How to Manage Hair Loss in Females

 

In males, usually generalized hair loss is due to male pattern common baldness. In females, though, the hair loss could be due to many causes.

The main causes of male type baldness in females is due to excessive production of circulating androgens, resulting from diseases of various endocrine glands, like polycystic ovarian disease, adrenal hyperplasia, cushing’s syndrome and adrenal and ovarian tumors.

As we have already discussed, hair fall can also have many other causes, usually due to abnormalities in hair cycling. (hair has got growth, resting and falling cycles, any abnormality of these will cause hair to fall)

Normal causes for hair loss or alopecia in females are:

  1. Following delivery: hormonal changes.
  2. Stress
  3. Prolonged illness
  4. Nutritional deficiencies.
  5. Anemia: an important cause
  6. Local causes in the scalp: dandruff, too much chlorine in water and contact allergy.

Tests for Hair Loss in Women

  • Hormone levels (DHEA, testosterone, androstenedione, prolactin, follicular stimulating hormone, and leutinizing hormone)
  • Serum iron, serum ferritin, and total iron binding capacity (TIBC)
  • Thyroid levels (T3, T4, TSH)
  • VDRL (a screening test for syphilis)
  • Complete blood count (CBC)
  • Vitamin D3 levels
  • Scalp biopsy — A small section of scalp, usually 4 mm in diameter, is removed and examined under a microscope to help determine the cause of hair loss.
  • Hair pull – Your dermatologist lightly pulls a small amount of hair (about 50-60 strands) to determine if there is excessive loss. If more that 5-6 hairs come out, then the patient is likely suffering from excess hair loss. Normal range is one to three hairs per pull.
  • Densitometry — The densitometer is a handheld magnification device used to check for miniaturization of the hair shaft.
  • Trichoscopy

Here is what to do if you are a female suffering from hair loss:

  1. If you have any of the above triggers, try to correct them
  2. Check your Hemoglobin level. If it is lower than 11 gms/dl, you should take an iron-folic acid supplement.
  3. Do not use hot water to wash your hair. Do not put on tight clips.
  4. Take a balanced diet
  5. Practice relaxation techniques.

Specific treatments, along with the above:

  1. Topical hair tonics, with or without 2% minoxidil
  2. Multivitamin for hair
  3. Treatment for specific causes as determined through the lab investigations.

Also read:

Published by Dr Hanish Babu, MD on 9th June, 2018

Click here to book an appointment with Dermatologist Dr Hanish Babu, MD



Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

 

How to Treat Hair Loss?

Hair Loss Causes

Treatment of hair loss depends upon finding the cause and treating it. It is not as simple as it sounds, though!

Proper diagnosis, as was discussed earlier depends upon detailed history, clinical examination including hair pull test and trichoscopy and relevant lab investigations.

Once these are done, we are ready to deal with the enigma of hair loss or alopecia!

The first step would be to differentiate scarring from non-scarring alopecia.

How to Differentiate Scarring from Non-Scarring Hair Loss?

Close examination of the skin is enough to differentiate the scarring from non scarring alopecia. In scarring alopecia, there is absence of hair follicle opening and increased wrinkling of the involved skin. The skin surface is thin, shiny and dry. Underlying small blood vessels may be visible through the atrophic skin. Towards the periphery of the bald patch, hairs will be twisted because of the pull of the scar tissue.

Treatment of Common Baldness

Treatment of common baldness could be medical or surgical.

Medical Treatment of common  baldness: Topical Minoxidil is THE treatment for baldness. Most so called herbal and other miraculous cures are ineffective, or a concoction containing minoxidil itself.

Finasteride is an oral medication used for extensive male pattern baldness. It works by binding the enzyme which converts free testosterone to Dehydrotestosterone (DHT). This is a prescription medication and should only be used under the supervision of a dermatologist.

Salient features of Minoxidil therapy:

  • Life long treatment
  • Limited improvement
  • Arrest progress of hair loss
  • Expensive
  • Response is seen typically after 3-4 months
  • Hair fall restarts after stopping medication
  • Should be used carefully in those with fluctuant blood pressure and heart diseases
  • Irritation and allergic contact dermatitis may occur to the application.
  • Application 1 ml twice daily after wash with minimal rubbing

PRP Treatment and Mesotherapy for Common Baldness and Hair Loss 

Platelet Rich Plasma injections and Mesotherapy with hairtonics and vitamins are becoming increasingly popular in treatment of hairloss including common baldness.

Surgical Treatment of Common Baldness: 

Before contemplating surgery like hair transplantation, the subsequent risks and cost of such surgeries should be considered. In milder cases, a change of hair style or later, a wig would suffice. Flap and strip grafts, scalp reduction operations are also available as alternatives to hair transplantation . Hair weaving is a new technique that is gaining popularity.

When to Consult a Dermatologist

  1. Sudden , generalized hair fall should be reported at once
  2. If associated with other systemic symptoms like generalized weakness, palor, in females, menstrual iirregularities et

Generalized Hair Loss Treatment Tips

  1. Do not pour hot water on the scalp
  2. Do not use harsh shampoos
  3. Hair fall is common after delivery or after a prolonged illness, take nutritious food and use mild shampoos.
  4. Vitamin supplements are beneficial, especially biotin and zinc containing vitamins help hair growth.
  5. Check haemoglobin level for anaemia, and, if present, correct it.
  6. Rule out thyroid and other endocrinological causes.
  7. Learn to manage stress properly, here is an appropriate program which gives a practical program to manage your stress for life.

Localized Non Scarring Hair Loss:

Recurrent Patchy Hair Loss (Alopecia Areata) is the commonest type of localized hair loss : Learn more about alopecia areata.

Also Read:

 

Published by Dr Hanish Babu, MD on 9th June, 2018

Click here to book an appointment with Dermatologist Dr Hanish Babu, MD

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

How to Diagnose the Exact Cause of Alopecia or Hair Loss?

Diagnosis of Hair Loss includes extensive history taking and investigations
Diagnosis of Hair Loss includes extensive history taking and investigations.

Treatment of hair loss depends upon finding and treating the cause of alopecia. Hence diagnosing the cause of alopecia is the first step in the effective management of hair loss. This involves extensive history taking, thorough examination of the hear bearing areas and doing relevant lab tests. What makes the alopecia an enigma is that even after such thorough clinical approach, the cause of hair loss may still remain a mystery,

As we have already seen in the previous article on different types of hair loss, alopecia can either be scarring or non-scarring. Androgenic alopecia  or male pattern baldness, alopecia areata, and telogen effluvium are examples for  non-scarring alopecia.

Taking extensive history about the hair loss is of utmost importance in making a diagnosis as to the cause of the hair loss. Your dermatologist may ask the following questions:

  1. How long have you been experiencing hair loss?
  2. Is the hair loss gradual or sudden?
  3. Whether extensive or localized and patchy?
  4. Any associated symptoms like itching, scaling, burning sensations etc?
  5. Has the patient noticed hair thinning also, in addition to hair loss? Gradual hair thinning and hair loss may be due to male and female pattern baldness.
  6. Do you feel tired all the time(anemia)?
  7. Any history of hormonal imbalances (Thyroid disease or hyperandrogenism)
  8. Is hair pulling test positive? In hair shedding due to telogen effluvium and alopecia areata, hair pulling test will be positive.
  9. Any history of recent illnesses, trauma, stress, medications?
  10. While doing hair pulling test, is the hair coming out along with the root or is it breaking on traction?
    • Hair pull test (coming out as a whole with root) is positive in:
      • Telogen effluvium
      • Alopecia areata
      • Androgenic alopecia
      • Drug induced hair loss
    • When hair breaks on pulling, showing hair shaft weakness, the causes may be:
      • Tinea capitis (fungal infection)
      • Use of hair straighteners and other abrasive hair cosmetic treatments
      • Hair shaft abnormalities
      • Hair growth retardation
  11. In females, a detailed menstrual history is important to rule out hormonal causes
  12. Is there hair loss in other body parts as well??
  13. Is there a family history of hair loss? A genetic predisposition has to be ruled out.
  14. What are your food habits? Balanced nutrition is essential for normal hair growth.
  15. How often do you expose your skin to sun? Vitamin D deficiency is an important cause for chronic hair loss and hair thinning.

What is hair pulling test?

This is a simple and easy test to assess the status and degree of hair loss.

  • Hold around 50- 60 hairs firmly between the thumb, index, and middle fingers , near the base of hair shaft. Pull firmly along the direction of hair follicle.
  • If more than 10% (5-6) whole hairs (with roots) come out from the scalp, the hair pull test is considered as positive. Shampooing should be avoided at least 1 day before.

Trichoscopy for Hair Loss

      Trichoscopy (dermoscopy of hair) is very useful in outpatient diagnosis of hair loss causes. Being non-invasive it carries better patient acceptance as well.

Laboratory investigations in alopecia:

Essential tests in case of chronic hair loss:

  1. Serum ferritin
  2. Hemoglobin
  3. Vitamin D3, Serum Zinc and Calcium levels should be routinely tested
  4. Thyroid Function tests
  5. in women with androgenic alopecia, an endocrinologic profile including serum testosterone, androstenedione and dehydro-epiandrosterone (DHEA) are done to rule out hyperandrogenism.
  6. if discoid lupus erythematosus is suspected, antinuclear antibody tests are indicated.

Once the diagnosis is made, a comprehensive treatment plan can be charted out.

Read also:

Published by Dr Hanish Babu, MD on 9th June, 2018

Click here to book an appointment with Dermatologist Dr Hanish Babu, MD

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD