Understanding hair fall

. 5 min read

In our previous blog posts, we have explored skin conditions such as acne and stretch marks. Now let's take an in-depth look at hair fall, shall we?

At some time or another, most of us experience hair fall. While the symptoms for many of us may be similar, it’s important to note that hair fall is not just one condition. It is a term that includes several different medical conditions, all of which require proper diagnosis, understanding, and different forms of treatment. It’s critical to understand the underlying cause of your hair fall, so that the right treatment can be taken.

We often hear many people say that hair fall is purely genetic which happens as you get older, and that there’s not much that you can do to treat it. This is absolutely not true! While age and hereditary factors definitely play a role, there is a wide variety of treatments available that can slow down or stop your hair fall, and in some cases even help with regrowing hair that you might have lost. Consulting a dermatologist as early as possible gives you the best chance of improving the quality and quantity of your hair.

The types of hair fall we see most commonly are androgenetic alopecia (or loss of hair with age) and telogen effluvium (or active hair shedding).

About androgenetic alopecia (AGA)
Commonly known as male or female pattern hair loss, this is a genetically determined condition where your hair changes from regular hair to thinner, shorter hair. This leads to a decrease in the thickness and density of your hair. A family history of AGA (especially on your maternal side) will make it more likely that you will develop it.

As the condition progresses, the “growth phase” of your hair gradually reduces, and the shedding phase increases, leading to your hair becoming shorter, and eventually there will be appearances of bald patches. AGA is a common cosmetic disorder affecting both men and women, but is more commonly seen in men. According to statistics, almost 60% of men aged 30 to 50 years experience this condition.

AGA starts gradually - men usually start thinning in the temple area. It then progresses to the frontal forehead area and then the top of the head. Women start with a diffuse thinning of the crown, and progresses to a widening of the centre parting. Women do not experience loss of the frontal hairline, and usually experience gradual overall thinning rather than extreme baldness.

There is a clear correlation between this type of thinning and the levels of the hormone DHT (dihydrotesterone). Testesterone and weaker androgens (male hormones) are converted to strong androgens like DHT at the skin level.

hair photo

The severity of your AGA is described different if you’re male or female:

  • There are seven grades of AGA for males. This ranges from minimal reduction in the hairline (grade 1), to only a narrow band of hair remaining (grade 7)
  • There are three stages of AGA for women. This ranges from thinning seen in the front part of the crown (stage 1), to an almost bald crown (stage 3)
    Once AGA sets in, maintenance of your hair is a lifelong phenomenon. The main goal is to prevent thinning and reversing the shrinking of hair.

There are several medical treatments that are used to treat AGA:

  • The medication Minoxidil has been the mainstay of treating AGA. At least 6 to 9 months of continuous use is needed before you will be able to assess the results
  • Finasteride is a drug that helps inhibit the conversion of testosterone to DHT. Taken daily for 6 to 12 months, it can help to prevent progression of AGA. As with all medications, this drug should always be taken under medical supervision. It is also not advised for women who are pregnant, or for men or women who are planning a family.
  • Some women with polycystic ovaries or hormonal imbalances can also present with AGA, sometimes with facial hair. In that case, correcting the hormonal imbalance with certain oral contraceptive pills, or with anti-androgens can help. If you suspect that you might have PCOD or a hormonal imbalance, you should get yourself tested.

3-6 months of continuous treatment to reduce hair fall, and 6-12 months to improve hair coverage are needed. If treatment is stopped, the hair fall can revert to its original level within 6-12 months.

Hair fall treatments

Medical management alone is a slow process. Moderate to severe AGA may require other procedures like mesotherapy and platelet rich plasma (PRP) therapies, in addition to oral and application medications. Mesotherapy can be done with rollers or devices, where hair restoration cocktail solutions are applied to the scalp. PRP consists of using the patient’s blood to stimulate growth factors.

Hair transplant surgery can be done if the donor has sufficient hair. Several surgeries can be planned over time to achieve maximum response. Combining transplant with minoxidil and finasteride gives the best results.

About telogen effluvium (TE)
TE is a cause of hair shedding, where the hair is abnormally disrupted in its growing phase, and as a result goes through a phase of shedding. TE which lasts less than 6 months is termed “acute”, and anything longer than this is “chronic”. This type of hair loss does not result in balding.

In acute TE, hair loss begins within 2 to 3 months of a triggering event. The most common triggering events are:

  • Stress
  • States that cause fever such as tuberculosis, malaria, typhoid, surgery, crash diets, post-pregnancy, drugs with arsenic, and selenium
  • A deficiency of vitamins, zinc and especially iron
  • Thyroid problems. These can even become chronic if not corrected early enough
  • Inflammatory states of the scalp like psoriasis, eczema or dandruff. These irritate the hair follicles and can lead to shedding
  • Excessive hair treatments such as frequent use of heat, iron, hair colour. These produce stress on the scalp and hair follicles

The causes for chronic TE (longer than 6 months) may be the same as the acute, but there is often also a recession of your hairline. Liver and metabolic illnesses, thyroid disorders, cancers, nutritional deficiencies, severe weight loss and various drugs can cause chronic TE.

In terms of treatment, it’s important to do a thorough history with your dermatologist to identify the cause. Removing the underlying cause of shedding is an important first step. In addition, there are various hair vitamins containing biotin that can be taken as supplements for the hair. Many lotions and serums containing hair peptides, stem cells, caffeine can also help stop shedding and help stimulate hair follicles for growth and improvement in the density of your hair.

How can I treat my hair fall?
Since the loss of hair could be due to a number of possible conditions and many more underlying causes, it’s important that you get a diagnosis done by a trained dermatologist, who will also be able to prescribe the right treatments for you. But always remember – hair fall is not inevitable, and the sooner you take action, the better your results will be in improving your hair

It’s important to note that you should never self-medicate – only take medical treatment for your hair fall that has been prescribed by a dermatologist. With Remedico, you can consult with a certified dermatologist wherever you are, from your smartphone. We will send you a personalised treatment plan within 24 hours.