By Dr Khushboo Sethia · Dermatologist, SkinWise Clinic Published Last reviewed
Hair fall: an honest dermatologist’s guide for Indian patients
Almost every patient who comes to us for hair fall has already tried something. A hair oil their grandmother recommended. A biotin supplement from an Instagram brand. A serum sold by an influencer. A multivitamin. A protein powder. Sometimes a salon “PRP-like” treatment that wasn’t PRP. By the time they sit down in front of us, they’ve usually spent six months and quite a bit of money, and they’re still finding hair on the pillow.
The honest dermatology answer is that hair fall is one of the most common, most over-treated and most under-diagnosed conditions in our practice. The treatments people reach for first are rarely the ones that match what’s actually causing the hair fall. And the most important question — what kind of hair fall is this? — is the one most often skipped.
Here’s how we approach hair fall at SkinWise — what’s normal, what isn’t, what the different patterns mean, and what actually works.
What “normal” hair fall looks like
Losing 50–100 hairs a day is normal. You see it on the pillow, the comb, the bathroom floor, the towel after a shower. On hair-wash days you’ll see more (the previous days’ shed has been gathering), and that doesn’t mean shampoo is causing the hair fall.
What is not normal:
- Visible widening at the parting (women)
- Visible recession at the temples or crown (men and women)
- Round, well-defined bald patches
- Sudden diffuse increase in shed — handfuls every wash, for weeks
- Hair coming out by the root rather than breaking mid-length
- Scalp visible through the hair in good lighting
When patients describe any of these, the right next step is not a serum or a supplement — it’s a diagnosis.
The patterns of hair fall (and why pattern matters)
Different patterns of hair fall have different causes and very different treatments. Treating one pattern with the regimen meant for another is the single most common reason patients “don’t respond.”
Androgenetic alopecia (pattern hair loss)
The most common cause of long-term progressive hair fall. Genetically driven, hormonally influenced. The hair miniaturises — gets thinner and finer with each cycle — until the follicle stops producing visible hair.
- In men: recession of the temples and a thinning crown that progresses into a horseshoe pattern
- In women: widening of the central parting, often with visible scalp in the front-central scalp; the frontal hairline is usually preserved
This is what most adult hair fall in Bengaluru turns out to be. Treatment is medical and ongoing.
Telogen effluvium
A sudden, diffuse increase in shedding triggered by an event 2–3 months earlier:
- Fever, COVID, or any significant illness
- Surgery, particularly under general anaesthesia
- Sudden weight loss
- Childbirth (typical onset 3–4 months postpartum)
- Severe emotional stress
- Some medications
Diffuse shed across the whole scalp; the parting doesn’t widen; the hair pulls out by the root. Almost always self-limiting — recovers over 6–12 months once the trigger is past.
Alopecia areata
Autoimmune patchy hair loss — coin-sized round patches appearing suddenly. Different disease, different treatment. See our alopecia areata guide.
Traction alopecia
Hair loss from chronic tension on the follicles — tight braids, ponytails worn high every day, extensions, certain religious or cultural styles. Recedes from the front and temples in proportion to where the tension is highest. Reversible early; permanent if traction continues for years.
Scarring alopecias
Less common but important to recognise. Lichen planopilaris, discoid lupus, frontal fibrosing alopecia and others destroy follicles permanently. Tell-tale signs: redness around follicles, loss of follicular openings, sometimes itching. Diagnosis usually needs trichoscopy and biopsy. Early diagnosis matters — these conditions can be slowed but not reversed.
Nutritional and metabolic hair fall
Hair fall from iron deficiency, vitamin D deficiency, B12 deficiency, thyroid disease (over- or under-active), severe protein deficiency. Often layered on top of one of the patterns above. Correcting these doesn’t fix pattern hair loss on its own — but pattern hair loss treatment under-performs while these are uncorrected.
Hormonal hair fall (PCOS)
In women with PCOS, an androgen-driven thinning at the crown and parting, often combined with hirsutism (excess facial hair) and acne. See our PCOD guide.
Why so many people get the diagnosis wrong
Three reasons.
- The wrong question is asked first. Patients walk in asking “which serum should I use?” when the question that matters is what kind of hair fall is this?. Skipping the diagnosis is what drives most of the wasted spend in the industry.
- Multiple causes often overlap. A 32-year-old woman post-pregnancy with iron deficiency and underlying pattern hair loss has three things going on, each contributing. Treating only one disappoints. Treating all three resolves.
- The timelines are long. Most hair-fall treatments take 3–6 months to show effect. Patients on a 4-week trial of any single intervention give up before it could have worked.
Our approach to hair fall at SkinWise
Step 1: a real history
Onset, pattern, family history, recent illnesses, medications, dietary changes, contraceptive history, post-pregnancy timeline if relevant, hairstyling habits, what’s already been tried.
Step 2: examine the scalp
Including trichoscopy — a magnified examination — to see:
- The pattern of miniaturisation (or not)
- Follicular openings (still there, or scarred over?)
- Inflammation (suggests scarring alopecia)
- Hair-shaft variability (suggests androgenetic)
- Yellow dots, black dots, exclamation-mark hairs (suggest alopecia areata)
This 5-minute examination tells us more than most lab tests.
Step 3: the right tests
Not a 20-test panel for everyone — but a focused, indication-led set:
- Iron, ferritin (ferritin <40 ng/mL is meaningfully associated with hair fall)
- Vitamin D, B12
- Thyroid function (TSH, free T4)
- CBC, fasting glucose / HbA1c in selected patients
- Hormonal panel when PCOS is suspected — total testosterone, SHBG, sometimes DHEAS, prolactin
- Punch biopsy in selected cases where diagnosis is unclear or scarring is suspected
Step 4: a plan matched to the diagnosis
For pattern hair loss (androgenetic alopecia)
- Topical minoxidil — the medical foundation. Daily, indefinite. See our PRP vs minoxidil guide for the full picture.
- Oral therapies in selected patients:
- Finasteride for men
- Spironolactone for women, particularly with PCOS-driven thinning
- Low-dose oral minoxidil — increasingly used in carefully selected patients with monitoring
- PRP (platelet-rich plasma) — a course of 4–6 sessions, 4 weeks apart, then maintenance every 4–6 months. Most effective as an accelerator on a stable medical foundation, not a standalone fix.
- Microneedling — sometimes paired with topical minoxidil for additive effect
- Hair transplant — for stable, advanced pattern baldness in selected patients, when medical therapy has been optimised
For telogen effluvium
- Address the trigger if still present
- Iron, vitamin D, protein adequacy
- Time, sometimes with topical minoxidil as a supportive step
- Reassurance — this is the biggest piece, because the natural recovery is slower than patients expect
For traction alopecia
- Behavioural change (looser styles, no traction during sleep)
- Topical minoxidil
- Early intervention — the longer the traction continues, the more permanent the loss
For scarring alopecias
- Specific anti-inflammatory treatments (topical steroids, intralesional steroid, oral hydroxychloroquine, others)
- The earlier the treatment, the more follicles are preserved
- Often shared care with a trichology-focused dermatologist
For PCOS-driven hair fall
- The dermatological hair-loss treatments above, plus
- Addressing insulin resistance, oral therapy for androgens, sometimes coordinated with gynaecology
- See PCOS skin and hair
Step 5: the boring foundation
- Protein-adequate diet
- Sleep, stress
- Reasonable shampoo/conditioner routine — fragrance and detergent matter less than people think
- Gentle handling — no aggressive tugging when wet
- Cool-water final rinse, soft towel-blot rather than vigorous rubbing
- No chronic tight hairstyles
- Reasonable heat styling, not daily flat-ironing
What not to do
- Don’t buy a “hair growth” serum from an influencer before getting a diagnosis. Most fail because the wrong product is being used for the wrong problem.
- Don’t stop minoxidil at week 6 because of increased shedding. That early shed is the medication shifting follicles into a new cycle and is the opposite of failure. Persist through it; you’ll see the benefit at month 3–4.
- Don’t self-prescribe finasteride or spironolactone. Hormonal agents need real medical history, baseline tests, and monitoring.
- Don’t do salon PRP. What most salons offer as PRP is a vitamin-cocktail mesotherapy. Real PRP requires medical-grade equipment, sterile technique, proper centrifugation, and appropriate scalp injection.
- Don’t take handfuls of supplements “because they can’t hurt.” Some can — particularly high-dose biotin (which interferes with thyroid tests) and high-dose selenium.
- Don’t insist on a hair transplant before optimising medical treatment. Most early-to-moderate pattern hair loss responds well to medical therapy. Transplant should follow, not replace, that.
- Don’t accept a serum-only plan from a clinic without examining your scalp, taking a history, and addressing the underlying cause. That’s how money disappears with no result.
Frequently asked questions
How long until I see results? 3–4 months for most treatments. Visible change before that is usually wishful thinking.
Will minoxidil cause facial hair growth in women? Topical 5% applied to the scalp — rare. Oral low-dose minoxidil — possible in some patients; we discuss the trade-off when proposing oral therapy.
Is hair loss after COVID real? Yes — post-COVID telogen effluvium is real, well-described, and almost always recovers within 6–12 months. Hair-fall trajectory matters: if it’s still actively shedding past a year, something else is contributing.
Are hair vitamins worth it? For most patients with normal levels, no. For patients with documented deficiencies, correcting them is essential — usually with targeted supplementation, not a multivitamin.
Can a hair transplant cure pattern hair loss? A transplant redistributes hair to where you’ve lost it; it doesn’t stop the underlying genetic process. Ongoing medical therapy is needed alongside, otherwise the surrounding native hair continues to thin.
Why does my friend’s biotin supplement seem to work? Hair fall often improves over time with no treatment, with placebo, and with seasonal cycles. Without before/after photos under matched lighting and a clear pattern, anecdotes aren’t reliable evidence.
What about traction from tight braids and headscarves? Real cause, reversible if caught early — permanent at the temples and front if the traction continues for years. Switching to loose styles when possible, and rotating hairstyles, helps.
Are oils harmful? Most oils are neither magic nor harmful. They don’t penetrate to the follicle and don’t stimulate growth. They moisten the hair shaft, which can reduce breakage. They’re fine if you enjoy them; they’re not treatment.
Where to go from here
If you’re seeing hair on the pillow, widening at the parting, recession at the temples, or sudden patchy loss — book a hair-loss consultation. We’ll examine the scalp, run the right tests, and build a plan matched to your diagnosis, not a generic regimen.
Hair fall doesn’t have one answer. But for most patients, the correct answer exists — and it’s usually faster, cheaper, and more effective than the cycle of serums and supplements that comes before the dermatology visit.
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