Results: Search by author Dr. Santosh D (Dermatologist).

Hair loss and treatment



Hair is one of the skin appendage. Though it appears as dead structure, it is undergoing continuous cycles of growth and loss. As compared to animals, human beings are less hairy due to process of evolution. The hair growth pattern is very important part of overall appearance of individual.
Hair growth pattern varies individually and according to gender. The pattern of hair growth is determined in when we are in womb. Subsequently, with advancing age and changing hormonal pattern, hair density changes.

Every hair has cyclical growth. It has growth phase (Anagen), resting phase (Telogen) and involution phase (Catagen). The duration of these stages varies according to body site.

Factors which control hair growth

• Age
• Nutrition – iron, minerals, vitamins
• Hormones  - androgens, thyroid
• Physical damage to hair – withering of hair shaft due to dryness, heat application
• General health
• Drug intake (medicines)

Hair loss
Also called as alopecia. It is broadly divided as diffuse and localized, scarring and non-scarring and patterned hair loss.

Diffuse hair loss
Hair loss is from all over scalp. Normally up-to 100 hairs are lost daily which re-grow. If more than 100 hairs are lost daily from scalp then it is considered as significant.

Common causes are

• After acute febrile illness
• Chronic illness
• Nutritional deficiency – iron, minerals, vitamins
• Thyroid diseases
• Drug intake like post chemotherapy
• Scalp diseases like dandruff

Diffuse hair loss is usually reversible and treatable.

Patchy or localized hair loss
Alopecia areata – it is a patchy loss of hair noticed suddenly. Usually self limiting and hair re-grow with treatment.

Trichotillomania – emotionally disturbed patients pluck their hair either knowingly or unknowingly. Psychiatrist intervention needed.

Scarring alopecia
Scalp diseases or trauma which lead to scar formation and hair loss locally. Hair loss is permanent and hair cannot re-grow unless transplanted.

Patterned hair loss
It is due to effect of androgens on scalp hair. Androgens cause miniaturization of scalp hair in a pattern. It is seen in males and females as well.

Males – Hair line start receding from late 20s and early 30s in a pattern (Frontolaterally and over crown of scalp). The severity of hair loss depends on genetic susceptibility. If early treatment is started, progression can be arrested in majority. Treatment has to be continued lifelong and is safe.

Delayed treatment cannot restore lost hair. They are candidates for hair transplantation.




Females - Thinning of hair density over crown area start developing in late 40s. Can be seen in young girls if associated with androgen excess (obesity, polycystic ovary disease). Progression of late age onset can be stopped with treatment which has to be continued lifelong. Young girls canbe treated with hormonal therapy, weight reduction.





Myths about hair care

• Regular oil application to scalp helps to grow longer hair and prevent hair graying – Hair oils act like hair conditioners. It does not affect hair growth. Scalp massage during application may increase scalp circulation which gives relaxation effect.

• Shampoos cause hair loss - Loose hair are shed off during scalp wash which otherwise also would have shed gradually. Since they are shed off together, it gives impression of hair loss. Shampoos do not affect hair growth. Excessive use may cause hair shaft withering and increased breakability.

Hair transplantation
Male and female patients with advanced hair loss cannot be restored natural looking hair line with medicines. Such patients are candidates for hair restoration surgery.

Technique of hair transplantation
Back (Poserior) portion of scalp hair are usually seen retained in advanced male pattern hair loss. Because these (occipital) hairs are resistant to androgen effect. Hair follicles (individual hair unit) are harvested from this area and grafted to frontal bald areas. The restored hair line is permanent and natural looking compared to wigs or hair patch. The results of surgery depend upon severity of balding and surgeon’s expertise.



Two techniques for hair transplant

• Follicular unit transplant – Strip of hair is removed from occipital scalp. Individual hair units are separated by careful dissection and transplanted. This technique is useful for treatment of large bald areas, quicker and less expensive.


• Follicular unit extraction – Individual hair units are extracted from occipital scalp and transplanted. It is time consuming, expensive technique but without scar on occipital area.





Before                                 After



Technique selection depends on patient’s scalp condition, severity of hair loss and surgeon’s familiarity with the technique. Repeat sessions of surgery may require for larger bald areas.


No hospitalization is required. Patient can return home same evening.

Hair transplantation can be used in restoration of eyebrows, eyelashes or scarring alopecia.



Dr Santosh D
MD (Skin & VD), DDV, Fellowship in hair transplant surgery (South Korea), Fellowship in STDs and AIDS (Thailand)
Consultant Dermatologist, Cosmetologist & Hair Transplant Surgeon, Thane



It affects 85% of individuals between the ages of 12 and 24 years. It is also seen to be increasingly affecting older adults. Acne is often associated with anxiety, depression  & higher-than-average unemployment rates.

Why and how acne develop?
With the pubertal spurt, due to surge of sex hormones, the sebaceous glands in skin increase in size. The glands start secreting more sebum. The sebaceous gland openings on the surface of skin get blocked due to abnormal keratinisation of sebaceous ducts. It is visible as comedone (White head and black head).

Comedones are precursor of acne. The blocked sebaceous glands get infected by bacteria (Propionibacteria). This leads to inflammation which is called as acne. According to severity of inflammation, acne are classified as mild, moderate, severe.

Most acne patients do not typically have significant hormone abnormalities.



Factors which worsen acne

• Obesity (particularly teenage)
• Application of oily substances over face, head
• Hot, humid climate
• Before menses
• Stress
• Intake or application of steroids

Myths about acne

• Intake of oily, spicy food cause acne
• Constipation or indigestion
• Blood impurity
• Frequent washing of skin clears acne

None of the above has scientific correlation

Treatment of acne
Even though acne are self limiting in majority, cosmetic concern is very common and understandable. Delay of treatment or lack of treatment can cause significant permanent scarring.

Treatment depends on severity of acne, age of patient and pregnancy status. Treatment also depends upon patient expectations and urgency to see the results (Social functions, marriage, interviews, etc).
It can be only applications (creams, gels, lotions) or combination with oral medicines.




Applications (creams, gels, lotions)

• Antibiotics
• Benzoyl peroxide
• Retinoids

Oral medicines

• Antibiotics
• Retinoids
• Hormonal therapy


Used as supportive therapy to acne treatment. When used alone, rarely effective.

Maintenance therapy
It is continued for longer period of time once acne lesions are healed. It is essential because acne therapy only target effects of hormones on skin without disturbing hormones. Hence, once treatment is discontinued, acne may reappear. Maintenance therapies are usually applications which are safe for long term use.

Treatment of acne scars and pigmentation
Residual acne scars and pigmentation is of concern in some individuals. Various procedures can minimize these scars. The results of the procedures are individual specific and cannot be generalized.


Procedures for acne scars

• Chemical peels – Routinely glycolic acid peels are used in varying concentrations. Other peels available are salicylic acid, mandelic acid, trichloroacetic acid. Peels are used as adjuvant therapy during active acne.
• Microdermabrasion (Skin polishing)
• Dermaroller
• LASER resurfacing
• Scar subscision
• Scar excision
• Feelers  therapy


Dr Santosh D
MD (Skin & VD), DDV, Fellowship in hair transplant surgery (South Korea), Fellowship in STDs and AIDS (Thailand)
Consultant Dermatologist, Cosmetologist & Hair Transplant Surgeon, Thane

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