signs of hair fall, some other symptoms may also be present with your hair fall.
Intense itching and redness in the scalp: This could occur due to an underlying infection in the scalp.
Scaly bald patches, often with sores: It can be a sign of fungal infection like ringworm or due to a chronic disease like psoriasis.
Burning and tingling on the scalp: Some people who have alopecia areata experience might experience burning and stinging prior to sudden hair loss.
Pus-filled sores on the scalp: Some conditions such as folliculitis can cause pus-filled blisters on the scalp resulting in temporary hair loss.
Types Of Hair Loss
Hair loss, also known as alopecia, is broadly classified into cicatricial alopecia and non-cicatricial alopecia. In non-cicatricial alopecia, hair loss is not permanent whereas in cicatricial alopecia, scars occur along with hair fall and destroy the hair follicle resulting in permanent hair loss. A few types of hair loss are discussed below:
1. Non-cicatricial or Non-scarring alopecia
Androgenic alopecia: Androgenic alopecia is also called hereditary hair loss. In men, it is known as male pattern baldness which is characterised by gradual loss of hair above the temples and thinning at the top of the head, usually creating a shape of ‘M’. In women, it is known as the female pattern baldness and results in thinning all over the scalp or widening of the part.
Alopecia areata: It is an autoimmune disorder in which the body starts to attack its own hair follicles. This is hair loss that can affect every part of the body, including the scalp, face, trunk, and extremities. When it affects only a portion of the body, it is called alopecia areata. When it affects an entire site it is called alopecia totalis. When it involves the whole body, it is called alopecia universalis which is mostly associated with conditions like vitiligo and thyroid disorders.
Anagen effluvium: In this, diffuse and rapid hair loss occurs, which is mainly caused by the effect of radiation and chemotherapy. Hair usually grow back after completion of the treatment.
Telogen effluvium: It is a type of sudden diffuse hair fall that is mostly seen after some stressful event, period of emotional shock , illnesses or taking certain medications. It can also occur due to hormonal fluctuations that happen in pregnancy, childbirth, starting or stopping hormonal birth control pills or menopause.
Traction alopecia: This type of alopecia results from too much pressure on the hair, mostly because of tight braids, ponytails, or buns.
Trichotillomania: In this type of impulse control disorder, a person pulls his/her own hair subconsciously. This leads to irregular bald patches and uneven hair length. It mostly occurs in children or adolescents. In children, it is more like a habit that will eventually resolve on its own, but in adolescents, psychiatric help might be required.
2. Cicatricial alopecia or scarring alopecia
Cicatricial alopecia is a broad umbrella encompassing uncommon inflammatory hair loss disorders that result in scarring patches of hair loss with absence of hair follicles. Causes of hair follicle destruction include fungal infections, chemicals such as hair relaxers, and inflammatory disorders which include discoid lupus erythematosus, lichen planopilaris, dissecting cellulitis, tufted folliculitis, folliculitis decalvans, alopecia mucinosa, alopecia neoplastica, central centrifugal cicatricial alopecia, and acne keloidalis.
Risk Factors For Hair Loss
There are many risk factors for developing hair loss. Some of these risk factors can be avoided, while others cannot. The following are some of the risk factors:
Hereditary: If you have a family history of hair loss, then there is a good chance that you will experience it also. Hereditary hair loss can affect both men and women.
Stress: A person who is frequently experiencing stress can be a risk factor for hair loss. Stress of all kinds can cause a negative effect on the body. It can cause the hair to stop growing.
Hormonal changes: Hormonal changes that happen in pregnancy, childbirth, starting or stopping hormonal birth control pills or menopause can also increase the risk of hair loss.
Medications: Certain medications may lead to hair loss. If you begin to experience hair loss after the beginning of a medication, talk to your doctor to check if this is a side effect of your medication.
Chemotherapy: During the treatment for cancer, there is a good chance of losing hair. The hair will begin to grow back after the series of chemotherapy treatments is done.
Significant weight loss
Medical conditions such as hypothyroidism, hyperthyroidism, diabetes, lupus and STDs
Diagnosis Of Hair Loss
Diagnosis for hair loss includes a detailed history, physical examination with a focused evaluation of the hair and scalp. Other diagnostic measures include a fungal screening of the scalp, hair pull, and tug test, and light microscopy, and/or trichoscopy.
1. Pull test: In this test, also known as traction test, 20-60 hair strands are grasped between your thumb and index and middle finger, held from the hair shaft firmly, and tugged away from the scalp. If the hair shedding is more than 10% of the total hair grasped then it is called a ‘positive pull test’ & indicates active hair shedding.
2. Light microscopic examination: The hair that is collected by the pull tests is then examined under the microscope for fractures, irregularities, coiling, and other hair shaft disorders.
3. Scalp biopsy: Scalp biopsies are done in cases of cicatricial hair loss and undiagnosed cases of non-cicatricial alopecia.
4. Blood tests: Your doctor might ask you to get a thyroid profile done as low levels of thyroid hormone tend to cause hair loss. Also, sometimes doctors may recommend blood tests to check the level of various nutrients as deficiencies of these can lead to hair loss. The following are usually tested:
- Iron: Iron deficiency in pre-menopausal women is one the major causes of hair loss. Iron contributes to hemoglobin production, which helps in delivering nutrients and oxygen to hair follicles. When iron is not present in adequate amounts the hair won’t grow, causing progressively thinner hair.
- Zinc: Zinc deficiency can also impact hair growth and cause hair thinning.
- Biotin: Also known as Vitamin B7, it stimulates keratin production in hair and can increase follicle growth. Biotin deficiency can hence lead to hair loss.
Prevention Of Hail Loss
If you are already experiencing hair loss, then making a few changes in your hair care routine and following these simple tips can help alleviate the problem. These are:
Limit the use of hair styling products and tools such as hot rollers, curling irons, hot oil treatments, etc as it can cause hair breakage and lead to hair fall.
Say no to tight hairstyles and avoid unnecessary twisting, rubbing, or pulling your hair. Don’t rub wet hair with a dry towel but wrap a towel to soak water and allow it to dry naturally.
Avoid combing aggressively as it can cause split ends and hair breakage. Instead, use a wide-toothed comb.
Apply oil regularly as it can prevent dirt and toxins from entering the follicle. Also gently massage the scalp as it can promote blood circulation in the scalp area.
Eat a diet rich in essential nutrients such as vitamins, minerals, and antioxidants especially iron, biotin, zinc along with proteins, fats, and carbohydrates to prevent hair damage.
Do not follow crash diets as rigorous dieting can impair the supply of nutrients to the hair follicles.
Quit smoking as smoking can cause premature aging of the hair cells which can make the follicles brittle and thin, causing the hair follicles to break easily.
Manage your stress as it can lead to hormonal imbalance in the body with hair loss.
Do consult a trichologist or a dermatologist to know the exact cause of the hair fall and get proper treatment. Do not self-medicate like the use of supplements or hair care products for hair growth.
Specialist To Visit
Hair loss could be due to an underlying health problem such as Nutritional deficiencies, PCOS, Thyroid disorders and Anemia, etc. So it is always advisable to discuss your issue of hair loss with your General Physician. The following specialists can also help you in diagnosing and treating hair loss:
Treatment Of Hair Loss
There are many treatment options for hair loss right from the use of medications to hair transplantation. These are:
1. Oral supplements
Vitamin B12 (Cobalamin): This vitamin is responsible for the production of red blood cells, which deliver oxygen and essential nutrients to all parts of your body, including hair follicles.
Vitamin B7 (Biotin): This vitamin is known to stimulate keratin production in hair and can increase the rate of follicle growth. Supplements of Vitamin B12 are beneficial for regrowing hair in people with its deficiency.
Zinc: Zinc is an essential mineral that’s involved in several biological processes within your body. It plays a key role in making proteins in your hair and other cells.
Iron: The best way to treat hair loss with ferritin is to increase your iron levels. Hair loss as a result of low iron is not permanent and it can be treated with supplements and foods rich in iron.
It is an over-the-counter medication that is FDA approved for use in both men and women. Administered topically, the 5 % concentration is used to treat male pattern baldness whereas 2% is only approved for female pattern baldness treatment. It stops the thinning of hair and is known to stimulate hair growth.
It is also an FDA-approved drug for the medical management of hair loss but only in men. It is a prescription drug that is commonly used to treat an enlarged prostate, but a higher dose is used to treat hair fall. It stops the production of the hormone 5-dihydrotestosterone (DHT), excess of which is known to cause hair loss.
4. Topical corticosteroids or steroid injections
These are steroids that help to stop inflammation and treat hair loss. This usually comes in the form of topical cream or injection that needs to be injected into the scalp to promote hair growth. These injections are usually given every 4 to 8 weeks as needed. Talk to your dermatologist to know about it.
B. Platelet rich plasma (PRP) therapy
PRP is a process in which the patient's own blood is processed and injected into different points in the scalp. PRP, which is rich in growth factors helps in hair growth. The following steps are followed:
Step 1 - The blood is drawn usually from the arm and processed in a centrifuge (a machine that spins and separates fluids of different densities).
Step 2 - After about 10 minutes in the centrifuge, the blood separates into three layers:
red blood cells
Step 3 - The scalp is locally anesthetized. The platelet-rich plasma is drawn up into a syringe and injected into areas of the scalp that require more hair growth.
C. Hair transplantation
During a hair transplant procedure, a dermatologist or cosmetic surgeon removes hair from a part of the head that has hair and transplants it to a bald spot. Possible risks include bleeding, bruising, swelling and infection. Follicular unit extraction (FUE) and follicular unit transplantation (FUT) are the two most common techniques for hair transplants. Talk to your dermatologist to know which procedure best suits your condition.
1. Follicular Unit Transplantation or FUT
FUT is the older of the two methods and uses strips of skin with hair on them from your scalp itself to be transplanted in a bald spot. The scarring left behind on the donor site is covered up with new hair. This technique requires much aftercare and is quite a hassle to go through.
2. Follicular Unit Extraction or FUE
It is a newer technique and is sufficiently advanced in the technology it uses to get the result. In this method, incisions are made around every follicle unit, which is then transplanted to the balding area. This method leads to very little scarring, and the recovery process takes a lot less time compared to FUT.
D. Laser treatment
There is numerous laser equipment available in the market which claims to stimulate hair growth and treat hair fall. These include brushes, combs, and other electronic devices, however, the efficiency and safety of these devices are not known.
Home- care For Hair Loss
1. Onion (pyaaz) juice
Onions contain sulfur, which is needed for the production of amino acids, proteins, and collagen, which in turn are needed for hair growth and prevent hair loss. Applying onion juice on the scalp is known to increase blood supply to hair follicles and thus, prevent hair fall due to hair thinning and promote hair growth.
Eating eggs can be beneficial for hair growth and prevent hair loss because eggs are loaded with nutrients like biotin, Vitamin A, Vitamin E, and folate, which are proved to aid in hair growth and prevent hair loss caused due to nutritional deficiency.
3. Aloe vera
This traditional home remedy is known to soothe the scalp, condition dry hair, and reduce dandruff along with nourishing the hair follicles and improve overall hair health when rubbed over the scalp and length of the hair.
4. Coconut (nariyal) oil
Coconut oil improves hair health and luster. This is because it contains lauric acid, which penetrates easily into the hair shaft and thus, reduces protein loss from both damaged and undamaged hair when used as a pre and post-wash treatment.
5. Fenugreek (methi) seeds
Fenugreek seeds contain phytoestrogens (plant hormones) which were believed to enhance hair growth.
Eclipta alba (bhringraj) is one of the most popular and widely used traditional home remedies for hair fall. Methanolic extract of E.alba in water can promote hair growth by increasing the anagen-phase (the active growth phase of hair follicles).
7. Tea tree oil
Tea tree oil is one of the very few essential oils which are known to prevent hair fall and promote hair growth. It is due to its powerful cleaning, antimicrobial and anti-inflammatory properties. When applied topically it can improve the absorption of nutrients by the follicles and thus, enhance hair growth.
Complications Of Hair Loss
Hair loss or alopecia does not have any harmful physical effects as such but the psychological impact of hair loss cannot be denied. Anxiety and depression are some of the psychological consequences of alopecia that affect both genders. Interestingly, high levels of stress and anxiety further accentuate hair fall. Failure of treatment or its ineffectiveness also contributes to psychological conditions.
Alternative Therapies Of Hair Loss
A compound in sandalwood, rosemary, and thyme oils is used to boost hair growth. Rubbing one or more of these oils into your scalp for at least 2 minutes every night can promote hair growth.
Acupuncture is known to reduce hair loss and promote hair regrowth for patients with hair loss by improving cerebral blood circulation. However more scientific research and backing is required to prove the same.
Microneedling can help in stimulating and inducing stem cells in the hair follicles that lead to hair growth. It might also improve the absorption of products used to treat hair loss, like minoxidil, platelet rich plasma and topical steroids.
Living With Hair Loss
Living with hair loss can be challenging. For most people, their hair is inherently connected to their self-image. If their hair looks good, they feel good about themselves. But if they start losing hair, their confidence begins to suffer. Some people also experience the feeling of looking or getting old. If you start noticing thinning hair, you don’t have to just smile and bear it. Go ahead and try one or many treatment options for dealing with your hair loss. In case the treatment options for the hair loss deem ineffective you can go for other options such as:
Try wearing scarves or bandanas
Wearing a silk or cotton scarf around the head or knotting a bandana can be a stylish option while also masking any hair thinning. Just make sure to choose fabrics that are very soft, so that they don't irritate the scalp.
Explore hair extensions or a wig
If you are losing hair, you can consider adding hair extensions. If you’ve lost all your hair as a result of alopecia or chemotherapy, a wig might be a better way to cover your head occasionally or on a regular basis.
Try wearing hats
Hats can be a good option as well when you’re dealing with hair loss. You can also combine this with other solutions like, you could wear a wig to work and wear a hat on your holidays.
While some people may feel just fine about their appearance after losing hair, some might feel under confident and depressed, and no scarf or hat can fix it. In such a case, don't be apprehensive to consult a counselor or therapist. Sometimes sharing your feelings can help you deal with them better.
Join a support group
It might be good to talk to someone who is going through exactly the same feelings as yours. Join a group or you can also interact online, if you prefer to interact with people from the comfort of your own home.
This approach is not for everyone but some people find the courage to embrace their baldness. Rather than covering it up, they feel free or liberated to flaunt it to the world.
Frequently Asked Questions
- Phillips TG, Słomiany WP, Allison R. Hair Loss: Common Causes and Treatment. Am Fam Physician. 2017 Sep 15;96(6):371-378.
- Hadshiew IM, Foitzik K, Arck PC, Paus R. Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia. J Invest Dermatol. 2004 Sep;123(3):455-7.
- Phillips TG, Słomiany WP, Allison R. Hair Loss: Common Causes and Treatment. Am Fam Physician. 2017 Sep 15;96(6):371-378.
- Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatol Ther (Heidelb). 2019 Mar;9(1):51-70.
- Alopecia.National Health Portal. September 2015.
- Treating Female Pattern Hair Loss. Harvard Health Publishing.August 2020
- Sharquie KE, Al-Obaidi HK. Onion juice (Allium cepa L.), a new topical treatment for alopecia areata. J Dermatol. 2002 Jun;29(6):343-6.
- Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002 Jul;27(5):396-404.