Smoking and tobacco addiction affect hair growth in various ways.

Presence of smokers in the room has lead to nicotine levels detected in the hair of non smokers. Use of hookah and smokeless tobacco for chewing, snuff and tooth powder are unique to India. Smoking is an internal as well as external cause of hair loss. As per the Global Adult Tobacco Survey (GATS) published by the Ministry of Health, in October 2010 the incidence of smoking in India is rising, contrary to its decrease around the world.

Smokers have poor quality hair with diffused hair loss or rapidly progressive hair loss pattern. This study records the use of tobacco in two thousand hair loss patients over one years and indicates the benefit of treatment with antioxidants, vitamins, iron, calcium, B-complex, biotin, amino acids, omega 3, 6, 9 fatty acids and low light laser therapy.

A study conducted by Dr. Rajesh Rajput’s team showed that there is an incidence of smoking and use of smokeless tobacco in patients who have hair loss. We were curious to know if the use of vitamins and low light laser treatment, can improve the hair growth in these patients. In our practice we have also noticed common lifestyle habits associated with hair loss.

Study in detail 

Material and methods

• Details of smoking, use of tobacco in other forms, diet and lifestyle were recorded in a questionnaire for all patients who were presented at our hair loss clinic.
• The study included two thousand patients seen over a period of one year. Global photography, Folliscope counts for hair density and hair caliber were used for initial evaluation and for recording the progress every two months. Patients were explained the benefits and encouraged to quit smoking.
• All patients applied minoxidil 2% two times a day.
• All patients received a low dose, once in 3 days, cyclical vitamin program (3, 4). The program included, antioxidants, calcium, Vit D3, zinc, magnesium, on day one, iron, folic acid, Vit C, omega 3, 6, 9 fatty acids on day two, B-complex, biotin and amino acids on day three. These were repeated every 3 days, in the same cycle (3, 4).
• Patients received a low light laser therapy for hair growth once a week, for twelve weeks (5), after which the laser was stopped and low dose vitamins continued for 12 – 18 months.

Observations
It was observed that dry scalp, siborrhoeic scalp, oily skin, stress, sedentary work, lack of exercise, night shifts, poor water intake, constipation, high consumption of meat, colas, juices, fast foods, MSG containing Chinese food, use of whey protein, body building supplements, excess of fried foods, more than four cups of tea or coffee, excess of sugar foods, dairy products and alcohol, all are commonly associated with the complaints of hair loss.

Inquiry into smoking and use of smokeless tobacco in the form of snuff, tooth powder, toothpaste or chewing tobacco, revealed interesting details. Smoking hookah or water pipe is the new addiction among youngsters, it has effects similar to smoking.

• The incidence of smoking among hair loss patients was 32% in men and 7% in women.
  Occasional smokers 8% men and 3% women had one cigarette once in a while but did not smoke every day. Another 9% men and 5% women smoked hookah though not every day. Most of this occasional smoking, up to 80% was at parties and was associated with alcohol consumption.
• Among regular smoking patients, 48% combined smoking and alcohol consumption.
• Number of cigarettes per day varied from 3 to 20. The average being 4 per day in women and 7 per day in men.
• Patients living with a smoking member at home, getting exposed to second hand smoke while being with friends, having exposure to passive smoking at parties, pubs, office, etc. were 39%.
• Average age of smoking the first cigarette was 17 years. 12% had quit after smoking for a while. Those who had restarted smoking later in life found it difficult to quit again.
• 90% of smokers and tobacco users consumed it within 30 minutes of waking up in the morning.
• Smokers who also chew tobacco were 19%. This was associated with lower social status and lower educational status.
• Use of smokeless tobacco, chewing, snuff, use of tobacco containing toothpaste or tooth powder was seen more in semi urban and rural areas, being 37% in men and 16% in women. This was associated with lower social status and lower educational status.
• A few Parsi and Muslim patients were heavy smokers but had lower grades of hair loss. While some Gujrati and Bhramin patients being occasional smokers had severe hair loss.
• Female smokers who used, spa treatments, regular hair care and protein packs had better quality hair than males who never used any hair care at all.
• After explaining the benefits and due to the fear of continued hair loss 15% smokers could quit the habit.
•  Grey hair were seen in 34% smokers in varying extents and proportions.

Treatment progress
Progress recorded every 2 months showed improvement commencing within 2 months.

Hair loss reduced within 2 months, though it was never zero and some hair loss always persisted. The benefit increased gradually as patients continued treatment, though all patients did not record the same response. The 15% patients who managed to quit smoking had a better response (Figures 1 to 6). Overall the patients had 30% – 58% improvement in hair density, 8% – 24% improvement in hair caliber. The hair condition deteriorated in 9% patients who discontinued the vitamins after 4-6 months. These patients restarted the program and found improvement again after 4 months.

Complaints frequently associated with hair loss have led Dr. Rajesh Rajput and his team to advice diet and lifestyle modification to all our patients (3, 4). Similar complaints associated with hair loss were noted by Lee et.al. & Severi et.al. (6, 7). Smoking in men has shown a 10% reducing trend in India, but smoking in women is increasing and appears to have doubled over the recent years (2, 8, 9, 10).

A 2005 WHO report states that smoking using a hookah or water pipe poses a serious potential health hazard and is not a safe alternative to cigarette smoking (11). The average hookah session typically lasts more than 40 minutes, and consists of 50 to 200 inhalations that each range from 0.15 to 0.50 liters of smoke.

In an hour-long smoking session of hookah, users consume about 100 to 200 times the volume of smoke of a cigarette (11, 12). Even occasional smokers seem to have hair loss. Combination with alcohol worsens the condition (13). Alcohol reduces the absorption of fat, nitrogen, sodium, water, thiamine, folic acid and vitamin B12 leading to chronic mal nutrition and anemia (14), causing hair loss.

It was noticed that female smokers who used, spa treatments, regular hair care and protein packs had better quality hair than males who never used any hair care at all. Similar benefit was noted by Apelberg et.al. (16) who evaluated nicotine levels in the hair and noted that smokers reporting hair treatments other than coloring (bleaching, permanent, or straightening) in the past 12 months had 66% lower hair nicotine concentrations than smokers who had no hair treatments at all (16).

Dr. Rajput and his team explained the need to quit smoking and had a success rate of 15%. The best quit rate reported in the Indian population is 20% (8, 21). Smoking quit rates in USA, UK, Brazil are as good as 35% (8). The quit rate could be improved by involving a dedicated counselor or psychiatrist.

Conclusion
There is a significant incidence of smoking and use of tobacco in other forms among the Indian men and women. Tobacco use should be routinely inquired during clinical evaluation of hair loss patients. There is an epidemiological and scientific basis for hair loss in smokers. Stimulation of hair growth with minoxidil, low light laser therapy, use of antioxidants, antioxidants, calcium, Vit D3, iron, folic acid, Vit C, omega 3,6,9 fatty acids, biotin and amino acids can help in the treatment of hair loss in smokers.