Hair & Scalp Health

Losing 50-100 hairs per day is normal — this is the natural end of the hair growth cycle (telogen phase) replacing existing hairs. People notice shedding more on hair wash days because washed-out shed hairs accumulate. Concern is warranted when: hair is thinning visibly (the parting widens, the scalp shows through), you see clumps of hair coming out at once, bald patches appear, or shedding clearly exceeds baseline (filling a brush dramatically more than before, blocked drains). Context matters: after fever, surgery, major illness, childbirth, or extreme stress — a sudden increase in shedding 2-3 months later (telogen effluvium) is expected and usually self-limiting. In this case shedding is widespread, not patchy, and regrowth follows. A dermatologist can do a pull test (gently pulling 50-60 hairs — more than 10% coming loose suggests active shedding) and trichoscopy (scalp dermoscopy) to assess follicle health.

Yes — minoxidil is one of only two medications approved by regulators for androgenetic alopecia (pattern hair loss), the other being finasteride/dutasteride. Topical minoxidil (2% for women, 5% for men and women) applied to the scalp once or twice daily prolongs the anagen (growth) phase of hair follicles and increases follicle size. It works in about 60% of users — those who respond see reduced shedding and increased density over 3-6 months. Important caveats: it must be used indefinitely (stopping causes regrowth to reverse within 6 months), it prevents further loss more effectively than it regrows lost hair (early use has better outcomes), and it does not work for completely bald areas where follicles are gone. An initial increase in shedding during the first 4-8 weeks of use is expected and normal — follicles are cycling. Oral minoxidil at low doses (0.625-1.25mg daily for women, 2.5mg for men) has better efficacy than topical and is increasingly prescribed by dermatologists in India.

Alopecia areata is an autoimmune condition where the immune system attacks hair follicles, causing patchy, well-defined bald areas — typically round or oval, smooth skin with no scaling. It can affect the scalp, eyebrows, eyelashes, or beard. Severity ranges from a single small patch (most common — 80% of cases) to total loss of scalp hair (alopecia totalis) or all body hair (alopecia universalis). In mild patchy disease: intralesional corticosteroid injections into the patches by a dermatologist are effective — repeated every 4-6 weeks. Topical steroids and minoxidil support regrowth. Spontaneous regrowth occurs in many mild cases within a year. Severe or resistant alopecia areata: JAK inhibitors (baricitinib, ritlecitinib — the first oral medication specifically approved for alopecia areata) are transformative for severe disease, achieving significant or complete regrowth. Available in India, though costly.

Dandruff (seborrhoeic dermatitis of the scalp) is caused by overgrowth of Malassezia — a yeast that normally lives on skin but proliferates in sebum-rich areas, causing an inflammatory reaction that speeds up skin cell turnover and produces the visible flakes. It is not caused by poor hygiene — washing frequency doesn't cause it, though irregular washing lets flakes accumulate. Effective treatment: antifungal shampoos are the most evidence-based treatment. Ketoconazole 2% shampoo (Nizoral) used twice weekly until controlled, then once weekly for maintenance. Zinc pyrithione shampoos (Head & Shoulders) are milder with lower antifungal potency, suitable for mild dandruff. Selenium sulphide and coal tar shampoos are alternatives. Leave the shampoo on for 3-5 minutes before rinsing. Malassezia lives on the scalp permanently — dandruff is managed, not cured. Stopping treatment causes return. If the scalp has redness and scaling extending to the forehead and ears, this is seborrhoeic dermatitis requiring topical antifungal + steroid combination treatment.

PRP involves drawing the patient's own blood, concentrating the platelet-rich fraction, and injecting it into the scalp. Platelets release growth factors that may stimulate follicle activity. The evidence for PRP in androgenetic alopecia is positive but heterogeneous — multiple trials show improvement in hair density and thickness, though the protocols, platelet concentrations, and injection techniques vary widely between studies and clinics. PRP appears most effective as an adjunct to minoxidil and finasteride rather than as a standalone treatment, and works best in early or mild hair loss. The treatment requires 3-4 initial sessions (monthly), then maintenance sessions every 4-6 months — which adds up in cost. In India, PRP is widely offered at varying quality levels. A dermatologist's assessment of whether PRP is appropriate for your specific type and stage of hair loss matters more than clinic marketing.