Hair Fall: Scientific Way of Treatment

Hair loss, (also known as alopecia or baldness)

Hair loss is one of the most common complaints among all patients consulting a dermatologist and is usually associated with severe psychological disturbances, distress and symptoms of depression [1, 2]. Falling of hairs from scalp is not problems but it is stage of hair growth cycle. However, problem arises when the rate of fall increase significantly and its reduced density become apparent on scalp. To reach at any substantial conclusion, there should be a clear idea about structure, chemistry & growth cycle of hair [click the link to watch the video or PPT on above topics]. Nevertheless, it not possible for all to go all such technical details and therefore, let’s have look on only following issues.

Facts & Figures (source)

• Changes in seasons and daylight exposure affect hair fall as it is more in spring & fall than summer and late winter
• 90K out of 140K hair follicle found in scalp.
• Growth rate of scalp hair in adult is 0.35mm/day, while eyelashes grow @ 0.16mm/day
• Hair is stronger than Cu wire of same diameter with tensile strength of around 1.6x 10^-9 N/m²
• Hair can stretch 1/5^th of its length before break.
• 1k hair found /in² while losses 100 hair/day due to hair cycle
• Chemically hair is made up of C (50.65%); O2 (20.85%); N2 (17.14%); H2 (6.36%) & S (5%) along with Mg, As, Fe, Cr, etc. in traces.
• 7-15K hair present in man beard & in life time removed 8.4m long hair, while eyebrows contain 550 hairs
• Men remove 8.4 meters of face stubble in their lifetime
• In terms of raw elements, on average, hair is composed of 50.65% carbon, oxygen, nitrogen, hydrogen, and 5.0% sulfur. Hair also contains trace amounts of magnesium, arsenic, iron, chromium and other metals and minerals
• A weight of 5,600kg and 8,400kg can be hung from human hair bethought breaking (although your neck would not take it!).

Types of Hair Loss & their Causes

Some of the more common types of hair loss are described below, including:

Figure 1: various types of hair loss

• Androgenetic Alopecia (AGA): Male- and female-pattern baldness (most common):

When it affects women, it leads to diffuse alopecia over the mid-frontal scalp (female pattern hair loss) [1]. Miniaturization of hair follicle is responsible for it, which represents a progressive reduction in diameter, pigmentation and length of the hair shaft [2,3]. Researches supports that androgens induced it in genetically susceptible persons, which is manifested by increased 5α-reductase activity and dihydrotestosterone (DHT) levels in hair follicles. In such genetically susceptible cases, the DHT binds to the androgen receptor and the hormone-receptor complex, activating the genes responsible for the transformation of the normal hair follicle in miniaturized follicles [4, 5]. The reduction in the number of terminal fibers per follicular unit will produce a diffuse alopecia [3]. The impact of androgenetic alopecia is predominantly psychological.

·         Alopecia areata (AA) (~2%)

Alopecia areata is a nonscarring autoimmune, inflammatory scalp, and/or body hair loss condition characterized by patchy hair loss. Histopathology shows an increased number of the catagen and telogen follicles and the presence of an inflammatory lymphocytic infiltrate in the peribulbar region [6].

·         Scarring alopecia (cicatricial alopecia)

It can be caused by a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss.

• Scleroderma – a condition affecting the body's connective (supporting) tissues, resulting in hard, puffy and itchy skin
• Lichen Planus – an itchy rash affecting many areas of the body
• discoid lupus – a mild form of lupus affecting the skin, causing scaly marks and hair loss
• Folliculitis Decalvans – a rare form of alopecia that most commonly affects men, causing baldness and scarring of the affected areas
• Frontal Fibrosing Alopecia – a type of alopecia that affects post-menopausal women where the hair follicles are damaged, and the hair falls out and is unable to grow back

·         Anagen effluvium

It is the pathologic loss of anagen or growth-phase hairs. Classically, it is caused by radiation therapy to the head and systemic chemotherapy, especially with alkylating agents [7].

·         Telogen effluvium

Telogen effluvium (TE) is an increased loss of normal club hairs that occurs by a perturbation of the hair cycle, may be caused by premature termination of anagen [8]. It is proposed that nutritional deficiency, stress, fever, drugs, postpartum, hypothyroidism/ hyperthyroidism, hepatic failure, chronic renal failure, idiopathic could be responsible for it.

• Trichotillomania (hair pulling disorder), 7 times more common in pediatric population than adult, in which irregular patches of hair loss with strange borders can be observed [10].

Less common causes of hair loss without inflammation or scarring include

·         certain medications including chemotherapy, HIV/AIDS, hypothyroidism,

·         malnutrition including iron deficiency. Causes of hair loss that occurs with scarring or inflammation include fungal infection, 

·         lupus erythematosus,

·         radiation therapy,

·         sarcoidosis.

Diagnosis

Because they are not usually associated with an increased loss rate, male-pattern and female-pattern hair loss do not generally require testing. If substantial hair loss occurs in a young man or women with no family history, one should go for the following chart.

Figure 2: Testing of various hair fall

Prevention

If some substantial loss of hairs (i.e. >100 hairs after combing or bathing and >250 hairs after shampoo) occur without family history, attention on following points can be drawn:

• Eat a nutritionally balanced diet.
• Avoid tight hairstyles, such as braids, buns or ponytails.
• Avoid compulsively twisting, rubbing or pulling your hair.
• Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair.
• Avoid combing in wet condition.
• Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.
• Head massage with any natural oil and proper cleaning thereafter some time shall be helpful

Solutions

It not merely a question of treatment, discussion should be on planning to get-rid-off from problem. Nevertheless, the problem may or may not be genuine in most of cases, as it would be just a matter of perception. Therefore, prior to think of treatment, proper observation should be done. After finding some real problem, first of all think about the health condition. If health is all fine, treatment should be adopted accordingly.

Reappraisal of diet is one of most important concern as a healthy hair could grow only on healthy scalp. A healthy hair should be shiny and full of luster, because of presence of a smooth hair shaft. Thus, if there is some diversion from this fact, there is a need to think on health of hair.

 

Figure 3: medically suggested treatment plan for Androgenetic Alopecia

Figure 4: Medically Suggested treatment plan

Appropriate diet plan for healthy hairs must be assured and for this an elementary idea about chemistry of hair shall be helpful. Hair is basically made up of protein, lipid, water, trace elements and pigments. [watch this video to know about hair chemistry].

The requirement of various nutritional components and their recommended sources are given (fig. 6). In fact, this is in itself a quite big issue to deal with but some elementary components, especially recommended for hair shall be described here. The requirement of various constituents of hair and the biomolecules take part in their formation has been listed in figure (5).

One of the factor with which everyone is familiar, the protein. However only very few are knowing about exact requirement of protein’s components, i.e. amino acids and their availability in various natural sources. (FigA) or table. one of the important point that every vegetarian keep in mind that Tryptophan is an important amino acid rarely occurred in herbal sources, except Custard apple (Annona senegalensis) and cow milk so it should be taken in good amount. Briefly, there are only 11 types of amino acids out 20 standards ones are required in a definite proportion, for daily body requirement (Fig 6).

Figure 5: Requirements of various biomolecules for hair growth

Figure 6: Various sources for requirement hair

Figure 7: amount of essential amino acids for a person of 70 Kg (Source)

Alternative medicine

There is only one small trial of saw palmetto (Serenoa repens; endemic to Shawana) which shows tentative benefit in those with mild to moderate androgenetic alopecia. Ginger juice was reported to be good in alopecia, areata, but exact mechanism is yet to be revealed [11], though author have tested it. There is few evidence for biotin, niacin [12]. Evidence for most other produces is also insufficient There is no good evidence for Gingko biloba, aloe vera, ginseng, bergamot, hibiscus, or sorphora as of 2011 [12]. However, effective trails report on natural products are rarely occur. To explant it, I would like give you one example. Have anyone ever seen advertisement of barley or mays while contrary to this huge number of advertisement available on their synthetic product. Therefore, many people use traditionally claimed articles for the treatments. Egg oil, in Indian, Japanese, Unani (Roghan Baiza Murgh), and Chinese traditional medicine, was traditionally used as a treatment for hair loss. Benefits of phytochemicals of Brassica (mustered oil and leaves) in human health is established well and one of fantastic review can be seen for further study [13]. Therefore, advocacy to use as hair nourisher is still consistent.

Authors Recommendations

Prior to go for treatment plan, it is important to assure about what type of medical condition you are suffering from? Is there really any need to worry? As per researchers, loss of ~100 hairs/day is a usual phenomenon while after shampoo, 250 hairs loss is fine. A consistent loss of more than these numbers for some time, seeks attention. So first important thing should be done is analysis of hairs and scalp. Of course, you can’t see by your own but you will have a digital camera to see it without cost. After observation, a key is given in fig (2), which can be applied for treatment.

Most of cases, where it is due to hormonal therapy to have an idea that when & how can we intervene into it and up to which extent? Should the type of hair loss you are suffering, indeed deserve to seek your attention?

Accordingly, lets group the problems according to their severity.

•          Type I: you need not to seek much attention, it will usually go by its own

•          Type II: where your attention does matters

•          Type III: where even your attention will not able to make significant change & that too up to limited extent.

Maintenance of Hair

Ø  Combing should not be done in wet hairs but in dry hair, as wet hair is comparatively more fragile. A hair serum may be necessary to apply to shield your mane before using a comb or hair brush.

Ø  Shampoo is a hair care product that is used for the removal of oils, dirt, skin particles, dandruff, environmental pollutants and other contaminant particles that gradually build up in scalp & hair.

Ø  shampoos do not feed, resuscitate, invigorate or revive hair (a shaft of dead proteins). Produced by sebaceous glands in the skin, it coats and protects the hair. Unfortunately, sebum also acts as a virtual magnet for dirt and residue from hair treatment products

Ø  All-natural:

Ø  Some companies use “all-natural”, “organic”, “botanical” or “plant-derived” ingredients (such as plant extracts or oils), combining these additions with one or more typical surfactants. In India, a variety of herbs and their extracts are used as shampoos. A very effective shampoo is made by boiling soapnuts with dried Indian gooseberry (aamla) and a few other herbs, using the strained extract. This leaves the hair soft, shiny and manageable. Other products used for hair cleansing are shikakai (Acacia concinna), soapnuts (Sapindus), hibiscus flowers and arappu (Albizzia amara).

However, there is serious need to research on the exact extraction & revelation of underlying mechanism in the effect of natural products, as described in traditional medicine.  Moreover, natural products should be apply as per traditional way rather than as marketed items. 

Shampoo and conditioner:

Ø  Sulfate free shampoos are less harming on color treated hair

Ø  Shampoos have a pH of between 4 and 6 and do not contain soap

Ø  Conditioners are often used after shampooing to smooth down the cuticle layer of the hair, which can become roughened during the physical process of shampooing.

Ø  There are three main types of conditioners:

Ø  anti-oxidant conditioners, which are mainly used in salons after chemical services and prevent creeping oxidation;

Ø  internal conditioners, which enter into the cortex of the hair and help improve the hair’s internal condition (also known as treatments);

Ø  external conditioners, or everyday conditioners, which smooth down the cuticle layer, making the hair shiny, combable and smooth. Conditioners can also provide a physical layer of protection for the hair against physical and environmental damage.

Ø  Only shampoo your scalp, condition your hair.

Ø  Hair commercials may lead you to believe that sudsy shampoo should lather your locks from root to ends, but not only is this waste of shampoo, but also it’s bad for your hair.

Ø  Shampoo, by design, washes away oils, which is great for cleansing your scalp but unnecessary and damaging with regard to the lengths of your hair.
Ø  Conditioner, on the other hand, is designed to detangle, moisturize and, well condition, which is great for the lengths of your hair (especially the ends) but conditioner on your scalp leads to limp locks, a greasy scalp and makes you have to wash your hair more often.

Ø  Shampoo brand, in fact doesn’t matter at all.

Ø  Hairstylists love to say you can reduce the times you shampoo to three times a week. But if you have fine and/or oily hair, you don’t have to walk around looking dirty. Shampoo daily, but “thoroughly drench your hair with water before you lather up,” says New Orleans dermatologist Mary P. Lupo. “Then concentrate on just the hair two inches closest to the scalp, since that’s where sebum collects. And rinse really, really well under the coldest water you can stand.” Bonus: This will smooth the cuticle so frayed ends are less obvious.

Ø  For centuries, natural oils have been used to condition human hair. These natural products are still used today, including essential oils such as tea tree oil and carrier oils such as jojoba oil.

Ø  Hair conditioner is a hair care product that changes the texture and appearance of hair, which includes silicone, fatty alcohols, and quaternary ammonium compounds

Ø  Amino acid replacement shampoo and conditioner, however, this is against the fundamental of trichology

Ø  Some of the ingredients used in anti-aging skin care products, such as collagen, peptides, and sunscreens, are now found in hair care products, don’t appeal me at least to do so.

Ø  Recent research has identified three amino acids — histidine, tyrosine, and lysine – that, when added to products like shampoo or conditioners, help repair hair by restoring the amino acid balance. Likewise, though its seems true that lysine usually less in diet of vegetarians but it’s doesn’t seem arguable that amino acids can reach to shaft and penetrates to hair follicle and make it available to for translation.

Attributes go in favor & Against Hair (source)