Hair loss is extremely worrying for men and women of all ages. Arab News asks Mike Ryan, a trichologist, what can be done about it.
Please tell us about your experience as a trichologist. How is it different from being a dermatologist?
I have been a clinical trichologist for six years. Prior to that I was involved in hair research and development with famous brands. Trichology — the branch of medicine, cosmetic study and practice — is concerned with the hair and scalp. It is a specialty within a specialty.
What do you think of hair transplants as a solution for those who have extensive hair loss?
Hair transplants should be the last option and most certainly in the case of female hair loss! For men, there are some fantastic results with transplantation. Female hair loss is completely different. It is not normal. I would advise any female to get a proper diagnosis from an expert before having a transplant.
What are the most common problems and their treatment?
Alopecia Areata is the common term for localized, patchy hair loss. Autoimmune problems can involve any system, organ or tissue of the body and the scalp is commonly affected. Conditions such as psoriasis may only involve the cells of the outer skin, leaving the hair relatively unscathed. Some may influence both, causing hair loss of a sometimes temporary nature such as Alopecia Areata. Still others scar the skin, destroying hair follicles and other underlying skin appendages as they progress.
Telogen Effluvium (TE), or diffuse shedding, has an abrupt onset. The active shedding lasts one to four months and can lead to thinning of the hair over the entire scalp. Once the daily shedding returns to normal, it may take several months for the scalp hair to regain its normal density. The patient’s hair goes back to normal within one year of onset of TE in 95 percent of people. A specific trigger can be found in approximately 75 percent of patients with acute TE.
Chronic TE is defined as increased shedding lasting at least six months, but usually more than one year. Chronic TE can last for many years with fluctuating severity. Its onset may be abrupt or gradual. A definite trigger is often not identified in patients with chronic TE. Chronic TE usually affects middle-aged women, many of whom provide a history of extremely thick hair prior to the onset of their problem.
Women with chronic TE may have normal-appearing hair, albeit thinner than the patient’s normal hair, or may show shorter frontal hairs or thinning. Women with chronic TE often state that they have lost half or one third of their hair. A woman with chronic TE may complain that she is unable to grow her hair as long as she could in the past.
Iron and thyroid levels are usually checked and supplements given if there is a deficiency. In patients with acute TE, it is important to tell patients that there is a 95 percent chance of complete recovery. It is important to stress that no one goes bald from TE and that every shed hair is replaced.
Hair breakage can be chemical or mechanical, the latter being over-use of hair-dryers and straightening irons. Chemical damage is a result of over processing the hair with hairdressing services such as color, keratin and permanent waves.
Overproduction of sebum is a direct result of increased androgen activity and is generally noticed on the skin first with the appearance of pimples. The hair then becomes oilier much quicker. This can be an indicator of some underlying medical condition.
Why is dandruff the most talked about problem among people? Is there a permanent solution for it?
I think because it is one of the most misunderstood conditions. Dandruff is actually the mildest form of Seborrhea Eczema, which is an oily condition and not dry as most people think. There are a few different causes for dandruff, so there are many reasons for people to have it. Dandruff is caused by skin cells forming too fast. The epidermis, or outer, protective layer of the skin, is constantly changing. The cells begin to grow from the base layer deeper in the skin and gradually move to the surface, this is called the epidermal turnover. Normally it takes approximately 28 days for the cells to move through the skin and to reach the surface, once there they come away when we wash. The increased epidermal turnover may be caused or exacerbated by abnormally high levels of a yeast, Malassezia Globosa, which is always found in the scalp, even a scalp without dandruff. Dandruff occurs when the quantity of the Malassezia yeast increases for one reason or another, but other factors such as stress or dietary factors may also trigger the condition. Those with greasy skin types are most at risk because the yeast likes to grow in sebum.
What are the best products on the market to get rid of dandruff?
Washing the hair and scalp with ordinary anti-dandruff shampoos helps in the removal of scale, but some of these shampoos are quite harsh and abrasive and can exacerbate the problem in the long term. If the underlying cause of the problem is not treated properly then the scale will quickly return.
Shampoos which control the level of micro-organisms on the scalp, but which also have a calming and soothing effect on the irritated scalp tissues, are usually the best form of treatment.
Are hair problems affected by changing weather, humidity and the sun?
Many people forget their scalp is in fact skin and can burn just as easily as the skin on their body. It’s also therefore prone to the same irritation and peeling, and more importantly, to cell changes and skin cancer. To help protect your scalp from ultraviolet rays, use a protective hair cream with a sun protection factor over your hair and on your parting. Although the sun’s rays are natural, they’re actually just as damaging to your hair as bleach and can burn it, dry it out and cause changes to your hair's protein structure. This makes your hair more vulnerable to breakage and split ends. Salt and chlorinated water can also do this, and cause discoloration, so always use a protective cream when sitting in the sun or engaging in water activities, to keep your hair hydrated and protected. Humidity will play havoc with your hairstyle but will cause little problems for hair loss. A good anti-humectants spray can help.
What natural ingredients can help eliminate or solve the problem of dandruff?
Treating topically with a hair rinse containing loose-leaf rosemary and tea-tree oil may help. Rosemary contains anti-fungal essential oils and tea-tree oil has been shown to have anti-fungal activity against a wide range of fungi. Topical aloe vera gel has also shown improvement in seborrhea dermatitis due to its anti-inflammatory properties. Apply it topically at night and rinse in the morning. Anti-itch creams such as shea butter and canola oil can also help.
Coal-tar shampoo is capable of slowing down the epidermal turnover, which is why it has been used in the treatment of psoriasis and other skin disorders. Juniper tar, a tree tar, is more effective than coal tar and tends to be used in more modern treatments.
Can you provide some advice for healthy hair?
Without a doubt frequent shampooing and conditioning is most important for healthy looking hair.
Don’t scrimp on sleep. The hair follicle is the second-fastest growing selection of cells in the body, second only to bone marrow. Good quality sleep, for a period of eight hours a night, can help improve the strength and condition of your hair.
Eat for your hair. A diet rich in protein and potassium will ensure your hair receives all the essential nutrients it requires. Protein helps strengthen keratin, while potassium is an essential element in preventing hair loss.
As hair grows only half an inch a month, it would take six months before you would begin to notice any appreciable changes.
— Mike Ryan is a member of the Institute of Trichologists (London) and the International Association of Trichologists. He has been involved in the hair industry for 30 years. He started out his career with Philip Kingsley Trichological Clinics in London.
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