Hair Care

By Stef Schwalb

Hair loss. It isn’t a burden only men have to bear, and the number of women suffering from this condition may surprise you. Seeing as how it can be considered the biggest health issue facing your hair, we got in touch with an expert source in the field to get some inside answers on the causes of hair loss; to learn about some of the solutions; and to discover what other hair restoration advancements are on the way. We recently spoke with Ken Washenik, M.D., Ph.D. He is the medical director of the hair restoration practice Bosley, and the executive vice president of Scientific and Medical Development of the Aderans Research Institute.

BN: What are the causes of hair loss? How much of an effect do genetics, diet and maintenance have on the problem?
DW:: One out of every two women in the United States will experience hereditary hair thinning, and hair loss affects over 30 million women in the United States alone. After hereditary female pattern baldness, telogen effluvium is the most common cause of hair loss in women. This is a temporary hair loss in which a higher than normal percentage of hair shifts into a shedding phase. Telogen effluvium can occur after pregnancy, or when a woman goes on or off birth control pills. Often there is an apparent cause such as the traumatizing loss of a loved one. Another condition called alopecia areata (areata is Latin for round or circumscribed) occurs as small bald spots here or there, or tiny short hairs that are broken off. Sometimes it’s noticed by the person cutting their hair. It’s believed to be some type of immunologic imbalance where the immune system goes after its own hair for some unknown reason and causes it to go into the resting phase, which slows down its growth so strands break off or come out. A lot of times, the hair regrows by itself. In fact, probably most people who have that condition don’t come to the doctor. It just goes away by itself.

But physicians have also linked crash dieting and protein deprivation to temporary hair loss. Sometimes, hair loss is due to an underlying medical condition such as lupus, polycystic ovary syndrome, a thyroid problem, low iron levels or hormonal imbalances. Hair loss can also be a side effect of medications such as antidepressants, hypertension drugs, anticoagulants and chemotherapy. Treating and diagnosing female hair loss is not as simple and straightforward as male pattern baldness. Given the variety of possible causes, early diagnosis by a physician is the best measure to increase the possibility of stopping or reversing the loss.

Another cause of hair loss is trichotillomania. Considered an impulse-control disorder, TTM causes those inflicted with the illness to pull out their hair, generally from the scalp, eyebrows and eyelashes resulting in severe hair loss. Sadly, because of the private nature and the lack of public knowledge of this disorder, people who suffer from TTM often do so quietly, harboring shame and embarrassment for their appearance. TTM occurs in men and women and is most commonly reported among preadolescent and adolescent girls, though cases have been recorded in patients ranging from 1 to 70 years old.

BN: What are the early signs of hair loss that people need to be aware of so they can get treatment before too much is gone?
DW: It is said that a person can lose 50% of their hair before other people begin to notice it. Most women, of course, notice it long before then. They see a loss of volume and body and experience difficulty in maintaining their existing hairstyle. Hair loss is actually the progressive miniaturization of the hair follicle in which it becomes progressively smaller and finer due to heredity, and often with age. Hair that is following a reduced life cycle looks unhealthy and thin. The individual may even lose pigment, and in the end, the follicle may remain permanently dormant.

BN: What are the options for hair loss once it is had reached a more advanced stage? And what are some of the different levels of treatment that Bosley offers?
DW: In 1988, the U.S. Food and Drug Administration approved the first medication for application to the scalp proven to grow human hair – Minoxidil. In actuality, it can slow down or help halt hair loss in some cases, and help regrow hair on the vertex of the head in some cases. To remain effective, it must be used on a daily basis. The FDA approved a 2% and 5% solution for men and a 2% solution for women. Another option is hair transplantation surgery. Because women do not experience pattern baldness like men, many women are not hair transplantation candidates in spite of thinning hair. However, very good results can be obtained for many women (each patient is different and must be evaluated by a physician). The women who are potential candidates for this method have a protected area of “donor” hair and a “focal” area of need. The donor area supply must have enough hair to meet the recipient area demand. Some examples are:

- Women who have suffered hair loss due to mechanical or traction alopecia (non hormonal). – Women who have had previous cosmetic or plastic surgery and are concerned about hair loss around the incision sites. – Women who have a distinct pattern of hair loss, similar to that of male pattern baldness. This includes hairline recession, vertex thinning and a donor area that is not affected by androgenetic alopecia. – Women with alopecia marginalis, a condition that looks very similar to traction alopecia.

At one time, surgical transplantation techniques were less appropriate for many women because the transplant procedure was more traumatic to existing hair follicles in the recipient area. This was more of a problem in women because, unlike men, they usually have hair in their balding zone. With today’s techniques, however, hair transplants surgeons can place grafts around the remaining hair.

BN: What are some preventive measures people can take to reduce significant hair loss?
DW: For those who suffer from genetic and hormonal hair loss, there is only a clinically-proven medical solution, and there are few preventative options. At the first sign of hair loss, it is best to seek a medical diagnosis that will dictate appropriate treatment.

BN: Are there any styling products to avoid when you are experiencing hair loss (ie does coloring have a significant impact)?
DW: Hair loss (sometimes permanent) and breakage has been reported after the use of some chemical treatments such as relaxers. Any harsh treatment such as perming or straightening can lead to breakage and fragility of the hair shaft. Color can weaken hair but is unlikely to lead to hair loss.

BN: How much of a differentiation is there between men and women in regard to hair loss? Are there any particular factors that play into it?
DW: While men tend to start losing hair in their 20′s, women start a decade later – though it can occur as early as the 20′s. While men tend to lose hair in the front and at the top of the head, women’s hair thins diffusely through the scalp. Total baldness is rare in women. Women have their own pattern of baldness that for most women is not associated with the male hormone DHT (dihydrotestosterone). Men lose hair along the hairline, which progresses to the back of the scalp and finally involves the entire top of the head. Women have an over-all thinning, resulting in see-through hair as they age (if the condition is genetically determined). They can lose hair behind the frontal hair zone resulting in an almost bald spot, but they do not generally see an alteration of their hairline.

BN: What are some future advances on the way in the field of hair restoration that readers should be on the lookout for or may be interested to know?
DW: Follicular neogenesis is on the horizon within the next four or five years as an alternative treatment for hair loss. The field of science is called “tissue engineering,” and the new technology it generates will affect many people who were not previously candidates for hair restoration due to insufficient donor hair. The layman can call the process “hair multiplication.” From a small piece of tissue, thousands of hair seeds can be grown (follicle progenitors). These “hair seeds” will be planted in the scalp most likely by injection.

Surgical hair transplantations have been performed at Bosley since 1974 when the company was founded by hair restoration pioneer, L. Lee Bosley. During its 30th-year anniversary in 2004, the company completed nearly 180,000 procedures. It has advanced many of the artistic techniques used to achieve natural results throughout the world today. There are 85 Bosley clinic locations throughout the U.S., Canada and Mexico. The Aderans Research Institute is a biotechnology firm involved in researching tissue engineered hair follicle neogenesis and cellular-based hair restoration. For more information, log on to http://www.bosley.com or http://www.aderansresearch.com.

Originally published June 2005
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