Brief Answer:
Telogen effluvium Or Androgenetic alopecia; Minoxidil sol'n; Oral Iron

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your query and I have noted down your concern.

Two most likely causes for a chronically persisting hair fall in females can be either 'Androgenetic alopecia' Or 'Telogen effluvium'.

Androgenetic alopecia is characterised by thining (miniaturisation/ hair becoming finer) and hair loss mainly from the center part of scalp (i.e front, mid and vertex part of scalp). Initially this manifests as widened part-width and later as diffuse thining, loss of volume and visible scalp.
Hair fall in androgenetic alopecia is gradual and is chronic, however, it results in considerable loss of volume and patients would also usually complain that hair does'nt grow as long as it used to grow a few years back.

Another close possibility is that of Telogen effluvium.
Telogen effluvium lasting this long is knwn as 'Chronic Telogen Effluvium' and important underlying causes can be Reduced Iron Stores (Serum Ferritin levels) Or Thyroid abnormalities.

Hard water may be an exacerbating factor for increased hair fall but it is certainly not the sole reason.
Dandruff/ seborrheic dermatitis can also be a contributing factor for increased hair shedding in many individuals.

Sometimes, 2-3 factors together play a role in increased hair shedding e.g androgenetic alopecia may be unlasked by telogen effluvium Or androgenetic alopecia and dandruff may co-exist and contribute to increased shedding.

I suggest a few basic blood tests e.g Thyroid profile i.e T3, T4 nad TSH levels (an important cause of hair shedding in females), serum ferritin levels and complete hemogram, vitamin D levels and Vitamin B 12 levels. Thyroid, ferritin levels or deficiencies if any should be corrected apprpriately

I suggest her to use a topical minoxidil 2% solution, 1 ml, twice daily at scalp skin. Minoxidil is a non specific hair growth promoter and cut shorts telogen effluvium. You may use it for 4-6 months for noticeable response. Topical Minoxidil solution is also recommended for androgenetioc alopecia in females.

Oral Iron supplement e.g Tab Autrin, once daily on empty stomach along with Vitamin C tablet (to increase iron absorption) and also an Oral Biotin supplement e.g Tab. Revilus Or Tab. H-vit forte once daily for 4-6 months are all part of treatment in most cases of increased hair shedding.

These are prescription medications and should be taken under supervision of a dermatologist after thorough history and lab tests aimed at identifying a cause for increased shedding.

Regards

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