Written by Dr. Daniela Steyn
Hair loss is a big deal. Hair plays a significant role in our sense of self. Your hair shapes who you are. It impacts your well-being. Most of the babies I had the privilege to deliver were born with hair. My children were born without hair. I loved seeing how my children’s hair changed from birth. As they grew up, their hair continued to change. My oldest now has straight hair, my second child has thick wavy hair, and my youngest have thin hair with beautiful curls. Every baby is born with different hair, according to their genes. Those genes will also determine whether they will keep their beautiful thick curls or lose them later in life. The good news is that our genetics are not the only cause of hair loss, and for many types of hair loss, there is something we can do about it.
In my family practice, I have learned over the years that hair doesn’t only affect my patients cosmetically but also has a very high psychological impact. Once I noticed the effect on mental health, I made it my mission to find out everything I could about hair loss and how to treat and prevent it.
I will discuss the four most common conditions I see in my clinic.
1. Hair shedding
The medical term for hair shedding is Telogen Effluvium. It is very common to see postpartum moms suffer from hair loss. There are multiple reasons for this; for some it may be due to blood loss during delivery, for some due to a hormonal shifts and for others due to the physiological stress that their bodies have gone through.
I commonly see hair loss in patients after they had COVID. Other causes of hair loss could be iron deficiency, thyroid hormone deficiency, infection, medication, stress, chemotherapy, after admission to ICU or major surgery (again, stress on your body). I also see it very commonly after a patient lost a loved one or went through a stressful period (as seen in my refugee patients).
I would first diagnose the root cause of hair loss by doing a thorough assessment of my patient’s history. I would ask not only about their medical and surgical history, medication, and infections but also about stressors in their lives.
During my initial exam, I always ask about the five s’s of hair loss:
Site of hair loss
Speed of hair loss
Symptoms
Supplements and medication
How much hair they are shedding
The next step is to do bloodwork. Your family physician will start by testing for iron deficiency and thyroid disorders. They might also request testing for nutritional deficiencies.
2. Androgenetic alopecia
Androgenetic alopecia happens to males and females. In males, we recognize a balding pattern easily, as we commonly see older men with this type of balding pattern. In females, it is also common, but typically, my female patients go to great lengths to hide this, so we less commonly see women with balding hair, as they will more often wear wigs/hair coverings.
3. Tinea capitis
Tinea capitis is a fungal infection of the scalp that is sometimes found in school-aged children. You will recognize this by a grey patch and dry scaling of the scalp. Your primary care provider can diagnose this by sending skin scrapings away, where the laboratory will do a fungal culture.
4. Alopecia areata
Alopecia areata is an autoimmune disorder that affects about 2% of patients. It looks like a coin-shaped bald patch on the scalp. The individual hairs are thick but then thin closer to the scalp, known as an exclamation mark morphology. We sometimes see this on other body parts such as eyelashes, eyebrows or beard hair.
5. Traction alopecia
Traction alopecia is when hairstyling practices could cause hair loss. Styles such as braids, twists, weaves or cornrows can cause this.
If you have significant scalp itching, burning, bruising, tenderness, or pain, make sure you see your primary care provider as soon as possible for a biopsy (or referral to a doctor who does biopsies). One condition we can diagnose with a biopsy is scarring alopecia.
Treatment options
Nutrition
Eating healthy foods and avoiding toxins in your diet is critical to healthy hair. You can look at ewg.org to ensure your foods and beauty products are safe. I use the Yuka app. It is an easy way to scan products, and the app shows you right away whether the ingredients are safe or not. Your nutrition can make a big difference. You can look at my YouTube video for foods to help your hair grow stronger naturally.
Aloe Vera
Flax seed
Healthy fats such as walnuts
Wild caught salmon
Supplements
Biotin helps promote hair growth, thickens your hair strands and reduces the risk of hair loss.
Niacin is also known as Vitamin B3. It plays a vital role in converting our food into energy and is great for repairing and restoring skin and hair.
Vitamin D combats against autoimmune diseases which contribute to hair loss.
Vitamin C is a natural shield against damage caused by free radicals. This also means it is great for reducing hair thinning while enhancing collagen production.
Vitamin E in the form of mixed tocotrienols may reduce hair loss.
Omega-3 assists in healthy hair growth by nourishing follicles and strengthening the roots.
Magnesium ensures hair follicles don’t get clogged.
Iron assists with hair regrowth.
Zinc supports the hair follicle and can help reverse hair loss if there is a deficiency.
Lifestyle Changes
Some lifestyle changes can help treat hair loss, promote hormonal balance, nourish the scalp, and keep the body rested and in optimal health. They include the following:
Regular exercise has been shown to help reduce hair loss. To protect already weakened hair, you may want to choose sports that do not require the use of helmets or caps for an extended period of time, such as swimming and bike riding.
Lowering stress is one of the most important treatment strategies, as high stress can stunt hair growth or damage hair follicles. Try meditation, positive affirmations, or conscious breathing.
Limiting exposure to harsh hair products and damaging styling techniques, such as blow dryers or hair straighteners, can help hair become stronger and less likely to fall out.
Quitting excessive alcohol drinking and smoking is very important in hair loss treatment as both can directly or indirectly lead to hair becoming weak and falling out.
Medication
Your doctor might prescribe minoxidil. Be patient. It takes up to six months for minoxidil to take effect, and you might experience extra shedding in the first month, where your body gets rid of weaker hair to make room for stronger hair. Avoid this when you are planning on falling pregnant. Tell other people in your household not to touch these products if they consider falling pregnant.
For people with androgenetic alopecia, this is a balding pattern of hair loss; a medication called finasteride can be very effective (in combination with topical minoxidil). Unfortunately, a large randomized clinical trial found finasteride ineffective in women with androgenetic alopecia. This is another medication pregnant women should not take or even touch.
An option for alopecia areata (the autoimmune type of hair loss) is to inject steroids into the lesion with hair loss. With my autoimmune patients, I work extensively looking at a whole body approach, addressing their immune system with diet and lifestyle.
Best wishes on your journey to beautiful hair. Whether your hair loss is so severe that your doctor diagnoses it medically or is on the spectrum where it bothers you, get help. Help your body heal by optimizing the nutrients in your diet.
Medical disclaimer: This blog is intended for educational purposes only. For your medical advice, please get in touch with your own Health Care provider. Never ignore medical advice because of something you have read on this blog.
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