Hair loss, known medically as alopecia, is a leading concern in Singapore, affecting over 44% of research participants in a 2022 local survey. Hair loss affects millions of people, regardless of age, gender, or ethnicity. Let us take an in-depth look into the causes, diagnostic methods, and strategies for hair loss management.

What is hair loss?

Hair loss happens when the natural cycle of hair growth and shedding is disrupted, or when the hair follicle is damaged and replaced with scar tissue instead (also called scarring alopecia). 

What causes hair loss?

Hair loss can be caused by medical issues such as nutritional deficiencies and hormones. If you suffer from hair loss, it is recommended to undergo a hair loss screening test at Assure Family Clinic.

Assure Family Clinic’s hair loss screening includes the following components:

1. Full Blood Count [FBC]

2. Iron Panel

• Ferritin
• Serum Iron
• Total Iron Binding Capacity [TIBC]
• % Iron Saturation [TSAT]

3. Vitamin B12

4. Folate

5. Vitamin D

6. Thyroid Profile:

• Free T3
• Free T4
• TSH

7. Zinc

8. Hormone Test​

Besides nutritional deficiencies and hormones, there are also many factors that can lead to hair loss, largely depending on the specific type. Common kinds of hair loss include: 

1. Androgenetic Alopecia (AGA) / Female Androgenetic Alopecia (FAGA) 

AGA is one of the most common forms of hair loss. In AGA, hair loss can begin at any point after reaching puberty and becomes more progressive with age. It can affect people of both genders.

• In men –  AGA is responsible for 95% of hair loss in men, and in Singapore, 50% of men face AGA by age 50. Male-pattern hair loss is observed in 7 stages:

1. Hair loss is typically first seen in the hairline and/or thinning at the crown of the scalp. 
2. Hairline recession often progresses near the temples. 
3. Deep hairline recession around the temples, with the hairline forming the shape of a ‘U’ or ‘M’.
4. A noticeable bald spot at the crown of the scalp.
5. Hairline recession merges with a growing bald spot.
6. Thinning of the hair between the temples and crown. 
7. Complete baldness at the top of the head, with only a band of hair around the side of the head.

• In women –  FAGA is experienced by 40% of women by age 50. Hair loss is first noticeable as a wider centre part due to diffuse hair thinning at the top and crown of the scalp. Advanced stages of FAGA would be observed as a bald patch at the centre top of the head. 

AGA in both men and women can be attributed to a multitude of factors:

• Hormones – In some cases of AGA, male sex hormones, and more specifically dihydrotestosterone (DHT), are in excess. It was observed that a high level of DHT can shrink hair follicles, which makes it harder to develop a healthy head of hair. DHT, in excess, is also believed to shorten the hair growth cycle. 

• Genetics – A common factor in AGA is genetic predisposition. Many individuals have a family history of AGA because the AR gene, which is responsible for the body’s production of androgens, is inherited from the parents. 

• Age – Typically, early stages of AGA are noticed by age 30, but AGA can start from early adulthood and progressively worsen over time. Approximately one in four men notice the initial symptoms of hair loss before the age of 21.

• Diet & Lifestyle – For individuals who are genetically predisposed, certain choices in lifestyle and diet can exacerbate AGA. Diets lacking in vitamin B12, vitamin D, biotin, riboflavin, iron etc., smoking, and alcohol consumption, as well as chronic stress, are all known to worsen AGA.

2. Traction Alopecia

By its name, traction alopecia is a form of hair loss caused by continuous and excessive tension, or traction, on the hair and scalp. This tension is often due to:

• tight hairstyles like slicked-back ponytails and buns, tight braids
• hair extensions or weaves
• hair rollers worn for excessive periods (e.g. worn to sleep)

Traction alopecia is more noticeable in individuals of Asian origin due to their typically, straight, dark hair, and it causes hair to come off in patches along the hairline.

3. Alopecia Areata

Alopecia Areata is an autoimmune disorder that attacks the hair follicles. This disease leads to hair loss in small, round patches on the scalp, eyebrows, eyelashes, and other facial hair areas.

The age of onset of alopecia areata and the rate of progression can vary amongst individuals. However, it often develops first in children and teens. The exact cause of alopecia areata is not yet fully understood. Still, some observed factors for this disorder include:

• Genetics – While in many cases, affected individuals have no family history of alopecia areata, researchers have discovered connections between several genes and the condition, which suggests that one could be genetically predisposed to alopecia areata. 

• Autoimmune Disorders – It was observed that alopecia areata is more common in individuals who have other autoimmune disorders such as vitiligo, morphea, thyroid disorders, and even type 1 diabetes, etc.

4. Frontal Fibrosing Alopecia (FFA)

Frontal Fibrosing Alopecia (FFA) has similar features to alopecia areata. It is an autoimmune disorder that causes hair loss at the front and sides of the hairline. Advanced stages of FFA also affect the eyebrows, and other areas, including the arms, legs, underarms, and pubic area. 

However, unlike alopecia areata, FFA is a form of scarring alopecia and is characterized by progressive frontotemporal hair loss. While FFA can affect individuals of any age and gender, it is most commonly seen in post-menopausal women. The exact cause of FFA is still not fully known, and so far only a few possible factors have been considered. These include: 

• Inflammatory Response – Apart from hair loss in the frontotemporal areas, FFA is also characterised by inflammation in the same affected areas. It is possible that this inflammation contributes to the destruction of hair follicles, which makes FFA a form of scarring alopecia.

• Hormones – Medical researchers believe that hormones may be a contributing factor because FFA typically affects post-menopausal women, and it is possible that the hormonal imbalance experienced after menopause triggers the inflammatory response.

Can hair loss be reversed?

Hair loss, depending on its cause and stage of severity, can be reversed or slowed down. Scarring alopecia, unfortunately, is irreversible. 

Scarring alopecia usually involves inflammation at the proximal region of the hair follicle. When stem cells found in that region are destroyed, it is impossible to regenerate the hair follicle, leading to permanent hair loss. 

Some forms of scarring alopecia and their symptoms include: 

• Frontal Fibrosing Alopecia (FFA)  
  • Frontotemporal hair loss and hair loss at the eyebrows/other areas of hair growth
  • Itchiness/pain at the scalp
  • Small bumps (resembling pimples) near the hairline and on the face
  • Rosacea (reddened/flushed skin mainly at the cheeks)
• Central Centrifugal Cicatricial Alopecia (CCCA)
  • Hair Loss in the centre of the scalp, either as one central patch, or scattered patches
  • Tenderness/burning at the scalp
• Pseudopelade of Brocq (PPB)
  • Hair Loss in small, asymmetrical patches
  • Affected areas are slightly depressed (said to resemble ‘footsteps in the snow’)

When detected and treated early, the rate of hair loss can be slowed/stopped and symptoms can be alleviated. In some cases, hair loss can even be reversed if treated before hair follicles can develop scars, so be sure to consult a doctor when you notice these signs and symptoms. 

Treatments for hair loss

There are numerous treatments available for forms of hair loss that are reversible. The choice of treatment would depend on underlying causes and the specific type of hair loss— you can consult our General Practitioner (GP) & aesthetic doctor for a diagnosis and tailored advice on how to better manage your condition.

1. Alopecia Areata

Treatment options for alopecia areata are recommended based on its severity and the affected individual’s age. Treatment for this form of hair loss aims to stimulate hair growth and manage the autoimmune response that causes the hair loss.  

• Corticosteroid 
  • Topical Corticosteroids in the form of prescription-strength ointments/creams are applied directly to the affected areas, 1-2 times daily. This medication helps to reduce inflammation and promote hair regrowth. 
  • Injections of corticosteroids are directly administered into areas with hair loss, every 4-6 weeks. This is often recommended for larger or more persistent areas of hair loss. 

• Minoxidil 

• Minoxidil is another topical medication typically used alongside corticosteroids to promote hair regrowth.

2. Androgenetic Alopecia (AGA/FAGA)

• Medication 
  • Minoxidil – Minoxidil helps to promote hair regrowth, increase hair thickness, and slow the progression of hair loss. 
  • Finasteride – Finasteride is typically prescribed to men experiencing male-pattern baldness to reduce excess dihydrotestosterone, thereby promoting hair regrowth.
  • Spironolactone – Spironolactone is typically prescribed to women with suspected hormonal imbalances, to reduce hair loss and increase hair thickness.

• Low-Level Laser Therapy (LLLT) – LLLT devices use low-level laser light to stimulate hair follicles and promote hair growth. It is a safe and painless treatment, however, it does require multiple sessions over a period of months.

• Lifestyle Changes – Since poor nutrition is known to exacerbate AGA, your GP may recommend vitamins and supplements such as vitamin B12, vitamin D, biotin, iron, and more. Assure Family Clinic offers personalised practitioner-grade dietary supplements that are tailored to your unique health goals, which can boost your nutrition and potentially mitigate hair loss.

Who should I consult for hair loss?

When experiencing concerns about hair loss and scalp health, it is important to consult a GP.

To prepare for your consultation, do take note of:

• Medical History
  
  • Consider past medical conditions you have or have had in the past
  • Family history of any hair loss-related conditions

• Documenting your hair loss and/or symptoms 

The rate of your hair loss and the pattern of hair loss helps your GP better diagnose the type of alopecia you may be experiencing. Taking note of other associated symptoms such as itchiness/burning at the scalp can help as well. 

During the consultation, expect that your GP may perform physical examinations on your scalp or even recommend further tests, such as blood tests, to diagnose the cause of your hair loss and put together a personalised treatment plan. 

Summary 

Understanding the underlying causes and learning about the available treatments for hair loss is key for those experiencing this condition. Noticing symptoms early and consulting a GP in Singapore for an accurate diagnosis, followed by appropriate treatment, can help individuals regain their confidence and maintain healthy hair.

Visit Assure Family Clinic

If you are suffering from hair loss, you can book a consultation with our GP who is skilled in aesthetic medicine. Dr Au is a trained Aesthetic Doctor with a Diploma from the American Academy of Aesthetic Medicine (AAAM).  She can help you to accurately diagnose your type of hair loss and suggest a treatment plan. In particular, she is experienced in a variety of treatments and personalised practitioner-grade dietary supplements. Book an appointment today to start alleviating your hair loss through a holistic approach. 

References

1. Statista: Leading hair concerns among people Singapore 2022. [Online] 
2. WellaHolic: Hair Loss Alert: Don't Ignore the Signs of Traction Alopecia. [Online] 
3. SingHealth: KK Women's and Children's Hospital. Hair Loss: Causes and Treatment. [Online] 
4. The Sire: Androgenetic Alopecia: Causes of Androgenetic Alopecia in Singapore. [Online]
5. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): Alopecia Areata. [Online] 
6. PubMed Central (PMC): Hair Disorders: A Comprehensive Review. [Online]
7. PubMed Central (PMC): Alopecia: A Review of Laser and Light Therapies. [Online] 
8. Oxford University Hospitals (OUH): Alopecia. [Online
9. Healthline: Frontal Fibrosing Alopecia: Causes, Symptoms, and Treatment. [Online] 
10. National Center for Biotechnology Information (NCBI) Bookshelf: Central Centrifugal Cicatricial Alopecia. [Online]