I live in a place that has an iron-rich water supply, and I have been experiencing heavy hair fall for three months to the point that I have barely any hair left and can now see bald patches. In addition, my scalp feels painful, and my hair has become rough, light, and dry. At first, I thought it was due to the rainy season, but now too, the hair fall has not stopped. Please help.
After going through the history provided and the images (the attachments are removed to protect the patient's identity) provided from your end, sudden hair loss may be due to multiple reasons, including genetic susceptibility. In the case of female pattern hair loss, also called FPHL, runs in the family and is usually transmitted from parents or ancestors due to hormonal imbalances, especially androgen fluctuations, which results in the formation of hair loss with bald patches, A similar condition called PCOS (polycystic ovarian syndrome) which also result in the formation of fluctuations in the hormone levels resulting in the formation of bald patches and hair loss. They may also be associated with other symptoms, including menstrual irregularities, acne, and unwanted excess facial hair growth. To rule out the presence of PCOS, it is advised to consult a gynecologist in person to normalize the hormone fluctuations. The other causes of sudden hair loss include dietary changes, including consumption of fewer fruits and vegetables and more red meat, milk and dairy products, sweets, and fried food which triggers hormonal fluctuations and results in the formation of hair loss due to using hair care products in the form of creams and gels and undergoing treatments including smoothening, straightening and coloring of hair. One of the most common causes of hair loss includes seborrheic dermatitis in the form of dandruff, which results in hair loss along with itching, pain, and discomfort in the areas of hair loss. As you mentioned, the presence of pain in hair loss could also be associated with dandruff and flakes and the affected area. Apart from the same, lichen planopilaris is also a condition that results in the formation of a painful scalp with hair loss in particular areas, which usually appears as a coin-shaped hair loss. In the image provided, there does not appear to be a coin-shaped loss of hair, Due to which the same may be ruled out based on the image. However, the presence of thick skin, dry scales, patchy lots of hair in the form of coin-shaped loss, pain, pigmentation in the form of bluish-black color, and redness around the follicles from where the hair grows requires taking a punch biopsy at a dermatologist clinic to examine these cells under the microscope to rule out the above condition. Hair loss may also be associated with sudden bodily stress following a viral infection, including chicken pox, COVID infection, and other infections like typhoid, and in case of undergoing any surgeries which result in the body undergoing a temporary period of stress resulting in sudden hair loss which fortunately is reversible by medications and procedures which helps in stimulation of hair growth.
1. As I mentioned earlier, the first step to rule out the presence of lichen planopilaris may be to undergo a punch biopsy wearing a portion of the scalp area with scales, and pain would be examined. It would be viewed under the microscope to see for cells to provide a confirmative diagnosis for the same. The biopsy would help in a confirmative diagnosis. Still, the medications and procedures for hair regrowth remain the same; therefore, I would be including the different treatment plans that may be opted for hair regrowth.
2. KZ (Ketoconazole and Zinc pyrithione) plus lotion may be applied to your scalp to eliminate the dry scales and the symptoms. This lotion must be diluted in a 1:3 with water taking almost a teaspoon of the lotion and mixed with three times as much water. The mixture is to be applied to your scalp and massaged with moderate pressure to remove the flakes and scales for a minute, following which it is advised to wait for three minutes before washing the mixture on your scalp. This lotion may be used twice a week, preferably two to three days apart, for better results and will be continued for months together.
3. Depending on the change in the climate, in extreme climates, sometimes there may be a painful scalp associated with dandruff and seborrheic dermatitis. Therefore, the above medication may help get rid of that.
4. Tablet Follihair (vitamins and minerals) once daily to be taken orally after dinner for two months. They help in hair growth stimulation and provide the required vitamins for hair growth.
5. Minoxidil 2 % solution may be applied to the areas of hair loss for stimulating hair regrowth. Minoxidil works by increasing the blood supply to the hair follicles to stimulate hair growth; therefore, abrupt stopping of the medication is not advised as it may result in the obliteration of the blood supply, causing the regrown hair to fall off again. Minoxidil needs to be used for years for better results and, initially, at least one year for the results to show significance. For example, for the initial year, Minoxidil needs to be applied at night in a quantity of one milliliter using the spray or the dropper available with the solution and massaged onto the scalp once daily for a week for the first year, following which they may be reduced to once daily for six days per week for the next year and later taper down to five days per week for the following year and so on. In this manner, tapering down the medication is advised rather than abrupt stopping. In case of a history of any medical conditions, seizures, migraine, or any other significant medical condition, it is not advised to be used as Minoxidil may trigger them.
6. Procedures for hair regrowth stimulation play a major role when coupled with the above medications. Platelet-rich plasma or PRP treatments, as well as growth factor concentrate (GFC) treatments, are superficial injections that are taken on the scalp after drawing around ten to 12 mL of your blood and centrifuged in a machine to extract the growth factor concentrates alone, which are later injected superficially using an insulin syringe onto the scalp which causes stimulation of the follicles for hair growth. This is usually done every three to four weeks in at least six sessions and maybe repeated yearly. Apart from the same, mesotherapy, wherein the same procedure is done using a solution that consists of biotin and other vitamins which is necessary for hair growth, is injected onto the scalp at various locations, especially on the areas of bald patches, which helps in hair stimulation and may also be done coupled with the PRP or GFC treatments every 15 days. For these procedures, it is advised to consult a dermatologist in person for undergoing the treatment.
7. There are also laser techniques available where the laser beams penetrate the area of the bald patch and help with hair growth stimulation. These are also done in sessions of at least six every three weeks and require consultation with a professional. However, this procedure may be relatively expensive but yields good results.
8. Blood tests, including CBC (complete blood count), serum ferritin, serum iron, vitamin D3, vitamin B12, fat, TFT (thyroid function test), and ANA (antinuclear antibody) are blood tests to rule out vitamin and mineral deficiency as well as changes in the hormonal levels and thyroid hormones along with ruling out the presence of autoantibodies which may have been formed against one's cells resulting in the formation of bald patches which may also be seen in case of lichen planopilaris as mentioned above. In case of a fluctuation in its normal values, it becomes essential to start supplements and medications to treat any underlying condition to prevent the recurrence of bald patches and hair loss.
9. Apart from the above, I would also like to suggest you make sure to have a balanced diet including healthy fruits, vegetables, green leafy vegetables, fiber, proteins in the form of eggs, especially egg whites, and at least 12 glasses of water in a 250 mL glass size and a daily basis to prevent dry scales and pain on the scalp by providing hydration on the skin. In addition, make sure to avoid fried and oily food, red meat, sweets, milk, and dairy products, as they may trigger the formation of dandruff or dermatitis, resulting in bald patches and sudden hair loss.
The above medication and the form of oral and topical medications, along with the procedures, would help in hair growth stimulation and reduce the pain and dryness present on your scalp due to external and internal triggers. Hair loss associated with dandruff may be on and off because of the external and internal triggers that may result in their formation. External triggers may be controlled. However, internal triggers may not be controlled, and in case of hormonal changes due to PCOS, they may require treatment from a gynecologist, as mentioned above.
Kindly revert with the results of the above blood tests and a biopsy if required after an in-person physical examination by a dermatologist. As per the image provided, it does not appear to be lichen, But it is essential to rule out its presence in person considering the current symptoms you are experiencing.
I hope you find it helpful.
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