In this second and last part, I shall discuss about the diseases and conditions that lead to true hair fall or ‘hair loss’.
As said earlier, hair fall is natural and this should not be called a disease or may not require any treatment other than explanation unless it is excessive. Hair naturally regrows. Hair fall and regrowth is a life cycle of hair. Most cases of hair fall are naturally replaced by new hair.
When hair fall is more than its regrowth, it causes progressive loss of hair. Apparently, this manifests as overall decreasing density. Loss may be diffuse or localised. Thus, it is better to call this condition as ‘hair loss’. Unlike hair fall, hair loss needs treatment.
[Androgenetic alopecia or common baldness]
Most common cause of hair loss is ‘androgenetic alopecia’ (AGA). The term alopecia means loss of hair.
Simply, this is the common baldness in males. Hair loss starts over temple (sides) and vault (top) of scalp. Frontal hair line recedes and ultimately it leads to baldness. Females also commonly develop this. However, in them, frontal hair line remains but hair is gradually thinned out on the vault.
Many cases are inherited. However, the inheritance is not always direct from parents. Uncle or aunts can transmit the condition to us.
AGA can start any time after 20 years of age.
Many cases are obviously not inherited.
Its prevalence in females is less than males but it is not uncommon. As said earlier, this appears little differently than males.
In females, menstrual irregularities often hint at hidden abnormalities. Some females may have few to many male like hairs on chin etc.
Investigations are necessary for these cases.
Management for AGA is minoxidil and many other drugs. Newer treatment like peptides, mesotherapy and PRP are now practiced by many
All severe degree of baldness may be tried to be corrected with hair root grafting, i.e. hair transplantation. It’s a permanent method of hair restoration.
Hair regrows following treatment. But this takes long time. Patient needs to have patience to see the result. Do not stop the treatment prematurely.
Many infections of the hair and scalp can lead to localised hair loss. Some fungal and bacterial infections can commonly cause hair loss. Unlike all other forms of hair loss mentioned above, these infections can permanently damage the hair roots. Unless diagnosed and managed rapidly, these can leave permanent loss of hair.
Various rare skin diseases can also damage the hair roots permanently. Thus diagnosis is vital to identify these. Biopsy may be important and should be undertaken sooner than later.
It should be remembered that any disease on scalp can lead to hair loss although they are not primarily hair disease. Psoriasis thus can cause hair loss. Severe dandruff may cause hair loss.
[Permanent loss of hair]
Although, many cases of hair loss are reversible, in some conditions, hair roots are permanently damaged. These cases show poor response to treatment. Pus-filled eruption at the base of hair is frequently a sign of poorer outcome.
In many of these cases, damage to roots is progressive. Thus, early treatment often result is better final outcome.
Management of hair loss is important. Patients develop tremendous psychological impact due to hair loss. Their depression needs to be property addressed.
Investigations are of utmost value in many of the alopecia. Treating dermatologist is the key person to decide the right tests. Ultrasonography of abdomen, hormonal assays, hemoglobin, and iron assay may be needed.
Treatment depends on the cause. Good food rich in iron, vitamins and proteins are necessary.
Oral drugs may be required. Medicinal hair lotions of various forms are the mainstay of treatment. Regular shampooing is important.