Hair loss – A growing problem among medical students

INTRODUCTION

Hair loss is a common problem that affects people of different ages, genders, and professions. It can result from various factors such as genetics, hormonal imbalances, medical conditions, medication side effects, stress, poor nutrition, and environmental factors. Hair loss can lead to a reduction in self-esteem, confidence, and overall quality of life.^[1]

Medical students have a greater rate of hair loss than the general population and it is critical to understand the underlying reasons for this occurrence. For medical students, in particular, hair loss can be a significant concern for several reasons, including the rigorous academic curriculum that demands long hours of studying and clinical rotations, leading to high-stress levels, lack of sleep, and poor nutrition.^[2] This article explores the various causes and types of hair loss, including androgenetic alopecia (AGA), alopecia areata, and telogen effluvium, as well as lifestyle modifications and medical interventions that can help reduce the risk of hair loss among medical students.^[3] Creating a supportive environment that promotes self-care practices and addresses stressors in the academic environment can also help medical students to maintain good mental and physical health and reduce the risk of hair loss. The study aimed to classify the reasons for hair loss in medical students and to gather information from previously published studies that dealt with the subject. Further, the aim was to investigate the causes of hair loss in medical students, collect data from published articles on hair loss in medical students, and classify the causes of hair loss in medical students.

MATERIALS AND METHODS

The literature analysis aimed to find out the reasons for hair loss faced by medical students. Google Scholar and PubMed were used to conduct the literature review. To gather data, keywords such as “Young population, medical students, hair loss, hair fall, and COVID-19” were used and the past 5 years’ worth of data was collected during the literature review. The literature review was completed from 2022 to 2023 by collecting data from 16 articles. Using the data collected, the information revealed the different variations of hair loss due to numerous factors.

RESULTS

According to the research, stress has a significant impact on the hair loss reported by medical students. While a variety of factors can contribute to hair loss, stress has emerged as a primary culprit. Other variables that contributed to hair loss were poor diet, hormone imbalances, and the use of chemicals in hair treatment, among others. Stress-induced hair loss has been found to appear in disorders such as alopecia areata or telogen effluvium. The study also offered insight into COVID-19’s effect on hair loss and the link between hair color usage and hair damage. Furthermore, the research examined several therapeutic options for treating hair loss in both men and women, including prescription and topical therapy [Table 1].

MAIN CAUSES OF HAIR FALL

AGE GROUP AND GENDER BEING AFFECTED

Various epidemiological patterns are depending on the type and cause of alopecia. With no racial or sexual preference, alopecia areata has a prevalence of 0.2% and can affect people of any age. A common disorder, androgenic alopecia, affects 15% of women and 50% of men, particularly postmenopausal women. Women typically experience telogen effluvium more than men. Tinea capitis is more prevalent in children under the age of five and in people with dark skin who do not have any sexual preferences.^[8]

TYPES OF HAIR LOSS

Hair loss can affect both genders and has different types and causes. Men experience thinning at the temples, frontal and vertex scalp, or complete hair loss with hair remaining at the back and sides, while women experience diffuse hair thinning at the vertex with preserved frontal hairline and lateral scalp thinning [Figure 1].^[3]

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Figure 1:

Types of hair loss.

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There are two primary types of hair loss disorders: Nonscarring alopecia and scarring alopecia. Non-scarring alopecia refers to hair loss conditions where the hair follicle is preserved, but the hair cycle, size, or breakage has changed. Scarring alopecia refers to hair loss where hair follicles are destroyed due to inflammation or malignancy. Different types of scarring alopecia include lichen planopilaris, frontal fibrosing alopecia, chronic cutaneous lupus erythematosus, central centrifugal cicatricial alopecia, and folliculitis decalvans. Each type has distinct patterns of hair loss and symptoms.^[3]

One of the most significant hair issues affecting both men and women is pattern hair loss (PHL). Age-dependent forms of scalp hair loss in women were well-known long before this condition was given a clinical description. Female-PHL, also known as AGA, is a common hair issue that causes a decrease in hair density over the frontal scalp and crown in women.^[9] Male-PHL is a common problem among most men which can begin as early as puberty and worsen with age.^[10]

Anagen, catagen, telogen, and exogen are the four stages of the development of hair [Figure 2].^[11]

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Figure 2:

Phases of hair growth.

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Stress, according to a comparative study of stress among medical, engineering, and nursing students, can also induce alopecia areata (partial loss of body hair) or alopecia universalis. Stressors can cause hair loss directly or indirectly by encouraging inappropriate hair-plucking behavior.^[6]

Three hundred and eighty-five participants, mostly women (81.2%), were surveyed about their hair care practices and awareness of hair loss risk factors. Half (53.2%) reported daily hair loss, and risk factors such as dandruff, unbalanced diet, insomnia, and hereditary factors were identified. Physically active males had less hair loss, but there was no such correlation among females. A lack of knowledge and understanding about hair loss risk factors was observed. Hair care practices were found satisfactory for both genders.^[12]

EPIDEMIOLOGY ACROSS THE GLOBE

The increase in industrial and energy-related activities has led to a rise in environmental pollution, resulting in the accumulation of toxic elements in the biosphere. This study aimed to compare the concentration of toxic elements in hair samples of individuals from different regions across the world. The study analyzed 198 hair samples of 1^st-year students at the People’s Friendship University of Russia, originating from South and East Asia, Latin America, Arab countries, Central Asia and Afghanistan,

South and Central Africa, Iran and Azerbaijan, and Russia, Ukraine, and Moldova. The study used inductively coupled plasma mass spectrometry to measure the concentration of seven toxic elements, including aluminum, arsenic (As), beryllium, cadmium, mercury, lead, and tin (Sn). The median concentration of these elements in the general group fell within the normal range. Except for Latin America, students from Russia, Moldova, and Ukraine had much greater Sn levels in their hair than students from other locations. Although most of the toxic elements fell within the normal range, some subjects exceeded the recommended levels for As. Overall, this study provides valuable insights into the distribution of toxic elements across different regions worldwide.^[13]

ADVERSE EFFECTS OF STYLING

Hair care and styling have grown in popularity in recent years, particularly among teenagers. It has been observed that modern styling methods and the use of various hair care products have resulted in hair loss and damage. The process of chipping the hair cuticle is a primary cause of hair damage.^[4] Girls have unique hair care and style habits. These habits have been linked to an increased incidence of scalp and hair dermatoses. Straighteners and dyes have been linked to allergic or irritating dermatitis, chemical burns, scarring alopecia, and increased hair breakage.^[4]

COVID-19 AND HAIRFALL

The mechanism by which COVID-19 causes hair loss is still not fully understood, but it is believed that the physiological response of follicles to the stress of the infection may contribute to the effluvium that often develops 3–4 months after a fever-producing illness. The cytokines generated during the illness or fever cause the follicles to enter catagen and telogen too soon, leading to shedding. Hair loss is the most recent post COVID-19 symptom to emerge. Although it might be exceedingly distressing, patients can be reassured that they will recover due to the temporary nature of the sickness. The majority of COVID-19 patients have telogen effluvium, which is a nonscarring, transient hair loss caused by an aberrant change in the follicular cycle.^[14] It has also been linked to the fast progression of alopecia areata, exacerbating pre-existing conditions in some patients. Stress brought on by isolation during the pandemic has also been connected to the development of alopecia areata.^[15]

MEDICATION

There are currently two medications authorized for the treatment of hair loss in men: Oral finasteride and topical minoxidil. Both medications affect the hair-growth cycle and lengthen existing hair, enhancing scalp coverage, and preventing additional hair loss in the vertex and frontal areas. However, neither medication fully regrows hair nor response to treatment is same among individuals. The treatment duration is typically 6–12 months. Finasteride reduces the conversion of testosterone to dihydrotestosterone by acting as a competitive inhibitor of Type 2 5’-reductase, and a daily dosage of 1 mg is safe and well tolerated. Minoxidil encourages hair growth by lengthening the anagen phase and enlarging underdeveloped and miniature follicles. The majority of side effects from topical minoxidil are dermatological, including scalp irritation and hypertrichosis. Anthralin possesses an immunomodulation and anti-Langerhans’ non-specific cell action. Since it is safe, it is usually chosen for usage in both children and adults with severe alopecia areata, including those who have lost all of their scalp hair. While estrogen has been used in women with AGA, topical minoxidil appears to be more effective in improving scalp coverage and slowing hair loss. Spironolactone has not been shown to effectively treat women with AGA. One of the more successful therapies for people with persistent alopecia areata that affects more than 50% of the scalp is topical immunotherapy (contact sensitization). A strong contact allergen is applied to the patient’s scalp to sensitize them, and successive weekly administrations of the same substance cause allergic contact dermatitis. Itching and cervical lymphadenopathy are two side effects of topical immunotherapy that are always present.^[16]

CONCLUSION

The study looked at several factors that lead to hair loss, such as genetic vulnerability, dietary deficiencies, internal illnesses, incorrect hair care practices, food and examination-related stress, and environmental impacts such as the COVID-19 epidemic. Hair loss was shown to be widespread among international clinical college students. Hair loss has also been linked to stress, particularly in women. Furthermore, hazardous chemicals were discovered to accumulate in people from various places as a result of their hair makeup. The statistics obtained reveal that medical students have shown a greater degree of hair loss that is related to stress along with other factors compared to the general population. Various types of hair loss have been examined. Genetic mutations, contemporary styling practices, and other factors have all contributed to hair loss and damage. The study underlines the multifactorial nature of hair loss and the significance of a holistic approach to hair care, which includes treating the underlying cause of hair loss and employing appropriate hair care products. To address hair loss successfully, it is critical to understand the various types of hair loss and the particular treatment techniques for each. To minimize hair loss, it is critical to develop creative stress management and resilient measures for medical students.