Proper Hair Care

Proper Hair Care

Each year, Americans spends millions of dollars on hair-care products and treatments. Unfortunately, some of these efforts are too rough or done frequently. The result is hair damage rather hair care. Damaged hair stays damaged until it grows out and is cut off. This can take many months, because your hair grows only about 1/2 inch each month.

Choose shampoo and conditioner that is right for you. Hair gets dirty when sebum, an oily substance secreted by the skin's sebaceous glands, coats the shaft. Dead skin cells and airborne dirt stick to the sebum. A "good" shampoo leaves hair manageable, easy-to-comb and glossy. Most modern shampoos are synthetic detergents called surfactant -- replacements for the older types that dulled hair by depositing a scum on its surface. Surfactant molecules surround a tiny glob of oil, forming a package called a "micelle." Rinse water carries the micelle away. Coloring, perming, combing, teasing and shampooing can break the cuticle's long protein chains. The cuticle gets shaggy, and hair becomes rough. Static, due to combing, can develop.

Most modern conditioners contain cationic quaternary ammonium compounds that provide a positive charge which reduces static and makes hair less "fly-away" and more manageable. Some products, particularly those containing benzalkonium chloride as the active ingredient, are good conditioners. Those with added polymers, collagen, balsam, silicones or resins that bond with and coat the hair shaft, may provide a protective film, smooth out the cuticle, reducing snarls and tangles. Conditioners that give "extra body" may contain waxes that, when dry, make it look fuller, some contain oil/fats (e.g., lanolin, mineral) to smooth hair, and a few have humectants that supposedly hold in water content. Price and exotic ingredients bear little or no relation to efficacy. Most conditioning products that claim to nourish hair do nothing of the sort as the ingredients cannot enter the hair unless they contain transformants -- molecules small enough to pass into the cortex.

Quaternary ammonium compounds in conditioners have a tadpole-shaped molecule that is attracted to a damaged site on the cuticle. When many such molecules attach to hair, they make it slippery and easy to comb. Shampoo molecules and conditioner molecules normally counteract one another when combined. But several new shampoo/conditioners contain conditioning agents that stay suspended until the hair is rinsed. Diluting the lather releases these agents, so they can coat the hair.

Protein shampoos do not penetrate your hair, but they do coat it, giving your hair more bulk. A protein shampoo acts as a shampoo and conditioner in one. Follow your shampoo with a cream rinse or conditioner. These products lubricate your hair between washings and help minimize damage from brushing or combing. Those containing protein ingredients may also thicken your hair temporarily. use shampoos tailored to your hair type--oily, dry or normal. Permanent - waved, straightened, or dye hair needs low pH shampoos. Excessive flaking may require dandruff shampoos (see treating dandruff).

Choosing the right conditioner or shampoo for your hair can be a matter of trial and error. Some products may make your hair limp, while others may even dull it with a film. Choose two different brands of shampoo and conditioner that are right for you, alternate use will give the best result.

It is a myth that shampooing increases hair loss. Whether dry or greasy, hair should be washed as often as required to look good, even every day. Most experts recommend at least once a week washing to prevent dandruff from clogging the scalp. If you have an oily scalp, frequent shampooing will keep the hair from lying flat, weighted down by the fats in sebum. Shampoo will also reduce surface sebum, which contains high levels of testosterone and DHT that may re-enter the skin and affect the hair follicle. Very dry hair may be improved by massaging with a little olive or almond oil, covering and leaving on overnight, washing out next morning. If done gently, daily shampooing will not damage your hair. The amount of washing will depend on the type of your hair, the weather, your physical activity, and perhaps even your occupation.

A proper and thorough brushing should precede every shampooing. For proper washing, wet your hair completely with warm water. The first rinsing acts as a pre-wash to remove dust and water-soluble dirt and hair-care products.

After the first rinsing apply the shampoo with hand to the oiliest part of the scalp and massage the entire scalp gently, using your fingers instead of your nails as you work the lather outward from your scalp. Try not to tangle the hair, and avoid scrubbing the ends, particularly if your hair is long.

Rinse thoroughly with water. Shampoo can leave a residue that can dry the hair, attract dirt, and irritate the scalp. If you shampoo daily, lather only once, even if you have oily hair. Over- cleansing can create a vicious cycle in which you stimulate oil production and then dry out the hair. If you shampoo less frequently, experiment with one or two sudsings.

Handle With Care

After washing, towel dry by patting gently. Since heat from curling irons and blow-dryers are notorious hair destroyers, to prevent damage, the hair should be dried naturally. If a blower is necessary, use it on a lowest setting and leave your hair slightly damp. If you brush or comb your hair while it is wet, you pull out much more hair than you would by gently untangling it with your fingers and waiting until it is damp or dry before you carefully brush or comb it. An occasional massage with the fingertips will enhance blood flow to the scalp.

Your hair requires gentle handling. Wet hair is especially fragile because it might become stretched. A natural bristle brush is preferred over a synthetic one because the synthetic material may create static and cut the hair. Brush the hair gently from the scalp to disperse scalp oil over the hair. Brushing is especially important for long hair because the natural oils do not normally reach the ends, but it's equally beneficial for short hair. It increases circulation to the scalp and stimulates hair growth. If you prefer a comb, use a wide-toothed comb to avoid injury to your hair.

Begin to brush the hair at the ends and remove large tangles gently with your fingers. Continue to brush, picking up more hair and working along the length of the shaft until you reach the scalp. Then brush thoroughly from the scalp to the ends with long continuous strokes. Bend at the waist and brush the hair down toward the floor to stimulate the scalp by increasing blood flow to that area.

Styling

Certain hairstyles and treatments can cause breakage or root damage. Avoid excessively tight braiding, buns, or ponytails. do not roll your hair too tightly in curlers. Teasing and back combing should be done gently or not at all. To much exposure to sun, wind, or swimming-pool chemicals will dry out your hair and cause it to knot.

A styling gel or mousse can give your hair more body or thickness. They do not necessarily damage your hair, but you may experience extra dryness, especially at the hair ends.

Hair bleaches chemically alter the melanin granule in the middle layer of each hair strand. Despite careful treatment, persistent bleaching eventually damages even healthy, strong hair shafts, but it does not injure the roots from which future hair growth takes place.

Hair dyes work more like paint by covering hair strands with color or by mixing with the melanin granules without altering them. Dyes come in temporary form, which eventually wash out, and semi-permanent and permanent forms, conduct a patch test to check for possible irritation, because a severe allergic reaction to hair dye could cause hair loss. Curling is safest if you twist your hair into pin curls overnight. Use of hot rollers or curling irons gives the best results for coarse hair, but they may damage strands or roots when used to excess. When you use a curling iron always roll in the ends last. For safe curling of fine hair, let it air dry and wind it loosely around sponge rollers.

Permanent waving rearranges the inner hair molecules, breaking and reforming its sulfur bonds, in a step-wise chemical process (that gives off the familiar sulfide odor which wafts off the head being waved). Permanent waving is safe for healthy hair, but you may find it results in increased dryness and splitting. Straightening and permanent waving use the same chemical methods to change the properties of hair strands.

In permanent waving, a gentle shampoo first strips off the sebum, then swelling agents open up the hair shaft -- to allow entry of the bond-rearranging waving solution. Modern waving solutions (mostly ammonium or sodium sulfide) are more flexible than the former types, safer and more controllable. The latest acidic waving lotions, although more expensive, have the gentlest hair-reforming action, and are advised for use on fragile or tinted hair. Wound on rollers of varying sizes, hair gets a permanent curl of the desired type. The final extent of the wave depends on the kind of hair (finer curling faster), the time the solution stays on and the size of roller used. After the hair is arranged in its new, curly configuration. Waving solution is rinsed off and the second solution, the neutralizer which restores the linkage is put on to halt the curling process. The waving action must be stopped at the right time to avoid overprocessing. Modern waving solutions are often self-timed, the hair-altering reaction automatically halted after a designated time. A permanent waving should never be done on hair dyed with metallic products and only with extreme care (using the gentler waving lotions) on hair that's been recently bleached or tinted with permanent, oxidative dyes. Dual processing could disintegrate hair made porous by the tinting procedure. Waving after coloring hair requires great care and use of weaker waving lotions -- a fact known by any trained hairdresser. Done by a reliable stylist, permanent waving today is pretty safe.

Diet and Your Hair

The quality of your hair reflects in part the adequacy of your diet: regular, well-rounded meals are best for you and your hair. Consuming extra protein or amino acid preparations will not promote hair growth. In fact, there is evidence that megadoses of some vitamins-particularly A and E may contribute to hair loss. Iron deficiency, due to inadequate consumption of red meat or heavy menstrual bleeding in women, could cause hair shedding. Crash diets and eating disorders such as anorexia nervosa can damage hair dramatically.

Various claims are made for the value of analysis of hair samples-- measuring its mineral content -- as a means of assessing nutritional status or detecting nutritional deficiencies, but the process has no validity and can be considered one of the many scams aimed at appealing to people concerned about their health. The chance of getting accurate information from a single hair strand is nil. The results are distorted by contamination from sweat, the shampoos, conditioners, sprays and coloring agents used to groom hair, and by the hair's rate of growth. It's highly questionable whether the metal or mineral content of a hair accurately reflects amounts elsewhere in the body.

Common Drugs That Cause Hair Loss

It is well known that many cancer chemotherapy medications cause baldness. Most people are willing to put up with hair loss when accepting treatments for life-threatening diseases. But a large number of popular medications can cause hair loss while neither pharmaceutical industry nor your doctor will tell you about this side effect.

Here we compile a list of drugs that are know to cause hair loss in some patients:

Cholesterol-lowering drug:

clofibrate (Atromis-S) and gemfibrozil (Lopid)

Parkinson Medications:

levodopa (Dopar, Larodopa)

Ulcer drugs:

cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid)

Anticoagulents:

Coumarin and Heparin

Agents for gout:

Allopurinol (Loporin, Zyloprim)

Antiarthritics:

penicillamine, auranofin (Ridaura), indomethacin (i\Indocin), naproxen (Naprosyn), sulindac (Clinoril), and methotrexate (Folex)

Drugs derived from vitamin-A:

isotretinoin (Accutane) and etretinate (Tegison)

Anticonvulsants for epilepsy:

trimethadione (Tridione)

Antidepressants:

tricyclics, amphetamines

Beta blocker drugs for high blood pressure:

atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), propranolol (Inderal) and timolol (Blocadren)

Antithyroid agents:

carbimazole, Iodine, thiocyanate, thiouracil

Others:

Blood thinners, male hormones (anabolic steroids)

Next time your doctor prescribes any drug for you, ask if it will cause hair loss. You doctor may not realize this side effect. You can ask him or her to look it up in the Physicians' Desk Reference, which lists the side effects of all prescription medications. If the drug is linked to reversible alopecia, ask if another can be substituted. And just to make sure your physician has given you accurate information, when you get the prescription filled, ask your pharmacist as well.

Other Baldness Solutions

Other Baldness Solutions

Wigs made from artificial or, increasingly, real hair, kept in place by adhesives, are becoming more natural-looking.

Sutured hair pieces may be permanently stitched into the scalp, i.e., synthetic hair fibers or the real hair of others is permanently attached, sewn in or "shot" (like tiny barbs) into the bald scalp by non-medical technicians. Although claimed to be safe, it is not, because whenever a foreign object is permanently placed in the body there's almost always a consequent infection or skin allergy.

Hair weaving, also called "hair intensification" or "hair integration," involves adding to thin hair by weaving or braiding human hair or synthetic fibers into existing hair. Apart from the expense (anywhere up to $2,500), this poses two problems: first, it may be difficult to keep your hair and scalp clean. And second, it stresses existing hair and may cause it to fall out.

The American Hair Loss Council advises that only people with plenty of healthy hair should consider hair weaving. And even they should plan to keep the "intensified" hair for only a few weeks.

Hair weaving. The procedure is not surgical but merely cosmetic in that it attaches extensions, either natural or synthetic, to existing hairs. On the downside, the extensions must be repositioned every four to six weeks as the hair grows out. Hairpieces. Toupees seem to be out of favor with Baby Boomers. Hairpieces have gotten a bad name because so many men wear cheap ones that make them look as if a weasel died on top of their head. It's very hard to spot a good toupee, but the dreadful ones get noticed.

If you're thinking about a hairpiece, your best bet is to go to someone who offers a free consultation. Go with a custom piece rather than an off-the-rack toupee. Synthetic pieces are better for active, sports-minded men because they hold up to weather and water better and are easier to keep clean. Natural pieces tend to look slightly better at first, but the harsh processing done to Oriental hair--the largest hair source--makes the hair break down sooner. As for comparative costs, figure about $150 more for a natural vs. synthetic piece in the $1,000 category.

Cosmetic Remedies

To reduce the visual effect of you thinning hair, you can always resort to camouflage. The universal rule in dealing with thinning hair is, less is more. Cut it short, cut it blunt. It will make your hair look fuller and less patchy, and will be easier to maintain. With longer hair, it would bunch together and the bunches would separate, showing wide expanses of scalp.

A skilled barber can also help you when hair is thinning only in certain areas. If you are thinning in the front, the hairline is creeping back at the temple. To minimize this condition ask you barber to trim the forward part short, while letting the hair at your temples grow longer.

If your hair is thinning at the crown of the head, keep the back short; long hair in the back of the head will be heavier, pulling down and away from the crown and exposing the balding area. If you still have reasonably thick hair on the top of your head, grow it long and cover the bald spot.

If your hair is fine, you're going to have a harder time covering the bald spot. You might want to try what's known in the hair-cutter's trade as a "swell" perm, a mild perm that increases hair volume. Such a light perm will be hardly recognizable to others.

If you have dark hair, lighten the color a bit. This trick will reduce the contrast between the remaining hair and the scalp, thereby making the skin less noticeable. One cosmetic trick that may work for women: buy a powdered eye shadow the color of your hair and apply it lightly to your scalp in the thin spots. It's harmless and may make thinning hair less noticeable.

When it comes to grooming products, stay away from gels, which can cause sections of hair to stick together and create gorges of empty space that reveal the scalp. Light sprays serve a better purpose. Many hairstylists recommend the following products which make you hair look fuller.

Surgical Treatments for Baldness

Surgical Treatments for Baldness

If you do not respond to medical treatments and If you have time, money, and a stoic attitude toward pain, Surgical hair restoration is the only truly permanent solution to baldness. It involves a series of operations that extract plugs of scalp from the sides an back of your head, where hair grows densely, and implant them on top and in front, where you're going bald.

The procedure, which usually isn't covered by medical insurance, can cost as much as $15,000 and takes a year or two to complete. Despite the time and expense, an estimated 250,000 American men each year elect to have the surgery.

Restoration is possible because the hair follicles on the sides and back of the scalp are insensitive to the hormones that cause androgenic alopecia, so the hairs are immune to fallout. During surgical hair transplantation, hair follicles are redistributed in balding areas, where they grow hairs that continue to grow for the rest of the individual's life.

Hair transplants are better than they used to be, for doctor can use a variety of techniques to make it look like natural hair. Here is a rundown of the major surgical treatment for baldness.

Hair Transplantation

The common method of implanting grafts is illustrated in figure 3. There are two type of donor grafts taken from the hair-bearing posterior scalp: cylindrical, elliptical (also macrografts) and micrografts or minigrafts.

The most common type of Macrografts is cylindrical plug. Using a device like a hole puncher, the surgeon removes 1/8-inch-round graft containing about 12 to 20 hairs and placed into a smaller cylindrical hole in the anterior balding region of the scalp.

Depending on the degree of baldness, 1 to 4 sessions of transplantation are required, with placement of 50 to 60 plugs at each session. Successive transplantation sessions are scheduled with at least a 3-month interval between procedures. Average cost: $12,000 per 50 grafts ( one session). The number of grafts depends on the hair coverage desired.

Elliptical grafts are used for large posterior areas of baldness. Nowadays macrografts are no longer used by most surgeons, since these techniques tend produce artificial appearance.

Micrografts (1 to 2 hairs) or Minigrafts (3 to 4 hairs) are implanted along the anterior hairline to mask the "doll's hair" look of the cylindrical plugs and give a natural appearance to the hairline.

A narrow two-inch section of scalp is removed from the back of the head. It is then divided into 1 to 2 millimeter grafts and implanted in tiny incisions made in the bald area. Average cost: $1,200 per 50 grafts (one session). When used with other procedures, at least two sessions may be required.

After transplantation, the recipient area is covered with a scab for several days, the donor hairs fall in 2 to 4 weeks, and new definitive hairs grow within 3 months. one study (19) showed that if topical minoxidil is applied twice daily beginning within 48 hours after hair transplantation, the hair in the grafts will stay and regrowth of hair begins immediately.

Typically, men with hair loss limited to the frontal area of the scalp are the best candidates for hair transplantation. However, the patient's age and the potential for more extensive baldness must be considered carefully. These factors may dictate that other procedures should be performed in addition to hair transplantation.

Certain hair characteristics make it easier for surgeons to re-create truly outstanding hairlines. Individuals with blond, gray or light brown hair usually require the transplantation of fewer grafts because there is less contrast between hair color and skin tone. Generally, if a patient has darker hair, more single-haired grafts are blended into the frontal hairline area.

Men who have at least some natural wave in their hair have an advantage over individuals with straight hair because the natural curl provides extra volume. Sometimes patients with straight hair opt for a permanent wave once their newly transplanted hairs grow to a sufficient length.

Scalp Reduction

Scalp reduction, also referred to as galeoplasty, male pattern reduction or bald area reduction is performed on patients with well-defined bald spots in the crown area of the scalp. It is sometimes done in conjunction with hair transplantation to reduce the size of the bald scalp, especially in patients who do not have enough donor hair to cover the bald areas. A section of bald scalp (up to 2 by 7 inches) is removed, and the sides of scalp are lifted and sutured together. Small hair grafts fill in the remaining bald areas. For patients with large area of baldness, successive scalp reductions are performed to reduced progressively the bald area. Average cost: 1,600 per procedure.

Scalp reduction is recommended for men with bald spots smaller than 3 inches in diameter. This technique is not suitable for patients with little or sparse donor fringe.

Flaps

A large horseshoe-shape piece of scalp is partially detached from the donor fringe area. The free end is positioned over the bald spot where a corresponding patch of hairless scalp has been removed. Additional small grafts are needed to create a natural look. Average cost: $2,7000 to 8,000 per flap, depending on the size.

There are some disadvantages associated with this procedure. First, the resulting straight frontal hairline does not appear natural, and a scar along the hairline can sometimes be detected. Second, the hairs of the flap grow in a direction different from the natural hairs, giving an artificial look. Discuss with your surgeon about your concern.

Tissue Expansion

As illustrated in the figure 6, silicone bags are inserted beneath an area of hairy scalp and gradually inflated with a saline water over a six-week period. This causes the hair-bearing skin to stretch, thus increasing the amount of hair-bearing scalp. After removing the bags, expanded hair-bearing skin is lifted and moved to an adjacent bald area where a similar-sized patch of scalp has been excised.

The major disadvantage is that patients have to tolerate the strange appearance of balloons in their heads for several weeks. Though men can camouflage this, most find it embarrassing. The procedure is even less suitable for smokers, whose blood supply to the scalp may not be sufficient to allow normal healing, and for diabetics, who are more susceptible to infection. Average cost: $4,000.

Before Making Any Decision

In US any licensed physician can perform hair the surgery, it is easy to end up with Unsatisfactory results--scarring, patches of thin transplanted hair over scalp sections that continue to grow bald, a "doll's hair" look, or loss of hair that leaves the scars from transplantation visible--are no longer as likely as they once were, but they are still a risk.

If you decide to go this route, choose your surgeon with care, and beware of seductive advertising brochures showing "after" photos of men with thick, way hair. Ask to see some real people whom the doctor has treated. The best way, actually, to find a surgeon is through a referral from a satisfied customer, but even then you should be sure the doctor's credentials check out. Check with the department of plastic surgery or dermatology at your nearest university medical school. You can also call or write to the American Hair Loss Council or the American Academy of Facial Plastic and Reconstructive Surgery (1110 Vermont Avenue NW, Suite 220, Washington, DC 20005; telephone 800-332-3223).

Get to Know Your Hair

Get to Know Your Hair

The amount of hair and where it grows vary with different mammals. The entire body of the dog, the sheep, the cow, and the horse is covered with a hairy coat. The whale and the hippopotamus have only a few hairs. In humans, hair is not found on palms of the hands or the soles of the feet.

The coloration and pattern of coats in animals serve both as a camouflage for protection against enemies and as an allurement to mates. Fine and transparent, human hair is a vestige of our hairier animal forbears, that probably evolved from the scales of reptiles. The adult human body averages five million hairs, of which 100,000 to 150,000 are on the scalp.

Hair is composed of keratin, the same protein that makes up nails and the outer layer of our skin. The part seen rising out of the skin is called hair shaft or strand. Each strand consist of three layers. The outermost protective layer (cuticle) is thin and colorless. The middle layer, or cortex , is the thickest. It provides strength, determines your hair color and whether your hair is straight or curly.

Hair color is determined by melanin from your pigment cells. The more pigment granules there are, and the more tightly packed, the darker the hair. Two kinds of melanin contribute to hair color. Eumelanin colors hair brown to black, and an iron-rich pigment, pheomelanin colors it yellow-blonde to red. Whether hair is mousy, brown, brunette or black depends on the type and amount of melanin and how densely it's distributed within the hair. For example, deep-black African hair contains closely packed melanin in the cortex, a few in the cuticle. Very dark European hair, quite apart from having more melanin granules than lighter or blonde hair, has more melanin per granule. When pigment-producing cells cease to function, the result is the uncolored white or gray hair.

Scalp hair varies tremendously between races, between individuals of same race, and even within an individual. Mongolians have straight hair simply because their scalp hair has the greatest thickness and the roundest cross-section. In Caucasians the hair is more elliptical and slender; in Negroes it is flattened, resulting in kinky curls. Mongolians, both male and female, have much less public, axillary, facial, and body hair than Caucasians. In Caucasians, true blonds typically have more hair (about 140,000 hair) than brunette (about 105,000) or redhead (about 90,000).

Below your skin is the hair root which is enclosed by a sack-like structure called the hair follicle. Tiny blood vessels at the base of the follicle provide nourishment. A nearby gland secretes a mixture of fats (called sebum) which keep the hair shiny and waterproof to some extent. Secretions from some sweat glands also produce a characteristic odor. A dog can differentiate a human being by the typical scent secreted by these glands. Two sets of glands discharge secretions through the skin. while sebaceous, or oil, glands arise from the walls of hair follicles and produce an oil called sebum that lubricates the skin and hair, Sweat glands, embedded in the subcutaneous layer, are scattered over the body, particularly in the palms and soles. Sweat glands produce moisture called perspiration that reaches the skin's surface through the pores and evaporates to cool the body.

At the base of the follicle is the papilla, which is the "hair manufacturing plant." The papilla is fed by the blood-stream which carries nourishment to produce new hair. Male hormones or androgens regulate hair growth. Pubic and axillary (armpit) hair are particularly androgen-sensitive and grow at lower androgen levels than hair on the chest or legs. In boys, most pubic hair is grown by age 15, followed by the development of armpit hair two to three years later. In girls, too, an increase in androgens at puberty triggers growth of pubic and armpit hair. Scalp hair, not directly androgen-responsive, is influenced by local amounts of a testosterone derivative, dihydrotestosterone.

Hair follicles initially form in utero. No new follicles are created after birth, and none are lost in adult life. The first hair to be produced by the fetal hair follicles is Lanugo hair, which is fine, soft, and unpigmented. This is usually shed in about the eighth month of gestation.

The first postnatal hair is vellus hair, which is fine, soft, usually unpigmented, and seldom more than 2 cm long. Vellus hair remains on the so-called hairless regions of the body, such as the forehead and balding scalp. At puberty, the vellus hair in some areas is replaced by terminal hair, which is longer, coarser, and pigmented. Growth starts in the pubic region; then the eyelashes and eyebrows become thicker. Axillary hair and male facial hair appear about two years after growth of pubic hair begins. Body hair continues to develop long after puberty, stimulated by male hormones that paradoxically, also cause terminal hair to be replaced by vellus hair when balding begins.

Scalp hair fibers grow from 100,000 to 350,000 follicles which are reported to occupy the human scalp; however, not all the follicles are productive.[1] In each producing follicle, the duration of the hair's life cycle is influenced by age, pathology and a wide variety of physiological factors. [1,2] The life cycle is divided into the anagen (active), catagen (transitional) and telogen (resting) phases.

The anagen phase is the period of active hair growth where protein synthesis and keratinization are continuously occurring. In normal subjects, this phase lasts for up to five years, although longer durations have been documented.

The cessation of the anagen phase is characterized by a transitory phase known as catagen. This phase lasts for two to three weeks. Following the catagen phase, the hair enters the telogen or "resting" phase. In normal subjects, telogen hair is retained within the scalp for up to 12 weeks before the emerging new hair dislodges it from its follicle.

During the anagen phase, protein s thesis is the main distinction of the hair bulb. In the telogen phase, the dermal papilla undergoes renewal. It is at this time that structural characteristics can be modified. The new hair should be identical to its predecessor, but with advancing age, and in some pathological states, a strict copy is not maintained. In these circumstances, the hair may become finer and shorter, modifying the esthetic profile. Since these effects occur over several hair cycles, years may elapse before the affected individual recognizes the difference.

Like skin cells, hair grows and is shed regularly. Shedding anywhere from 50 to 100 hairs per day is considered normal. The average rate of growth is about 1/2 inch a month. It is now known that hair grows fastest in the summer, slowest in the winter, speeds up under heat and friction, but slows down when exposed to cold. Hair grows the best between the ages of 15 to 30. But, hair growth begins to wind down sometime between the ages of 40 and 50. Progressive hair loss begins naturally in both sex about age 50, accelerating in the 70s. About 40 percent of Caucasian men lose hair to some extent by age 35.

What cause hair loss? can we do something about it? we will discuss these matters in upcoming chapters.

The Social Dimension of Hair Loss

The Social Dimension of Hair Loss

Hair plays a significant role in our life. Another person's hair is one of the first characteristics we notice upon meeting. Our own hair is one of the first and last things we attend to before a meeting or a social engagement. Hair disorder, especially when severe, often profoundly affects the lives of those afflicted. Severe hair loss evokes not only cosmetic concerns but may also evoke feelings of vulnerability (nakedness), loss of self-esteem, alterations in self-image, and, perhaps, even self-identity.

In 1992, researchers at Old Dominion University in Norfolk, Virginia, surveyed 145 men, and found that 84 percent of the balding men were preoccupied with their loss. They described themselves as filled with self-consciousness, helplessness, and envy of men with full heads of hair. Single men and woman who had begun losing hair in their early twenties were more likely to suffer from extremely low self-esteem.

While stressful, balding isn't the end of the world. Although the men reported glancing in the mirror constantly and wearing hats even in warm weather, they manage to make it through their daily lives without much problem. For some it even sparked self-improvement tactics like fiddling with hair styles, working out more, and dressing better. Survey result is shown in the following chart.

How deep does a bald man's anxiety runs?
Reported experience

extent of hair loss


low


high
Notice bald/balding men

54%


82%
spend time looking in mirror at hair

54


69
Look older than actual age

40


55
Feel self-conscious

42


78
Worry that others will notice

39


56
worry about aging

37


46
Feel less attractive

31


51
Envy good-looking men

33


34
Try to improve hair style

63


66
Try to improve physique

41


36
dress nicer

26


45
Wear hats or caps

23


41
Seek reassurance about looks

23


39
Grow a beard or a mustache

18


36

Stereotypes associated with baldness are not flattering. A research back in 1971(2) had been conducted to investigate how one person was perceived by others can be influenced by quantity of scalp hair (regular, balding, and bald) as well as color, length, and quality of scalp hair. Pictures of the same person were presented to 60 judges. Differences in appearances of this person (i.e., experimental conditions of regular, balding, and bald) were manipulated through modifications made by a commercial artist. The results revealed that the person with a regular quantity of hair was rated as most handsome, virile, strong, active, and sharp. The person with a balding head of hair was rated as least potent, weak, dull, and inactive, and the person with a bald head of hair was rated as most unkind, bad, and ugly.

Many other studies also show employment discrimination based on a person's appearance.

Motivation to avoid baldness is not confined to this century. In 1150 BC Egyptian men smear their pates with fats from ibex, lions, crocodiles, serpents, geese, and hippopotamuses. In modern society, this aversion is readily evident from the many available remedies such as creams, hormones, vitamins, hairpieces, wigs, scalp reduction and hair transplants. A government report in 1983 reveals that over the past 9 years the FDA has overseen the investigation of ingredients in about 300,000 products claimed to help hair regrowth, none of them has any medical benefit, of course.

Non-surgical Treatments for Baldness/Hair Loss

Non-surgical Treatments for Baldness/Hair Loss

Balding men and women seem to go to almost any lengths to regrow thinning hair. Until now, inherited balding in either sex has not responded well to any anti-balding stimulants, applications, injections, or other treatments. Specific foods or vitamins don't regrow hair -- although good nutrition is essential for healthy hair.
Antiandrogen Therapy

In the United Kingdom, the most commonly used anti-androgen for women is CPA (cyproterone acetate) in combination with ethinyl-estradiol. In the United States, where CPA is not available, the aldosterone antagonist spironolactone has been given in dosages from 75 to 100 mg per day with some benefit. However, higher doses (150 to 200 mg per day) appear necessary to produce a significant increase in cosmetically useful hair, as occurs with CPA therapy.

Anti-androgen treatment must be continued for at least 12 months. Often two years is required before a subjective improvement is observed. Complete reversal of the hair loss can never be achieved unless treatment is instigated within two years of its onset. This is probably due to the atrophy of the miniaturized hair follicles with time. The degree of benefit observed is dependent upon the subject's age and the duration of alopecia; however, most patients are satisfied with the thought that no further hair loss will occur. Some improvement in hair quality should be expected in all cases, although withdrawal of therapy results in further progression of the alopecia.

Nonhormonal aspects are critical to ensure an optimal therapeutic response is achieved. And, the need to maintain vitamin and serum ferritin levels above values previously thought adequate has recently been demonstrated.

The side effects of oral CPA therapy in combination with ethinyl-estradiol are well documented and are similar to those associated with other oral contraceptive regimens. Spironolactone disrupts the menstrual cycle and increases menstrual bleeding in some patients; but, in general, it is well tolerated.

To understand how these hormonal remedies work, you need to know a little science. DHT is one of several male hormones, called androgens, that compete for a berth on the hair follicle's receptor sites. In principle, if you could keep the receptor busy metabolizing other hormones, like progesterone, DHT would never have a chance to move in and start shrinking the follicle. The researched based on this concept have made little progress over the past decade. The biggest hurdle: to limit the effects of the androgen blocker to the scalp only.

If DHT is blocked at other sites around the body, a male will lose his sex drive and develop a vocal delivery that resembles a teenage girl's. Blocking the activities of DHT in female who have hair loss is, of course, less problematic. Spironolactone or Aldactone does just that, and very effectively.
Rogaine

By far the most publicized medical treatment available for male pattern baldness is minoxidil (Rogaine). The idea of using minoxidil topically to grow hair was serendipitous. This drug was originally developed to treat high blood pressure and had the unanticipated side effect of stimulating hair growth, sometimes in unwanted areas. This observation led to the testing of topical minoxidil on balding areas of the scalp. Since its introduction in 1988, Upjohn, the manufacturer, sells about $150 million worth of the drug each year, even though its ability to grow back hair is, at best, modest.

A large-scale clinical trial involved over 2,300 participants with male pattern baldness was carried out by having 1,547 patients apply 1 ml of 2% or 3% minoxidil and 779 patients apply 1 ml of placebo ( no active ingredients, only alcohol and propylene glycol) twice a day to the balding area. Actual counts of vellus hairs, indeterminate hairs, and terminal hairs in an one-inch patch were made before and after treatment. At 4 months, 5% to 8% of patients had moderate to marked hair growth on the balding vertex of the scalp. This figure is statistically no different from the number of men who regrow hair in response to a plcaebo. another 15% to 20% of patients had some growth of vellus hair on the balding area. At 12 months, 39% of patients had moderate to marked hair growth, while 11% of those using placebo reported an increase in hair growth. This result shows that you to used minoxidil for more than 4 months in order to decide whether this treatment works for you.

Who is the best candidate for this drug? research showed that you have to be:

1) young man (20 to 30 years old), who only recently (within 5 years) had begun to bald

2) not completely bald, and

3) not bald at the temples

This drug works best on small areas of vertex baldness (smaller than 1 square inch). There is no evidence that topical minoxidil could regenerate hair on the receding temple area. Topical minoxidil was as effective at a concentration of 2% as at 3%. A 1% formulation was less effective.

Successful treatment, however, does require a lifetime commitment. The topical solution must be applied to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness within 3 to 6 weeks. The cost? Anywhere between $600 to $1,000 a year, depending on the size of the area to be treated.

Why minoxidil works remain a mystery. It is know to be a powerful vasodilator, but other drugs the dilate blood vessels do not promote hair growth. It is postulated that it delays or prevents some follicles' entry into the next anagen phase for long periods of time and stimulate these follicles back into active production. But this theory remains to be vindicated.

The disadvantages of minoxidil are: 1) lifetime commitment; 2) high cost : It is not covered by health insurance schemes as it's considered a cosmetic; 3)Its side effects; including itching and prickling, headaches (in 40 per cent), dizzy spells and, in some, heartbeat irregularities. Although apparently safe when rubbed into the scalp - since little is absorbed into the bloodstream - it is a vasodilator and not recommended for anyone with heart trouble. Its safety in men over age 49 and its long-term safety remain unknown. Some scientists believe that minoxidil is more effective in preventing hair loss than in promoting regrowth, but no controlled trials are available.

At the time of writing this book, the only away you can obtain rogaine is through a doctor's prescription. That could be changed soon. Upjohn is confident it will obtain FDA approval to take the drug over the counter.
New Treatments

Medical researchers in Asia believe that hair loss is caused mainly by insufficient blood supply to the scalp. The other possibility is excessive sebum in the scalp which causes pore clogging and malnutrition in the hair root( "sebaceous Gland Hypothesis", proposed by Dr. Yoshikata Inaba of The Inaba Aesthetic Surgery in Tokyo). The so-called 101 hair regrowth lotion is formulated to attack the problems. 101 became famous after it had won several international awards, among them, "gold medal" from 14th International Inventors Exposition in New York (June 4, 1991). According to Dr. Zhuang-Guang Zhao, the inventor, 101 promotes blood circulation by removing blood stasis in the scalp and dilating the blood capillaries, it also remove sebum in the scalp. Unlike other treatments, it has no side effects, the active compounds in this lotion are isolated from plants, According to Newsweek and New York Times reports (references at page 48), there is no questioning its popularity with the 3 million bald folks in Japan. Masashi Sada, a popular Japanese singer, said recently on the radio that the product worked wonders on his head. Millions of men and women in Asia reportedly have used 101 and 90 percent are said to have found it effective in hair regrowth and a significant reduction of hair loss. According to a spokesperson for the 101 products, the improved formula called Fabao 101D, 101F and 101G will be introduced to USA. (Interested reader may visit manufacturer's web site: fabao for more information)

One anti-androgenic drug now being tried as a baldness remedy is oral finasteride. It inhibits the 5-alpha reductase (enzyme) that transforms testosterone into the dihydrotestosterone (DHT) form responsible for hair loss. Blocking the action of DHT seems to stimulate growth of stronger, thicker and more pigmented hair. In one multicentre study, 200 males aged 18 to 35 with distinct baldness had a one-inch circle of scalp shaved and periodically examined for hair growth. The report states that "men taking 5 mg per day of oral finasteride had significantly increased hair growth. Side effects - such as impotence, loss of libido and reduced sperm counts - were not widespread, and often decreased with time, affecting about three per cent of the sample." Ideal candidates for finasteride treatment are men who have already fathered all the children they wish, as its use for baldness might be lifelong and it could harm any fetus conceived (while taking it). Further studies are needed to assess the drug's efficacy, dosage and long-term safety. Another dihydrotestosterone-inhibitor now being tested is a derivative of hyaluronic acid, the chemical at the tip of sperm that aids penetration of the egg's membrane. Massaged into the scalp, this substance apparently blocks the androgenic action that causes hair loss, but more research is needed.

Hair Loss, Men and Women

Hair Loss, Men and Women

By far the most common form of hair loss is determined by our genes and hormones: Also known as androgen-dependent, androgenic, or genetic hair loss. It is the largest single type of recognizable alopecia to affect both men and women. It is estimated that around 30% of Caucasian females are affected before menopause. Other commonly used names for genetic hair loss include common baldness, diffuse hair loss, male or female pattern baldness.
1. Male Pattern Baldness (MPB)

Signs and Symptoms

· Receding hairline

· Moderate to extensive loss of hair, especially on the crown
2. Female pattern Baldness (FPB)

Signs and Symptoms

· General thinning of hair all over the head

· Moderate loss of hair on the crown or at hairline

MPB is the hair loss most frequently encountered. It usually starts with the hair at the temples, which gradually recedes to form an "M" shape. You also may find your hair is finer and does not grow as long as it once did. The hair on the crown of your head begins to thin out and eventually at the top points of the "M" meet the thinned spot on your crown. Over time, you are left with a horse-shoe pattern of hair around the sides of your head. Any remaining hair in the balding areas usually manifests some miniaturization - it is thinner and grows at a below-normal rate, changing from long, thick, coarse, pigmented hair into fine, unpigmented sprouts.

Female pattern baldness usually begins about age 30, becomes noticeable around age 40, and may be even more noticeable after menopause. Female hair loss is usually an overall thinning -- two hairs where five used to be--rather than a bald area on top of the head, though women may have a receding hairline, too. It's thought that about 20 million American women have such hair loss. As in males, hair follicles simply shut down, with hormones playing some role in the process.

A receding hairline reflects age, but not necessarily great age, since some men start balding quite young. With the spurt in androgen secretion at puberty, the hairline moves back a little in 96 per cent of boys and 80 per cent of girls. Most boys continue to shed hair as they mature and, if baldness runs in the family, lose increasing amounts. By age 35 to 40, two thirds of Caucasian men are noticeably bald. The loss may begin at age 20, then stop, only to start up again a few years later. Since this type of baldness is largely hereditary, a man can usually, although not always, predict the extent of his future baldness by examining family portraits. About 50 per cent of children with a balding parent of either sex will inherit the dominant baldness gene.
The mechanism of balding

The rate of hair shedding in androgenic alopecia is speeded up by three forces: advancing age, an inherited tendency to bald early, and an over-abundance of the male hormone dihydrotestosterone (DHT) within the hair follicle. DHT is a highly active form of testosterone, which influences many aspects of manly behavior, from sex drive to aggression.

The conversion from testosterone to DHT is driven by an enzyme called 5-alpha reductase, which is produced in the prostate, various adrenal glands, and the scalp. Over time, the action of DHT causes the hair follicle to degrade and shortens the anagen phase. Thought the follicle is technically still alive and connected to a good blood supply--it can successfully nurture a transplanted follicle which is immune to the effects of DHT--it will grow smaller and smaller (figure 3). Some follicles will gradually die, but most will simply shrink to the size they were when you were born which produce weaker hairs. With a steadily shorter anagen growing cycle, more hairs are shed, the hairs becoming thinner and thinner until they are too fine to survive daily wear and tear. Balding hair gradually changes from long, thick, coarse, pigmented hair into fine, unpigmented vellus sprouts.

However, the sebaceous gland attached to it remains the same size. As the hair shafts become smaller, the gland continues to pump out about the same amount of oil. So as your hair thins, you will notice that your hair becomes flatter and oilier.

But the hormonal link in balding is complex. Eunuchs, who produce no testosterone, never go bald -- even if carrying a baldness gene. However, if castrated men with a family history of baldness are given testosterone, they lose hair in the classic horseshoe-shaped pattern.

Studies show that while balding men don't have higher than average circulating testosterone levels, they do possess above-average amounts of a powerful testosterone derivative, dihydrotestosterone in the scalp follicles. In male balding, genetically primed follicles convert circulating testosterone to dihydrotestosterone, which successively diminishes or miniaturizes follicle size, producing ever weaker hairs. With a steadily shorter anagen growing cycle, more hairs are shed, the hairs becoming thinner and thinner until they are too fine to survive daily wear and tear. Balding hair gradually changes from long, thick, coarse, pigmented hair into fine, depigmented vellus sprouts.

Other physiological factors might cause hair loss. Recently, a group of Japanese researcher reported a correlation between excessive sebum in the scalp and hair loss. Excessive sebum often accompanying thinning hair is attributed to an enlargement of the sebaceous gland. They believed excessive sebum causes an high level of 5-alpha reductase and pore clogging, thus malnutrition of the hair root.

Although this condition could be hereditary, they believe diet is a more prominent cause. The researchers note that Japanese hair was thick and healthy, with a small gland and little scalp oil, until the occidental habit of consuming animal fat crept into their diet after World War II. This change has led to a significant height increase in the Japanese population, but it has also resulted in more Japanese men losing hair. To some extent, their observation makes sense since problems with greasy hair have often been noted as much as six months to a year prior to when thinning hair becomes noticeable, but this might be just one of the symptoms, not underlying cause, more research is needed. Most doctors agree that if you have a oily scalp with thinning hair, frequent shampooing is advised. shampooing can reduce surface sebum, which contains high levels of testosterone and DHT that may reenter the skin and affect the hair follicle.