Q: A head of beautiful luscious hair is vital to a woman. Even though I am a healthy young woman aged 23 years, I am already lamenting my thinning hair.
I have used shampoo targeted at resolving thinning hair and hair loss, sought herbal hair treatment that used Chinese herbs to open up follicles and maintain a healthy scalp, and applied hair tonic in the hope of promoting hair growth.
However, the problem still remains. I have browsed online for natural remedies, such as applying coconut oil to the scalp and rinsing hair with apple cider vinegar. Are these types of treatment viable?
What other suitable remedies would you recommend to counter thinning hair? As most Chinese believe beauty comes from within, would a change in diet help?
A: Diffuse hair loss is distressing. It can affect both sexes at any age.
Scalp hair grows in cycles, with each hair follicle undergoing 10 to 30 cycles in its lifetime.
Diffuse hair loss is the result of a disruption of one phase of the hair cycle.
The three phases are anagen (the phase of active hair growth), catagen (the phase of involution) and telogen (the resting phase). Dead hair stays on the head until new hair replaces it at the end of telogen.
Normally, each hair follicle cycles independently so that while some follicles are growing hair, others are resting and others are shedding.
Thus, the density of the scalp hair and the total number of scalp hairs remain stable.
Most people have about 100,000 scalp hairs, and normally 10 to 15 per cent of these are in telogen. Shedding of 100 to 150 telogen hairs per day is normal.
Diffuse hair loss can be due to a variety of reasons.
One common type of diffuse hair loss is telogen effluvium, in which hair follicles prematurely transition from anagen to telogen, resulting in a noticeable increase in hair shedding at the end of telogen two to three months later.
Triggers of telogen effluvium are numerous. They include physiological stress such as surgical trauma, high fever and childbirth (telogen gravidarum).
Chronic starvation and crash dieting can induce diffuse telogen hair loss.
Women with heavy menstruation may also suffer from iron deficiency and this can also cause diffuse hair loss.
Medical conditions such as hypothyroidism (when the thyroid does not produce enough hormones) and hyperthyroidism (when the thyroid produces excessive hormones) can cause diffuse telogen hair loss.
Other medical conditions, such as autoimmune diseases, liver and kidney failure as well as infections, can trigger diffuse hair loss.
Certain types of medication, such as hormone pills, can cause telogen effluvium.
Important in the differential diagnosis of telogen hair loss is early androgenetic alopecia (male pattern hair loss or female pattern hair loss).
Early androgenetic alopecia can start as episodic telogen hair shedding before the distinctive pattern of hair loss is seen.
Men with male pattern hair loss start to lose hair above both temples and then the top of the head, and the hairline recedes.
In women, the hair becomes thinner all over the head, and the hairline does not recede.
Anagen hair loss, the result of interruption of anagen, can also show up with diffuse hair loss.
One example of anagen hair loss is diffuse alopecia areata.
It is sometimes considered akin to an autoimmune condition where the body's immune system targets the hair follicle and results in the hair loss.
Do see a dermatologist. A detailed history and physical examination to identify the temporal association of possible triggers and any underlying systemic disease is needed to determine the cause of your hair loss.
Different types of hair loss require specific types of management.
For telogen effluvium, the management is to address the underlying medical condition.
Once the underlying medical condition is appropriately managed, the hair condition will improve.
As for androgenetic alopecia, the aim of management is to retard the rate of hair loss.
Treatment includes topical as well as oral medication.
As for diffuse alopecia areata, oral or topical immunosuppressants are the mainstay of treatment.
DR RAYMOND KWAH
Consultant dermatologist at the Raffles Skin & Aesthetics Centre at Raffles Hospital
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