Let me start with a simple, blunt question. Why are our patients doing everything right and still losing hair?
They are washing correctly, using premium products, layering actives and are following each word as advised by the dermatologist and his team. And yet, they walk into our clinics frustrated, shedding, and convinced that nothing works.
So here’s the uncomfortable truth.
The problem may not be undertreatment, but rather it may be overtreatment. Hair and scalp are biological systems, not cosmetic canvases. But we treat them like skin care routines that can be endlessly layered and upgraded. Every shampoo, even if sulphate, paraben and dye-free, strips something away. Every serum alters the follicular environment, every new active ingredient challenges the scalp’s ability to adapt, and at some point, the scalp stops responding. It is not because the treatment is weak, but because the system is overwhelmed.
How does this failure occur?
1. Over-cleansing: We have convinced patients that frequent washing equals hygiene. In reality, repeated surfactant exposure disrupts the scalp barrier, increases inflammation, and pushes follicles into telogen. The shedding that follows is not disease progression, but it is treatment-induced damage.
2. Obsession with hair activities: Niacinamide, peptides, caffeine, botanicals, growth factors — all applied together. This is not precision therapy.
This is chemical noise. The result is irritant dermatitis that quietly worsens hair fall while the patient adds yet another product to fix it.
3. Occlusion masquerading as nourishment: Oils, serums, and silicones accumulate around follicles, alter the microbiome, and suffocate follicular function. We call it nourishment. The follicle experiences it as stress.
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4. Constant switching due to patient frustration and wanting rapid results: Hair biology operates in months. Our patients switch products every three weeks. So when treatment fails, we escalate. Stronger activities, more steps, resulting in higher cost, and that is how we create the illusion of resistance. The reality? The follicle never had a chance. This leads us to a difficult admission. A significant proportion of hair treatment failure is iatrogenic. We are not just witnesses, we are contributors.
What's the solution?
It is not the next breakthrough product. It is a restraint. It is subtraction, not addition. We need to move from hair care maximalism to hair minimalism. Opting for fewer products with clear intent, barrier protection, microbiome respect and timelines that match biology, not marketing cycles.
In many patients, the most powerful intervention is a reset. Stop the excess, calm the scalp, and let the follicles recover.
As clinicians, our responsibility is not to prescribe more. It is to prescribe smarter. Because before escalating therapy, we must ask one critical question. Is the hair failing, or is the routine failing the hair?
The author is a Mumbai-based dermatologist.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.