Hair is considered a sign of beauty in almost every culture. It is a general belief that long lustrous hair adds to the personality of an individual. Our hair is regarded as no less than a crown on our head. Be it a man or a woman good hair is everyone’s dream.
The importance of healthy hair has always been stressed in our society. But what happens when this sign of beauty is seen not on the head but on the pillow when you wake up in the morning, near the bathroom drain after a shower, or in the comb after combing?
With every strand of hair that falls, it can be definitely said that our hearts break a bit. Premature hair fall and baldness have been the talk of the town for years but a proven treatment for the same has not yet been devised. Many cosmetic companies have banked on this condition, to an extent that even Bollywood has cashed on this topic. Be it Bala, Gone Kesh or Ujda Chaman premature hair fall and baldness sells like hotcakes.
It may be easy to talk about hair fall and advise people on the same but those who actually suffer from it understand the agony of the situation and it may not be wrong to say that they are willing to try every solution under the roof to solve this problem. Let us discuss the causes and treatment for hair fall in this article.
The Hair Cycle
The hair cycle is divided into 3 phases (1).
The first phase is called the anagen phase or the active phase. In this phase, the hair grows and replaces the old hair and continues growing over several weeks to a few years.
The second phase is the transition phase or the catagen phase which changes the active hair to resting hair. This phase lasts up to 3 weeks.
Telogen hair is the third phase in which the hair will stay on the scalp without growing and can be removed by pulling and combing. Also, during this phase, the hair can stay till the new hair grows and lets the old hair fall spontaneously. This phase can last up to 3 months.
A normal human being has approximately 1 million hair follicles on the body, of which 1 lack hair is on the scalp. A hair normally grows at the rate of approximately 1 cm per month (2). Loss of 100–150 telogen hair is considered normal, but hair loss in the anagen phase is abnormal (3).
Hair Fall
The scientific term for hair loss is Alopecia. In the medical field, alopecia is classified into two types
Scarring alopecia – hair follicles are preserved with potential for hair regrowth.
Non-scarring alopecia – hair follicle is irreversibly destroyed due to the destruction of stem cells in the bulge area of the outer root sheath, and replaced by fibrous scar tissue, leading to permanent hair loss (4).
Types of non-scarring alopecia include shedding or telogen effluvium (TE), androgenetic alopecia (AGA), alopecia areata (AA), traction alopecia (caused by pulling hair), and trichotillomania (compulsive hair-plucking).
Related:
Diet and Hair Fall: Are They Connected?
Causes of Hair Fall
A variety of factors cause different types of hair fall. Let us understand them based on the types of hair fall that they cause
Causes of non-scarring type hair fall
Shedding or telogen effluvium (TE)-
Following are the potential triggers (5)
- Pregnancy, delivery, or miscarriage
- Illness or fever
- Hospitalization or surgery
- Abnormal thyroid hormone function or change in dose of thyroid medicine
- Significant emotional trauma such as the death of a loved one, divorce, or job loss
- Starting, stopping, or changing hormone medications including birth control or IUD
- Nutritional deficiencies (protein, vitamins, and minerals)
- Entering menopause
Androgenetic alopecia (AGA)-
The most common cause of AGA is family history. This condition aggravates with aging and presents as male-pattern baldness and female-pattern baldness occurring gradually in predictable patterns — a receding hairline and bald spots in men and thinning hair along with the crown of the scalp in women (6).
Alopecia areata (AA)-
It happens due to a defect in the immune system, causing inflammation of the hair roots and thus their loss. It is associated with autoimmune disorders like arthritis. vitiligo, lupus erythematosus (LE), psoriasis, thyroid diseases, and atopic eczema. It may also result due to conditions like anemia, sexually transmitted diseases and hormonal changes during pregnancy, and consumption of hormone pills (7).
Traction Alopecia-
Practices such as tight braiding, wearing ponytails or elastic hair bands, using rollers, or other devices that place extreme and repetitive stress on the scalp hair are responsible for most cases (7).
Trichotillomania-
This can range from an underlying emotional problem to a definite mental disorder. It can be caused as a result of insecurity in children. In women, it can be associated with depression or anxiety (7).
Causes of Scarring Type Hair Fall
Common causes are fungal or bacterial infections, skin diseases, trauma, scarring bullous disorders, and neoplastic disease like skin tumors. Tinea Capitis is a type of scarring alopecia mostly observed in children and is caused due to ringworm infection (1).
Other Causes
Abnormalities of the hair shaft
The hair shaft may get affected due to certain inherited disorders or external damage. Repeated trauma to the hair shaft in the form of traction, bleaching, perming, or blow-drying is the most common cause. they result in different shapes of the hair shaft the most common being trichorrexis nodosa, a nodal area where the hair splits into strands (6).
Chemotherapy-induced hair fall
Chemotherapy disrupts the proliferation of the hair bulb that produces the hair shaft. Hence the hair shaft is compromised and the hair follicle breaks causing hair to fall. Hair loss is one of the most distractive and emotional side effects of chemotherapy but hair does eventually again grow after the therapy (7).
Treatment for Hair Fall
Various treatment modalities have been suggested for hair fall. Before starting any treatment, it is advisable to consult a physician or a practicing dermatologist as they will be able to tell you the exact cause of your hair fall and suggest the treatment accordingly. Hence, the treatment will vary from person to person. It is very common to see patients consulting their peers, friends, family members, etc for tips and home remedies to prevent hair fall but they will not be helpful if the cause is not addressed.
Medical treatment
Certain topically applied over-the-counter drugs can be prescribed for reducing or arresting hair fall and for regrowth. If the cause of hair fall is the consumption of specific medications like during chemotherapy or certain anti-hypertensive drugs, a change or discontinuation for a certain period of these drugs may be advised by the treating doctor.
Another important aspect of hair fall treatment that everyone should understand is, that the medication prescribed to one patient should not be used by others in the family.
Surgical treatment
Cosmetic surgeries like hair transplants can also be recommended. Modern hair transplant using hair grafts continues to be the most successful method to treat hair fall provided the case is initially examined by the surgeon and deemed fit for the same. It will help fill in the bald areas and give 100% natural hair (1).
Laser treatment
Low‒level laser comb is approved by the FDA as a safe treatment for alopecia in both males and females. It stimulates hair follicles and promotes proliferation and duration of the anagen phase (6).
Ayurvedic treatment options and home remedies
Certain ayurvedic treatments like Nasya therapy and Pracchana Karma have been advised in Ayurveda for hair fall. Studies are still in progress for the same. It is advised to TAKE these therapies from a trained practitioner (8,9). Many home remedies like the application of egg masks, yogurt, honey, henna, and massages using onion, fenugreek, hibiscus, castor oils, etc have been practiced in different traditions and cultures. The results of these differ to a large extent for different people.
Haircare and grooming
A few practical points to be remembered to prevent chemical damage and hair fall are as follows
- Avoid using shampoo excessively.
- Avoid the excessive use of chemicals for conditioning (conditioners just coat the hair shaft).
- Avoid excessive exposure to the sun.
- Avoid the use of harmful chemicals and frequent chemical treatment for hair.
- Using heat treatments also damages hair and causes hair fall. Indulge in these sparingly.
- Do not wear tight braids. Tight braids, especially in children, can result in a form of baldness called traction alopecia.
If you find the information in this blog useful, please do let us know in the comments section below.
Author: Dr Pooja Nilgar (Content writer and editor)
References
- Al-Aradi I, Al-Ghareeb M. 2005. Hair Fall: Common Causes and Treatment Modalities.
- Neeru, S., Yadevendra, Y., Usha, S. and Chand, S.K., 2020. Concept of Hair Problems and its Treatment in Ayurveda.
- Nayak, K., Garg, A., Mithra, P. and Manjrekar, P., 2016. Serum vitamin D3 levels and diffuse hair fall among the student population in South India: a case–control study. International journal of trichology, 8(4), p.160.
- Lin, J., Saknite, I., Valdebran, M., Balu, M., Lentsch, G., Williams, J.N., Koenig, K., Tromberg, B.J. and Atanaskova Mesinkovska, N., 2019. Feature characterization of scarring and non‐scarring types of alopecia by multiphoton microscopy. Lasers in surgery and medicine, 51(1), pp.95-103.
- Nalluri, R. and Harries, M., 2016. Alopecia in general medicine. Clinical Medicine, 16(1), p.74.
- Likhitkar M, Shakur AA, Bansal KK, et al. 2018. Alopecia‒reason and possible treatments. MOJ Drug Des Develop Ther,2(5):198‒208.
- Mulinari-Brenner, F. and Bergfeld, W.F., 2001. Hair loss: an overview. Dermatology nursing, 13(4), p.269.
- Parwe, S., Shaikh, M. and Nisargandha, M., 2020. Study of effect of narikel (Cocos nucifera) oil nasya in khalitya (Hair Fall): A study protocol, 5(5) pp. 507-509.
- Kathad, D., Bariya, S.K. and Varsakiya, J.N., 2019. Role of Pracchana Karma followed by Bibhitaki Lepa in Indralupta (Alopecia Areata). AYUHOM, 6(2), p.69.
