Hair Conditions

By: Ms Jessica Chong, Pharmacist at Unity Kallang Bahru

First seen in Lifestyle Magazine (January 2014), pg 92. This article is an unbreached version of the printed edition.

White Flakes – But wait, Christmas isn’t here yet…

We all know the embarrassing moment when people can see white flakes – dandruff on your shoulder. Human skin cells continuously regenerate themselves. As skin cells in the scalp are renewed, the dead skin cells are pushed to the surface of the scalp to be expelled. For some, their skin cells regenerate faster, resulting in more shedding and making dandruff more noticeable. Dandruff however, is not contagious. Causes of dandruff may include oily skin, mental stress, dry skin, not enough brushing and certain skin conditions such as eczema, seborrhoeic dermatitis, and psoriasis. People with dandruff may also experience itching, irritation and redness on the scalp. Although it is embarrassing and itching is bothersome, dandruff is not harmful.

Yellow Dandruff?

If the dandruff flakes are greasy and yellow, you may have seborrhoeic dermatitis. It is an inflammatory skin condition that causes flaky, white to yellowish scales to form on oily areas such as the scalp, eyebrows, eyelids, creases of the nose, lips, behind the ears, in the outer ear, and middle of the chest. The skin may be red and inflamed. Other symptoms include skin lesions, plaques over large area and itching. Though seborrheic dermatitis is related to hormones, fungus, and even neurological problems, it is treated the same as dandruff: with antidandruff shampoos. Severe cases may need steroid or antifungal medicine.

Ways to treat and reduce dandruff

To decrease the buildup of dandruff from dead skin cells, try an antidandruff shampoo daily. Leave shampoo on for 5 minutes, then rinse well. You may need to try several dandruff shampoos to find one which works best for you. If that does not help, visit a doctor.

  • Anti-dandruff shampoo: Anti-dandruff shampoo can be tried and used to reduce dandruff. For people with dry skin, a mild gentle shampoo may be used instead.
  • Antifungal shampoo: Antifungal shampoo contains ketoconazole, an antifungal used to treat dandruff, seborrhoeic dermatitis or other skin fungal infections.
  • Selenium sulfide (Eg. Selsun): Selenium sulfide appears to inhibit the cell growth of the epidermis and follicular epithelium (layers of the skin), thus reducing skin production. Selsun comes in 2 concentrations, 2.5% or 1%. For the shampoo containing 2.5% selenium, use it twice a week to control dandruff. Then, it may be used at longer intervals depending on condition. Selsun shampoo containing 1% selenium can be used daily.
  • Corticosteroid: If the scalp becomes inflamed and red, and the dandruff could not be resolved using the above mentioned methods, you may need to see a doctor. Corticosteroid solution might be given to apply on to the scalp to reduce the inflammation and redness.

Hair loss

Some experts estimate that we may shed up to 100 or more hairs a day. That is not a cause for alarm, nor does it mean you are going bald. About 90% of your 100,000 hair follicles are producing hair at any given time. The other 10% are in a resting (telogen) phase, and the hair falls out after about 2 to 3 months. It is replaced by new hair, and the growth cycle starts over again.

What causes hair loss?

Our hair follicle consists of dermal papilla, from which our body cells differentiate and form new hair follicles. The dermal papilla gets its essential nutrients from the blood capillaries for proper hair follicle growth. The dermal papilla also has lots of androgen receptors.

Hair loss could be due to an increase of a hormone named dihydrotestoterone (DHT) in the body, due to changes in metabolism of DHT or genetic make-up that affects amount of DHT produced. When DHT binds to the androgen receptors, it disrupts the absorption of essential nutrients needed by the hair follicles to form healthy hair. Hence hair follicles begin to shrink, resulting in a shorter lifespan. In men, more than 95% of hair loss is due to a genetic trait called male-pattern baldness. The gene can come from either parent, although the trait is influenced more by the mother’s gene. Male pattern baldness often starts with receding hair at the temples, then on the crown, leaving a horseshoe-shaped ring of hair around the sides of the head.

Hair loss in women (female-pattern baldness) more commonly affects the top of the head, with hair thinning all over the head. Women tend to lose their hair slower than men do. Having longer hair will not strain the roots, nor will shampooing causes hair loss, it just gets the ones that were falling out already. Other less common causes for hair loss would be certain medications such as isotretinoin, warfarin, gemfibrozil, antidepressants and allopurinol, consuming too much vitamin A, or not getting enough protein/nutrients.

Hair loss does not imply any medical condition, nor does it pose any significant health risk. Rather, people are concerned by it by the first impression and image it can give to their peers.

Is there a cure for hair loss?

Currently, there is no way to cure male-pattern baldness. However, hair loss can be slowed down with some supplements, medications or with surgery.


There are various supplements available over the counter for hair. These tend to work better for hair loss due to malnutrition.


Minoxidil is an FDA-approved over-the-counter medication applied to the scalp. It slows the rate of hair loss in men, and some even grow new hair. But once you stop using it, hair loss returns.


Finasteride (a Prescription-Only Medication), slows hair loss by reducing the body's production of DHT. New hair growth is reported in some men with its consumption. In general, it is considered to work better than minoxidil. Pregnant women should not handle the drug since it can cause birth defects in male fetuses. Like minoxidil, it works only as long as it is used.

Hair Transplant

In hair transplant, the doctor will move healthy hair from the back and side of your head to the top to restore a natural look. Hair transplants can be expensive and you may need to go through several procedures. After two months, most of the transplanted hair is shed, but it is replaced with the new hair that grows back. The hair will start to look normal within 6 months.