Dr. Mona Mislankar on Hair Loss: Keep Your Hair On

hair loss
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One of the most common complaints I receive in the clinic, especially from the South Asian patients, is regarding hair loss. This complaint has become even more common within the last year, given the medical and psychological stressors surrounding the COVID-19 pandemic. There are many causes for alopecia (hair loss), including scarring and non-scarring processes. Two of the most common reasons we see for hair loss in the office are androgenetic alopecia and telogen effluvium.

Androgenetic alopecia refers to hormonal and genetic related hair loss whereas telogen effluvium refers more to stress-related hair loss.

Telogen effluvium is better understood by discussing the scalp hair cycle. There are four different phases, with anagen and telogen being the most relevant in this scenario. Anagen is the growth phase in which a single hair follicle can exist for two to six years, as 85-90% of our hair does. Telogen is a three-month rest period until the follicle is pushed out by new anagen hair. At any given period 10-15% of our hairs exist in this phase, however a number of stressors, both mental or physical (pregnancy, surgery, illnesses, infections, COVID – especially this year, medications, etc.) can alter this balance, causing a larger number of hair to enter this resting telogen phase. This will occur over a two- to four-month phase and involve extreme hair shedding. In a normal scenario, it is common to lose approximately 100 hairs a day. However, during telogen effluvium, one can experience losing up to three times as much hair.

The most important thing is to try to identify the cause of hair loss.

A sudden increase in hair loss is commonly due to telogen effluvium, a reversible condition in which hair falls out after a physical, medical, or emotional stressor. The hair loss usually starts two to four months after the inciting factor. Therefore, if you can recall a stressful event, rest assured that hair growth usually starts approximately six months after the hair starts falling out. Consider seeing a dermatologist if it has been over six months since the hair loss began and there are no signs of regrowth, such as a growing fringe, seen as small peripheral hairs noted on the hairline.

This is important so one can rule out any underlying causes that can cause a chronic telogen effluvium and require intervention, such deficiencies in iron, vitamin D, vitamin B12, or various hormones. The most common etiologies I identify in my South Asian patients is either a low iron level, demonstrated by very low ferritin levels, or a vitamin D deficiency.

This is usually attributed to many South Asians following a strictly vegetarian diet. Additionally, if you notice true bald patches of hair loss, consider seeing a dermatologist as soon as possible for treatments to reverse the process. Some proven vitamin supplements available over the counter include Nutrafol and Vivascal Pro and offer more benefits than only biotin, which can be dangerous if taken in high doses. I always recommend discussing vitamin supplementations with your physician. Additionally, minoxidil 5% foam, commonly know as Rogaine, can also help boost the hair growth. Prescriptions for stronger topicals can be available via a dermatologist. Platelet-rich plasma treatment by your dermatologist provides an adjunctive treatment for telogen effluvium if used along with the appropriate medical therapy.

Although it will not contribute to stress-related hair loss, some additional factors contributing to hair loss are poor hair practices, such as including too much heat via styling (blow-drying, or using straighteners or curling irons), chemicals from hair dyeing or bleaching, washing your hair too often or not enough, rough drying with towels, or brushing too harshly.

Most importantly, patience is key. If hair loss is due to telogen effluvium, it is important to know that the hair should start to grow back approximately six months after extreme hair shedding is noticed. Otherwise, gentle hair practices are crucial, such as avoiding harsh treatments that will alter the bonds of the hair, over-washing, overbrushing, and overheating the remaining hairs. Using a UV/heat protectant while styling the hair can be very helpful. Additionally, silk pillowcases have shown to have less of a drying effect on the hair and to provide less friction on the sleep surface, thus resulting in less irritation and tangling of the hair. My personal favorite is our 25 mm grade 6A 100% mulberry silk pillowcase from our skincare line, Oath MD.

Mona Mislankar, MD, FAAD, is a board-certified dermatologist. For more details, visit Dr. Mislankar on Instagram @drmislankar.

This article is for informational purposes only and should not be construed as medical advice.