Hair loss is one of the commonest complaints that can baffle a person because of multiple causes that are difficult to investigate, poor response to various modes of treatments and anxious state of patients mind.
Hair loss can be of various types.
Cosmetic alopecia – Brush roller , hot comb, massage alopecia and hair loss secondary to hair weaving.
Disturbances of hair Cycle (-Telogen effluvicum)—It is loss of hair that occurs 2-4mths after a stressful episode like :
- Prolonged fever- Typhoid, Malaria, Tuberculosis , HIV
- Stress —Injuries, surgeries, difficult labor, hemorrhages, emotional stress, starvation
- Malignancies—– lymphoma , leukemia
- Kidney/ liver dysfunction.
- Iron deficiency anemia , Hair dye application
Hair loss due to hormonal disturbance
- Hypothyroidism/ hyperthyroidism/ Diabetes Mellitus/ Hypoparathyroidism/ hypopituitary states
Hair loss due to chemicals and drugs
- Thallium- a pesticide can contaminate foodgrains
- Excessive vitamin A & systemic Retinoids
- Occupational exposure to Bismuth in rubber industry
- Some anticancer , antifungals for long duration & few of the blood pressure lowering agents
Other causes for hair loss
- Alopecia Areata– hair specific autoimmune disease. Presents as round or oval patches of hair loss. It is a recurrent problem. Dermatologist should be consulted as soon as possible. If there is extensive scalp involvement, therapy response will be poor.
- Androgenetic alopecia– It is a harmone (androgen) dependent hereditary disorder. Both men & women can have it. In men it is frontoparietal recession and women it is diffuse hair loss all over the scalp with preservation of frontal hair line.
- Traumatic/ traction alopecia – It is a psychological disorder where hair loss is due to recurrent pulling out one ‘s hair of which the patient is not aware. It can also be due to tying of hair in a severe fashion.
Investigations in Hair loss
- Daily scalp hair counts – Useful to help quantify how much hair is being lost. It is normal to loose 100-150 hairs per day. Patients are asked to collect hairs shed in one day, count them and place them in small plastic bags. All shed hair in shower, brush or sink are collected. Shampoo days are labeled separately. Do this daily for 7 days. Performing a hair count is tedious and time consuming for the patient. But it is something which they can do on their own and follow the progress.
- 60 second hair count (To be done by the doctor if required)
- Pull test(To be done by the doctor if required)
- Trichogram/ biopsy—(necessary only if no clue or actors can be shortlisted for the hair loss.)
There are various modalities available. Each is given depending on the type of hair loss diagnosed by the doctor
Minoxidil lotion , Finesteride tablet, antiandrogen therapy,vitamin & amino acid combo, steroids in certain cases, behavior modification therapy and surgical options of hair transplantation / scalp reduction.
Part 2 of this series will be coming soon and we will discuss hair transplantation and the safer option concerning hair coloring.