Dr. Anil Abraham
is presently Professor & Head of Dermatology at the St. John’s Medical College in Bangalore. He trained at Stanford University during which he specialized in cosmetic procedures including laser surgery and went on to become a Fellow of the American Academy of Dermatology. He is the recipient of many prestigious medals and awards. A well known orator, Dr. Abraham is married to Dr. Veena Abraham, with whom he is also running a successful private practice in Bangalore.


HAIR Hair is often referred to as the crowning glory and has been praised as an important attribute of beauty by poets like Kalidasa. References to the black waist length hair of Shakuntala or Damayanti are common in literature. Draupadi left her hair loose until her vow was fulfilled. Even for men hair is often considered a sign of virility and good looks. Samson even lost his hair when his hair was chopped off by Delilah. In the animal species the mane of the lion or the attractive feathers of birds like the peacock underline the fact that hair and its modifications have long been a socially accepted part of interaction between the sexes. The hair can tell you about the typeof person in front of you. A sheved head can mean a bereavement in the family or recent pilgrimage to Tirupati or Vailankanni. Uncut hair in a male wearing a turban can help to identify a person as a Sikh or may even make people the focus of unwanted attention as happened in the US after the 9/11 tragedy. A punk cut with purple or pink tints may signify trendiness or rebellion whereas a military cut just before an interview may help to convey to the interview board that you are reliable and disciplined.. The hair can be your method of making a first impression and combing the hair in a mirror is probably what every person does before leaving the house. Open any magazine or newspaper and you will invariably find advertisements of products or persons who promise to help you grow hair or improve the colour, texture or length of your hair. It is obvious that loss of hair does not mean a serious illness yet millions of people all over the world suffer from hair loss and worry about their problem. To understand why we lose hair we must first learn a little about hair.


Humans have about 5 million hair follicles at birth. No follicles are formed after birth but their size and growth may vary based on hormonal influences. The hair shaft is dead protein and consists of 3 basic layers – an outer cuticle, a cortex and an inner medulla. The cuticle protects and holds the cortex cells together. Split ends results if the cuticle is damaged by vigorous brushing or cosmetic treatments. The hair bulb (Fig 1) contains the matrix with rapidly multiplying cells. The mitotic rate of the hair matrix is greater than any other organ. Systemic diseases, nutritional factors and drugs may therefore interfere with hair growth and result in hair loss.



There are three types of hair (Table 1). Thick, pigmented hairs are called terminal hairs. Terminal hairs on the top of the scalp and in the beard, axillary and pubic areas are influenced by androgens. Androgens are important in regulating hair growth. At puberty, androgens increase the size of follicles in the beard, chest and limbs and decrease the size of follicles in the bitemporal region, which reshapes the hairline in men and many women. Lanugo hairs are the fine hairs found on the fetus; similar fine hairs found on the adult face and body are called vellus hairs. Vellus hair is short, fine, relatively nonpigmented and covers much of the body. Hair on the rest of the body is independent of androgens.


Clinical Presentation telogen
Onset of shedding after insult 2-4 months
Percent hair lost 20-50
Type of hair lost Normal club (white bulb)
Island Trading Helen Bennett
Hair shaft Normal



  • Average scalp has more than 100,000 hairs
  • Scalp hair grows 0.3 to 4 mm /day
  • 90 -95 % of hair are in anagen phase
  • 5-10 % are in telogen phase
  • Upto 100 telogen hairs may be lost per day.


The causes of hair loss (alopecia) are numerous. A systemic approach for evaluation of hair loss is outlined in tables 3 and 4.


Diffuse Localised
eg. Telogen effluvium eg : Alopecia areata
Scarring Non scarring
eg. Telogen effluvium eg : Alopecia areata


History Diagnostic procedures
eg. Telogen effluvium eg : Alopecia areata /td>
Sudden vs. gradual loss Hair pull test
Presence of systemic disease or high fever Daily count
sdfjh Part width
Recent psychological or physical stress Possible trichotillomania
Medication or chemical exposure /td> Potassium hydroxide examination for fungi
Examination Scalp biopsy
Localized vs. generalized Scarring vs. nonscarring
Inflammatory vs. noninflammatory Hormone studies
Density: normal or decreased Presence of follicular plugging

History Diagnostic procedures eg. Telogen effluvium eg : Alopecia areata Sudden vs. gradual loss Hair pull test Presence of systemic disease or high feverDaily count sdfjhPart widthRecent psychological or physical stressPossible trichotillomania Medication or chemical exposure Potassium hydroxide examination for fungiExamination Scalp biopsyLocalized vs. generalized Scarring vs. nonscarring Inflammatory vs. noninflammatory Hormone studies Density: normal or decreasedPresence of follicular plugging Skin disease in other areas

Generalized Hair Loss

A number of events have been documented that prematurely terminate anagen and cause an abnormally high number of normal hairs to enter the resting, or telogen, phase. The follicle is not diseased but has had its biologic clock reset and undergoes a normal innovational process. Usually no more than 50% of the patients hair is affected. Scarring and inflammation are absent. Resting hairs on the scalp are retained for approximately 100 days before they are lost; therefore telogen hair loss should occur approximately 3 months after the event that terminated normal hair growth. High fever from any cause may result in a sudden diffuse loss of club hairs 2 to 3 months later. Hair loss begins abruptly and lasts for approximately 4 weeks. Hair pluck tests show telogen counts that vary from 30% to 60%. Full recovery can be expected. Telogen effluvium is to be differentiated from anagen effluvium (Table 5).


Clinical presentation TelogenAnagenOnset of shedding after insult 2-4 months 1-4 weeks Percent hair lost20-50 80-90Type of hair lostNormal club (white bulb)Anagen hair (pigmented bulb)Hair shaft Normal Narrowed or fractured

Areata Alopecia

Alopecia areata (AA) is a common asymptomatic disease characterized by the rapid onset of total hair loss in a sharply defined, usually round, area. The diagnosis is made by observation. Any hair-bearing surface may be affected. The cause is unknown. An interaction between genetic and environmental factors may trigger the disease. Alopecia areata is a partial loss of scalp hair; alopecia totalis is 100% loss of scalp hair, and alopecia universalis is 100% loss of hair on the scalp and body.


The number of patients presenting with complaints of hair loss in Bangalore city has significantly increased by more than 80% over the last 5 years. The patients include both men ( 54 % ) and women ( 46 % ) and a large proportion of children even as young as 6 months. Software professionals and call-centre employees are the largest group among the patients with hair loss. Stress is an important factor and more than 85% of these patients had significant stress levels as indicated by a questionnaire study. Poor nutrition, inadequate or altered sleep patterns and work stress were found to be primary causes. In another group, college students and housewives who indulge in crash dieting were also found to have sudden unexplained hair loss together with hormonal problems. Several of the patients complained of increased hair loss after coming to Bangalore and blamed the change in water especially from bore-wells for their loss. Typical complaints were that hair came off easily during combing, bathing or during application of oil. Many patients already had significant hair loss when they first approached their doctor and others had tried several hair oils or advertised remedies before seeking medical help. The study was carried out by Dr. Anil Abraham, Professor of Dermatology, St. John’s Medical College Hospital who has been elected as a Fellow of the International Congress of Trichology and a spokesperson for the Asia - Pacific region on Hair loss and Pigmentary Disorders based on this work. He has been invited to address several groups of international dermatologists on hair loss and pigmentation among Asian and Indian patients. Dr. Anil Abraham has trained at Stanford University in USA and presently practices from Bangalore at his clinic near Mt. Carmel College Dr. Anil Abraham, MD. FAAD (Stanford, USA) Professor and Head of Dermatology docanilabe@yahoo.co.in ,98440-66844,080-22261560

Check List of causes for hair loss

  • Stress -domestic,work related, studies / exams / others including commuting
  • Hormonal : menses / Thyroid / Others
  • Shampoo / Oil / Dye / Others
  • Water source / Swimming / Bath / Combing
  • Recent illness / Medical problems / Anemia
  • Medication / Drugs
  • Itching / Dandruff
  • Diet / Food habits
  • Pregnancy / Child-birth / Surgery
  • Family history