Hair Fall in Men and Women, Its Reasons and Treatments

Introduction

It's normal for people to lose around 50 to 100 hair a day. Excessive and persistent loss of hair from the scalp (Head) is medically known as alopecia. there are different types of alopecia, a most common among men is Alopecia areata. Some instances of hair fall may be temporary and reversible, others may require medical intervention. Hair fall can bother both men and women due to various reasons, such as health conditions, genetic and environmental factors. Therefore, understanding the cause of hair fall is essential for its effective prevention and treatment plan.

How to Detect Whether Hair Fall Is Abnormal

1. Pay attention to the number of hairs you lose during daily activities like brushing, styling or showering (specially clogging the drains in bathroom).

2. Observe for receding hairline and thinning of hair.

3. Look for changes in your hair thickness, volume, widening of the part (if you part your hair) or if your scalp becomes more visible than usual.

4. Notice specific patches or areas with significant hair loss, which may be a sign of a more serious issue.

5. Pain or discomfort in the roots of the hair, also known as scalp pain which may be due to allergy or infection (bacterial or fungal)

6. Additionally, people experience 30% more hair fall during the monsoon due to humidity, greasy hair and dandruff.

Symptoms of hair fall

Reasons for hair fall and its treatments

Physical or mental stresses

Triggered by Major surgery, Extreme weight loss, Severe illness, Emotional stress, Hormonal fluctuations after childbirth or during menopause, After starting or stopping hormonal birth control pills.

Thus, hair loss due to above mentioned stressful conditions medically called Telogen effluvium which may last for few days to several months.

It is usually a temporary condition. Once the trigger is resolved, the affected hair follicles return to normal stage and hair growth resumes.

Use of certain medications

Certain medications can cause hair loss called drug-induced alopecia. The severity of hair loss can vary among individuals, and not everyone experiences this side effect. Medications commonly associated with hair loss include:

1. Hypertension controlling beta blockers

2. Medicines to control loss of consciousness and treat seizures (anti-convulsant)

3. Hormonal medications, including some forms of birth control pills

4. Retinols to treat conditions like acne or psoriasis (scaly skin)

5. Anti-coagulants that prevent the clotting of blood

6. Thyroid medications

It's not recommended to stop or alter medications without consulting a healthcare professional, as doing so can be detrimental for your overall health. Doctor can prescribe potential alternatives, or adjust the treatment plan if necessary.

Reasons of hair loss

Nutritional Deficiencies

Proper nutrition is vital for the functioning of hair follicles. Due to nutrient deficiencies hair prematurely enters the resting phase and falls out. Nutrients Essential for Hair Health are:

1. Iron: Iron is crucial for the production of haemoglobin, which carries oxygen to the body's cells, including hair follicles. Anemia, due to iron deficiency is a common cause of hair loss. Natural sources of Iron are red meat, poultry, fish, legumes, tofu, nuts and seeds.

2. Vitamin D: Hair follicles contain vitamin D receptors as it is essential for differentiation of cells within the hair follicle. This promotes transition of hair follicles from the resting phase (telogen) to the growth phase (anagen). It also reduces inflammation, and hence provides a healthier environment for hair follicles.

The primary source of vitamin D for the body is sunlight exposure, vitamin D can be obtained through certain foods such as fatty fish, fortified dairy products or through vitamin D supplements. Excessive vitamin D intake can have adverse effects, so its better to check its levels through a simple blood test.

3. Zinc and Protein: Zinc is essential for cell division. Hair follicles are constantly undergoing a cycle of growth (anagen phase), rest (telogen phase), and shedding (catagen phase). Its deficiency can interrupt this cycle, leading to an increased number of hair follicles entering the resting phase.

Zinc deficiency may also lead to increase of hormone dihydrotestosterone (DHT). This hormone forms a cementing layer around the hair follicle and narrows the blood vessels which reduces nutrients and oxygen supply to the hair follicles. This leads to thinning, shortening or miniaturization and eventual loss of hair. Natural sources of zinc are meat, poultry, eggs, legumes, chickpeas nuts and seeds.

Hair are made of protein keratin, deficiency of protein causes hair breakage and shredding. Protein is made up of amino acids. Lysin is the amino acid which is required for absorption of iron which is important for maintaining hemoglobin level in the body and providing nutrition to the hair follicles. Lysin is not made by the body itself. It has to be taken through food and non-veg. food items are its major source including milk apart from these nuts also hold good amount of lysin.

4. Vitamin B: Biotin (B7), cobalamin (B12), and folate (B9) are essential vitamins that play important roles in maintaining the health of hair, skin, and nails.

Biotin is crucial for the synthesis of keratin, a protein that forms the structural basis of hair, skin, and nails.

Vitamin B12 is essential for the production of red blood cells. Its deficiency can lead to anaemia, which may result in reduced oxygen and nutrient supply to hair follicles.

Folate is necessary for DNA, red blood cells synthesis and repair of hair follicles.

Natural sources of Biotin are Egg yolks, Almonds, Peanuts, and walnuts. Vitamin B12 is high primarily in animal-derived foods such as Meat, Fish, Milk, Yoghurt and Egg yolk. Folate is high in Spinach, kale, tender leaves of turnip, Lentils and chickpeas.

Tests to detect nutritional deficiencies

Foods for hair growth

Genetics

Family history plays a significant role in determining one's susceptibility to hair loss. The most common form of genetically influenced hair loss is known as Androgenic alopecia. It leads to conditions such as male pattern baldness and female pattern hair loss. The interaction between genes and environmental factors determines the probability and pattern of hair loss. Androgenic alopecia is strongly influenced by formation of hormone dihydrotestosterone (DHT), a derivative of testosterone.

This type of hair loss is more prevalent in males because the level of testosterone is naturally higher in males than in females. Therefore, possibility of converting Testosterone into high levels of DHT due to the excessive activity of enzyme 5 alpha-reductase is greater in males. Males experience a receding hairline with broad forehead with M-shape hairline or thinning at the crown followed by bald spots. The hair loss can start as early as late adolescence or early adulthood which may progress to partial or complete baldness in these areas with age.

Female-pattern baldness is less common and tends to occur later in life. The prevalence increases with age, and women may experience thinning of hair rather than a receding hairline or bald spots.

Genetical cause of hair loss

Treatment of genetically influenced hair loss is the toughest. Early intervention is often more effective in slowing down the progression of hair loss.

Minoxidil (2%, 5% or 10%) is an over-the-counter topical medication can be applied directly to the scalp. It is available mostly in liquid formulation which can dilate the blood vessels and increase the blood and nutrient flow to the hair follicles. It is effective for both men and women.

It is generally well-tolerated, some individuals may experience side effects which are usually mild. In rare cases, individuals may experience dizziness, light-headedness, or increased heart rate so consult doctors before use.

Finasteride is an oral prescription medication for men and is not approved for use in women of childbearing age. It works by inhibiting the action of the hormone dihydrotestosterone (DHT). It may cause side effects in males but it's important to note that side effects are generally not common such as erectile dysfunction, decreased sex drive, breast tenderness or enlargement in men and mood changes, including depression and anxiety.

Hair transplant is the last choice when nothing works to treat the bald areas or patches. In this treatment, individual follicular units (hair) are extracted directly from the donor area (back or sides of the head) and then implanted into the recipient area (top of head or bald patch) under Local anesthesia. Tiny cuts are made in the recipient area to implant the hair grafts by carefully placing these into those tiny cuts.

Postoperative care is important which includes management of swelling, avoiding strenuous activities, and caring for the transplanted area to reduce the risk of infection, bleeding and scarring. The transplanted hair usually sheds within a few weeks, but new hair growth begins in a few months (7-8 months) to show natural-looking, permanent hair. Hair transplant costs can vary depending on number of grafts and the surgeon's experience.

External influences

External influences individually or in combination with genetic factors can adversely impact the health and growth of hair. Few of the external influences are already described above such as Nutritional deficiencies, Physical and emotional stresses, Certain medications and Hormonal changes. Apart from these, environmental pollutants also play important role such as:

1. Particulate matter of air, heavy metals, pesticides, solvents and industrial chemicals.

2. Certain conditioners, hair dyes and styling agents may contain harsh chemicals.

3. Hard water containing high level of minerals.

4. Prolonged and unprotected exposure to ultraviolet (UV) radiation from the sun.

5. Toxins in cigarette smoke negatively impacting blood circulation and causing oxidative stress.

Scalp infections

Various types of infections can significantly affect the scalp health, leading to inflammation, damage to the hair follicles, and hair shedding. Some common scalp infections include:

Tinea Capitis: Most commonly called ringworm but not caused by any worm. It’s a fungal infection on the scalp involving dermatophyte fungi, such as Trichophyton and Microsporum species. It is more common in children but can be easily transferred to adults from infected children. Scraping from the affected area may be examined under a microscope to identify the infection causing agent.

Primary treatment for ringworm of the scalp involves use of topical antifungal shampoos, creams or oral medicines such as griseofulvin, terbinafine, or itraconazole under the supervision of specialist only. Preventive measures include practicing good hygiene and regular cleaning of hands, nails and scalp.

Dandruff: Overgrowth of Malassezia a yeast-like fungus on the scalp causes dandruff. Malassezia is a normal part of the scalp's microbiome, but an overproduction can lead to irritation and increased shedding of skin cells. Use of certain hair care products or styling products may contribute to dandruff. Antifungal agents such as zinc pyrithione, selenium sulfide or ketoconazole can help control the growth of Malassezia.

Folliculitis: Commonly caused by various bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa characterized by inflammation of hair follicles, red inflamed bumps or pustules around hair follicles. These bacteria can lead to infections if they enter damaged hair follicles. The scalp may be itchy, painful resulting in scarring and permanent hair loss. Folliculitis can also be caused by fungi or viruses, but bacterial folliculitis is a more common. Bacterial culture may be performed to identify the specific bacteria causing the infection.

Mild infection may be treated with topical antibiotics, such as mupirocin and clindamycin. More severe or recurrent cases may require oral antibiotics, such as cephalexin or dicloxacillin.