Hair fall: how much is too much?

Seasonality:

Seasonal hair fall is reversible, seen usually in rainy and summer seasons.

Ageing:

With increasing age, the hair follicles shrink to produce thinner and shorter hair strands, and finally die off. There is natural tendency for reduction of scalp hair with age.

Poor grooming:

• Hair fall due to poor grooming and cosmetic practices can be prevented, these include:
• Combing of wet hair can cause damage, as the wet hair is more elastic and susceptible to fracture. Hence, hair should be combed only when dry.
• Hot blowing hair should also be avoided as it causes hair damage.
• Poor cosmetic grooming practices as vigorous brushing, styling, coloring, bleaching, straightening, curling and perming can cause hair damage. Curly, long and aged hair are more susceptible to damage following cosmetic treatment.
• Tying the hair tightly can result in traction alopecia due to pull exerted on the hair. Customs like twisting of hair tightly on the vertex in Sikhs, and tight braiding in rows in African women contribute to traction alopecia. It can be easily prevented by changing one’s daily hair care habits, but once the hair loss occurs for a prolonged period, it may be permanent.

Stress:

Stress (physiological, psychological or pathological) also induces excessive hair shedding. These may include hair fall after pregnancy, severe illness or surgery. The psychological stress as loss of loved one, loss of job,undergoing divorce, work stress etc may also induce hair shedding. Usually hair fall starts 1 to 6 months after the inciting cause. For example, a mother complains of hair shedding 2 to 3 months after delivery. The hair loss in this condition is usually described in the terms of thinning of pony tail or plait, with increased hair shedding. When the stress is over, or as body readjusts, the excessive shedding stops. Within 6 to 9 months, the hair tends to regains its normal fullness. This type of hair shedding is temporary, until the stressor chronically continues, where hair shedding becomes long lived.

Nutritional deficiencies:

Drastic weight loss (~15 pounds) due to dieting, fasting, malnutrition result in low protein intake and micronutrient deficiencies (as zinc, iron, vitamin B &C) that are vital for hair growth, thus resulting in hair fall. Generally, this type of hair loss is reversible after resuming a diet rich in proteins, green vegetables and fruits. To hasten the hair growth or arrest further hair loss, nutritional and iron supplements are prescribed.

Chronic stress:

If patient suffers chronic stress as post illness or psychological depression, and hair fall continues over 4-6 months, he should his dermatologist.

Itchy or infected scalp:

Vigorous scratching of scalp damages hair. Any cause of itchy scalp as lice or dandruff should be treated promptly to minimize damage to hair.

Androgenetic alopecia:

Androgenetic alopecia is a very common, progressive and patterned type of hair loss leading to baldness for which medical advise is commonly sought. As the name implies, both genetic and hormonal factors are involved in its pathogenesis. The hair cycle is accelerated and thick scalp hair become shorter, thinner and depigmented. In males, it presents as recession of hair line followed by thinning of the hair on the crown and temples, starting usually at age of 30-40 years. In females, diffuse thinning of hair over crown with widening of central parting is seen, starting usually at post menopausal age.

Alopecia Areata:

Patchy hair loss or alopecia areata is another condition for which medical advise is sought. This patchy hair loss can be due various inflammatory disorders. Re-growth of hair is possible after medical treatment.

Trichotillomania:

Obsessive hair pulling seen in some individuals with psychological problems can also lead to patchy hair loss. In medical terms, this condition is known as trichotillomania. The identification of stressful period, proper counselling and behaviour therapy is required to correct this condition.