Brief Answer:
Hair fall and dandruff treatment

Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic

I am Dr. Kakkar. I have gone through your query.

You have mentioned 2 issues over here: 1) Hair fall and 2) Dandruff/seborrheic dermatitis

Dandruff Or Seborrheic dermatitis is a common cause of increased scalp hair shedding.
This condition is thought to arise as a result of interplay between factors like inflammation and overproliferation of the yeast, malassezia furfur. Whether inflammation is the result of yeast overproliferation or independent of it is not exactly known.
Change in environment and change of water have a role to play in causing dandruff. Dandruff is more common in winters i.e cold, dry climate conditions and hard water has a high mineral content and this can lead to dandruff due to its drying effect on scalp skin.

Nevertheless, dandruff is rarely a cause of hair loss to such extent, that makes underlying scalp visible.

There can be another cause of hair fall that may working together with dandruff/seborrheic dermatitis.
Therefore, I would keep a second possibility of Androgenetic Alopecia as well, in you. Androgenetic alopecia is characterized by hair loss and hair thinning mainly from the frontal scalp and vertex. There is widening of angles of the anterior hair line as a result of hair loss and hair thinning. This may also be associated with gradually receding anterior hair line.

Yes, I would like to know the medications and shampoos tried/prescribed.

Can you upload a few representative photographs? That would help me give an idea about the severity and pattern of hair loss from the scalp.

Regards

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Brief Answer:
Androgenetic Alopecia; Dandruff

Detailed Answer:
Hi.

I have gone through the attachment.
I can make out from the medications prescribed that you most probably have androgenetic alopecia. Dandruff is a separate/second issue.
The capsules that are mentioned in the prescription contain Saw Palmetto Extract as the main active ingredient for Androgenetic Alepocia.
The shampoo prescribed is a general cleansing shampoo and is not an antidandruff shampoo.
Hair oil too has no specific role in your case.

If I was the treating doctor I would have asked you to use a Ketoconazole based shampoo for dandruff. You may use it daily or every alternate days depending on the severity of dandruff.
Nizoral contains 2% ketoconazole and is available OTC. There are various other ketoconazole brands as well which are available on prescription of a dermatologist.

In Androgenetic alopecia, Dihydrotestosterone (DHT) which is derived from Testosterone is the main culprit. An enzyme called 5 alpha reductase, present in hair follicles, converts circulating testosterone to DHT. DHT in turn cause follicular miniaturization and hair loss in Androgenetic Alopecia/Male Pattern Hair Loss.
Finasteride inhibits the enzyme and prevents the conversion of testosterone to DHT. It is US FDA approved for androgenetic alopecia.

Saw-palmetto extract that you have been already taking also inhibits the same enzyme and is supposed to benefit in Androgenetic Alopecia, however, it is not US FDA approved for this type of hair loss.
Moreover, there are no comparison studies between Saw-palmetto and Finasteride in Androgentic Alopecia.

Apart from finasteride, topical Minoxidil also has approval for use in Androgenetic Alopecia.

I usually start my patients on Topical minoxidil, which is to be used twice daily in thoroughly cleaned scalp. It should not be applied immediately after shower/in wet hair as this might dilute the concentration. It should be applied after air drying hair on thoroughly cleaned scalp.

I also start my patients on Finasteride 1 mg rather than Saw palmetto.

Ketoconazole shampoo apart from being antidandruff also exerts local antiandrogenic effect which is desired in this type of hair loss.

Treatment must be continued religiously for at least 3-6 months to produce noticeable results and up to 2 years for maximum results. Thereafter the patients may be switched on to a maintenance program, which includes once daily or alternate day minoxidil application and once daily finasteride for the rest of life.

These are prescription products (particularly Minoxidil and Finasteride) and I will suggest that you seek another appointment with your dermatologist and discuss in more detail about these.

Regards

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Brief Answer:
Antidandruff; ciclopirox olamine

Detailed Answer:
Hi.

The shampoo you mention contains Ciclopirox Olamine which is an effective antifungal agent and an antidandruff preparation.

You may use it for dandruff, alternate days or even daily.

Regards

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Brief Answer:
Shampoo daily

Detailed Answer:
Hi.

In case the water supply that you get in the city is hard water; bottled water can be a temporary solution to the problem, if you moved in the new city for a short period of time.
Anyway, if you are washing your hair daily with a shampoo, hard water should not be a problem.
Use one of the antidandruff shampoos, as we have already discussed.

Regards

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