Hair Loss

Throughout time, hair has been an important aspect of a person's appearance and personality. Color, length, style, and amount have often been associated with youth, sex appeal, health, and power. It's no wonder then, that balding, thinning hair, or receding hairlines is a concern for those coping with hair loss. Hair has been called our “crowning glory.” Society has placed a great deal of social and cultural importance on hair and hairstyles. Unfortunately, many conditions, diseases, and improper hair care result in excessive hair loss. People who notice their hair shedding in large amounts after combing and brushing or whose hair becomes thinner or falls out may consult a dermatologist. With the right diagnosis, many people with hair loss can be treated.

Dr. Eileen Tan, a Singapore Specialists Accreditation Board Certified Dermatologist who specializes in treating diseases of the skin, hair, and nails. She has received post-specialist training in North America in managing various hair and nail disorders, hair transplantation, and lasers.

In patients with hair loss, she will evaluate a patient’s hair problem by asking questions about diet, medications (including vitamins and health food taken in the last six months), family history of hair loss, recent illness, and hair care habits. In women, hormonal effects may be evaluated by asking about menstrual cycles, pregnancies, and menopause. After examining the scalp and hair, a trichogram (examining hairs under the microscope), blood tests, or a scalp biopsy may be required for an accurate diagnosis. It is important to find the cause and to determine whether or not the problem will respond to medical treatment.

Hair Loss in Children

Common causes of hair loss in children include scalp infections (bacterial or fungal), self-inflicted hair loss (trichotillomania), alopecia areata, telogen effluvium (due to stress etc) and shaft abnormalities.

The diagnosis is established through directed patient history, scalp and hair examination, trichoscopy. Additional laboratory investigations and pathological examination may be required .

Alopecia Areata is an autoimmune condition presenting with patchy alopecia

Tinea capitis is a fungal infection. It often presents with itchy, scaly patchy or diffuse hair loss

Trichotillomania is self-inflicted plucking own hairs. May be related to stress or psychological issue

Hair Loss in Adults

Common causes of hair loss in adults includes androgenetic alopecia (male or female pattern hair loss), telogen effluvium (due to underlying medical diseases for example), alopecia areata.

The diagnosis is established through directed patient history, scalp and hair examination, trichoscopy. Additional laboratory investigations and pathological examination may be required

Androgenetic alopecia (male or female pattern hair loss)

Cicatricial Alopecia often leads to permanent destruction of hair follicles

Telogen effluvium often presents with acute hair shedding

Hair Biology

Normal hair growth

About 90 percent of the hair on a person’s scalp is growing at any one time. The growth phase lasts between two and six years. Ten percent of the hair is in a resting phase that lasts two to three months. At the end of its resting stage, the hair is shed. When the hair is shed, a new hair from the same follicle replaces it and the cycle starts again. Scalp hair grows about 1cm per month. As people age, their rate of hair growth slows. Most hair shedding is due to the normal hair cycle, and losing 50-to-100 hairs per day is no cause for alarm. However, if you are concerned about excessive hair loss or dramatic thinning, consult your dermatologist.

Common hair loss conditions

Patterned hair loss

Women with this type of hair loss have a pattern similar to what we observe in men. In other words, they have thinning in front or on top of their scalp with little hair loss in the permanent zone around the sides and in the back. Thus, the balding is in a characteristic "pattern" rather than generalized. Men and women with patterned hair loss generally are excellent candidates for surgical restoration.


As is men, the genes that cause hair loss can be inherited from either your mother or father. The expression of these genes is dependent on hormones called androgens, so common hair loss in both men and women is coined "Androgenetic Alopecia"

In Androgenetic Alopecia, hair follicles that normally produce healthy, terminal hairs begin to produce thinner, shorter, more brittle hairs with weaker shafts (this process is called Miniaturization and the hairs involved are called miniaturized hairs). Eventually, these follicles produce only fine, almost invisible, short, vellus hairs, or they may die out altogether.


Testosterone is converted to DHT by the enzyme 5-alpha reductase that is present in higher concentrations in the balding areas of the scalp. This is the hormone that is responsible for male sexual characteristics and, when the body converts it to DHT, it becomes the main culprit in causing baldness.

Women have only ½ the amount of this enzyme overall as men and have even less in the crown. In addition, women have higher levels of an enzyme called aromatase in all areas of the scalp that may block the formation of DHT. This enzyme is present in especially high concentration in the frontal hairline in women, possibly explaining why this area is fortunately resistant to balding in most females.


With age, some degree of hair loss occurs in everyone so that total hair volume will decrease over time in both sexes. The hair loss associated with genetic balding is also dependent upon time to accelerate itself. Hair loss tends to occur at different rates at different periods in one's life with increased loss often occurring during periods of hormonal change, such as pregnancy, menopause, or ill health.


There are both effective medical and surgical hair restoration techniques.

A thorough history and examination of the scalp can reveal the extent and trend of the hair loss process and the specialist will then offer you the most optimal treatment solutions such as

  • Hair Transplantation

  • Medical Therapies

  • Lower level laser light

Localized Hair Loss

Localized hair loss may be classified into scarring and non-scarring types.

Alopecia Areata is an auto-immune disease that typifies the non-scarring type. It manifests itself with the sudden onset of round patches of hair loss associated with normal skin and can be treated with local injections of corticosteroids or immunotherapy.

Scarring Alopecia can be caused by a variety of medical or dermatologic conditions such as Lupus and Lichen planus, infections, or local radiation therapy. Baldness from injuries, or from local medical problems that have been cured, are usually amenable to hair transplantation.

Localized hair loss can occur around the hairline after face-lift surgery or constant tugging on the hair (known as Traction alopecia). Both of these conditions can be treated with hair transplantation.

Diffuse Hair Loss

A number of "non-androgenetic" factors may be responsible for hair loss especially in women. Women's hair seems to be particularly sensitive to underlying medical conditions. Since "systemic" problems often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is important that women with undiagnosed hair loss, especially of the diffuse or "un-patterned" type, be properly evaluated.

Among the many medical conditions that can cause hair loss, the most common ones are:

  • anemia

  • thyroid disease

  • other endocrine problems (especially those that produce excess androgens)

  • gynecological conditions - such as ovarian tumors

  • connective tissue disease (such as Lupus)

  • surgical procedures and general anesthesia

  • rapid weight loss or crash diets that are not nutritionally balanced

  • severe emotional stress

It is also important to review the use of medications that can cause hair loss. The more common ones are:

  • oral contraceptives

  • thyroid medication

  • blood pressure medication (such as beta-blockers or water pills)

  • "mood" medication such as lithium, Prozac, or tri-cyclic antidepressants

  • blood thinners such as heparin or warfarin

  • cholesterol lowering medication