hair moisture

My hair is thinning!

“I can see through my hair.” I often hear this as a dermatologist. The first question I always ask is whether short hairs versus long hairs are found on the pillows, on the bathroom floor, in the shower, or in the brush/comb. I ask this question primarily because short hairs equal breakage and if someone is experiencing breakage, I further ask about the hair care regimen and products.  A guide to infusing moisture back into the hair can be found here.


Hair grows at an average set rate and length is inevitable while retention of length depends on moisture content of hair and daily care. If your hair is processed, with color, perms, relaxers, texturizers, etc, this changes the inherent pH of the hair and can allow for dehydration and a dry, fragile hair shaft. Daily wear and tear on fragile hairs further lead to breakage and split ends. If enough hairs involved, the ends of your hair will appear uneven and the density will become thinner the further down the hair you travel. A quick way to test for breakage at home is to grab a strand of hair and do a quick bend and tug. If the hair snaps, there is a fragility factor. Also look at the entire length and at the end to assess for splitting and frayed areas. Lastly, place a sheet of white paper behind your hair and have someone take a photo. If you can see a large portion of white paper through your hair, that is breakage. The more breakage, the more visible the paper until it starts tracking up higher in the hair.


If long hairs are found on the brush, floor, pillow, clothing, etc, there may be a concern for a shedding condition called, telogen effluvium (learn about the natural hair cycle here). Telogen effluvium is an excessive shedding phase that is reversible and does not destroy the follicles (non-scarring). Triggers include starting and stopping medications especially hormones and supplements, health conditions (anemia, thyroid, malnutrition, pregnancy, birth), and sudden stressors (illnesses, surgeries, crash diets, stressful event).  My patients will report diffuse shedding and thinning hair all over the scalp. The solution is to find the stressor and remove it. If it was a one-time event, when the stressor has finished, the telogen effluvium must run its course and fade out. I always counsel patients it is an unknown amount of time when the hairs exit out of this effluvium and enter back into their normal cycles. If the shedding is occurring for a long time or if the patient feels more than 50% of the hair density has been lost,  I can intervene with medicine to stop or slow down the natural process and help prevent further shedding.

A similar story of long hairs shedding rapidly can also occur from another shedding condition called anagen effluvium, commonly seen with medications that stop rapid cell growth, such as chemotherapy and particular medications. This condition is also non-scarring and is reversible.  Interestingly, with regrowth after these medicines the hair may return a different color or have a new curl pattern.


Lastly, I evaluate for age, nutritional status, and family history. Male and female pattern baldness is prevalent and I not only ask about hair loss in male family members but also among female members.  I check hormone levels to make sure there are no internal factors driving this condition. There are a few topical and systemic (oral pills) regimens that will help. Often these regimens regrows hair and thickens the hair and holds the patient for years as long as they continue the treatment regimen.

Other reasons:

A close look at the scalp is necessary as all hair thinning is not due to breakage, shedding, or genetics.  There are inflammatory, scarring (follicles turn to scar tissue and cannot grow a hair) permanent hair loss conditions that do warrant medications to slow or stop the process and I specialize in diagnosing and treating these conditions. Early assessment and diagnosis is important to prevent diffuse permanent hair loss. Other permanent hair loss disorders can occur from tight braids, removing glue-in weaves, wraps or headbands around the edges, and chemical burns.  We will talk about these conditions and how to prevent them in future articles.

In conclusion, hair thinning is very common either through medical or cosmetic reasons.  If you’re experiencing hair thinning, seek guidance from your local cosmetologist and dermatologist for treatment of any medical conditions and to help correct moisture imbalance so you can regain your thick healthy hair.



Hair 101: Hair follicles and their life cycle

We are born with roughly 100,000 follicles on our scalp. We cannot regrow or generate new follicles after birth so what we are born with is what we have. Follicles create hair from stem cells that sit near the follicle and produce a new hair bulb (the white part located at the root end of a shed hair and is released with the hair). Over time, we lose follicles through factors such as age, hormone, or genetic follicular miniaturization or scarring disorders that destroy the abovementioned stem cells.

Blondes have roughly 20% more follicles than brunettes and redheads have about 20% fewer follicles. Asians and African Americans have fewer follicles and lower hair density than Caucasians. The follicles on the scalps of Caucasians and Asians are straight. The follicles curl and are on a greater angle on African American scalps. This curled follicle is the reason follicles are more difficult to harvest for hair transplants in African American patients.

Follicles cycle through three natural cycles, a growth phase, a rest phase, and a fall out phase, medically referred to as anagen, catagen, and telogen phases, respectively.  Each follicle individually cycles through these three phases independently of each other. Of those ~100 000 follicles, 85-90% are in anagen, <1% are in catagen, and 10-15% are in the natural fall out phase, telogen.  Follicles stay in the anagen growth phase for 2-6 years, catagen for 2-3 weeks, and telogen for 3 months before the hair is released from the follicle. Applying these numbers, you will shed  on average 100-200 hairs/day.  If these hairs are collected, it can appear as a large amount of hair but be reassured that a fresh new anagen hair helps to push out that old telogen hair and a new follicle cycle begins.

Anagen follicles grow scalp hairs at a rate of 0.35cm/day or roughly 1cm/month. This rate may increase with medications or pregnancy and decrease with age, nutrition, medications, and illnesses. Follicles only create hair in anagen growth phases.  Therefore, hairs only grow in anagen phase, so follicles in the catagen and telogen phase only rest and fall out, respectively.  The maximum length is greatest at the end of anagen phase with the exception of breakage which can shorten hairs. Proper hair care can help maintain length retention. Moisture regimens can be found at

Check back to future installments of hair 101.