Educational topics for laymen loosing hair (by Dr. A)

Stay out of the Sun (UV rays harm hair)

As soon as summer sets in, the mind wonders about the extreme heat and the effect it has on our hair. As hair is very important for our self-confidence, hair loss or any type of hair damage is not considered good.


The damage caused by the sun is due to the evaporation of the natural oils. These oils take away moisture and natural shine of hair. So, it becomes dry and brittle - damaging the protein bonds and reducing the strength, shine and flexibility of the hair leading to split ends. Cutting the long tresses of hair seems the only solution. Or, regular oiling twice a week with Bringhraj oil may seem like a solution.

But stop …there is another culprit that even regular hair oiling cannot protect you from.

This unknown damaging agent lies in sunlight. Its UV rays.

Research shows that direct exposure to ultraviolet rays actually damages hair causing hair thinning and hair greying.
Hair protein degradation is induced by wavelengths of 254-400 nm of UV light. Absorption of radiation by photosensitive amino acids of the hair has adverse impact on hair proteins, especially keratin.
Melanin, a hormone produced in pituitary gland in brain imparts color to the skin and hair as well.
It can partially immobilize free radicals and block their entrance into the keratin matrix.

Melanin also absorbs and filters adverse UV radiations. Therefore, melanin is important for direct and indirect protection of hair proteins.

So, go ahead buy a cap or put your chunni on whenever you go out into the sun.

Dr A

Words of advise for young hairloss sufferers

Anyone losing hair can be prone to anxiety. The first thing they want is to DO something for it. Its not about whether the treatment is going to help or not. Its more about feeling that one is actively doing something for his hairloss.

This is an innate human characteristic and many “snake oil dealers” and unethical practitioners try to cash on this.

Do not rush into any treatment.
Whether you are 20, 40 or 60 years of age, the first thing for you to do is to write down the following things. (This is what we ask from our patients too).

  1. What is your current age?

  2. What is the extent of hairloss male members on both sides of your family experienced? (Does not matter what age they reached that level of hairloss).

  3. What is the current speed of your hairfall? (slow, moderate or rapid).

  4. Have you taken some good clear pictures of the extent of your hairloss? Most people do not like taking pictures that show them in an unflattering light. However, pictures are important. Both for your future doctor as well as for you to gauge your speed of hairloss.
    Take clear pictures, preferably with a good digital camera. Do not use flash while taking the pictures. Flash distorts the picture and it becomes difficult to evaluate the real situation.
    Take pictures in indirect natural daylight. You may take them standing in the balcony or near an open window on a bright sunny day.
    Take pictures with the hair combed back (no combovers, this has to be your moment of truth with yourself). Front view and side view must include till atleast the eyebrows.
    The top view must include the complete head (both ears included).
    Back view and a view of the donor area of the scalp with the hair parted.
    These pictures are your baseline.
    Now repeat the same exercise at regular intervals. Once every 2 months will be fine.
    Whenever you have to gauge your speed of hairfall, or the benefit you recieved from any mediation, this photographic record will be of help.
    Many people think that they can gauge their hairfall or restoration by just looking in the mirror. That is a mistaken notion.
    Now that you have completed taking some pictures, repeat the entire exercise with you hair wet. (Not dripping wet, just a wet comb will be sufficient). This will highlight areas where thinning may have just started.

  5. Have you consulted your family physician or an unbiased physician about the cause of your hairloss? Do so. They may not be very experienced or sympathetic but they will be able to rule out any major factors leading to your hairfall.
    Hairloss need not always be a DHT influenced pattern hair loss.

  6. Does anyone in your family or friend circle suffer from hairloss? If yes, talk to them about their experience. They have already travelled some of the paths that you plan to follow. Their experience may benefit you.
    Once you have this list, you have reached the starting point of doing your own research on something that is bothering you.
    This is your first active step.

Dr. A

How to stop HAIR FALL in monsoon

Monsoon has come and you have been waiting for this season from a very long time. But unfortunately some of us can’t take joy of pretty monsoon and avoid to play under rain due to increased hair fall in this season.

The most common problem during monsoon season is hair fall. Especially, in cities with high air pollution, toxic smog etc. All these lead to additional adverse effects on hair.

With first ever rain of a season, all those air pollutants mix with rain water and fall on earth’s surface. Also high-on-humidity weather is the main reason for hair breakage and fall. In this weather, your hair absorbs hydrogen, breaking di sulfide bonds leading to the smooth cuticle opening up and causing hair to be frizzy. So, just think before while having a rain bath.

However, you can take care of your hair by doing some simple and small DIY tips at your home.

1. Drink Plenty of Water

In this rainy season drink at least 2-3 ltr of water daily. Water helps clear off your body toxins. You may drink boiled water for best results.

2. Use Aloe Vera Gel

Aloe Vera can be used to treat dandruff, split ends and hair fall problems in any season. Massaging Aloe Vera gel into the scalp is also helpful.

3. Cut Caffeine

Excessive caffeine intake leads to dehydration which is another key reason for hair loss.

4. Oil & massage your hair

Oil your hair but massage gently to avoid breakage. Once or twice a week is good for nourishment, but doing it more often is not recommended, as your scalp is already oily due to the weather.

5. Shampoo Daily

You can wash and condition your hair as soon as you get home. Regular shampooing won’t lead to hair loss or dry scalp, provided you use a mild shampoo and apply liberal amount of conditioner after rinsing the shampoo.


6. Methi Seeds

Methi, also known as fenugreek, contains hormone antecedents which help revitalize damaged hair follicles. This makes hair strong and immune to damage.

7. Switch to healthy diet.

Add fresh fruits, leafy vegetables, wholegrains and protein-rich foods to your plate to tackle hair fall in the rainy season.

8. Keep your hair dry

Always gently dry your hair first and then comb it with a wide-toothed comb. Avoid using heated hair equipment.

9. Avoid Smoking:

Smoking cigarettes reduces the amount of blood that flows to the scalp and this causes a reduction in hair growth.

10. Physical activity

Make time for physical activity every day. Walking, gymming and swimming for 30 minutes a day helps balance hormonal levels, reduces stress levels besides reducing hair fall.


All above Image Sourced from : Google search

Don’t let Dandruff let you down!!

Dandruff is a skin condition that mainly affects the scalp. Symptoms include flaking and sometimes mild itchiness. It can result in social or self-esteem problems. A more severe form of the condition, which includes inflammation of the skin, is known as seborrheic dermatitis.

Dandruff affects about half of adults. Onset is usually at puberty. Males are more often affected than females.


Dandruff is often worse during the winter months and better when the weather is warmer. Certain hair care products can trigger a red, itchy, scaling scalp. Frequent shampooing may cause dandruff, as it can irritate the scalp.


Causes include dry skin, seborrhoeic dermatitis, not cleaning/scrubbing often, shampooing too often, scalp psoriasis, eczema, sensitivity to hair care products, or a yeast-like fungus. Dry skin is the most common cause of flaking dandruff.
According to one study, dandruff has been shown to be possibly the result of three factors:

  1. Skin oil commonly referred to as sebum or sebaceous secretions.

  2. The metabolic by-products of skin micro-organisms (most specifically Malassezia yeasts).

  3. Individual susceptibility and allergy sensitivity.

  4. Ringworm, or tinea, refers to several types of contagious fungal infections of the top layer of the skin, scalp, and nails. (Ringworm is caused by a fungus that eats keratin, a protein found in skin, hair, and nails).

Facts about dandruff.

  1. Dandruff occurs in 50% of adults.

  2. It is not just skin flakes. It is a fungal infection.

  3. Commonly causing fungi is Malassezia furfur (previously known as Pityrosporum ovale)

  4. Dandruff does not cause baldness.

  5. The common way of transmission of dandruff is through using shared things. Just as you do not share your toothbrush, similarly you should not share your comb/brush.

  6. So stay cool and if required use these medicines:

Ketoconazole (Nizoral) shampoo: shampoos use a combination of special ingredients to control dandruff.

Ciclopirox: It is widely used as an anti-dandruff agent in most cases.

Coal tar: It causes the skin to shed dead cells from the top layer and slows skin cell growth.

(Terbinafine (Lamisil),

Griseofulvin (Grisovin),


Shaving a child’s head: There is no evidence that this reduces ringworm infection or accelerates recovery time.

  1. And let no one no matter how big a post, don’t ever let a celebrity shrug off dandruff from your shoulder!

Why are men loosing hair in their 20’s?

Our ongoing research shows that people are losing hair 10 to 15 years before compared to their grandparents.

The main reason behind this is the toxins absorbed through the skin and scalp.

This started in the 1970’s. When MNC’s started putting toxins in body care products (shampoo, soap, make up items etc).
Below is the proof. Hope you benefit from it.

How can we get more Melanin on our hair? Are there Melanin shampoos or topicals that we can apply to our hair?

Is my hair loss genetic?

This is another oft-asked question.
Many people want to believe that their hair loss is due to a disease and will be reversed completely by curing the disease.

That may be the case in some. Unfortunately, not in all.

I have found an easy way to help differentiate and explain the type of hair loss is by understanding the concept of pattern hair loss.

Androgenic alopecia or the commonest form of balding follows a pattern.
The hair loss starts in the temples, hairline and/or the crown. There will be variations, but it almost never effects the sides and the back of the scalp

Diseases usually do not follow the same pattern.

Some diseases where you may experience hair loss but which are not androgenic alopecia are -

  • Alopecia areata, globalis and universalis . For further reading see this link

  • Psoriasis . Additional pictures and information is available at

  • Hormonal imbalances (especially thyroid).

  • Lichen planus. Additional information and pictures available at

  • Post chemotherapy, or due to injury (burn, surgical or accidental)

  • Trichotillomania. Additional information about this unusual condition can be found at

  • Traction alopecia (due to sustained and long-term traction on the hair roots). Two commonest subgroups affected by this are Black women wearing tight braids and Sikh gentlemen wearing hair tightly under their turban.

There are many more rarer causes and maybe veteran readers will be able to add them to this thread. But to keep this short, I will desist. Sufficient that you get a brief idea of the types of hair loss.

A good first step is to contact your family physician as the first step. He should be able to rule out or advise tests for hair loss due to reasons other then androgenic alopecia.

Some necessary definitions patients should know (Anagen, categen and telogen)

Anagen, categen and telogen
Hair growth cycle is divided into 3 phases. Anagen, catagen and telogen.


Recent advances have added more stages/phases but for ease of understanding, I am limiting this discussion to easy to understand simple stages.

The active growth phase is called anagen. During anagen, cells in the root/hair buld divide mitotically to add to the hair shaft.

During catagen, the hair bulb ceases to divide and starts involuting and regressing. Catagen phase starts at the beginning of involution and ceases when the involuting bulb reached the level of the bulge.

Telogen is the resting phase of the hair. The hair ceases all activity and stays as a club hair. It may shed at any time from the beginning of the telogen to the time new angen phase commences.
The event at which the telogen hair sheds is called exogen.

Exogen need not be at the time of the start of the next anagen. Effects like traction, trauma may bring it earlier on in telogen.
The various phases of the hair growth cycle differ in different hair (scalp, nape, body, beard hair etc. have different duration of the various phases).

For a present, we concentrate on the scalp hair.
Anagen lasts for anywhere between 2 to 6 years. Catagen for 2 to 4 weeks and telogen for 3 to 5 months.
As a thumb rule, we can say A:C:T is 3yrs:3weeks:3months.
In scalp hair approximately 85% hair are in anagen, 12 to 14% hair are in telogen and 2 to 4% hair in catagen.

Dr. A

Pain in hair transplants

� I want to know on a scale 1 to 10, how painful is hair transplant with 10

� being the most painful? The pictures I see on this board look horrifying
� as if someone is being stabbed thousands of times in the head.

I think this question would be best answered by patients who have already got the procedure done.

However, in brief -

  1. Injections of local anaesthesia are given in the donor and recipient areas to render them numb/ pain-free. So, the actual surgical procedure itself is pain-free (even though it may look messy or horrifying in the pictures).

  2. In strip FUHT, the sutured donor area will be tender after the effect of anaesthesia wears off at the end of the procedure. Painkillers are prescribed for the same for 5 days.

  3. The recipient area is usually pain-free at the end of the procedure.

  4. The donor area of FUSE/fue is usually pain-free even after the effect of anaesthesia wears off. There may be minor discomfort or soreness for a couple of days. Most patients do not feel the need of painkillers after a FUSE/fue procedure.

Evolution of hair transplants and some myths

For sake of convenience, I shall summarize the evolution of hair transplants from the 1950s.

1. Plug grafting - 4 to 5mm hair root bearing plugs were excised from the permanent donor area at the back and sides of the scalp and transplanted to the bald scalp, where they sprouted hair.

2. Minigrafts - 4mm plugs were bisected into 2 to 4 pieces. These were called minigrafts. They were transplanted in front of the 4 mm plugs to reduce the visible pluggy effect.

3. Micrografts - The plugs (or strip in some cases), were dissected into 1 to 2mm pieces containing 1 to 4 hair. These were called micrografts

4. Open shotgum harvesting v/s strip excision - Somewhere between the 1970s to 1990s, the open shotgun harvesting was gradually abandoned and replaced with suturing close the extraction site. Gradually the extraction was done in form of a strip.

5. Follicular unit dissection - The grafts were dissected under microscopes in their naturally occurring groupings called follicular units.

6. Follicular unit extraction - Individual follicular units were extracted from the scalp donor area. This did away with the necessity of a suture closure. The extraction tools and sites gradually became smaller.

  1. Body hair to scalp transplants gave valuable additional donor hair eventually reaching a stage where the most robust beard donor hair could be harvested and transplanted.

  2. All along this time in past about 15 years the number of follicular units that could be transplanted increased. This led to larger transplant sessions giving better hairline designs.

The myths or missteps along the way I shall write down separately.

Dr. A

Reducing post operative pain in strip FUHT procedure

Dear forum readers,
Pain and tenderness in the strip donor area, especially on the night immediately after the procedure has been performed, is a concern for some patients.


It is a good idea to inject the suture line with Injection Bupivacaine toward the end of the procedure. Bupivacaine is a long-acting local anaesthetic and very helpful in numbing the area overnight. Usually, 1ml is sufficient to lightly infiltrate the entire suture line in a full-length strip wound.

Please do discuss this with your hair transplant doctor before going for the HT.

Dr. A

Hair loss need not always be baldness/androgenic alopecia

Dear forum readers,
I sometimes come across patients suffering from hair loss due to causes not as common as androgenic alopecia. Recently I came across another example of hair loss - this one due to Lichen planopilaris.

In most of the instances, I have found that the majority of the medical community is as clueless about the causes and treatments of the less common forms of hair loss as the general population. It is vital that these forms of hair loss be discussed too. It’s also important to know when (and if ever) hair transplant can be an option for them.

I shall devote the next few posts to these topics. Please feel free to join in the discussion with questions, comments, experiences and suggestions.

Dr. A

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Alopecia areata (& alopecia totalis and universalis)

Alopecia areata occurs in 0.1% of the human population. However, in absolute terms, even that 0.1% is a huge number.

Alopecia areata is diagnosed clinically as a smooth patch on the scalp. Hair is usually lost in a matter of days.
It is thought to be an autoimmune disorder - that is, the body’s immune system starts attacking its own hair follicles in a particular area. Why that happens, and only in a particular area, is not known.

In most cases , especially, if the patches are small, they heal on their own. In other cases, steroids have been tried (orally, topically or as intradermal injections) with mixed results. However, the adverse effects of using corticosteroids on a long-term have to be weighed in when deciding to use them.
It has been observed that psychological stress aggravates this condition. However, that is an anecdotal finding.
In the healing or regrowth phase, it’s noted that the hair that grows back is initially non pigmented and thinner. Later, it regains its pigmentation and diameter.

In rare cases, the hair loss may spread to the complete scalp. Then it is called alopecia totalis.

If hair is lost from the complete body, including eyebrows, nasal and pubic hair, then it is called alopecia universalis.

Hair transplant is NOT a treatment for alopecia areata. The only rare situation in which transplant may be performed is if there is a stable, small patch that is not spreading (for atleast 1 year) and has been resistant to medical treatments.

More information about this set of hair loss condition can be found at click here

Dr. A

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Psoriasis and hair transplants

Scalp Psoriasis

Please remember scalp Psoriasis does not cause permanent balding.

It may lead to a temporary hair shedding in the psoriatic patches. However, upon remission, the hair grow back in those plaques.

When planning a scalp to scalp HT, it’s prudent to first treat any Psoriatic patches.

Psoriatic patches, most commonly, develop in the back of the scalp (donor area), though may occur as discrete patches in almost any part of the scalp.

Treatment of psoriasis in the scalp presents its own unique problems.

  1. The hair covering the psoriatic plaques, prevent adequate sun exposure. Sunlight exposure , in form of UV light, is a known treatment for Psoriasis.

  2. The presence of hair make application of many topicals difficult and messy.

  3. Scalp psoriasis may be overlapped by seborrhoeic dermatitis.

Scalp care -
Keeping the above things in mind, the following is a suggested scalp care regimen.

  1. Go for a buzz cut , if possible. That will help by more UV exposure to the affected area and will make application of topicals easier.

  2. Coal tar and Ketoconazole shampoos . Remember that medicated shampoos need to be massaged into the scalp and left in for a longer time. We recommend that you wet your hair first, apply the shampoo and leave it on for 10 minutes before rinsing it off.

Coal tar shampoos are sufficient for starting treatment for most scalp psoriasis patients. Ketoconazole can be added if the psoriasis is accompanied with seborrhoeic dermatitis (also called Sebo-psoriasis) and/or fungal infections.

Use these shampoos twice a week. For people who do not like the smell of these medicated shampoos, post bath, they can shampoo again with a non medicated shampoo of their choice, followed by a conditioner. That should take care of the smell issue.

For those suffering from more severe psoriasis, use of topicals may be required.
Topicals may be in form of steroids (Diprovate lotion is easier to apply as it is alcohol based instead of cream/oil base) can be used to alleviate the itching. Prolonged use of steroids should, however, be avoided. Its best to use them intermittently.

Coal tar creams, salicylic acid creams and Coconut oil compound ointment are more effective (though messy). Apply these creams by rubbing them into the plaques. Wait for 1 hour and then shampoo them out. Or, apply them before bedtime and leave them overnight. Wash the next day.

Resistant or difficult to treat psoriatic patches may require Dithranol,
Calcipotriol, phototherapy and oral medications.

Please remember that all treatments mentioned above must be taken under proper medical supervision.

It’s best to go for a hair transplant procedure once the psoriasis is under control.

Dr. A

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Baldness / Hairloss in women - some basic information

In recent months there has been a lot of enquiries on this topic. So I compiled a basic shortlist.
Please do not hesitate to add to the list of causes and possible treatments. I have kept this simple though there do exist other complex and rare conditions that may be causative factor.


Baldness / Hairloss in women
Hairloss is becoming increasingly common in women compared to previous decades.
Some of the common causes of such hairloss / baldness are :

  1. Hormonal �Any changes in female hormone levels can lead to increased hairloss. This can happen in conditions like menopause, surgical removal of ovaries, thyroid problems or sometimes due to prolonged oral contraceptive therapy. Correction of the hormone levels is usually sufficient to treat this type of hairloss.

  2. Telogen Effluvium (T. E.) � T.E. is a medical term which means that a lot of hair go into resting/ dormant phase at the same time. Therefore, a lot of hairloss is noticed. The most common incidence in T. E. is seen approximately three months after child birth. This is further aggravated by the stress and insufficient diet that ladies usually resort to nowadays to reduce their weight after child birth.

Other common cause of T. E. is extreme dieting. The good news is that if corrective measures are taken hair lost will grow back.

  1. Female Pattern Hairloss (also called Androgenic Alopecia) - This is genetic in nature and is usually noticed in successive generations. In this type, hair is usually lost from the central part area. Medical measures are rarely effective for this type of hairloss. Hair Transplant however can be performed in such case to get growing hair into the balding area does increasing its density.

  2. Use of harsh chemicals e.g. for hair straightening, coloring can cause hairloss.

  3. Traction alopecia � This refers to hairloss due to continuous traction/pull on the hair. This occurs if hair are tied very tightly e.g., in beads or due to use of hair extensions. Hair transplant can be used to regrow hair in such type of hairloss but the underlying cause should be removed.

Dr. A

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Customisation of hair transplants as per the patient requirement

Dear forum readers,
This is another often overlooked aspect of hair transplants.

One must spend time with the person and ask him/her what they want. This is one question I ask my patients and they are usually surprised.

Dr. A - What do you want?
Pt - Of course, I want hair.

Dr. A - I need to know

  1. what bothers you most about your hair,
  2. your priorities in terms of the different areas of hairloss,
  3. the sort of hairline you want
  4. Depending on how much donor you have, how much do you want to use right now given your age and your family predisposition to further hairloss.

Pt - You are the doctor, I guess you are the best judge.

This is where I stop. Remember, as a hairloss sufferer and as a recipient of a hair restoration, you are the one who is going to look at the results everyday in the mirror.

To one person, the bald crown may be more bothersome while another may want a really youthful hairline even if the crown is bald or thinning.

This personal psychological aspect is something that you as a patient must communicate to your HT doctor.
Even better, see multiple results, search for a person with hairloss and hair characteristics similar to yours and the resultant transformation and point it out to your doctor that this is what you want. If it is something he feels unrealistic or not possible for you, he will say so. If not, then atleast you will look in the mirror and be able to think that … yes, this is what I wanted (not that this is what my HT doctor thought best for me).

Dr. A

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Graft estimates

Dear forum readers,
Graft estimates is another important topic for patients researching HT options for themselves.

How does the doctor give graft estimates for a patient?
The wrong way to do this is to limit the graft estimates to the number of grafts the doctor/clinic can perform e.g., I have come across Norwood 6 level of baldness patient given graft estimates of 2500 grafts at some clinic.

What is happening in this scenario?
At best, there is a miscommunication. The doctor maybe telling the patient that 2500 grafts is the total number of donor grafts he can perform for the patient. The patient on the other hand may tend to believe that 2500 grafts will give him good coverage (maybe even a full head of hair).

So for the prospective patient it is important to keep the following information in mind -

The full non balding adult scalp has average 100,000 hair follicles (or 40,000 follicular unit grafts).

The numbers may differ among different races. The blond Caucasian have higher number of total follicular unit grafts while on the other extreme are the negroid and the Oriental/fast east people.

Nevertheless, one gets a base idea.

Now, if you look in the mirror and see that half the original hair have succumbed to the effects of male pattern hairloss (hair have vanished/miniaturised); you would realize that the number of follicular units lost is approximately 20,000 (half of the original 40,000).

2500 or even 5000 follicular unit grafts are not going to return the original head of hair back to you.

What you will need to do is sit down with your doctor and devise the sort of hair restoration you plan. Depending on the HT doctor’s philosophy and capability, he should let you know the total number of fu grafts available for transplant at his hands.
Then he will let you know what he can accomplish with the said number of grafts.

If what he can accomplish is alright with your expectations, go ahead.

Else, you will atleast be clearly in the picture and may decide that HT is not worth the trouble for you.

There is more on this topic but that for later.

P.S. - meantime, you may like to research about how much total donor fu grafts YOU have available for use.

Dr. A

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BHT - the preshaving protocol

Dear forum readers,

A larger %age of hair follicles are in resting/ non-growing phase on the body donor areas.

It is advisable to use only the actively growing hair for transplant.

Preshaving the body donor areas is a simple, non invasive method to locate the actively growing hair.


Please note - The body donor areas should be wet shaved with a razor (trimming with a hair trimmer alone will not suffice), 3 to 5 days before the procedure.

If you have very dense and long hair growth, you may first buzz cut the hair with a trimmer, followed by shaving the hair flush with the skin using a razor.

The duration of the anagen/telogen phase plays an important part overall, while the %age of hair in telogen gains increasing importance with each passing hair cycle.

Talking of durations -
Following is an extract

Hair Growth Tables
There are many factors that affect individual hair growth. These growth tables should only be used as a very generalized guide.

Telogen (%) Anagen (%) Duration of Activity

Scalp 15/ 85/ 2-6 years
Eye Brows 90/ 10/ 4 - 8 weeks
Cheeks 40 - 50/ 50 - 60/
Beard (Chin) 40/ 60/ 1 year
Moustache 45/ 55/ 16 weeks
Arm Pit 70/ 30/ 16 weeks
Pubic Area 70/ 30/ months
Arms 80/ 20/ 13 weeks
Legs & Thighs 80/ 20/ 16 weeks

Carl W. Bushong, Ph.D., LMFT
Richard A. Martin, Jr., M.D., FACEP
Kimberly L. Westwood, CPE, CCE
et al.


While the scalp donor hair have a growth phase of, an average, 3 years, most body hair have a growth phase lasting approximately 4 to 5 months.

Therefore, unlike scalp to scalp transplants, BHTs will show a marked cyclic variation.

Also while 85% of the scalp hair are in growth phase at any particular time, 40 to 80% of the body hair may be in telogen (non growth phase).

Thus, the significance of the Preshaving protocol.

Dr. A

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2 effluviums - a must read

Dear forum readers,

There is Anagen effluvium and telogen effluvium.
Both of these are not classic male pattern baldness. However, its very important to understand about them.

A lot of hair loss happenings/coincidences can be explained if these 2 are understood.

First, we shall talk about telogen effluvium


Telogen effluvium (TE) In animals, hair/fur goes into synchronized telogen and are shed. This is called telogen effluvium. It occurs in humans during phases of extreme stress, malnutrition, post pregnancy or when under certain drug therapy. For telogen effluvium to occur a significant proportion of hair have to switch from anagen to telogen at the same time. The hair are shed 2 to 3 months later .
Telogen effluvium may be acute or chronic. When hair sheds persistently for more then 6 months, its termed chronic. Chronic telogen effluvium is more common in females.
Acute Telogen effluvium is seen in many infants as a band of hairloss around the occiput that occurs 2 to 3 months after birth.
In order for a large number of hair to simultaneously switch from the anagen phase into the telogen phase, the body has to undergo some systemic injury .
There is usually a lapse of 2 to 3 months between the inciting cause and the hair shed. Therefore, it is often difficult to identify the exact cause in many cases.
A telogen effluvium is not caused by topical medications . But because there is a required time lapse of several months between the inciting cause and the excessive shedding of hair, the exact cause of the telogen effluvium is often not positively identified.

Hair shed is known to occur 2 to 4 months after pregnancy. This can be considered a classic example of telogen effluvium.

Other suspected causes of telogen effluvium include menopause, severe illness, job change, crash diets, major surgery, severe bloodloss, heavy metal poisoning etc. Hyper and hypothyroidism, SLE, end stage renal disease are other reasons. Medications, including anticoagulants, anti inflammatory agents, retinoids, calcium channel blockers etc. are some known causative factors of TE.
In all cases, the common factor is some form of physiologic stress several months before the hair shed.

Diagnosis 1. Hair pull test : Hold a bunch of hair between the thumb and fingers and pull firmly. Unlike in normal conditions, where 2 to 4 hair may shed, one notices a high number of hair coming out. Usually between 20 to 30. This test will be positive even in the scalp areas resistant to pattern hairloss, like the occiput area. At the same time, note that there are no slick bald patches like in alopecia areata.
The hair that get pulled out in the test will be club hair.
An obvious history of an inciting cause and the time frame between the physiological insult and the actual hair shed is usually sufficient to clinch the diagnosis.
A biopsy is usually not required.

Treatment Telogen is actually a variation of a normal hair shedding process, which occurs prematurely and in a synchronized manner in TE. Therefore, there is little in way of treatment except reassurance.
One must eliminate or treat the inciting physiologic event. Assuming there is no repeat of the physiologic insult, the hair should get replaced in 6 to 12 months.
In certain cases, telogen effluvium can coincide with early stages of Male pattern hairloss. In such cases, the hair that replace the shed hair may be miniaturized, giving the impression that the inciting physiologic event gave rise to male pattern hair loss.
Hair transplant is not recommended treatment for Telogen Effluvium.

Dr. A

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Testing for local anesthetic sensitivity


Dear forum readers,

It is a vital small detail.
In case you have not had local anesthetic ever in your life (or in recent years), a test dose of local anesthetic should be performed before the start of your procedure.
While relatively rare, Xylocaine (local anesthetic) sensitivity is something your treating doctor should watch out for.

Dr. A

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