Hair Problems

What is androgenetic alopecia?

Androgenetic alopecia, also known as hereditary hair loss, affects both men and women, presenting as a receding hairline, balding on the crown (in men), or diffuse thinning along the parting (in women). Understanding its causes, effects, and available treatments is crucial for effective management.

What causes androgenetic alopecia?

The primary cause of androgenetic alopecia is a combination of genetic predisposition and the influence of androgens, particularly dihydrotestosterone (DHT). DHT can shrink hair follicles in individuals with a genetic predisposition, leading to shorter and finer hair growth cycles, eventually resulting in visible thinning and baldness.

What are the symptoms of androgenetic alopecia?

Here are the typical symptoms of androgenetic alopecia:

Symptoms of androgenetic alopecia in men

• Receding hairline: the hairline typically recedes in an “M” shape, starting at the temples.
• Thinning at the crown: hair begins to thin on the top of the scalp, often progressing to partial or complete baldness.

Symptoms of androgenetic alopecia in women

• Diffuse thinning: women generally experience broad hair thinning, particularly at the crown of the head, rather than a receding hairline.
• Widening part: the part in a woman’s hair may gradually widen, showing more of the scalp.

Symptoms of androgenetic alopecia common to both men and women

• Increased hair shedding: more hair falling out during washing, brushing, or touching.
• Miniaturisation of hair follicles: hair gradually becomes finer and grows more slowly.

Androgenetic alopecia can cause significant emotional and psychological distress, but there are treatments available that can slow the progression.

Who is at risk of androgenetic alopecia?

Androgenetic alopecia (AGA), or pattern baldness, has several risk factors that make certain individuals more likely to develop this condition:

• Genetics: the primary risk factor for AGA is hereditary. A family history of pattern baldness increases the likelihood of experiencing it. The genetic influence can come from either parent's side of the family.
• Age: the risk of developing AGA increases with age. While it can begin as early as puberty, the likelihood becomes higher as individuals age, with significant numbers affected in their 40s and beyond.
• Gender: both males and females are equally susceptible to androgenetic alopecia.
• Concomitant hair problems: often, childbirth or illness-related telogen effluvium, nutritional deficiencies, or even alopecia areata can unmask an underlying predisposition to androgenetic alopecia.
• Hormonal factors: hormones play a crucial role, particularly dihydrotestosterone (DHT), a derivative of testosterone. Sensitivity to DHT in genetically susceptible hair follicles leads to thinning hair, so treatments that reduce DHT levels or block its effects are effective.

What are the treatment options for androgenetic alopecia?

Our specialists at Lumine Dermatology & Laser Clinic understand the profound impact of hair loss. They are dedicated to providing innovative, non-surgical solutions tailored to the individual needs of our patients:

• Hair loss supplements: hair supplements, such as oral proteoglycan (Nourkrin), are designed to support hair health from within.
• Topical medications: topical medications are targeted treatments applied directly to the scalp to encourage hair growth and thickness.
• Oral medications: oral medications, like Minoxidil, Finasteride, and Dutasteride, work to combat hair follicle shrinkage and promote regrowth.
• Microneedling Radiofrequency with application of exosomes: another treatment method at Lumine Dermatology & Laser Clinic includes applying growth factors or exosomes. Exosomes are extracellular vesicles, which are essentially tiny packets of information that cells use to communicate with each other. Exosomes stimulate hair growth by:
  • Stimulating hair follicle cells with growth factors, cytokines, and proteins.
  • Enhancing cellular communication pathways that are vital for hair growth and follicle development.
  • Promoting the formation of new blood vessels and increasing nutrient and oxygen flow to hair follicles.
  • Regulating the hair growth cycle which ensures that follicles spend more time in the growth phase.

What is alopecia areata?

At Lumine Dermatology & Laser Clinic, we understand that alopecia areata is more than just hair loss — it’s a condition that can profoundly affect your confidence and emotional well-being. Characterised by sudden, localised bald patches that can expand over time, this autoimmune disease sees the body’s immune system mistakenly attacking hair follicles.

What causes alopecia areata?

While genetics can play a role, anyone might experience alopecia areata at different stages in life.  The exact pathogenesis remains complex and multifactorial, essentially involving a misdirected immune response against hair follicles.

What are the symptoms of alopecia areata?

The symptoms of alopecia areata vary in severity and presentation, but here are the most common ones:

• Patchy hair loss: the most distinctive sign of alopecia areata is the sudden appearance of one or several round or oval patches of hair loss on the scalp or other areas of the body where hair grows. Early patches are often noticed by the hairdresser or family members.
• Exclamation point hairs: near the edges of the bald patches, hairs might narrow at the base, creating what is known as “exclamation point” hair.
• Widespread hair loss: in some cases, known as diffuse alopecia areata, the hair loss is diffuse and sudden. This condition can progress to complete scalp hair loss (alopecia totalis) or even complete body hair loss (alopecia universalis).
• Nail changes: although less common, some individuals with alopecia areata may also experience nail changes, such as pitting, ridging, or a sandpaper-like texture.
• Regrowth of white or grey hair: when hair regrows, it may initially be white or grey, though it can regain its original colour over time. Some individuals with alopecia areata may also describe a sudden shower of white hair.

Alopecia areata can affect anyone regardless of age and gender, and its course is often unpredictable. Hair may regrow on its own and then fall out again, or it may regrow permanently.

Who is at risk of alopecia areata?

Alopecia areata is an autoimmune condition, and while it can affect anyone, certain factors may increase a person's risk of developing it:

• Genetics: a family history of alopecia areata or other autoimmune diseases can increase the risk. If close family members have experienced alopecia areata or conditions like thyroiditis, rheumatoid arthritis, or type 1 diabetes, the likelihood is higher.
• Age: although alopecia areata can occur at any age, it most commonly begins in childhood or early adulthood. The majority of cases are diagnosed before the age of 30.
• Other autoimmune conditions: individuals with other autoimmune disorders, such as thyroid disease, vitiligo, lupus, rheumatoid arthritis, and type 1 diabetes, are at a higher risk.
• Stress: while not a direct cause, stress is often reported as a precipitating factor in the onset and flare-ups of alopecia areata. Stressful events may trigger the immune system to initiate or worsen hair loss.

Understanding these risk factors can help in early detection and management of the condition. If someone suspects they are developing symptoms of alopecia areata, especially if they have risk factors, consulting with Dr Evelyn at Lumine Dermatology & Laser Clinic is advisable for accurate diagnosis and potential treatment options.

What are the treatment options for alopecia areata in Singapore?

At Lumine Dermatology & Laser Clinic, we provide comprehensive care to modulate the immune response and foster hair growth. We will find the right tailored treatment option for you to restore your hair and confidence.

Treatment options for alopecia areata at Lumine Dermatology & Laser Clinic include:

• Topical treatments: designed to promote hair growth and reduce inflammation (more suitable for children).
• Intralesional steroid injections: intralesional steroid injections are administered to suppress the local immune response, encouraging the hair follicles to re-enter the growth phase.
• Supplements to reduce oxidative stress: supplements support overall scalp health and hair follicle function.
• Microneedling Radiofrequency with Exosome: a proprietary treatment where we utilize low doses of microneedling radiofrequency to stimulate the scalp hair follicles, and apply exosomes to boost hair growth.
• Oral medications: we also recommend oral medications, such as baricitinib, a JAK inhibitor, for severe alopecia areata, alopecia totalis, and alopecia universalis.

What is telogen effluvium?

Are you noticing more hair loss than usual during your daily routine? Is your once-thick mane feeling noticeably thinner? You might be experiencing telogen effluvium, a condition in which the typical rate of hair loss of about 100 strands per day increases to up to 300 strands per day.

What causes telogen effluvium?

Telogen effluvium is typically triggered by significant stressors, which can be emotional, physical, hormonal, or nutritional. When your body undergoes a stressful event, a larger-than-normal number of hair follicles prematurely enter the resting (telogen) phase in the hair growth cycle, which may lead to noticeable shedding weeks to months afterwards.

What are the symptoms of telogen effluvium?

Here are the key symptoms of telogen effluvium:

• Diffuse hair shedding: the most noticeable symptom is increased hair shedding. People affected may notice more hairs than usual on their pillows, shower drain, or hairbrushes.
• Thinning of hair: unlike alopecia areata, which results in patchy hair loss, telogen effluvium results in a general thinning across the entire scalp. The hair volume appears reduced, but complete baldness is rare.
• Usually temporary: the condition is typically temporary. Normal hair growth often resumes without treatment after the triggering event has been resolved or the body has had time to recover.
• Scalp visibility: as the hair thins, more of the scalp may become visible. However, the hairline usually does not recede.
• Onset after stressful events: the onset of telogen effluvium is usually several weeks to months after a triggering event. This could be severe stress, major surgery, significant weight loss, extreme diet changes, childbirth, or severe illness.
• More hairs in the telogen phase: a higher proportion of hairs enter the resting (telogen) phase of the hair cycle and subsequently shed. This is typically assessed through a hair pull test or scalp biopsy.

The condition generally resolves itself once the body recovers from the stressful event or the underlying cause is addressed, though recovery times can vary from several months to a year. If hair loss persists or if you're concerned about your symptoms, consult with Dr Evelyn at Lumine Dermatology & Laser Clinic to determine the underlying cause and start appropriate treatment.

Who is at risk of telogen effluvium?

Telogen effluvium, a form of hair loss triggered by stress or shock to the system, can affect anyone but is more likely to occur in individuals with certain risk factors:

• Recent major stress or trauma: individuals who have recently experienced significant physical or emotional stress such as surgery, severe illness, accident, or the death of a loved one are at higher risk.
• Postpartum women: women often experience telogen effluvium several weeks to months after childbirth due to the dramatic hormonal changes that occur.
• Severe infections or illness: those who have undergone severe infections, particularly if they have been hospitalised or have had a high fever, are at risk.
• Major surgical procedures: patients recovering from major surgery often experience this condition a few months later.
• Extreme weight loss or diet changes: sudden or extreme weight loss, malnutrition, or changes in diet (such as low protein diets) can trigger telogen effluvium.
• Certain medications: medications such as retinoids, beta-blockers, calcium channel blockers, antidepressants, and NSAIDs, have been linked to telogen effluvium.
• Chronic diseases: conditions like hypothyroidism or hyperthyroidism, lupus, and other chronic diseases can increase the risk.
• Iron deficiency: individuals, especially women with iron deficiency or anaemia, may be more susceptible to telogen effluvium.

Identifying and addressing the underlying cause, such as nutritional deficiencies, stress, or illness, is vital to managing this condition.

What are the treatment options for telogen effluvium?

At Lumine Dermatology & Laser Clinic, our diagnostic approach for telogen effluvium is thorough and patient-centric. We use a combination of clinical evaluations, including the bedside hair pull test and laboratory investigations, to understand your unique situation fully. Our goal is to identify not just the symptoms but the underlying causes of your hair loss.

Our treatment strategies are as unique as our patients and may include:

• Addressing underlying health issues: by identifying and treating any medical conditions or nutritional deficiencies contributing to hair loss, we aim to stop the shedding and prevent its recurrence.
• Nutritional supplements: adequate supplementation, such as proteoglycans (Nourkrin), iron, and vitamin D, can be crucial in correcting hair health deficiencies.
• Topical treatments: specific topical applications can help stimulate hair growth and reduce shedding.
• Microneedling with application of growth factors or exosomes: this approach utilises your body's healing mechanisms to rejuvenate hair follicles and promote hair growth.

Concerned about hair issues? Make an appointment with Lumine Dermatology & Laser Clinic today, and we can create a bespoke treatment plan for you.