Hair Fall: Causes, When to See a Doctor and What Helps

You notice it in the mirror at 22. The hairline has pulled back at both corners, and the comb collects more hair than before. The usual next step is a search online, a promising advertisement and a new shampoo.

Dr Vaishali Makwana, an MD in Skin and VD who practises at Sparkle Skin Hair and Cosmetic Clinic in Surendranagar, sees this often. Here is what she says is worth knowing before you experiment.

Why is hair thinning so early, and when should you see a doctor?

Dr Makwana says many young people now show frontal hairline recession, where hair is lost from the two corners of the forehead. The medical term is androgenetic alopecia. In her view, lifestyle is the main reason. Today's diet is not rich in vitamins, sleep is poor, routines are disturbed, and addictions such as smoking add to the problem. She notes that the lifestyle of our parents' generation was very different.

She gives simple signs for when to get checked:

• Women: losing more than 100 hairs a day.
• Men: the scalp becomes visible, or the frontal hairline starts receding.

In either case, she advises consulting a skin doctor and not waiting.

Does biotin fix hair fall?

Many people order biotin online on their own. Dr Makwana says supplements are needed in hair fall, but only the right ones. The doctor first has to find the cause. Low haemoglobin, low vitamin B12, thyroid problems and diabetes can all be behind it.

Her example: if a person's haemoglobin is very low, no amount of biotin will improve hair fall until the iron deficiency is corrected. Someone with low B12 may need B12 injections before hair fall improves. As she puts it, the scenario differs from case to case.

Oil, shampoo, dandruff and water: what to know

Oil. Dr Makwana explains that oil reduces dryness and keeps hair moist, and massage increases blood circulation in the scalp. But it is not a medicine. Hair fall can have many causes. A fungal infection of the scalp, for example, needs entirely different treatment, and oil cannot cure it. Her advice is to apply oil along the length of the hair once to three times a week, leave it for a few hours and wash it off. People with dandruff, an itchy scalp or acne should avoid oil massage, as it can worsen dandruff.

Dandruff. After the age of 12 to 15, hormones activate the oil glands of the scalp. More oil is produced and fungus grows, causing greasiness and scaling. It tends to increase in winter, when the air is dry. Dr Makwana treats it with an anti-dandruff shampoo along with an antifungal lotion applied to the scalp.

Shampoo technique. Apply shampoo to the scalp first and massage it, so dirt, fungus and flakes loosen. Then spread the foam along the length of the hair. People with an oily scalp may need to shampoo often, while those with a normal scalp can manage once a week.

Water. In her area the water is salty and hard. She says this dries the hair and can leave skin dry, dull and rough. With softer water, such as the Narmada water that reaches Surendranagar, scalp, hair and skin stay softer and wash more easily. She adds that the pH of water also has an effect.

What are PRP, GFC and mesotherapy?

When simpler measures do not control hair fall, people often turn to these procedures. Dr Makwana describes them as she uses them.

• PRP: The patient's own blood is drawn and spun in a machine to separate platelet-rich plasma. This is injected across the scalp, from the hairline up to the vertex, usually in monthly sessions. She says it helps reduce hair fall, supports new growth and helps preserve transplanted hair. Because it uses the patient's own blood, she says reactions do not occur.
• GFC: A more purified version of PRP, with growth factors already included. The process is the same but the kit is different. She says the results are better than PRP, and most clinics now use GFC.
• Mesotherapy: No blood is taken. Ready-made peptides, meaning growth factors, are injected directly.

She says she has done these treatments for many years and has not seen side effects. Whether any of them suits you is a decision to make with your own doctor.

Herbal shampoo claims and cheap hair dyes

Dr Makwana calls the belief that a herbal or natural shampoo will grow hair a complete misbelief. No shampoo is automatically safe. If one causes irritation, more hair fall, a very dry scalp or frizzy hair, it does not suit you. Do not trust a brand's claim that a product is 100 percent safe.

On hair colour, she says that if you have no allergy, you can dye your hair. But she is firm on two points. Use a good brand and have it done in a professional salon.

She warns against the cheapest pouch dyes. In her experience, they contain a chemical called PPD in high amounts. A tell-tale sign is a jet black result. She says these can cause allergy and hair fall, and sometimes even hair that was black turns white. Her advice is to delay colouring for as long as you can.

The same applies to products sold as "natural henna". Real henna gives a red or brown shade. If the result is black, the pack may contain PPD, and the ingredients are often not listed properly. She says the word "natural" on the front is one thing, and the ingredient list is another, so read the list.

Key takeaways

• Early hairline recession is common, and Dr Makwana links it mainly to lifestyle: diet, sleep and smoking.
• See a skin doctor for more than 100 hairs lost daily (women), or a visible scalp or receding hairline (men).
• Biotin will not fix hair fall caused by low haemoglobin or B12. Find the cause first.
• Oil moisturises but does not treat hair fall, and should be avoided in dandruff.
• Hard water can dry hair and skin.
• Be wary of "natural" claims and cheap pouch dyes. Check ingredients.

Common questions

How many hairs lost per day is too many?

Dr Makwana says women who lose more than 100 hairs a day should start treatment. For men, the warning signs are a visible scalp or a hairline that is receding. In both cases she advises seeing a skin doctor.

Should I take biotin for hair fall?

Not on your own. Dr Makwana says the right supplement depends on the cause, such as low haemoglobin, low B12, thyroid problems or diabetes. If haemoglobin is very low, biotin will not help until that deficiency is corrected.

Does applying hair oil stop hair fall?

Dr Makwana says oil reduces dryness and keeps hair moist, and massage increases scalp blood circulation. It is good hair care but not a replacement for medicine or treatment. People with dandruff, an itchy scalp or acne should avoid it.

Why does dandruff happen and how is it treated?

After about 12 to 15 years of age, hormones activate the scalp's oil glands, and fungus grows along with the extra oil. This causes greasiness and flaking, and it worsens in dry winter weather. Dr Makwana uses an anti-dandruff shampoo with an antifungal lotion applied to the scalp.

What is the difference between PRP, GFC and mesotherapy?

PRP and GFC both use the patient's own blood, and GFC is a more purified version with growth factors already included. Dr Makwana says GFC gives better results and is now more commonly used. Mesotherapy uses no blood and instead injects ready-made peptides, meaning growth factors.

Are cheap hair dye pouches safe?

Dr Makwana advises against them. She says they contain high amounts of PPD, which can cause allergy and hair fall, and sometimes turn black hair white. If you colour your hair, she suggests a professional salon and a good brand, and delaying it as long as possible.