What is diffuse hair loss?

  • Diffuse hair loss is a self-perceived loss of more than 25% of scalp hair.
  • The decrease in hair density is more apparent on the central and the front portion of the scalp.
  • This condition is called as ‘telogen effluvium’ in medical parlance and is different from ‘androgenic alopecia’ which is a patterned loss of hair.

What is normal hair growth and hair loss?

  • • Each hair grows at a rate of approximately 1 centimeter per week.
  • • The hair cycle has three phases (anagen, catagen and telogen). It lasts for 2-6 years and is longer in females than in males.
  • • Approximately 90% of the hairs on the scalp are in the growing phase also called as the anagen phase. The remaining hair are either in the resting phase (telogen phase) or about to fall off.
  • • On an average it is normal to lose up to 50- 100 hairs each day. Some people may experience more hair fall than others.

What are the causes of diffuse hair loss?

  • • Telogen effluvium is due to a sudden increase in the number of ‘telogen’ hair. Effluvium means ‘discharge or shedding off’. The effluvium of these increased telogen hair is perceived as abnormal hair loss and is called as telogen effluvium.
  • • Telogen effluvium can be caused due to multiple reasons:
  • • Nutritional deficiency; specifically iron deficiency, protein deficiency and zinc deficiency.
  • • Auto immune illness such as diabetes and thyroid disorders
  • • Sudden emotional stress or physical stress such as that seen after child birth, major surgery or loss of a loved one.
  • • Acute severe illness such as typhoid, malaria and dengue.
  • • Intake of certain medicines can also cause this kind of diffuse hair loss.

Can hair cosmetics or styling procedures aggravate hair loss?

  • • Shampoos with an alkaline pH can increase hair damage.
  • • Using hair prosthesis such as wigs, use of hair curlers, wearing tight braids and weaving of hair can lead to hair damage and cause hair loss.
  • • Similarly using hair cosmetics such as bleaching, coloring and straightening can also cause hair damage and hair loss.

Do environmental factors play a role in hair loss?

  • • Psychological stress, air pollution and tobacco smoking can lead to increased hair loss.
  • • Recent studies have shown that excessive sun exposure increases the rate of hair fall in women.
  • • However there is no evidence of role of hardness of water, used during hair wash, in causing hair loss.

What should be done if one suffers from hair loss?

  • • It is important to consult a dermatologist when one has a history of excessive hair loss.
  • • Dermatologists are trained to treat hair related problems. They can help in diagnosing the cause of hair loss and suggest appropriate therapy.i

How is hair loss diagnosed? Is it necessary to do some tests to diagnose the cause of hair loss?

  • • Assessing the hair loss in a patient is usually done clinically. A dermatologist will examine the scalp skin and hair and conduct a few bedside tests such as a hair pull test and dermatoscopy to make a clinical diagnosis.
  • • Laboratory tests such as a complete blood count, thyroid screen, estimation of vitamin D levels, serum ferritin (iron) levels and vitamin B12 levels may be advised. In selected female patients, tests for hormonal dysfunction may be required on basis of clinical suspicion.

How is hair loss treated?

  • • In many cases the hair loss tends to correct by itself by a positive change in the lifestyle or by improvement in the nutritional status.
  • Treatment of allied disorders such as thyroid disorders, vitamin D deficiency and anemia also helps in correcting hair loss.
  • Nutritional supplements and topical medications may be needed to help in hair growth. It takes 3-6 months to see a positive result.

How can I correct the thinning of hair that is left behind after my hair fall has stopped? Can surgery help in correcting the hair thinning?

  • • In case if the hair re-growth is not entirely satisfactory, you may consider to use hair prosthesis such as a hair piece, or a wig. However an improper prosthesis may cause further hair damage and hair loss.
  • • Hair loss due to increased telogen shedding is not treated with surgery. Hair restoration surgery is primarily indicated for androgenetic alopecia. Also hair loss due to burns or other trauma can be treated with surgery.

Does hair fall recur after the therapy is stopped?

  • • In certain cases where the cause of hair loss is unknown or where the cause cannot be corrected, hair loss may recur after discontinuation of therapy.
  • • In these cases the doctor may advise you to consider wearing hair prosthesis. Custom made wigs can help in restoring the positive self-image in a patient who is disturbed by the hair loss.

What are the myths associated with hair loss?

Certain myths are associated with the phenomena of hair loss. It is important to know that:

  • • Daily shampooing does not cause hair loss.
  • • Avoidance of combing doesn’t prevent hair loss.
  • • Shaving of scalp does not cause hair to grow back thicker.
  • • Dandruff does not cause permanent hair loss.
  • • Over the counter hair products do not help in thicker and faster hair growth.
  • • Coconut oil is effective as a conditioner and does not aid hair growth. Oils don’t penetrate the hair shaft and don’t help in growth.

What is Alopecia areata?

  • • Alopecia means loss of hair. Alopecia areata is a type of localized hairloss which is typically seen as bald patches.
  • • It may affect any hairy area of the body. It affects males and femalesequally.
  • • In majority of cases hair regrows after several months.
  • • It does not affect the general health of the person

What are the causes of Alopecia areata?

  • • Alopecia areata is considered to be an autoimmune disease. Thisoccurs when the body’s own immune system damages its healthy cells.
  • • In Alopecia areata, white blood cells gather around the affected hairroots (hair follicles). This causes inflammation which leads to hair loss.
  • • Genetics, atopy and environmental factors play a role.
  • • It is not a hereditary condition.

What is the course of the disease?

  • • It is difficult to predict the progress of a bald patch of Alopecia areata.
  • • Usually the hair regrows within a few months. Initially it is grey or whitein color and normal color returns after several months.
  • • At times, one or more bald patches develop a few weeks after the first one. Large bald patches can also develop.
  • • Patches of body hair, beard, eyebrows or eyelashes may be affected insome cases.
  • • Sometimes, the entire scalp hair is lost. This is called Alopecia totalis.
  • • In a small number of cases, all scalp hair, body hair, beard, eyebrowsand eyelashes are lost. This is called Alopecia universalis.

What are the treatment options in Alopecia areata?

  • • Alopecia areata is a very unpredictable condition. In many cases, baldpatches re-grow by themselves without treatment. If the hair loss becomes more extensive then the decision on whether to treat may beconsidered.
  • • Intralesional steroid injections, topical steroids and immunomodulators, phototherapy, topical minoxidil and contact immunotherapy can be used to treat Alopecia areata.
  • • It takes 1-2 months for the hair to start to regrow.

Androgenetic Alopecia is the most common cause of hair loss seen in both men and women. It is due to genetic or hormonal causes. It is also called as common bald ness, male pattern hair loss, female pattern hair loss, premature baldness.


What is male pattern hair loss?

  • • Male pattern hair loss (MPHL) is the most common type of hair loss in men.
  • • Baldness appears gradually on the crown of the scalp or as receding hairline atthe frontal and thinning of hair over temple areas.
  • • It affects about 30% of men by the age of 30 and 50% of men over the age of 50.

What are the causes of male pattern hair loss?

  • • Both genetic and hormonal factors are responsible.
  • • Testosterone is naturally converted in the body to dihydrotestosterone (DHT)which causes a change in the hair follicles on the scalp. Increased levels of DHThave been found in the balding scalp.
  • • The hairs become progressively smaller in diameter, shorter in length and lighterin color until eventually the follicles shrink completely and stop producing hair.

How does MPHL manifest? When does MPHL manifest?

  • • A receding frontal hairline is the usual pattern and there may be loss of hair fromthe top of the head.
  • • Hairs in the affected areas are thin and short before they become absent.
  • • Men become aware of scalp hair loss or a receding hairline at any time afterpuberty but most of them become aware of it as they approach their thirties.
  • • Hair loss may cause significant psychological difficulties.

How is MPHL diagnosed? Are there any tests to diagnose MPHL?

  • • A dermatologist diagnoses MPHL chiefly on history and clinical examination;a simple test such as dermatoscopy aids in the clinical diagnosis.
  • • The diagnosis is usually based on the clinical examination and history of hair losson the front/ top of the head or receding hairline, the pattern of hair loss and afamily history of similar hair loss.
  • • The skin on the scalp looks normal on examination.

How can MPHL be treated?

  • • Male pattern baldness is progressive and it does not improve or reverse withouttreatment.
  • • Minoxidil and Finasteride are commonly prescribed medications which may restore the hair to some extent.
  • • Hair restoration surgery or transplantation is a procedure where hair folliclesare taken from the back and sides of the scalp and transplanted onto thebald areas.

What causes FPHL?

  • • It is due to genetic and hormonal factors.
  • • There is gradual thinning of scalp hair at the center and increased shedding.
  • • Bald patches are uncommon in women.
  • • May be associated with conditions in which androgen (a group of hormones)levels are elevated such as polycystic ovarian syndrome (PCOS). Acne,increased facial hair, irregular periods and infertility are all signs of PCOS.

How does FPHL manifest? When does FPHL manifest?

  • • There is wide spread thinning of the hair, mainly on the crown of the scalp. It mayinitially start as widening of the hair parting areas.
  • • In females, the hairline at the front of the scalp often remains normal unlike inmen where receding of frontal hair line is observed.
  • • Hairs in the affected areas are initially thinner and shorter compared to hairs inunaffected areas, before they become absent.
  • • FPHL usually manifests after 40 years of age. Earlier onset may be seen inPCOS patients.

Can MPHL be cured?

  • • FPHL can be controlled with appropriate treatment. However, it tends to progressvery slowly, from several years to decades.

What are the treatment options in FPHL?

  • • Topical minoxidil and various hormonal treatments can be used to treat FPHL.