Hair Fall

Did you know that according to The Hair Society approximately 35 million men and 21 million women suffer from hair loss? Although hair fall is more prevalent in older adults, excessive hair loss can also occur in children.

According to the American Hair Loss Association, around two-thirds of men will begin to lose their hair by the age of 35. 85% of the global population will eventually suffer from hair fall by the age of 50, out of which women make up about half.

Hair loss, also known as alopecia or baldness, refers to excessive loss of hair from the scalp that can be temporary or permanent. Hair fall/hair loss can be a result of heredity, hormonal changes, medical conditions or aging. People typically lose 50 to 100 strands of hair a day as a part of the hair growth cycle. The hair goes through 3 phases that are known as the Anagen phase, Catagen phase and Telogen phase.

The phases of hair growth cycle are mentioned below in detail:

Anagen phase: Also known as the growth stage, it allows the hair to actively grow from the roots. During this stage, hair growth happens anywhere between 18-30 inches. The length of this phase varies based on genetics, age, health and other factors.

Catagen phase: This is also known as the transition phase and is the second stage of the hair growth cycle. This period is usually short and lasts only 2-3 weeks on an average. During this phase, hair growth stops as the strand detaches itself from the blood supply.

Telogen phase: This is the final stage of the hair growth cycle also known as the resting phase. The detached hair from the previous phase rests in the root while new hair begins to grow beneath it. This phase usually lasts for approximately 3 months.

This hair growth cycle is a natural process that begins with the growth phase (Anagen) transitioning towards Catagen phase finally entering the shedding phase (Telogen). Each follicle is independent and goes through this cycle of hair growth. During the shedding phase, the hair strands will fall out allowing new hair growth through the hair follicle. The hair growth cycle ensures we don’t lose patches of hair all at once. Hair loss occurs when new hair doesn’t replace the hair strand that has fallen out during the Telogen phase. Excessive hair fall can become a cause for concern as it may even leave a bald spot.

When faced with the problem of hair fall, many people aren’t sure where to turn for help and often go for:

• Cosmetic or chemical solutions to hide the hair fall problem
• Invest in costly but inefficient hair fall products that come with claims that they can treat hair loss
• Vitamins and other supplements for hair growth

Hair fall is the first sign of distress within the body and it needs to be taken seriously. Hair loss/hair fall is not just an external problem; it may indicate underlying health concerns. Did you know that the scalp can provide insightful cues into a host of latent disorders – such as thyroid problems, diabetes and heart diseases – much before a clinical diagnosis for hair fall is established?

Hair loss/hair fall can appear in many different ways, depending on what caused the loss of hair. Signs of loss of hair may include thinning hair, loose hair or patchy bald spots.

With numerous hair fall treatments and remedies that promise hair growth, it’s important to choose the one that works the best for you. An effective treatment for loss of hair requires a personalized approach. The hair fall treatment is chosen based on the hair loss causes, extent of hair loss, grade of baldness and condition of the scalp.

Types of Hair Loss

There are more than 40 different known types of hair fall. The type of hair fall helps to determine the different types of baldness you may be suffering from. Some of these types of hair fall are common, others are quite rare. Determining the type of hair loss can help in understanding which hair fall treatment will be most suitable for your hair loss and the type of baldness. Some of the most common types of hair fall are mentioned below.

Androgenetic alopecia – This type of hair fall can affect both men and women. The hormone dihydrotestosterone (DHT) is primarily responsible for this condition. According to a study published in the journal of The National Center for Biotechnology Information, it is estimated that of all the patients experiencing hair loss, androgenetic alopecia is recognized in 95% of them.

Genetic and environmental factors play an important role in causing androgenetic alopecia. The condition can be classified into the following two types of baldness:

• Male-pattern baldness — This type of baldness is typically characterised by a receding hairline at the temples and balding at the top of the head.
• Female-pattern baldness— This type of baldness is characterised by hair loss and widening of the hair parting, along with reduction in the density as well as the volume of the hair.

Involution alopecia — With advancing age, a larger number of hair follicles go into the resting phase of the hair growth cycle. This leads to the gradual thinning of hair, which is termed as involution alopecia.

Telogen effluvium — Telogen effluvium is a condition that causes hair thinning and hair loss all over the scalp. In this type of hair fall, hair loss is usually caused by a certain stressor or triggering factor. This causes the hair to prematurely enter the resting phase and, thereafter, shed. Hair loss may occur even three to six months after the initial stressor. The stressor could be anything that causes major physical or emotional impact, like childbirth, death of a loved one, sudden weight loss, starting or stopping of oral contraceptive pills, malaria and typhoid to name a few.

The patient often experiences severe hair loss, with hair falling out in bunches while washing or combing.

Anagen effluvium — It is characterised by the sudden loss of hair in very large numbers. The condition is known as anagen effluvium because the hair falls out in the growth stage of the hair growth cycle. Loss of hair in the growing phase can be quite severe. At any given time, 85-90% of hair follicles are in the anagen phase. Therefore, anagen effluvium can cause most or all the hair on the scalp to fall, which can lead to different types of baldness. It is most commonly seen as a side effect of radiation or chemotherapy given for cancer treatment.

Drug-induced hair loss— This type of hair fall can be caused as a side effect of certain medications. Some of these medications are commonly used, such as cholesterol-lowering drugs, blood thinners, oral contraceptives, medicines for the treatment of gout and so on. It is important to let your doctor know if you are experiencing hair fall due to any medication so that it can be treated accordingly.

Some of the drugs that can cause hair loss are: Allopurinol (used for the treatment of gout); Heparin and Coumarin (blood thinners); Clofibrate, Gemfibrozil (cholesterol-lowering drugs) and most of the chemotherapy medications.

Alopecia areata — Alopecia areata is an autoimmune condition characterised by the loss of hair in patches. The onset of alopecia areata can be quite sudden, with rapid hair loss.

The triggering factors for alopecia areata may be linked to the imbalance of the thyroid hormone or sudden and extreme stress. In severe cases, hair can be lost from the entire scalp (alopecia totalis) or from the entire body (alopecia universalis). The condition is known to vary from person to person. Often, the old patches can fill up while new patches still appear.

An important aspect of this condition is that there is no damage to the hair follicle. Therefore, with the right treatment, all the lost hair can potentially grow back.

Traction alopecia — Traction alopecia is caused because of traction or pull at the root of the hair. It can lead to a type of baldness caused by certain hair styles that pull at the roots, like tight braids, ponytails or buns. It can also occur when the hair gets pulled because of the incorrect use of clips, tight rubber bands, etc.

Trichotillomania — Also known as hair-pulling disorder, it is a psychological disorder in which people develop a tendency to pull out their own hair from the scalp, eyebrows and other areas of the body. This can cause hair loss in the form of bald patches. This type of baldness occurs more frequently in children. For many people with this condition, hair pulling is a way of dealing with negative or uncomfortable feelings, such as anxiety, stress, boredom, tension, loneliness, fatigue or frustration.

These are some of the major types of hair fall, causing different types of baldness. However, there can also be some other reasons for hair loss which can lead to a hair fall problem.

• Hair fall due to the presence of infections— Syphilitic alopecia (caused by systemic syphilis) and tinea capitis (a localised fungal infection of the scalp) are some of the infections that can cause different types of hair fall
• Hair fall due to generalised atrichia— The types of hair fall caused due to the presence of a recessive hairless gene fall under this category. This is one of the very rare types of hair fall

Heredity is known to be the most common reason for hair fall that occurs with aging. This condition is also called androgenic alopecia (AA). There are 2 types of AA i.e., male-pattern baldness (hair loss in men) and female-pattern baldness (hair loss in women). Dihydrotestosterone (male sex hormone) is a primary cause of hair fall in case of male and female pattern baldness.

However, there are some other common reasons for hair fall too. Some of which are mentioned below:

• Poor nutrition:This is one of the most common reasons for hair loss, especially in India. Iron deficiency (anaemia) tops the list followed by protein deficiency as the leading cause of hair fall. Improper absorption of nutrients can also lead to poor nutrition.
• Crash dieting:Excessive dieting (especially mono dieting) disturbs the balance of protein, carbohydrates and fat; becoming a major hair fall reason. Even after the patient gets back on a normal diet, hair loss may not be reversed.
• Oral contraceptives:Certain oral contraceptives with synthetic progesterone can be a reason for hair fall (female pattern baldness). Prolonged use of oral contraceptives can be a major hair fall reason even after discontinuation.
• Poor circulation:A study by The National Centre for Biotechnology Information shows that male pattern baldness in young men was associated with several other reasons for hair fall. These included increased serum cholesterol levels and higher blood pressure compared to men of similar age with no hair loss. Follicles that are constantly deprived of blood (and therefore nutrients) cannot produce hair properly making it a cause of hair fall.
• Smoking:Nicotine (tobacco) causes shrinkage in your blood vessels and blocks the blood circulation to your hair follicles. With decreased blood supply to your hair follicles, your hair growth cycle is disturbed. Therefore, smoking makes it a leading reason for hair fall.
• Mental stress:When an individual is highly stressed, it can be a major hair loss cause. The exact mechanism of this reason for hair fall is not known. Many people experience thinning hair several months after a physical or emotional trauma. This hair fall reason generally leads to a temporary loss of hair.
• Dandruff:Dandruff is inflamed, flaky skin on the scalp, which hinders proper circulation and nutrition to the hair. This becomes one of the many leading causes of hair loss.
• Medications:Drugs used in the treatment of gout, depression, arthritis, high blood pressure and heart problems contain ingredients that can trigger or be a cause of hair fall. Chemotherapy drugs and radiation treatment are other common hair fall reasons. Here are some examples of medications that have side effects and can be a cause of hair fall.
  • blood thinners
  • antidepressants
  • cholesterol-lowering drugs

It’s essential that you consult your doctor before stopping any medication, as it can cause serious health problems.

• Presence of systemic illnesses:Diabetes, lupus, scleroderma, etc. can be a reason for hair fall.
• Hormonal changes:Pregnancy, childbirth, menopause, hypothyroidism, hyperthyroidism, etc. can all be major hair fall reasons, especially in women. A common reason for excessive hair fall is hormonal imbalance (polycystic ovary syndrome or PCOS). Certain birth control pills can cause a temporary hormonal imbalance which also contributes to be a major reason for hair fall.
• Hair treatments:This is among the most common causes of hair loss. Chemical treatment of hair, especially with ammonia-based products, perming, straightening, ironing, etc., can be harmful. This can lead to hair damage and can become a major reason for hair fall.
• Infection of the scalp:Scalp infections such as ringworm can also be a cause of hair loss.
• Local diseases:Scalp diseases such as psoriasis, lichen planus, etc., can also be a reason for hair fall.
• Recuperating from serious illness:Illnesses such as high fever, sudden or excessive weight loss can be a hair fall reason. Even post-surgery conditions and metabolic disturbances can be a significant reason for excessive hair fall.

Hair Loss – Diagnosis

Hair loss is usually diagnosed based on the appearance and pattern of hair loss, along with a detailed medical history, including questions about the prevalence of hair loss in your family.

Hair fall treatment

The causes as well as the symptoms of hair loss are different for each individual. Therefore, the treatment for hair fall should also be unique for each individual with hair fall problems. A personalized approach is most effective when it comes to hair fall treatment.