Learn about symptoms and causes of hair loss, self help treatment options, medication and when to seek medical help.

What is hair loss?

There are between 100,000 to 150,000 hair follicles on a human head, 90% of which are producing hair at any given time. As part of the hair’s natural growth cycle, each strand of hair grows for between two to six years, rests for about three months, then sheds. It is estimated that individuals can shed between 50 to 150 strands of hair daily. These are then replaced by new strands of hair which grow from the same follicles.

Hair loss, also known as alopecia, is a condition where hair falls out from the scalp or other parts of the body. While hair loss is usually not a major cause for concern, it can become a concern when new hair does not grow back or too much hair is lost, as that can negatively affect one’s appearance and self-esteem. 

What are the possible causes of hair loss? 

Hair loss occurs when the cycle of hair growth and shedding is disrupted, or when the hair follicle is destroyed and replaced with scar tissue. 

Some common causes of hair loss include:

• Androgenetic alopecia, commonly known as male / female pattern hair loss , is the most common cause of hair loss. It is caused by a mixture of hormonal and genetic factors. 
• Hormonal changes during pregnancy, childbirth and menopause
• Medical conditions, such as thyroid disorders and autoimmune diseases (e.g. alopecia areata)
• Infections of the scalp e.g. fungal infection 
• Side effect of certain medicines 
• Stress 
• Obsessive pulling of hair  
• Hair care practices and hair treatments such as heat styling tools, tight hairstyles and chemical treatments
• Lack of nutrients such as iron, protein, biotin, omega-3 fatty acids, zinc and certain vitamins

What are the symptoms of hair loss?

The presentation of hair loss may vary depending on its cause. Most commonly, male pattern hair loss presents as receding hairlines at the temples, and then baldness on the top of the head. Female pattern hair loss usually presents as hair thinning throughout the whole head, without specific bald spots. For less common causes of hair loss (e.g. alopecia areata), baldness can present as sudden patchy hair loss.

What can I do to treat Hair Loss?

Hair loss can be treated with the following:

• Supplements, such as biotin (Vitamin B7) may help with hair loss if you are suffering from biotin deficiency. They have no proven efficacy in hair growth of healthy individuals
• Minoxidil, which is available as a topical solution, lotion or foam. This treatment can be obtained over-the-counter at pharmacies. It works by increasing blood flow and stimulating hair follicles to grow. In the first few weeks of usage, more hair loss may occur. Improved growth usually occurs after at least 2 to 4 months of continuous use. However, it is only effective for as long as it is used. Once treatment is stopped, hair density will return to pre-treatment levels within 3 to 4 months.
• Finasteride, a prescription medication
• Hair transplant surgery
• Laser therapies

When do I need to see a doctor?

Only male and female pattern hair loss can be treated with over-the-counter medications. Consult a doctor if you:

• Are under 18 or over 65 years of age
• Are pregnant or breast-feeding
• Are on certain medications e.g. blood thinners, cholesterol-lowering medications, oral retinoids, seizure medications, blood pressure medications
• Have no family history of hair loss
• Have sudden, unexplained, or severe hair loss
• Have patchy hair loss
• Have recently discontinued your oral contraceptives
• Have total baldness or complete loss of all body hair
• Have hair loss related to dietary deficiencies, medical conditions and/or treatment
• Have changes in hair textures or colour e.g. broken hair shafts
• Have a scalp that is red, inflamed, irritated, infected, itchy, painful, scaling, sunburned, or has broken skin
• Have changes in nail formation or growth
• Have loss of eyelashes or eyebrows

What else can I do to manage this condition?

Preventative strategies to minimise hair loss include:

• Healthy lifestyle: Exercise regularly and stay hydrated to improve blood circulation to the scalp; Eat a balanced diet rich in protein, minerals and vitamins to promote hair health
• Gentle hair care: Avoid excessive heat styling, harsh chemicals and tight hairstyles; use gentle shampoos and conditioners, and wash your hair regularly to keep your scalp clean
• Stress management: Practising relaxation techniques such as yoga and meditation can help reduce stress. 
• Protective measures: Apply sunscreen on your scalp or wear a hat when exposed to the sun for prolonged periods. This can prevent sunburn and potential damage to your hair follicles.

Disclaimers

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

 The content above is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always speak with your physician, pharmacist or other healthcare professional before taking any medication or supplement, or adopting any treatment for a health problem.