Alopecia; Causes, Symptoms, Diagnosis, Treatment

Alopecia
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Alopecia also is known as Hair loss or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Typically inflammation or scarring is not present. Hair loss in some people causes psychological distress.

Hair loss is often distressing and can have a significant effect on the patient’s quality of life. Patients may present to their family physician first with diffuse or patchy hair loss. Scarring alopecia is best evaluated by a dermatologist. Nonscarring alopecias can be readily diagnosed and treated in the family physician’s office. Androgenetic alopecia can be diagnosed clinically and treated with minoxidil.

Alopecia areata is diagnosed by typical patches of hair loss and is self-limited. Tinea capitis causes patches of alopecia that may be erythematous and scaly and must be treated systemically. Telogen effluvium is a nonscarring, noninflammatory alopecia of relatively sudden onset caused by physiologic or emotional stress. Once the precipitating cause is removed, the hair typically will regrow. Trichotillomania is an impulse-control disorder; treatment is aimed at controlling the underlying psychiatric condition. Trichorrhexis nodosa occurs when hairs break secondary to trauma and is often a result of hair styling or overuse of hair products. Anagen effluvium is the abnormal diffuse loss of hair during the growth phase caused by an event that impairs the mitotic activity of the hair follicle, most commonly chemotherapy. [rx]

Types of /Alopecia

Depending on the causes and the age and gender of the person, baldness is categorized into different types

  • Male Pattern Baldness – This hereditary condition is seen in men and can begin with a bald spot or a receding hairline.
  • Female Pattern Baldness – Seen in women, this is also related to the genetic makeup of the individual. It seldom results in complete baldness.
  • Alopecia areata – Hair loss occurs, which leads to bald spots. This can also progress to alopecia total is if the entire hair on the scalp is lost.
  • Scarring Alopecia – When the bald spots develop due to injury, burns, radiation, or diseases (like skin infections), the condition is called scarring the alopecia.
  • Toxic Alopecia – Usually temporary, this is called by severe illnesses, high fevers or certain medications.

These were the different types of baldness you can suffer from. Identify your symptoms and use the remedies listed below to deal with excessive hair loss and bald spots.

Causes of Hair Loss/Alopecia

Medical and dietary history risk factors that can cause nutritional deficiencies contributing to hair loss.

Medical or Dietary History Risk Factor Nutrient Deficiency
  • History of blood loss (menstrual in premenopausal women, GI in postmenopausal women and men)
Iron
  • Malabsorption disorders
Multiple vitamin deficiencies
  • Pregnancy
Iron, folic acid, zinc
  • Alcoholism
Folic acid, zinc, niacin
  • Malignancy
Iron, zinc, can depend on type of malignancy
  • Renal dysfunction
Selenium, zinc
  • H2 blocker use
Iron
  • Antiepileptics
Biotin, Zinc
  • Antihypertensives
Zinc
  • Prolonged antibiotic use
Biotin
  • Isoniazid
Niacin
  • Inadequate sun exposure
Vitamin D
  • Living in parts of China, Tibet, and Siberia
Selenium
  • Vegans/vegetarians
Iron, zinc
  • Excessive ingestion of raw egg whites
Biotin
  • Malnutrition
Multiple vitamin deficiencies

Although not completely understood, hair loss can have many causes

Pattern hair loss

Infection

  • Dissecting cellulitis
  • Fungal infections (such as tinea capitis)
  • Folliculitis
  • Secondary syphilis
  • Demodex folliculorum, a microscopic mite that feeds on the sebum produced by the sebaceous glands, denies hair essential nutrients and can cause thinning. Demodex folliculorum is not present on every scalp and is more likely to live in an excessively oily scalp environment.

Drugs

  • Temporary or permanent hair loss can be caused by several medications, including those for blood pressure problems, diabetes, heart disease, and cholesterol. Any that affect the body’s hormone balance can have a pronounced effect: these include the contraceptive pill, hormone replacement therapy, steroids, and acne medications[14]
  • Some treatments used to cure mycotic infections can cause massive hair loss.
  • Medications (side effects from drugs, including chemotherapy, anabolic steroids, and birth control pill.

Trauma

  • Traction alopecia  – is most commonly found in people with ponytails or cornrows who pull on their hair with excessive force. In addition, rigorous brushing and heat styling, rough scalp massage can damage the cuticle, the hard outer casing of the hair. This causes individual strands to become weak and break off, reducing overall hair volume.
  • Trichotillomania –  is the loss of hair caused by compulsive pulling and bending of the hairs. Onset of this disorder tends to begin around the onset of puberty and usually continues through adulthood. Due to the constant extraction of the hair roots, permanent hair loss can occur.
  • Traumas such as childbirth  –  major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium, in which a large number of hairs enter the resting phase at the same time, causing shedding and subsequent thinning. The condition also presents as a side effect of chemotherapy – while targeting dividing cancer cells, this treatment also affects hair’s growth phase with the result that almost 90% of hairs fall out soon after chemotherapy starts.
  • Radiation to the scalp – as when radiotherapy is applied to the head for the treatment of certain cancers there, can cause baldness of the irradiated areas.

Pregnancy

  • Hair loss often follows childbirth without causing baldness. In this situation, the hair is actually thicker during pregnancy due to increased circulating estrogens. After the baby is born, the estrogen levels fall back to normal pre-pregnancy levels, and the additional hair foliage drops out. A similar situation occurs in women taking the fertility-stimulating drug clomiphene.

Other Causes of Hair Loss

  • Alopecia areata  – is an autoimmune disorder also known as “spot baldness” that can result in hair loss ranging from just one location (Alopecia areata monolocularis) to every hair on the entire body (Alopecia areata universalis). Although thought to be caused by hair follicles becoming dormant, what triggers alopecia areata is not known. In most cases, the condition corrects itself, but it can also spread to the entire scalp (alopecia totalis) or to the entire body (alopecia universalis).
  • Localized –  or diffuse hair loss may also occur in cicatricial alopecia (lupus erythematosus, lichen Plano pilaris, folliculitis decalvans, central centrifugal cicatricial alopecia, postmenopausal frontal fibrosing alopecia, etc.). Tumors and skin outgrowths also induce localized baldness (sebaceous nevus, basal cell carcinoma, squamous cell carcinoma).
  • Hypothyroidism  – (an under-active thyroid) and the side effects of its related medications can cause hair loss, typically frontal, which is particularly associated with thinning of the outer third of the eyebrows (also seen with syphilis). Hyperthyroidism (an over-active thyroid) can also cause hair loss, which is parietal rather than frontal.
  • Temporary loss of hair  – can occur in areas where sebaceous cysts are present for considerable duration (normally one to several weeks).
  • Congenital triangular alopecia – It is a triangular, or oval in some cases, shaped patch of hair loss in the temple area of the scalp that occurs mostly in young children. The affected area mainly contains vellus hair follicles or no hair follicles at all, but it does not expand. Its causes are unknown, and although it is a permanent condition, it does not have any other effect on the affected individuals.
  • Gradual thinning  – of hair with age is a natural condition known as involutional alopecia. This is caused by an increasing number of hair follicles switching from the growth, or anagen, phase into a resting phase, or telogen phase, so that remaining hairs become shorter and fewer in number.
  • An unhealthy scalp – environment can play a significant role in hair thinning by contributing to miniaturization or causing damage. Air and water pollutants environmental toxins conventional styling products and excessive amounts of sebum have the potential to build upon the scalp. This debris can block hair follicles and cause their deterioration and consequent miniaturization of hair. It can also physically restrict hair growth or damage the hair cuticle, leading to hair that is weakened and easily broken off before its natural lifecycle has ended.
The port-wine stain of Mikhail Gorbachev (pictured here with Ronald Reagan) would have remained unknown if he had not been bald.

Other causes of hair loss include:

  • Alopecia mucinosa
  • Biotinidase deficiency
  • Chronic inflammation
  • Diabetes
  • Lupus erythematosus
  • Pseudopelade of Brocq
  • Telogen effluvium
  • Tufted folliculitis
  • Hormonal changes
  • Aging
  • Heredity
  • Lack of iron and proteins
  • Quick weight loss
  • Excessive consumption of vitamin A
  • Scalp infection
  • Trauma
  • Birth control oral contraceptives
  • Drugs intake
  • Stress and tension
  • Pregnancy
  • Menopause
  • The deadly disease, like cancer
  • Tight hairstyles
  • Thyroid disorders
  • Excessive use of drying and straightening machines on hair
  • Changes in diet
  • Short or long-term illness
  • Medical conditions, like anemia
  • Anabolic steroid.

Symptoms of Hair Loss/Alopecia

Baldness is a condition in which, a person faces excessive hair loss. The hair loss is so much that several bald patches start emerging on the head. The other symptoms of baldness are as follows:

  • Receding Hairline
  • Hair thinning
  • Hair fall on the pillow or while shampooing or while combing
  • A circular bald patch on top of the head
  • Full body hair-loss
  • Rapid loosening of hair
  • Rapid weight loss
  • Stress
  • Incomplete hair loss on the scalp
  • Nail problems, like white spots, dents, and roughness

Diagnosis of Hair Loss/Alopecia

Because they are not usually associated with an increased loss rate, male-pattern and female-pattern hair loss do not generally require testing. If hair loss occurs in a young man with no family history, drug use could be the cause.

  • The pull test –  helps to evaluate diffuse scalp hair loss. Gentle traction is exerted on a group of hairs (about 40–60) on three different areas of the scalp. The number of extracted hairs is counted and examined under a microscope. Normally, fewer than three hairs per area should come out with each pull. If more than ten hairs are obtained, the pull test is considered positive.
  • The pluck test – is conducted by pulling hair out “by the roots”. The root of the plucked hair is examined under a microscope to determine the phase of growth, and is used to diagnose a defect of telogen, anagen, or systemic disease. Telogen hairs have tiny bulbs without sheaths at their roots. Telogen effluvium shows an increased percentage of hairs upon examination. Anagen hairs have sheaths attached to their roots. Anagen effluvium shows a decrease in telogen-phase hairs and an increased number of broken hairs.
  • Scalp biopsy – is used when the diagnosis is unsure; a biopsy allows for differing between scarring and nonscarring forms. Hair samples are taken from areas of inflammation, usually around the border of the bald patch.
  • Daily hair counts – are normally done when the pull test is negative. It is done by counting the number of hairs lost. The hair from the first-morning combing or during washing should be counted. The hair is collected in a clear plastic bag for 14 days. The strands are recorded. If the hair count is >100/day, it is considered abnormal except after shampooing, where hair counts will be up to 250 and be normal.
  • Trichoscopy  – is a noninvasive method of examining hair and scalp. The test may be performed with the use of a handheld dermoscopy or a video dermoscopy. It allows differential diagnosis of hair loss in most cases.

There are two types of identification tests for female pattern baldness: the Ludwig Scale and the Savin Scale. Both track the progress of diffused thinning, which typically begins on the crown of the head behind the hairline, and becomes gradually more pronounced. For male pattern baldness, the Hamilton–Norwood scale tracks the progress of a receding hairline and/or a thinning crown, through to a horseshoe-shaped ring of hair around the head and on to total baldness.

Treatment of Hair Loss

Medications

Efficacy proven by clinical trials
  • Minoxidil – 5% solution (or minoxidil 5% foam if allergy occurs with the solution)
  • Dutasteride (Avodart®) 2.5mg Tab Once daily (for FPHL)
Non approved products with limited clinical data 
  • Hair products with Ketoconazole
  • Hair products with copper peptide
  • Hair products combining minoxidil and retinoic acid
  • Hair products with various vitamins, adenosine a

Treatments for the various forms of hair loss have limited success. Three medications have evidence to support their use in male pattern hair loss:

Minoxidil, finasteride, and dutasteride. They typically work better to prevent further hair loss, than to regrow lost hair.

Minoxidil 2% Solution

  • This is a potassium channel opener and its mechanism of action is still unclear. It is believed that it enhances angiogenesis around the follicle by increasing the expression of vascular endothelial and hepatocytic growth factors, the latter being a hair growth promoter. It is also believed that there is activation of cytoprotective prostaglandin synthase-1 (). Minoxidil induces telogen hairs to enter the anagen phase, prolonging anagen duration ().
  • It increases hair count () and weight. Topical minoxidil solution should be applied only to the affected area of the scalp at the dosage of 1ml twice a day () for a minimum period of 12 months before deciding about the efficacy.
  • This can be overcome with the use of the 5% foam that does not contain this ingredient. A recent study showed that 5% foam once a day was as effective as the 2% solution twice a day in female patients (). Another possible side effect is hypertrichosis of the forehead or face, usually caused by accidental contamination or improper application. Treatment should be continued as long as positive results occur. Once treatment is stopped, hair loss resumes.
  • Corticosteroids  – injections into the scalp can be used to treat alopecia areata. This type of treatment is repeated on a monthly basis. Oral pills for extensive hair loss may be used for alopecia areata. Results may take up to a month to be seen.
  • Immunosuppressants  – applied to the scalp have been shown to temporarily reverse alopecia areata, though the side effects of some of these drugs make such therapy questionable.
  • There is some tentative evidence that anthralin may be useful for treating alopecia areata.
  • Hormonal modulators (oral contraceptives or antiandrogens such as spironolactone and flutamide) can be used for female-pattern hair loss associated with hyperandrogenemia.
  • Cortisone  – cream applied on the bald patches or cortisone solution injected into the bald patches to suppress the immune reaction
  • Immunotherapy  – using chemicals such as diphenylcyclopropenone (also called diphencyprone or DCP) or squaric acid dibutyl ester (SADBE) on the scalp that can produce an allergic reaction, which may neutralize the turned-on immune cells.
  • Topical minoxidil (Rogaine) – which may increase hair growth by accelerating the speed of the natural hair cycle and increasing the diameter of hairs that begin to grow.
  • Anthralin (Drithocreme, Dritho-Scalp, Micanol) – applied to the scalp, which causes a scalp irritation that may stimulate early hair regrowth, and can be used with minoxidil
  • Psoralen and ultraviolet A phototherapy – (controlled exposure of the affected skin to ultraviolet lights.

Anti-Androgens

  • Synthetic anti-androgens are used orally to block androgen receptor binding. They include Cyproterone acetate (not available in the US), Spironolactone and Flutamide. Studies about the efficacy of Cyproterone acetate are not uniform ().
  • Probably it is more effective when there is evidence of biochemical hyperandrogenism (). Spironolactone is a potassium-sparing diuretic that acts by decreasing testosterone production in the adrenal gland and by blocking the androgen receptors in the target tissues (). Although not approved to be used in FPHL, it has been shown to be effective in the treatment of hirsutism associated with the polycystic ovarian syndrome and acne ().
  • It is has been used off-label as an anti-androgen for FPHL at a dosage of 50 to 200 mg per day () with better efficacy at 150 mg/day (). One study showed equivalent efficacy in FPHL when Spironolactone was compared to Cyproterone acetate ().
  • Flutamide use is limited because it can cause severe liver toxicity. One study reported the efficacy of Flutamide at a dosage ranging from 62.5 to 250 mg daily, without side effects at a low dosage; results were however only based on clinical examination (). Another study found hepatic toxic side effects even with very low doses of Flutamide (). Overall, there is not enough evidence-based data to support the routine use of antiandrogens in FPHL.

Finasteride

  • Finasteride is a type two 5 alpha-reductase enzyme inhibitor which inhibits the conversion of testosterone into dihydrotestosterone (DHT) (). Finasteride reduces hair loss and stimulates hair regrowth by increasing hair counts in men taking 1 mg daily (). In women, one controlled study with Finasteride 1 mg yielded no benefits on post-menopausal women ().
  • One uncontrolled study showed improvement in 62% of premenopausal women taking 2.5 mg of finasteride daily associated with an oral contraceptive containing drospirenone and ethinyl estradiol (). Several case reports, case series, and small trials confirmed improvement both in pre or postmenopausal women taking 2.5 to 5 mg of finasteride daily ().

Dutasteride

  • Dutasteride is a type one and two 5 alpha-reductase enzyme inhibitor. It inhibits the conversion of testosterone to dihydrotestosterone. There are limited data about the use of this drug in women. There is one case report of good response after 6 months of treatment with 0.5mg/d of Dutasteride in a female patient who ceased to benefit from finasteride ().
  • Still according to the above-mentioned author the association of Dutasteride 0.5 mg/d with Finasteride 2.5 mg/d was effective in an off-label study involving 14 postmenopausal women with FPHL and 5 premenopausal women with FPHL, hirsutism and nodulocystic acne ().

Estrogens

  • Estrogens have an uncertain role in human hair growth. The hair follicle has different estrogen receptors: alpha and beta. The beta receptor is the most common one present in the scalp and in general, it suppresses cellular function in the hair follicle. Studies in vitro are inconclusive and they show that estrogens may have opposite effects in male scalp hair, where they induce stimulation, versus female scalp hair where they inhibit hair elongation ().
  • Precursor androgens can be transformed into estrogens in the hair follicle (due to the presence of aromatase and 17-hydroxysteroid dehydrogenase in loco) () and estrogens may affect the amount of DHT by affecting the function of the 5-alpha-reductase enzyme ().
  • It has been suggested that a low estrogens to androgens ratio could favor the development of the disease in genetically susceptible individuals (). Controlled studies regarding the efficacy of topical estrogens for hair loss show controversial results ().

Lasers and Light Treatments

  • Lasers and light treatments are monochromatic lights that utilize wavelengths between 600 to 1,400nm, in the red/infrared spectrum (). There is some evidence that light treatments can stimulate hair growth and the mechanism by which this happens is uncertain ().
  • The light treatment effects might be attributed to the absorption of red/infrared light by the skin which then is absorbed by the cellular respiratory chain ().
  • The Lasercomb Hair MaxR is a portable laser device that uses a wavelength of 655nm widely marketed for patients as a hair regrowth device. There is one controlled study in males showing the efficacy of this technology () but there are no published studies in women.

Prostaglandin Analogs

  • latanoprost and bimatoprost were initially developed for eye glaucoma and one side effect noticed was the growth of eyelashes. There is one study in men showing that latanoprost 0.1% increased scalp hair density compared to baseline and placebo () but the study included only 16 male patients and the medication was applied to a very small area of the scalp. Different classes of prostaglandins seem to have opposite actions in the hair follicle.

Hair Transplantation

  • When the loss of hair has been stabilized in patients over 25 years old, hair transplantation is an alternative. The gold standard technique is the follicular unit transplantation, because of a better outcome in terms of natural architecture and final aspect ().
  • The hair follicles are implanted individually following the patient’s natural hairline. It is a multi-step procedure that should be performed by an experienced surgical team. The results will depend on sufficient donor area, a number of transplanted hairs, the quality of the hair harvested and the recipient area.

 Vitamins that Help Hair Loss

  • These 15 vitamins are essential for healthy hair. Add them to your diet and you’ll see improved hair health, hair that stays longer in the growth phase, and hair that is less likely to fall out and break.

Vitamin A for Hair Loss

  • We need vitamin A for the production of scalp oil, also known as sebum. Without sebum our hair gets dry and brittle, and dandruff and a thick scalp will develop, both of which can be annoying to treat.
  • Dry hair will eventually start to break, and when hair is broken and unhealthy, it can often lead to permanent hair loss. You can get plenty of vitamin A, which is also an anti-oxidant, from mangos, oranges, carrots, sweet potatoes, squash and liver.

B Vitamins for Hair Loss

  • Vitamin B is necessary for healthy hemoglobin, which carries oxygen to the scalp through the red blood cells. There are various B vitamins, and the best for treating hair loss are vitamin B-6, para amino benzoic acid, biotin and inositol. You can get vitamin B from fish and seafood, poultry, meat, beans, peas, bananas, oatmeal, eggs, potatoes and low or non-fat milk.
  • Specifically, Biotin and vitamin B5 are the most beneficial for hair growth. Biotin is a vitamin that helps build hair shingles to make them strong and it also helps repair damaged parts of the hair. Biotin is especially important for color-treated or styled hair, which becomes weaker with the excessive use of styling tools, heat tools, and styling products.
  • Vitamin B5 supports the adrenal glands responsible for boosting and stimulating hair growth. A study from 2011 in the British Journal of Dermatology found that the use of vitamin B5 increased the size of hairs, thickened hair fibers and allowed the hair to withstand greater force before breaking.

Folic Acid and Hair Loss

  • This vitamin can play a huge role in treating and preventing hair loss. Taking supplements and eating foods that have folic acid can not only help to decrease the chance of hair loss and prevent hair from thinning in the future. This can be a great help to those who are genetically predisposed to baldness.
  • Folic acid can be found in chickpeas, frozen peas, boiled asparagus, cooked lentils, medium papaya and collard greens.
  • Folic acid (also known as folate) is necessary for every tissue in your body. Your skin, nails, organs, and hair all particularly rely on folic acid to function optimally. Folic acid also helps prevent birth defects. Folic acid also helps improve the action of other vitamins in the body, including B-12 and vitamin C. Folic acid helps break down protein and make it more usable, which is essential for healthy hair growth.

Vitamin C for Hair Loss

  • Healthy collagen development depends on vitamin C, and collagen is important if you want to have healthy hair. We also need to have vitamin C to avoid many health issues, and it can help keep us from catching colds and the flu.
  • You can find many delicious foods that are loaded with vitamin C, including oranges, lemons, grapefruits, red sweet peppers, kiwi fruit, tomatoes, green peppers, strawberries, pineapples, mango, blueberries and guava

Vitamin D for Hair Loss

  • Hair loss and rickets are two health issues associated with a lack of vitamin D. It is involved in the health of hair follicles. Research done on mice showed that when certain genes were removed, the mice displayed vitamin D deficiency symptoms. These symptoms included rickets and hair loss.
  • Fatty acids play a role in the body’s production of vitamin D. Without enough essential fatty acids, the body is not able to produce enough vitamin D, leading to a deficiency that can cause psoriasis and a flaky scalp.
  • Vitamin D, although it is called a vitamin, is actually a hormone. Vitamin D is a hormone that is essential for calcium homeostasis, cell growth differentiation, and immune regulation. Individuals who have hair loss also often are deficient in vitamin D (as many Americans are

Vitamin E for Hair Loss

  • We need to have vitamin E in order to have good blood circulation in the scalp. It also helps to increase the absorption of oxygen, which is also important.
  • You can find vitamin E in vegetable oils, safflower oil, soybean oil, corn oil, nuts, turnip greens, and other leafy vegetables. It is best to ingest vitamin E rather than use it as a topical solution, as it will be absorbed by the body much better this way.

 Omega 3 for Hair Loss

  • This is an essential fatty acid, and it is necessary that we have omega-3 acids for healthy hair. The three main nutrients found in Omega 3s are ALA (alpha linoleic acid), EPA (ecoisapentaionic acid) and DHA (docosahexaenoic acid).
  • Omega 3 fatty acids can be found in shrimp, clams, salmon, halibut, albacore, trout, salmon, sardines, catfish, cod, tuna, herring, walnuts, almonds, and flax seed.
  • Omega 3 fatty acids have been shown to have a direct improvement on hair health in studies. In one study, 62 percent of women who supplemented with omega three reported an increase in hair density and thickness after the study concluded. 88 percent of the women in the study reported seeing some thickening or re-growth of hair by the study’s end

Zinc for Hair Loss

  • We need to have zinc for a number of reasons, including for healthy hair. Zinc is necessary for the production of sebum, which is the natural oil produced by the scalp and is necessary for healthy hair.
  • Zinc helps to keep the scalp conditioned, preventing dandruff, and keeps the hair shaft healthy and strong. Not enough zinc in your diet can lead to premature greying or balding. The body does not naturally store zinc, so it is important to get it from healthy dietary sources, such as yeast, egg yolks, pumpkin seeds, and shrimp, or from dietary supplements. You can find zinc in red meats, poultry, liver, wheat germ, shrimp, pumpkin seeds, soy products, egg yolks, and shrimp.

Nutrient deficiency and supplement use on hair loss. 

Nutrient Effect of Deficiency on Hair Loss Studies of Supplementation
Iron
  • Chronic diffuse telogen hair loss with iron deficiency anemia [].
  • In the absence of anemia, studies are not clear whether there is a significant link between ID and hair loss [].
  • Insufficient evidence to recommend iron supplementation to all hair loss patients with iron deficiency in the absence of anemia []. Approach on a case-by-case basis.
  • Excess supplementation can cause hemochromatosis [].
Zinc
  • Statistically lower serum zinc concentrations in a study of 312 patients with AA, MPHL, FPHL, or TE compared to 30 healthy controls [].
  • A case series demonstrated reversal of hair loss following oral supplementation in five patients with TE and zinc deficiency [].
  • Limited information on effects of zinc supplementation improving hair growth in the absence of deficiency.
  • One case report with a patient with dry brittle hair and alopecia, without clear zinc deficiency, who experienced improvement in alopecia following oral zinc therapy [].
  • Excess supplementation can cause acute toxic effects including epigastric pain, nausea, vomiting diarrhea, and headache and chronic toxic effects including reduced copper status, interaction with iron, reduced immune function, and decreased concentrations of HDL cholesterol [].
Niacin (Vitamin B3)
  • Diffuse hair loss with pellagra due to severe deficiency [].
  • No known studies regarding serum niacin levels in patients with hair loss.
  • Limited information on effects of niacin supplementation improving hair growth in absence of deficiency.
Fatty acids
  • Loss of scalp and eyebrow hair [].
  • Limited information on effects of fatty acid supplementation improving hair growth in absence of deficiency.
Selenium
  • In animal studies, rats deficient in selenium display sparse hair growth [], while knockout mice lacking specific selenoproteins exhibit progressive hair loss after birth, ultimately leading to almost total alopecia [].
  • One case report of selenium deficiency in a young child reported clinical manifestations of dry skin and sparse, light-colored hair, improving after supplementation [].
  • Limited information on effects of selenium supplementation improving hair growth in absence of deficiency.
  • Toxicity from excess supplementation is well documented and can cause generalized hair loss [].
Vitamin D
  • Serum vitamin D2 levels in a study of eight females with either TE or FPHL were shown to be significantly lower than in 40 age-matched female controls, with decreased levels correlating to increased disease severity [].
  • Limited information on effects of vitamin D supplementation improving hair growth in absence of deficiency.
Vitamin A
  • Deficiency has no known link to hair loss.
  • Limited information on the effects of vitamin A supplementation improving hair growth in the absence of deficiency.
  • Toxicity from excess supplementation has a strong known link to hair loss, as well as other effects on skin, vision, and bone [].
Vitamin E
  • Deficiency has no known link to hair loss.
  • Limited information on the effects of vitamin E supplementation improving hair growth in the absence of deficiency.
  • Supplementation in one study of twenty-one volunteers suffering from hair loss has shown a significant increase in hair number compared to placebo [].
  • Toxicity from excess supplementation can result in a risk of bleeding problems, decreased thyroid hormones, and decreased activity of vitamin K. Additionally, there is some evidence for adverse effect on hair growth with excess supplementation [].
Folic Acid
  • No significant difference in serum folate levels in a study of 91 patients with diffuse hair loss and 74 healthy controls [].
  • Limited information on the effects of folic acid supplementation improving hair growth in absence of deficiency.
Biotin
  • Deficiency can result in alopecia, eczematous skin rash, conjunctivitis, and candidiasis [].
  • Limited information on the effects of biotin supplementation improving hair growth in absence of deficiency.
Amino Acids and Proteins
  • Protein malnutrition can result in hair loss [].
  • L-lysine supplementation in addition to iron supplementation has been shown to significantly increase mean serum ferritin concentration in some women with chronic TE who failed to respond to iron supplementation alone [].
  • Limited information on effects other amino acids and proteins improving hair growth in the absence of deficiency.

Key of abbreviations: Alopecia areata – AA; Androgenic alopecia – AGA; Female pattern hair loss – FPHL; High-density lipoprotein – HDL; Iron deficiency – ID; Male pattern hair loss – MPHL; Telogen effluvium – TE.

Beta Sitosterol for Hair Loss

  • This is a natural plant extract that is loaded with nutrients necessary for healthy hair. Because it is all natural, there are no side effects, and it can be taken in combination with your regular medications.
  • Beta-sitosterol treats hair loss and promotes healthy new hair growth.
  • There is no danger in taking beta-sitosterol, and it can be used by both men and women. It is often recommended to men who are experiencing hair loss, and regrowth of hair occurs in many cases.

Iron for Hair Loss

  • A lack of iron can cause hair loss in women, so it is important to make sure that women are getting enough of this nutrient in their diets. There are three main reasons why women may have iron deficiencies: heavy periods with a lot of bleeding; ulcers and inflammations of the stomach that cause bleeding in the digestive tract, and blood loss after giving birth. Dietary sources of iron include lean red meat, dried fruit, tofu, and broccoli.
  • One of the strongest links found between vitamins and hair loss is the link between iron deficiencies and hair loss. Iron deficiencies have been associated as a possible cause for all major types of hair loss
  • Eating more iron-rich foods can help counteract some of the risks of a low-iron diet. Spinach, red meat, navy beans, Swiss chard, eggs, and beef are all naturally high in iron. You can also take iron supplements under the direction of a doctor. It is possible to overdose on iron, so don’t take iron supplements unless you are under advisement from a qualified health professional

Grape Seed for Hair Loss

  • This is one of the safest things that can be used to treat hair loss. It is available in liquid and capsule form, and it inhibits hair loss while promoting healthy hair growth.
  • Those who have certain genetic diseases or suffer from poor nutrition and are experiencing hair loss can benefit from using grape seed extract, which can be found at most health food stores or any store that has a vitamin section.
  • It stimulates the hair follicles, and hair loss can be reversed by using grape seed extract. It is also great for cleansing the body due to its many detoxifying agents.

Amino Acids for Hair Loss

Hair loss can be treated with amino acids, which will work even better when combined with other vitamins and nutrients.

The amino acids that are best for treating thinning hair are:

  • Methionine, which is a strong anti-oxidant and an excellent source of sulfur;
  • Cysteine, a non-essential amino acid that can increase hair growth substantially;
  • Cystine, another non-essential amino acid that is used to treat thinning hair and promote hair growth;
  • Tyrosine, yet another non-essential amino acid that is used to treat many health problems, including hair loss.

 Inositol for Hair Loss

  • This is used to help inhibit hair loss and allow healthy hair to grow back. It is also great for reducing cholesterol levels. Inositol is used by men and women to treat thinning hair, and it has anti-oxidant properties that keep hair follicles healthy.

Biotin for Hair Loss

  • Biotin is considered to be “food for your hair”, and it plays a huge role in hair loss. It is one of the most important vitamins you can have in your diet for healthy hair growth, and it may be that you will need supplements in order to get as much as you need.
  • Two foods that are excellent sources of biotin are liver and egg yolks, but you need to eat so much of these that it is much better to take supplements, or you would be doing nothing but eating liver and eggs all day long.

Home Remedies for Treating Hair Loss and Baldness

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Warm Castor Oil and Coconut Oil

  • Massage your scalp once in every 3 days with a mixture of warm castor oil and coconut oil.Mainly focus on the bald areas. After a light massage, wrap a warm wet towel over your head for 3 to 5 minutes. Remove the towel and flip your head upside down for 1 minute.
  • This formula increases blood circulation in the scalp, stimulates and encourages hair growth on a bald patch. Castor oil work wonders for your hair. It fights hair loss, treats scalp infection and stimulates hair growth.
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Neem Leaves

  • Washing your hair frequently with neem leaves water prevents premature hair graying and helps regrow hair on the bald head. Neem leaves possess powerful anti-fungal, antibacterial and anti-inflammatory properties that prevent scalp infection, dandruff problems which are the main reasons for hair fall.
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Wheatgrass

  • Wheatgrass is a good source of protein, minerals, vitamin A, C and E, dietary fiber and amino acids, making it good for hair regrowth. Daily drink a glass of wheat grass juice mixed with a tbsp of fresh aloe vera gel directly extracted from aloe vera leaf for up to 2 weeks to cure hair fall, prevent hair breakage and for strong thick hair naturally.
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Onion

  • Onion is a wonderful hair reconstructor. It is rich in sulfur which is one of the vital components in promoting hair growth and preventing hair loss. Eat one to two raw onions every day. The best choice to have raw onions is to include in salads and sandwiches. Applying the fresh paste of onion juice on the bald areas stimulates blood circulation and help stimulate new hair growth.
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Protein Rich Hair Pack

  • Nourish with Protein rich hair pack: Hair is mostly made up of a protein known as keratin, which means the hair needs an adequate protein for hair growth and strengthening the hair shaft.Make a protein pack by combining one egg yolk with 2 tsp of lemon juice and a tsp of olive oil.Feed your hair with this protein pack twice in a week.
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Baking Soda and Mustard Powder Mix

  • An excess build up of oil on the scalp can lead to hair thinning, hair fall and dandruff. Weekly scrubbing your hair lightly with a mixture of baking soda and mustard powder mixed with shampoo can help you get rid of different hair problems. Baking soda is an effective antifungal agent good for treating dandruff and itchy scalp caused by fungal infection. Mustard powder nourishes hair follicles and regenerates hair growth.
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Henna and Amla Paste Mix

  • Another useful remedy to regrow hair on the bald head is to apply an equal amount of henna and amla paste mixed with a little amount of coconut oil and yogurt. Henna restores your natural hair color and allows your hair to grow longer and thicker faster. Amla is an exceptional medicine for your hair.It is a valuable ingredient in the treatment of hair loss and baldness.
  • Another powerful way to regrow lost hair and cure baldness is by practicing the Balayam yoga. It’s a nail rubbing exercise that you have to do daily for 5 minutes twice in a day. Once in the morning and before going to bed.
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Coconut Milk

  • Coconut Milk is an extremely useful remedy to regrow hair on the bald head. Mix 1/4 cup of coconut milk with 2 tsp of yogurt and 1 tbsp of honey. Wash your hair with warm water to open up the hair follicles and then apply a thick layer of this paste on the scalp. Leave for 15 minutes and then rinse off with cool water.
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Fenugreek Seeds

  • Fenugreek seeds are a good home remedy for faster hair growth and to cure alopecia. Soak 4 tbsp of fenugreek seeds in warm water overnight. Grind to a paste by adding a little water. Mix 3 tbsp of vitamin E oil and apply on the scalp. Rinse after 20 minutes.

 Home remedies 

  • Regular application of castor oil combats hair fall and baldness. It is a very good home remedy to treat baldness/hair loss naturally.
  • Apply a fine paste made from pigeon pea or red gram. It is an effective home remedy in curing hair loss or baldness naturally at home.
  • Massaging the scalp with aloe vera gel or coconut oil prevents hair loss and helps in growth of new hair naturally. Try this home remedy to treat baldness/hair loss at home.
  • Seeds of lime and black pepper ground to fine paste when applied on a daily basis on the scalp helps in curing baldness/ hair loss naturally at home. Try this home remedy.
  • Take fenugreek, grind it to make a fine paste, and apply it on the bald patches, and let the hair absorb the paste of fenugreek for one hour. This baldness/hair fall treatment helps in treating hair fall/baldness.
  • The Home remedy of beetroot leaves, when mixed with henna, can do wonder in curing baldness or hair loss naturally at home.
  • Make a hair pack at home mixing hot olive oil, honey, and one teaspoon of cinnamon powder, and apply it on the scalp 15 minutes before bath. It is a very effective home remedy in treating hair loss and baldness at home.
  • Take elephant tusk, heat it in a pan, and burn it to ashes, then apply the dust of elephant tusk mixed with pure honey or ghee on the bald patches at night, and leave it on overnight. In the morning, wash it off completely. This remedy is age old home remedy of curing baldness. Do try this at home for sure and gain quick results.
  • Honey mixed with onion massaged on the bald patches helps in hair growth. This is a hassle free home remedy for treating baldness/hair fall at home naturally.
  • Take equal amount of camphor and curd, and apply it on the bald patches, and let it dry for 2-3 hours. It is very effective baldness/hair loss treatment at home for fighting baldness and hair loss.
  • Take fresh coriander leaves, and make a paste of it. Apply it on the scalp; it is a very easy and effective home remedy to treat baldness/hair loss naturally at home.
  • Grind licorice with milk and a pinch of saffron. This baldness/hair fall treatment promotes hair growth.
  • Juice of spinach and lettuce, when taken orally, promotes hair growth.
  • Scrub a half of lemon on the bald patches continuously for 1-2 months; this home remedy helps in fighting baldness and hair fall naturally at home.
  • Coconut oil mixed with lime juice is effective in curing hair loss/baldness.
  • Application of coconut milk is very helpful home remedy in treating baldness/ hair loss at home.
  • Juice of Indian gooseberry mixed with lime juice in equal amount fosters hair growth. Try this home remedy to cure baldness/hair loss naturally at home.
  • The oil prepared at home by boiling Indian gooseberry in coconut oil is a very easy and effective home remedy for treating hair fall and baldness at home.
  • Boil 250 grams of mustard oil with 100 grams of henna leaves to make a concoction to combat hair loss. Ever tried this home remedy to cure baldness/hair loss at home? Try it.
  • Use Amla oil (Indian gooseberry) with lime juice to make a shampoo to treat baldness/hair loss naturally at home.
  • Mix a few drops of Kanta-karika juice with honey. Apply it on the scalp to cure baldness/hair loss. This baldness/hair loss treatment must be followed regularly.
  • You can use a mixture of both castor oil and almond oil to treat hair loss. Regular use of this home remedy will result in hair growth.
  • You can apply red henna to cure hair loss and have beautiful hair. Try this home remedy to fight baldness/hair loss at home naturally.
  • Make a concoction of 2 eggs, 2 teaspoons of amla (Indian gooseberry), shikakai (acacia concinna), soap nut (reetha). Massage for 30 minutes on your scalp with this mixture, and wash off with a mild shampoo. You can use this home remedy 3-4 times a week to treat baldness/hair loss.
  • You can use egg yolk with honey as a home remedy to cure hair fall/baldness and get silky hair.
  • Amla mixed with honey also arrests hair loss.
  • Coconut oil in which a mango has been preserved for one year treats baldness/hair loss. This home remedy stimulates hair follicles to regrow hair
  • Boil hibiscus in a glass of water, and strain this mixture to apply with lime juice on your bald patches to cure them naturally at home. You can use this treatment after shampooing your hair.
  • You can rinse your hair with the water in which geranium leaves had been boiled to cure hair fall and baldness naturally at home.
  • Use aloe vera with herbal powder Triphala for 3- 6 months on a regular basis to treat baldness/hair loss. Use this baldness/hair loss treatment to fight baldness and hair loss at home naturally.
  • Take 4 parts bhringraj, 3 parts jatamansi, 5 parts dashamoola, and mix them with goat milk to make a solution. This home remedy, when taken orally, cures hair loss and promotes hair growth
  • You can use the juice of amaranth to treat baldness/hair loss naturally at home. Many people have benefited from this home remedy.
  • Ash gourd helps in treating baldness problem. Use this baldness/hair fall treatment to deal with falling hair naturally.
  • Curry leaves as a home remedy to treat baldness/hair loss naturally is excellent.
  • Rinse your hair with water in which rosemary leaves had been boiled to get rid of baldness and hair loss. Try this easy baldness and hair fall treatment at home for sure.
  • Take 1/2 cup of olive oil with 1 teaspoon of cumin seeds to rub on your bald patches to treat baldness and hair fall. Try this home remedy.
  • Juice of alfalfa with spinach or coriander is taken orally promotes hair growth and treats baldness naturally. You must try this home remedy for beautiful hair.
  • Rinse your hair with apple cider vinegar and sage tea to cure baldness and hair fall naturally at home.
  • You can drink the mixture of banana, honey, yogurt, skimmed milk as a home remedy to fight hair fall and baldness naturally at home.
  • Arnica oil is very helpful for combating hair fall. Arnica oil is extracted from the dried arnica leaves and is full of anti-inflammatory properties. This treatment is very helpful in curing premature graying of hair also. Remember, all these aforementioned home remedies are helpful in treating baldness/hair loss, but these must be followed on a regular basis, and it needs patience. Because baldness can not be cured in one day or a month; it takes time in arresting hair fall and the growth of new hair.
  • Homemade Brew – To reduce or eliminate hair fall, you can prepare a natural concoction at home. For this, you need to mix a teaspoon of pepper in 30-45 ml vodka or alcohol. Stir it well and add this solution in water. Now, rinse your hair with this water.
  • Tabasco Sauce – Can tabasco sauce be effective for baldness? Yes, it provides satisfying results! Just add some drops of tabasco sauce in the regular shampoo. Mix it well and use it to wash your hair.
  • Raw Mangoes – Soak some raw mango pieces in any natural oil. Keep it soaked for at least one year. Then, massage the bald area with the help of this infused oil. For best results, use it on a regular basis. Instead of pieces, you can also use raw mango pulp.
  • Datura – For treating baldness, datura can prove beneficial. You have to take a soft datura fruit and crush it to make a paste by adding little quantity of water. Place it on the affected area
  • Exercise – Apart from using various natural ingredients for treating hair loss or baldness, some exercise can also help in promoting hair growth. Just rub fingernails of your left and right hand with each other. This is one of the most cost-effective remedies for baldness.

Apart from using these home remedies, remember, a nutritious diet plays an important role in restoring healthy hair, so take a healthy diet which has plentiful of iron, calcium, protein ,vitamins. Do not forget to drink at least 2-3 liters of water daily to combat hair loss naturally and have shiny hair.

Homeopathic Remedies for Baldness

Apart from natural home remedies, there are several homeopathic remedies for baldness. These homeopathic remedies are side-effects free. Let’s have a look on these remedies.

  • Phosphoric Acid –  When hair turns gray very early along with the problem of thinning, this remedy is preferred.
  • Fluoric Acid –  This remedy is used when a person suffers with problems, like brittle hair, tangled hair, and hair fall in spots. He/she becomes extremely angry or irritating.
  • Graphites –  When the scalp becomes itchy, hair falls on the sides and bald patches appear on the scalp, graphites is used.
  • Phosphorous –  This remedy is suggested when hair falls while combing, scalp becomes dry and itchy
  • Sepia – It is used when baldness occurs as a result of menopause, and hair pain when touched
  • Mezereum – This remedy is used when hair falls excessively. Scalp becomes very itchy and dandruff starts developing.
  • Silica – This remedy is mainly for young people suffering from baldness. It is the best remedy in the case when hair falls in the forehead or frontal region and hair turns gray at a very early age.


References

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