HAIR LOSS | Singapore

ABCs to hair loss treatment

Hair loss. Man it’s a pain. But unfortunately, WE ALL go thru it. Recently, after my globe trotting, I noticed a sad truth. That I am balding lol.

So what are the common causes of hair loss?

1. •       Androgenic ( female and male pattern hair loss)
2. •       Alopecia areata ( coin shaped hair loss)
3. •       Telogen effluvium ( stress related)
4. •       Traction ( tight hairstyles)
5. .        Vitamin and mineral deficiencies ( Copper, zinc, iron magnesium)

First step is identifying if your hair loss is gradual hair thinning or a sudden fall of >100 strands, which would require medical attention. Next is looking at the pattern of the hair loss. Female pattern hair loss is the loss of hair along the top of the head and is the most common form of hair loss. Male pattern hair loss occurs at the back of the head and along the hairline in front. Treatment is dependent on the cause and can be divided into conservative and surgical.

Please note: hair thinning and hair falling is different! If  you noticed your hair gradually thinning over time, androgenic hair loss is the most likely diagnosis. If however, there is a sudden spurt in the hair fall of  >100 strands, this requires medical attention.

This article is designed to be highly educational. So it comes complete with a quiz haha.

Can u name the diagnosis?

Essentially, the most common cause is androgenic, meaning hormonal. Hence it is impt to recognise the different grades.

Grading Scales for androgenic alopecia Hamilton Norwood (Males)| Sinclair (Females)

Males tend to lose hair in the back of the head, and in the front along the hairline. Females tend to lose hair along the top of the head. Here are some illustrations.

To understand hair loss, you would first need to appreciate the hair cycle.

HAIR CYCLE

3 main phases exist. Anagen, catagen and telogen phase.

1. Anagen is the growth phase.
2. Catagen the intermediate phase.
3. Telogen is the resting phase.

Key principle of all the treatments is to increase the growth phase and reduce the resting phase.

HAIR CYCLE

HAIR LOSS treatment

Dr Daniel Chang’s 3 Step Formula to hair loss 

Key principle is that once you stop your minoxidil, propecia etc, hair loss tends to return. Hence its for long term use.

1.           Lifestyle changes – healthy diet and reducing hair trauma
2.           Medical:  topical minoxidil and oral Viviscal
3.           Specials: Light therapy and Platelet Rich Plasma injection (PRP)

Medication

1. • Topical Minoxidil 2-5% New users can start with 2% and gradually work up to 5%.
2. • Oral | Viviscal, finasteride, dusteride, spironolactone | Treatment for 6 months or more for better results. Viviscal is derived from fish proteins, and has had quite consistent results and is arguably safer than propecia, which can cause impotence, low libido, depression etc.
3. • Immunosuppressant | intralesional steroid, oral steroid, MTX| – Effective for alopecia areata

How to apply Minoxidil?

1. Dry your hair and scalp
2. Apply the prescribed amt twice daily to the affected area, starting from the centre.
3. Allow natural drying – No hairdryer
4. If you miss a dose, just continue with your next dose.

What are the side effects of minoxidil?

Minoxidil is generally well tolerated. However, there may be rare instances that you may experience the following side-effects: Localised skin reaction = itch, redness, rash, burning

How long do we need to use minoxidil?

Results take time. You may notice hair shedding as your old hair drops to allow regrowth of new hair. Peak results after a year of continued use. Minoxidil is safe and FDA approved. Need for continued usage.

Finasteride – Propecia and Proscar 

Who is suitable to consume propecia?

This medication is only suitable for males.

How does propecia work?

It contains an enzyme, which inhibits the conversion of testosterone to dihydrotetosterone. DHT in excess causes shrinking of your hair follicles. It comes in a 1mg tablet. If you miss a dose, just continue from where you have left.

When can I notice results?

Results take time. You may notice hair shedding as your old hair falls to make way for regrowth of new hair. Peak results after a year of continued use.

 What are the side-effects of propecia?

In very rare instances, decrease in libido may be experienced, reduced ability to get an erection and breast tenderness.

What are the evidence based treatments for hair loss?

Below are the top 3 FDA Approved products for hair loss. Viviscal, Propecia, Rogaine have been proven in controlled clinical studies to stop hair loss and regrow new hair. Scientists have discovered that men with male pattern hair loss have an increased level of dihydrotestosterone (DHT) in their scalps. Propecia blocks the formation of DHT. As a result, it interrupts a key factor in the development of inherited male pattern hair loss in men.

What is the difference between rogaine and propecia?

1. •Availability: Rogaine is available without a prescription. Propecia requires a prescription.
2. •Application: Rogaine is applied to the scalp. Propecia is taken as a pill.
3. •Mode of action: Rogaine works locally by reinvigorating the hair follicles. Propecia stimulates hair regrowth by altering male hormones.
4. • Suitability: While Rogaine Extra Strength is approved for men only, Rogaine as a 2% minoxidil solution is approved also for use by women. Propecia is not approved for use by women.

Advanced treatment

1. Cosmetic camouflages include coloured hair sprays to cover thinning areas on the scalp.
2.  Specialized scalp tattoos can also mimic the appearance of a short, buzzed haircut.
3.  Low level laser therapy is of  ? benefit in pattern balding but one device has been approved by the FDA for marketing.
4.   Hair transplantation is becoming more popular although not everyone is suitable for this procedure

Cochrane review

A Cochrane systematic review published in 2012 concluded that minoxidil solution was effective for. Minoxidil is available as 2% and 5% solutions; the stronger preparation is more effective, but may irritate and may cause undesirable hair growth unintentionally on areas other than the scalp.

A combination of low dose oral minoxidil (0.25 mg daily) and spironolactone (25 mg daily) has been shown to be most effective.

PRP

1. PRP stands for platelet-rich plasma. PRP is blood plasma that has been enriched with platelets. PRP contains several different growth factors and other cytokines that stimulate healing of tissue, as well as hair growth.
2. Human blood contains mesenchymal stem cells, and autologous blood products that contain essential and specific growth factors that assist in tissue regeneration and healing.
3. PRP was developed in the 1970′s and first used in Italy in 1987 in an open heart surgery procedure.

What is the evidence for PRP in hair loss treatment?

1. Medical literature worldwide confirms the safety and use of PRP therapy in medicine. In the past 20 years, 
2. PRP has been widely used in skin and wound healing, and is now being extensively used in cosmetic surgery, dentistry, sports medicine and pain management.
   
3. In the field of hair loss treatment, evidence supports PRP therapy  to promote hair growth. Studies have shown that growth factors released from platelets may act on stem cells in the bulge area of the hair follicles, stimulating the development of new follicles and promoting neo-vascularization. ( Journal of Aesthetic Cutaneous Surgery, 2014).

Can PRP replace medication for hair loss?

However, PRP is in the early stages of scientific research for hair loss therapy,  hence PRP is not meant to replace current FDA approved therapies such as DHT blockers and Minoxidil.

How is PRP Hair Loss Therapy performed?

1. Your blood is drawn and then spun in a sterile centrifuge system
2. A topical anesthesia is applied to your scalp to reduce any discomfort during the PRP treatment.
3. The highly concentrated platelet rich plasma is then injected into your scalp
4. Your hair will then be washed and you may return to your daily routine. You are able to drive after the procedure.
   

How many sessions are needed?

Studies for hair loss indicate an average of 3 treatments scheduled 6 weeks apart. This may vary depending on the severity of hair loss and desired result. 

Thats all from me. I wish you a hair raising experience.

To learn more about:

ALL Aesthetic treatments, do click here Ultimate Guide to Korean Medical Aesthetics.

Threadlifts, pls click here Facelift, V-Lift.

Dermal fillers, pls click here ABCs to Dermal Fillers. 

Pigments and pigmentation in skin.  Please click here PIGMENTS