Hair Fall Causes, Tests and Treatment in Kolkata

Many people in Kolkata notice their hair coming out in handfuls a couple of months after dengue, typhoid or another high fever, or after having a baby. Others see a slowly widening parting or a thinning crown over several years. Both get called "hair fall", but the causes differ, so the right treatment depends on the right diagnosis.

How much hair fall is normal?

According to the American Academy of Dermatology, it is normal to shed about 50 to 100 hairs a day. Old hairs fall out as new ones grow in their place. You may notice more on wash days, simply because loose hairs collect in one place.

Signs you may be losing more than normal:

• A parting that is getting wider

• A receding hairline or thinning at the temples

• A thinning crown, or more scalp showing under bright light

• Round or oval bald patches

• Hair coming out in clumps

Common causes of hair fall

Shedding after fever, illness or stress (telogen effluvium)

A shock to the body can push many hairs into a resting phase at the same time. Common triggers are high fever (such as dengue, typhoid or COVID-19), surgery, childbirth, crash dieting and major stress.

Shedding usually starts 2 to 3 months after the trigger, so people often do not connect the two. In most people it settles over 6 to 9 months. See a doctor if it is heavy or goes on for more than about 6 months.

Pattern hair loss (androgenetic alopecia)

This is the most common long-term cause. It runs in families and is linked to hormones. Men usually notice a receding hairline or thinning crown. Women more often notice a wider parting and general thinning. It tends to get worse slowly, so it helps to see a doctor early.

Patchy hair loss (alopecia areata)

Here the body's immune system attacks the hair roots, causing smooth, coin-sized bald patches on the scalp, beard or eyebrows. Hair often grows back, but the course is hard to predict, so get it checked.

Low iron, poor diet and supplements

Low iron and too little protein can add to hair fall, especially in women with heavy periods and people on strict diets. Supplements help only if you are actually low in something. Too much of some supplements, such as vitamin A or selenium, can itself cause hair loss. It is better to test than to guess.

Thyroid, PCOS and medicines

An underactive or overactive thyroid can thin hair across the whole scalp. In women, polycystic ovary syndrome (PCOS) can cause thinning hair along with irregular periods, acne and extra facial hair. Some medicines can also trigger hair fall. Do not stop a prescribed medicine on your own, but do tell your doctor.

Scalp conditions

Scalp psoriasis and fungal infection of the scalp (tinea capitis) can lead to hair loss. Dandruff (seborrhoeic dermatitis) can add to shedding and breakage, mainly through itching and scratching. Tinea capitis is most common in young children and needs prescription treatment, because shampoo alone cannot reach the infection inside the hair root.

Hair-care habits

Tight ponytails, buns and braids pull on the roots and can cause traction alopecia. If the pulling goes on for a long time, the hair may not grow back. Harsh chemical treatments and frequent heat styling cause breakage that looks like hair fall.

Hair fall myths and facts

• Myth: Oiling prevents hair fall. Fact: Oil can soften hair and reduce breakage, but there is no good evidence that it prevents hair falling from the root. On a dandruff-prone scalp, heavy oiling may make things worse.

• Myth: Washing hair daily causes hair fall. Fact: Washing only rinses away hairs that were already shed.

• Myth: An expensive shampoo can fix hair fall. Fact: Shampoo can help manage dandruff, but it cannot fix hormonal, nutritional or genetic causes.

When to see a doctor for hair fall

Book a visit with a dermatologist if you have:

• Sudden or very heavy shedding

• Bald patches

• Scalp pain, redness, scaling, crusting or pus

• Hair loss with tiredness, weight change, irregular periods or extra facial hair

• Loss of eyebrow or beard hair

• Hair loss in a child

• Hair fall that is not getting better after about 3 months, or any shedding that lasts more than 6 months

Dengue warning signs: go to hospital straight away

Hair fall is rarely an emergency, and hair fall weeks after dengue is not a sign of severe dengue. But if you have dengue now, or your fever has only just come down, watch for these warning signs: severe belly pain, repeated vomiting, fast breathing, bleeding gums or nose, blood in vomit or stools, restlessness, or pale and cold skin. The World Health Organization notes that these signs often appear just as the fever is settling. If you notice any of them, call 112 or go to the nearest hospital emergency department straight away.

What happens at a hair consultation

A dermatologist visit for hair fall may include:

1. Questions about your history. When shedding started, recent illness or childbirth, diet, periods, medicines, stress, hair care and family history.

2. Examination. A look at the scalp, hairline, eyebrows and nails, and a gentle "pull test" to see how easily hairs come out.

3. Trichoscopy, if needed. Some dermatologists use a magnified look at the scalp (a dermoscope) to help tell causes apart.

4. Blood tests, only if needed. Common examples are a complete blood count, iron stores (ferritin) and thyroid tests. Rarely, a small scalp biopsy is needed.

If your doctor advises blood tests, samples can be given at the clinic.

Treatment options a dermatologist may discuss

The right plan depends on the diagnosis. Results vary, and no treatment works for everyone.

• Treating the cause. For example, correcting a proven deficiency, or managing thyroid disease or PCOS with the right specialist. Shedding after a fever often needs reassurance and time more than medicine.

• Prescription medicines for pattern hair loss. Some are applied to the scalp and some are taken by mouth, only under a doctor's care. Some are not suitable in pregnancy or if you are planning a pregnancy, so tell your doctor. They usually take at least 3 to 6 months to show an effect, and up to a year for the full effect. They usually need to be continued. If treatment ends, any benefit usually fades.

• Treatment for alopecia areata and scalp conditions. This may include medicated lotions, creams or shampoos, and sometimes injections into the patches.

• Procedures. Some procedures are used for certain types of hair loss, but they do not suit everyone and each carries risks. Your dermatologist can explain whether any fits your diagnosis.

Everyday habits that help

• Eat enough protein: dal, eggs, fish, paneer, curd, soya.

• Use a wide-toothed comb and do not rub wet hair hard with a towel.

• Choose loose hairstyles and cut down on heat styling and chemical treatments.

• Keep dandruff under control, get enough sleep and manage stress where you can.

Frequently asked questions

Will my hair come back after dengue hair fall?

Usually, yes. Shedding after dengue or another high fever is usually telogen effluvium, which settles on its own in most people. If it is very heavy or lasts more than about 6 months, see a dermatologist.

Should I see a dermatologist or a trichologist?

In India, trichology is not a recognised medical specialty, and the title alone does not mean the person is a medical doctor. Check the person's medical qualifications. A dermatologist (MD, DNB or DDVL) is a medical doctor trained to treat problems of the skin, hair, nails and scalp. Be careful of anyone who promises results. Our guide on how to choose a dermatologist explains what to check.

Consult a dermatologist at Cara, MCR Behala

Cara is the skin and hair division (Dermatology Department) of MCR Super Speciality Polyclinic & Pathology in Behala, Kolkata. Its dermatologists include:

• Dr. Kaushiki Hajra (MBBS, MD Dermatology, Venereology & Leprosy)

• Dr. Sushil Kumar Singh (MBBS, MD Dermatology, Venereology & Leprosy)

• Dr. Asad Ansari (MBBS, DDVL)

Read more about our Cara skin & hair clinic.

How to book

MCR Super Speciality Polyclinic & Pathology, 11A, Sourin Roy Road, near Behala Tram Depot, beside Ellora Cinema Hall, Behala, Kolkata 700034. Phone/WhatsApp: +91 9830525004. Clinic hours: Monday to Saturday, 8 AM to 8 PM (closed on Sunday).

Call or WhatsApp to check when the dermatologists are available, or book a clinic visit online.

General information: This article is general information and does not replace a consultation with a doctor.