Hair loss: what should be considered before deciding the treatment?

1. How much hair fall is considered abnormal ?

Excessive and prolonged shredding more than 100 hairs a day is considered abnormal and needs to see a dermatologist to fix those problems. The quick tool for estimate of hair loss per day is internationally published and attached here.

Figure1: Shedding scale short length hair; Normal hair shredding is scored 2-3. Unusual shredding is scored >3(> 100 hairs).  

Picture from: The Hair Shedding Visual Scale: A Quick Tool to Assess Hair Loss in Women. Dermatol Ther (Heidelb). 2017;7(1):155-165. 

2. Which type of hair loss do you have ? 

Dermatologist classified hair loss (Alopecia) into 2 main types; 

2.1 Non scarring alopecia (the scalp still has hair follicle opening and no scar in these types)- the most common subtype is androgenic alopecia followed by telogen effluvium and alopecia areata. 

Figure2 Androgenic alopecia 

Figure3 Telogen effluvium 

Figure4 Alopecia areata 

2.2 Scarring alopecia (the scalp has no hair follicle opening because of severe inflammatory reaction and finally turns to scar)-the most common subtype is lichen planopilaris followed by discoid lupus erythematosus and central centrifugal cicatricial alopecia. 

Figure5 Lichen planopilaris 

Figure6 Discoid lupus erythematosus 

Figure7 Central centrifugal cicatricial alopecia 

However, there are many other less common types of hair loss such as syphilis, trichotillomania, or folliculitis decalvans the required dermatologist confirmation. So, if you have hair loss, please see a qualified specialist for correct diagnosis. 

3. What hidden disorder is associated with hair loss ?  

Anemia, iron metabolism (particularly in women of childbearing age), thyroid disorders, PCOS, low-calorie and low-protein diets, pregnancy, menopausal disorders, cancer, and, particularly, chemotherapy. 

4. Which investigations do we offer to find the specific causes of hair loss ? 

  • Clinical examination 
  • Lab: nutritional check, hormone check and autoimmune check 
  • Trichoscopy(Dermoscopy) 
  • Trichogram 
  • Scalp biopsy 

5. How do we regrow the hair without the operation ? 

  • Find specific causes 
  • Medication according to the type and causes of hair loss 
  • Supplement according to nutritional evaluation 
  • Hormonal adjustment  
  • Platelet rich plasma injection 

Ref: 

– Biomedicines, 9(12), 1755. https://doi.org/10.3390/biomedicines9121755 
– Dermatol Ther (Heidelb). 2017;7(1):155-165. doi:10.1007/s13555-017-0171-8 
– Actas dermo-sifiliograficas, 104(10), 867–876. https://doi.org/10.1016/j.ad.2013.03.004

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