Month: January 2016

January QoM: Is Brazilian Keratin Treatment safe?

Every now and then someone asks me this question: Is the Brazilian Keratin Treatment (BKT) safe?

What is Brazilian Keratin Treatment?

The Brazilian Keratin Treatment has been been a hot topic for several years now. The concept behind it is however not new. Brazilian Keratin Treatment is based off of a now defunct method of permanent press technology used in the ’70s to create wrinkle free clothing. It involved the use of formaldehyde which was found to keep textiles straight for quite extended periods. The problem was that the amount of formaldehyde used resulted in high amounts of formaldehyde being released over time from the clothing and people were not comfortable with that. Newer agents have been used since.

Fast forward several decades later, Brazilians considered using the same method to keep hair straighter for longer. The result was a new straightening method that used formaldehyde to essentially stun the hair straight.

Mechanism of Action

Unlike chemical relaxers and permanent waves, the formaldehyde does not break the disulphide bonds which are the backbone of the hair fibre. Instead, it forms reversible cross-links with the side chains of the keratin protein of hair. These bonds are stable for 3-4 months. This is what keeps the hair in the new formation, NOT the keratin amino acids in the product as claimed by most companies. The added keratin is just for conditioning purposes. Most products use about 2%-5% of formaldehyde in their products.

 

Method of Application

  1. The hair has to be free of all product.  A stripping, chelating, and clarifying shampoo is used to wash the hair.
  2. The hair is then towel dried and the product is sprayed in after which the hair is blow dried straight.
  3. The hair is then flatironed straight.
  4. The product is left in for at least 2 hours. The original products required a 72 hour wait period with explicit instructions to not get the hair bent or kinked in any way.
  5. After the  marination period has passed, the hair is then washed again with a salt and sulphate free shampoo which would not strip the product out. The hair is then blown straight and flatironed.
  6. The client goes home with maintenance products that will help to prolong the style.

The end result is hair that stays straight for up to 3- 4 months. However, there are numerous problems with the method of straightening:

  1. A lot of companies were not declaring the correct percentage of formaldehyde in their products exposing both cosmetologists and clients to higher than what is accepted in most products. The FDA sent out warnings about this.
  2. Cosmetologists were developing respiratory problems and other concerning growths in their nose and respiratory system due to the release of high amounts of formaldehyde when flatironing the hair. This occurred especially in places where there was poor ventilation thus exposing the stylist to a lot of formaldehyde on a daily basis.
  3. Companies would state that they were using formaldehyde free products when all they simply did was switch from formaldehyde to glutaraldehyde or other ingredients that form formaldehyde when broken down. Higher amounts of these ingredients are used to get the same effect as formaldehyde has the best efficacy.
  4. In the hands of poor stylists, great damage could occur due to the high heat used to flatiron the hair, and how many passes of the flatiron it would take to straighten the hair.

So is it safe?

For the consumer, it is relatively safe because the amount of formaldehyde that is released from the hair on a daily basis at home is not significantly higher than what you would normally be exposed to anyway. Just a side note: Formaldehyde is present in surprising places, like food, and in furniture and building material. It naturally occurs in several foods that we eat, see a list of those here: http://www.cfs.gov.hk/english/whatsnew/whatsnew_fa/files/formaldehyde.pdf. Also read what the CDC says about formaldehyde in our regular environment: http://www.cdc.gov/nceh/drywall/docs/whatyoushouldknowaboutformaldehyde.pdf

For the stylist who has to do several clients a day, that is where the problem lies. The stylist would have to ensure that the product she/he uses is safe for use as well as make sure that she/he wears a mask when applying the product and the procedure should be done in a well ventilated room. See the FDA’s advice: http://www.fda.gov/Cosmetics/ProductsIngredients/Products/ucm228898.htm

Read what the American Occupational and Safety & Health Administration have to say about it:

https://www.osha.gov/SLTC/hairsalons/

 

 

 

Treatment of Female Pattern Hair Loss

It’s been a little while since I’ve done a blog post. The last blog post was on Female Pattern Hair Loss, a very common and distressing entity.  Though the the true cause of FPHL has not been completely determined, it certainly has more medical (non-surgical) treatment options than Male Pattern Hair Loss.

Medical Management of Female Pattern Hair Loss

The medical management of FPHL can be categorised into two types: Topical and Oral.

Topical Treatment of Female Pattern Hair Loss

Topical Minoxidil (Rogaine)

Like Male Pattern Hair Loss, FPHL is treated with the agent Minoxidil. The dose recommended for women is the 2% solution used twice daily or the 5% foam (available only in the brand Rogaine)  once daily. To be honest, most hair loss experts like to use the 5% solution or foam twice a day as it just seems to work better. The real problem lies in one of the side effects which is excessive hair growth (hypertrichosis). It is more likely to occur in women and with the 5% concentration used twice daily. To combat this, it is best to decrease the dosing to once a day or once alternate day. Again, like with Male Pattern Hair Loss, it takes 4-6 months with continuous use, to see the benefits.

Oral Treatment of Female Pattern Hair Loss

This medical management of Female Pattern Hair Loss is has many more options for women. Men only have Finasteride (Propecia) available for use, while women typically have four major agents available. Most of these agents are anti-androgen or anti-male hormone, HOWEVER, most women with Female Pattern Hair Loss have been found to not have excessive male hormones. The interest thing however, is that they still respond to the use of these agents. Why this is so, is still being determined scientifically.

Finasteride (Proscar/Propecia)

Finasteride is also used for Female Pattern Hair Loss. This agent is a 5 alpha reductase antagonist. This therefore blocks the formation of dihydrotesterone from testosterone, stopping the more potent androgen from acting on the hair follicle. The optimal effect is at a much higher dose than what is used in men. Again, like with men, it takes about 4 months to see the benefit.

It is not recommended in women who plan to get pregnant. Persons who are in that stage of their life are advised strongly to not get pregnant whilst on the drug as because it is an anti-  male hormone drug, it potentially could affect male foetuses. It however, does not stop someone from getting pregnant. In fact we advise persons to try starting conception at least 1 month after stopping the medication.

Dutasteride (Avodart)

This is another 5 alpha reductase inhibitor. However, it is more potent as an anti-androgen as it acts on two forms of the enzyme that converts testosterone to dihydrotestosterone. It is a newer agent that is use off-label mainly for post-menopausal women as it stays in the body for a much longer time than Finasteride. Again, the time to see a difference is up to 4 months of using the medication continuously.

Spironolactone (Aldactone)

Spironolactone is an anti-hypertensive diuretic aka a “water pill” that promotes loss of Sodium in the urine to help aid in dropping the Blood Pressure. It, at a low dose has been used for this indication in both men and women for more than 50 years. At much higher doses, it  has anti-male hormone effects. Again, it takes 4 months to see any difference.

It is used more in women with an underlying cause of Female Pattern Hair Loss such as Polycystic Ovarian Syndrome (PCOS). It can reduce body hair on the chin and chest BUT it increases the growth of hair on the head. It is used more in pre-menopausal women.

This medication is used a lot in the United States where Diane 35 is not available.

Cyproterone acetate (Androcur)

This is another anti-male hormone medication that has been used in pre-menopausal women. It is present in low doses in certain contraceptive pills such as Diane 35 which is found in many countries other than the United States.  For effective control of hair loss, Androcur is used because it is at a higher dose. Again, women are advised not to get pregnant whilst taking the medication.

Flutamide

This is another anti-androgen medication that is available in the arsenal of medication for Female Pattern Hair Loss. The problem with this medicaiton is that it can cause severe liver toxicity. Most use this as a last resort.

To get optimal effects, a combination of topical and oral modalities is preferred especially since in women the true nature of the cause of Female Pattern Hair Loss is not known.

 

Surgical Management

Like with Male Pattern Hair Loss, sufferers of FPHL can also benefit from hair transplantation. However, women can be poorer candidates than men because their hair loss tends to cover a much larger area from very early. It is quite a successful operation as more than 95% of the transplanted hairs will grow and stay. The main problem is that the original hairs surrounding the transplanted hairs are still being affected by Female Pattern Hair Loss. These hairs will have to be addressed using some sort of medical management or the person will have to end up doing more than one hair transplant in their lifetime. Hopefully hair cloning will be successful and will be available in the future.

Treatment of Female Pattern Hair Loss can be quite tricky, however, the results can be so life changing for women who suffer from this condition.