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Hair Loss Disorders

So, after discussing the basic properties of hair, the next in the blog series will be on Hair Loss Disorders. There are two main types:

1. Non Scarring

These hair loss disorders may be due to hormonal or inflammatory processes which causes hair loss with hair follicles not being affected. Once the process resolves, or is treated, the hair will grow back. Examples of non-scarring hair disorders include: Female and Male Pattern Hair Loss (Androgenetic Alopecia), Alopecia areata, and Telogen Effluvium. Traction Alopecia is also non-scarring in its early stages.Extremely inflamed Psoriasis, Seborrhoeic Dermatitis and Contact Dermatitis have been causes of temporary non-scarring hair loss.

2. Scarring Alopecia

Scarring type alopecias usually result from an inflammatory process whereby the body, for whatever reason, attacks the hair follicle, destroying it in the process. The hair follicle is replaced by scar tissue, and as such, hair will not grow back. Most of these scarring hair loss disorders, if treated from very early, can have favourable outcomes with the hair growing back. Examples include: Traction alopecia, Lichen Planopilaris, Central Centrifugal Cicatricial Alopecia, Dissecting Cellulitis, Folliculitis Decalvans, Chronic Discoid Lupus Erythematosus.

Scalp Massage and hair growth

There are a myriad of solutions, techniques, and machines that are advertised as the next best thing to regrow hair. Scalp massage is one of the methods promoted on the internet. The link between scalp massage and hair growth has been described in several articles on the internet. Is it really useful? Is it all “hocus pocus”?

Scalp Massage Benefits

Massage in general has been shown to increase blood and lymphatic flow to the skin. Therefore, scalp massage should also increase blood flow to the scalp. The increased blood flow results in increased availability of essential nutrients within the blood, thus bathing the dermal papillae of the hair follicle with nourishing molecules. The increased blood flow is also reported to be the method by which Minoxidil and caffeine help to increase hair growth.

Massaging the scalp has also been found to lift any skin cells clogging the hair follicles, thus allowing increased and deeper penetration of skin products through the hair follicle. This is important for persons who use hair growth products. Using products with small sized ingredients that can penetrate the hair follicle will be of even more benefit.

Scalp massage and Hair Growth

Unfortunately, not many studies have been done to examine the direct effects of scalp massage on hair growth. There was one done in Scotland in 1998, examining daily scalp massage with the use of topical essential oils. The group with the essential oils got more hair growth than those without. However, the study group involved patients with Alopecia areata, a rare auto-immune hair disorder that is significantly different from the commonplace Female and Male Pattern Hair Loss. Indeed, the study was more geared towards examining the effects of the essential oils and not the scalp massage. So the question remains, how beneficial is scalp massage for hair growth?

However, if you’re stumped for options, you may consider doing daily massage. Five minutes should suffice. Whatever you do, don’t use your fingernails. Only use the pads of your fingers or fingertips.

Hair Loss After Surgery

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Dear Doc,

I have a friend who did surgery for weight loss a few months ago. She keeps saying that her current hair loss is due to the surgery. Is this really possible?

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Sounds like the two of you have been debating the cause of her hair loss. Well, hair loss after surgery is actually not uncommon, especially after major surgery such as bariatric surgery aka gastric bypass surgery. There are several reasons she could be having hair loss after surgery.

First, the anaesthetics which put her too sleep are quite notorious for inducing hair loss. Any significant blood loss during the surgery could also trigger it. The stress the body undergoes from the surgery alone also causes hair loss. Any deficiencies that she may acquire post surgery, such as low iron, and especially after bariatric surgery, low proteins etc, can also trigger hair loss. The fact that she would have experienced rapid weight loss after the surgery is also a contributor. Hair loss often accompanies rapid weight loss.

The hair loss phenomenon she is experiencing is Telogen Effluvium, a diffuse hair loss characterised by excessive shedding of hair. It usually occurs a few months after a stressful event, such as surgery. Eventually, after six months it should correct itself, however, if she is worried about her hair loss, she should seek help from a dermatologist to help with controlling the hair loss after surgery. She should also make sure to follow the dietary regimen and vitamin supplements that her doctor would have prescribed for her.

ATHD Investigates- Castor oil

Castor oil has long been touted in the West Indies as a miraculous natural hair restorative product. You will come across some woman in Jamaica or Haiti who has used this oil at least once in her lifetime. Reports of thicker and longer hair have been mostly anecdotal with no actual scientific data to back up claims. With so many persons claiming that it works, does it truly have the potential to actually grow hair? Let’s look into the properties of this oil.

How is castor oil made?

Castor oil is derived from roasting or cold pressing the castor bean. The colour of castor oil is actually pale to golden yellow. This is what you will find in products that are made from cold pressed oil. The traditional method of preparing the oil results in a much darker product. This arises because the beans are roasted then pounded before boiling. The ash produced in the process darkens the final product.

What are the properties of castor oil?

Castor oil is comprised of the fatty acids ricinoleic acid (~97%), with linoleic acid and oleic acid. Ricinoleic acid has several properties with the most notorious one being a laxative. Countless Jamaican children can attest to “de-worming” with this oil. It stimulates the E2 and the E3 prostaglandin* receptors**. The latter are in the intestines and the uterus. It therefore increases the motility of these organs. This is why pregnant women are not recommended to ingest or use the oil as it reportedly can induce labour. Studies done haven’t definitively proven this, however, it is used by many for this purpose around the world.

So, can castor oil really grow hair?

The E2 prostaglandin receptors are present in several areas of the body, including the hair follicle. Could this be the reason for castor oil’s reputed effects on hair growth? This has never been extensively studied by scientists. Prostamide, (prostaglandin-ethanolamide) receptor stimulants, like bitmatoprost (Latisse) and lantanoprost- used for glaucoma, have been found to grow hair as a side effect. Could castor oil have some cross effect on these prostamide receptors as well? After all, the prostaglandin and prostamide receptors are somewhat similar in shape. Their activity on these newly discovered receptors has never been determined.

Castor oil has reportedly been reported to not only grow hair but also to thicken the hair strand. This is not impossible since Minoxidil has also been found to thicken vellus (thin baby-like hair) to thicker terminal hairs; however, the actual Mechanism of Action of Minoxidil is still not known. So are those “before and after” pictures really true? Considering that the actual hair counts and hair fibre determinations have not been done, then from a scientific point of view, it could be pure coincidence. After all, lots of persons experiencing hair loss also take vitamins and utilise many different methods which may rectify their hair loss WITHOUT the help of the castor oil.

Is castor oil all hype?

There is absolutely no way to tell from the available information if it is truly all hype. The placebo effect is a real phenomenon. There are persons who will experience positive effects even though the entity they are using actually isn’t doing anything to help their ailment. However, so many persons have given such glowing reports on the effects of castor oil, that you do have to wonder that it really does what people say. In any case, it doesn’t hurt to use castor oil as it is a really great emollient and has significant cosmetic effects on the hair. Here are some easy ways you can add it to your routine:

Add it to your deep conditioner
Make a pre-shampoo treatment mixing it half and half with honey
Use it daily as a sealing oil on top of your regular leave-in-conditioner
Hot oil treatment

*prostaglandins are locally produced hormones in the body, i.e. they are not influenced by the hypothalamus in the brain. They are mostly responsible for setting up the body’s response to external injuries. Read up on prostaglandins here: http://www.yourhormones.info/hormones/prostaglandins.aspx

**receptors are complex structures present on the cell membranes, (the wall which holds in the contents of all cells). When stimulated by certain hormones, they can increase or decrease specific activities in the cells.

December’s QOM- Can I dye hair before braiding?

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Is it ok to dye hair and (deep) treat your hair one day before braiding?

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I am assuming that by “braiding” you mean putting in braid extensions. It is best not to dye hair one day prior to braiding. In general, you should avoid chemical treatments right before installing any hair extensions or weaves. This includes both relaxers and permanent and semi permanent hair dyes. Hair will be weak from the chemical bonds being broken in the processes. Wait at least two weeks after the processes to install the braids. This is because new growth would be stronger than the already dyed hair and thus be more likely to handle the added hair than weak dyed hair.

For the second part of the question, yes, go right ahead and do a deep treatment for your hair. In fact, it is always good to perform a deep treat before braiding. That way the hair will be adequately prepared for the added hair fibres that will absorb oils from your own hair. If your hair goes in dry and brittle, it will be even drier when the extensions are removed, despite using braid spray on a daily basis.

Dr. Llorenia Muir-Green is a practising dermatologist in Jamaica. She graduated from the University of the West Indies, first obtaining a double major in Chemistry and Biochemistry. She then went on to pursue a career in Medicine. Having obtained her Medical degree from UWI, she went on to pursue postgraduate specialisation in Clinical Dermatology at Cardiff University, for which she got distinction. She was a recipient of the 2013 Fellowship in Hair and Scalp Disorders at the University of British Columbia. She is a member of the North American Hair Research Society, International Society of Hair Restoration Surgery, Dermatology Association of Jamaica as well as an Associate Member of the Caribbean Dermatology Association. She currently works at the Dermatology Clinic at National Chest Hospital where she recently established a Hair Clinic.