Stages of hair growth and loss
Growth – Anagen stage -On the scalp lasts between 2-6 years.
During this time the hair’s matrix proliferate and are pushed upwards- hair grows longer.
Similar to skins epidermal cells, the cells of the hair (as they are pushed upwards) become keratinised and die.
Regression – Catagen stage -Lasts 2-3 weeks.
Eventually the hairs marix cells stop dividing. The hair follicle atrophies (shrink) and the hair ceases to grow.
Resting –Telogen stage -3-4 months Neither growth or regression occurs.
At the end of the resting stage the hair loss is replaced by a new growing hair from the follicle. This type of hair loss is normal and occurs at the rate of about 100 hairs per day.
With between 100,000 an 120,000 hairs on the human scalp, very few hairs are being shed at any one time. In fact most scalp hairs (about 85%) are usually in the growth stage which ensure the normal scalp is adequately covered.
For abnormal hair loss to occur something has to interrupt the regular order of the hair growth cycle.
Types of abnormal hair loss:
Cicatricial (scarring) alopecias are always permanent
Begins in men after puberty-
Triggered by the associated rise in androgens in puberty. Androgens are the hormones responsible for male sexual development and therefore effects men, but can sometimes effect women too.
It is inherited from both maternal and perternal parents. It is therefore a genetic trait and is referred to as Androgenic alopecia.
Male pattern hair loss cause:
This requires two main components
Normal levels of testosterone (T) and dihydrotestosterone (DHT) and
The genetic prediposition for the hair loss- the presence of the enzyme 5 alpha—reductase.
5 alpha –reductase is present in its highest concentration in the male productive tissues, the liver and the skin (especially the skin overlying the genitalia)
The function of alpha 5 –reductase is to convert testosterone into its more potent form, dihydrotestosterone . 5 Alpha—reductase therefore enhances the androgen action of testosterone.
There are two types of alpha 5—reductase-
For Male pattern hair loss to develop, it requires the presece of the type 2 alpha reductase. Therefore follicles thsy contain this enzyme have the ability to convert testosterone into dihydrotestosterone (DHT)
DHT is a catalyst for hair loss and that individuals who have normal androgen levels and the presence of type 2 5 alpha –reductase have the prediposition for developing MPHL.
Male pattern hair loss develops in puberty , where there is a rise in androgens circulating.
In genetically predisposed follicles , the anagen phase is shortened plus there is an increase in the shedding of telogen hairs.
Terminal hair follicles undergo minaturisation to become vellus type follicles, which produces hairs that have a shorter length and smaller diameter.
Signs of hair loss becomes apparent.
Progression of male pattern hair loss
Predicatable from stage 1-7
Typical pattern-bi-temporal receding
Vertex hair loss – two hairs converge
Vertex pattern- vertex pattern loss begins soon after temporal receding then progresses as a typical pattern
Anterior pattern- frontal receding, moving backward to the vertex of hair loss, stage 2 diverges from the typical pattern as vertex hair loss progresses at an earlier stage.
Cause
Female pattern hair loss is similar to male pattern hair loss in that its genetically driven and involves activation of hair follicle androgen receptors. Miniaturisation of the hair follicle occurs and the clinical outcome is patterned hair loss.
Occasionally FPHL occurs as a secondary to diseases of the endocrine system , such as polycystic ovarian syndrome and adrenal or ovarian tumours.
FPHL can also be exacerbarated by causes of telogen effluvium such as low ferritin (iron ) levels or thyroid dysfunction.
Loss
Its slower than MPHL with only 3% showing before the age of 30.
Generally presents loss of volume to the mid frontal scalp. Patients commonly report pony tail loss volume – an important clinical finding.
There is also preservation of the anterior (front ) hairline. A third of cases also have Bietemporal recession.
Sometimes referred to as the Christmas tree effect.
Each scalp hair goes through several years of growth before it is shed.
The hair growth is not synchronised (each hair grows independently), only a few hairs are shed each day.
Hair loss is too small to really notice and the Catagen hair soon re-enters its anagen stage and replace the lost hair.
In some altered conditions an abnormally large number of hairs can enter the catagen stage ogether, which is noticeable as diffuse hair loss.
Cause
Clinical sign of underlying condition
For hair to remain in its Anagen stage it needs blood supply. If the quality of the blood is altered this can lead to hair loss.
Main causes include
Post –partum hair loss
Febrile illness
Blood loss
Post-operative responses
Endocrine disorders
Drugs and medication
Metabolic and nutritional disorders
Cause
High levels of female hormones which result in many follicles being in the anagen phase.
After child birth these follicles rapidly enter the telogen phase and the hairs will be lost for two or three months later. The condition will return to normal about six or twelve months after giving birth
These are temporary stresses that can produce diffuse hair loss usually 6-16 weeks after the event
Spontaneous regrowth normally occurs so no treatment necessary
Diffuse hair loss is also a common symptom of many endocrine disorders.
Hyperthyroidism and hypothyroidism in particular can cause thinning of the scalp and body hair
Compromised hair distribution may be the only sign of hypothyroidism.
Alopecia due to hypothyroidism usually improves with the introduction of thyoxine.
Other endocrine disorders that may affect hair growth include hypopituitarism and hypoparthyroidism.
Can have side effects and compromise hair growth
Anticoagulants may cause increased shedding of hairs, this stops when the drug is discontinued .
Chemotherapy causes diffuse or total alopecia
Anagen follicles are shed acutely, a condition known as anagen effluvium
Other drug related causes of diffuse hair loss include
Systemic retinoids- or too much vitamin A cause kinking and thinning of hair
Other drugs which can cause temporary thinning, especially 2-3 months after after stopping, include-
Oral contraceptive
Beta blockers
Lithiumcarbonate
Cimetidine
Ibuprofen
Hair growth can be compromised in cases of nutritional insufficiency
Leads to dry, brittle and thinner hair shafts
Zinc deficiency can result in diffuse hair loss
Low levels of ferritin in the blood can result in thinner hair
Because ferritin is used to transport iron to all tissues including hair follicles.
Introducing more liver and iron can improve hair growth and the diameter of the hair shaft.
Common cause of patchy hair loss
Characterised as circles of hair loss
Non scaring
Skin looks normal
Has small exclamation hairs at the periphery representing dystrophic hairs
Onset can be dramtic
Initial patch can reach 1 cm over night
Subsequent to onset, growth of patch slows taking 2-3 weeks to double in size
Additional patches can occur, one at a time, every few weeks.
Adjacent patches join and if it continues, the liklihood of alopecia totalis increases
Prognosis
Regrowth potential exists but is unpredictable
There are frequent spontaneous remission periods where hair starts growing back by itself.
In chronic cases, chances of regrowth decrease
Factors associated with poorer outcome are –
Occitial hair loss (ophiasis )
Nail involvement (pitting)
Family history of autoimmune disease
Young age onset
Cause
Organ specific Autoimmune disease (mediated by T Lymphocytes) and is directed to the hair follicles .
If hair is consistently pulled or rubbed, the hair becomes twisted, deformed and produces areas of hair loss.
There is no set shape or pattern
2 main forms
Trichotillosis – manifestation of psychological disturbance and compulsive behaviour, therefore its management needs strong consideration to its cause. Needs referral to a cognitive behavioural therapist.
Self inflicted condition Caused by hair pulling and rubbing over long periods.
Signs include associated body focused repetitive behaviours such as-
Nail biting
Skin picking
Lip biting
Skin chewing
Cause
Stress related compulsive behaviour
No other underlying demo conditons
Anxiety and depression
Serotonin deficiency
PTSD- post traumatic stress disorder
Habit
Prognosis
Gets better with a happier life
Constant pulling of hair through the wrong styling technique or tight ponytail exerts pulling force on hair and scalp
Signs
Little red bumps
Areas of hair loss and sides and front of scalp and broken hairs
Damage intensifies with time
Visable inflammation of hair follicles (folliculitis)
Scaling
Pus filled blisters
Symptoms
Inflammation with soreness, stinging or itchy scalp
Cause
Very long hair can also cause this
Afro Caribbean styling techniques such as braids, cornrow and dreadlocks
Buns or tight ponytails
Men can suffer hair loss in their beard by habitually twisting
Prognosis Reversible if treated quickly If styling techniques are continued inflammation becomes more widespread and affects stem cells which creates permanent scaring hair loss.
Cicitricial alopecia is a condequence of inflammation causing permanent destruction of the hair follicle. The reason why destruction is permanent is due to the presence of inflammation at the site of the stem cells at the bulge region of the follicles.
Hair follicles can be destroyed in two ways
Scarring caused by internal disorder (diseae)which called primary cicatrical alopecia
Non-scaring alopecia | Cicatricial alopecia |
Inflammation is found at the bottom (bulb area) of the hair follicle | The upper part of the hair follicle is where the bulge and sebaceous glands reside |
Bulge region unaffected by inflammation | The bulge region of the hair follicle is affected by inflammation |
Stem cells remain untouched | Since stem cells reside at the bulge region, the follicle cannot regenerate |
Potential for regrowth | Hair loss is permanent |
Is asymptomatic | Accompanied by symptoms |
Primary cicatricial alopecia
From internal trauma- hair follicle is destroyed by white cells from immune system
White cells are either Lymphocytes or Neutrophils
The inflammation involving lymphocytes is called lymphocytic infiltrate and the inflammation involving neutrophils is called neutrophilic infiltrate.
Secondary cicatricial alopecia
Caused by external trauma
These factors do not directly target the hair follicle but damages the region where the hair follicle resides.
Causes include Burns and sustained tension (traction alopecia)
Burns – can have a variety of causes to include-
Friction burns-an abrasion (rubbing) on the surface of the scalp
Radiation burns-from sources such as x-ray, solar radiation, radiation treatments for cancer
Electrical burns – contact from an electrical source
Thermal burns – contact with a heated object , such as curling tongs or hair straightneers
Ice burns –when a cold object such as ice is applied to the skin
Chemical burns –from hair bleach and dyes
Lichen planopilaris (LPP) is the most common cause of cicatricial alopecia
It spreads quickly from a small area of active infiltrate and scarring, to extensive scarring within a few months.
This makes its control difficult to manage and needs a rapid diagnosis and treatment.
Active lesions are nearly always symptomatic.
Signs and symptoms
Painful itchy areas of hair loss with perifollicular erthema and scaling. When viewed under a dermatoscope, white dots and ostia are apparent.
Clinical activity is generally at the periphery of lesions as the lesioned area spreads.
Associated signs
Approximately 20-30% of LLP patients have associated signs, so it is useful to check areas distance to the scalp.
Ohers affected areas could be wrists, ankles, oral (buccal) mucosa, genital mucosa and nails
Cause
Hair follicles undergo an autoimmune insult from lymphocytic perifollicular infiltrate.
Frontal fibrosing alopecia is a recent phenomenon that typically affects postmenopausal women and is considered to be one of the variants on the lichen piloplanus (LPP)spectrum
Signs
FFA presents as a symmetrical band of hair loss on the frontal scalp, that is preceded by the loss of eyebrows. Unlike a normal forehead, the skin is pale and smooth and frequently has the off orphaned or marooned hair in the region of hair loss. In contrast to LPP, there is an absence of inflammation
Associated signs
There is sometimes an absence of underarm hair and pubic hair and eyebrow loss
Cause
All that is known is lymphocytes attack the hair follicles which means its an autoimmune disorder.
Prognosis
Due to the scaring nature, the prognosis is poor and gets worse over time.
Facts
Very similar to Lichen planopilaris (LPP) Usually affects women over 40 but can affect men.
It usually starts with an asymptomatic patch of alopecia at vertex and progression thereafter is varible .
Develops slowly
Even after 15-20 years bald patch can be concealed.
If it does progress quickly, total baldness would occur in 2-3 years
Signs
Patches are small, soft and round
Lesions are slightly depressed like footprints in the snow
Irregular bald patches where lesions meet and join
Uninvolved scalp is normal
When condition is active, hairs around lesion edges can be easily extracted
Symptoms
Usually asymptomatic but can later be accompanied by itching
Cause
Present in around upper third of follicles
Autoimmune basis
As condition progreses the follicles are destroyed
Epidermis becomes thin and atrophic and the dermis becomes dense and sclerotic (hard underlying)
Follicular ghosts in the absence of inflammation are present
Prognosis
Areas of hair loss are irreversible
Irregular hairloss which spreads centrifugally (from the centre out) over the scalp
Affects predominantly black skin
Most common form of hair loss in black women
Signs
Irregular hair loss to the vertex that expands centrifugally
Hair breakage
Pustulation
Crusting and scaling
Patient may have concomitant seborrhoeic dermatitis- leading to scratching and picking
Symptoms
Often asymptomatic but can sometimes be associated with itching and pain
Cause
The exact cause is vague but its thought to be a combination of factors
Considered both primary and secondary forms of cicitricial alopecia
External factors
Heat styling tools
Tight hair styles such as plaits and braids
Chemical burns
Sensitivity to oils
Abrasion from scratching itchy areas
Internal factors
Autoimmune disorder
Bacterial infection
Fungal infection
Genetic influences
May represent a form of scarring female pattern hair loss
Prognosis
If diagnosed early, further progression can be avoided
If condition progresses, it often results in permanent hair loss.
Neutrophillic infiltrate attacks the hair follicle in folliculitis decalvans of the scalp and occurs in both sexes.
In women it is prevalent is age 30-60
In men its from adolescence onwards
Signs
Usually presents as isolated plaque of alopecia all over scalp vertex.
The central area is thick and spongy and pustules or crusting is seen at the edge of the patch of hair loss.
The tufting (close grouping )of hair follicle is also a classic sign alongside presence of perifollicular inflammation .
The plaque expans the circumference over the course of months to years
Associated signs
Scalp usually involved but can affect other regions including
Beard
Underarm
Pubic regions
Thighs
Lower legs
Arms
Symptoms
Itchiness and burning
Cause
Not completely understood
Staphylococceus aureus is implemented (which can grow from the pustules)
Can be a fungal element to the infection
Scaling condition that affects the scalp
Scaling occurs on the sebum rich areas of the scalp, face and trunk
The condition arises from copious sebum secretion
Its made worse by presence of malassezia yeasts and results in reactive hyperplasia (overgrowth of the epidermis )
Pityriasis capitis is part of a spectrum of conditions that include seborrhoeic dermitits and pityriasis amiantacea.
Pityriasis in its mildest form can be refeted to as dandruff
All conditions on this spectrum often signal a compromised immune system (immunodeficiency)
Signs
Scaling to scalp and a thickened epidermis
Associated signs
Scaling may affect other sebum rich areas , such as face and trunk
Symptoms
Mild itchiness
Causes
Over secretion of sebum
Presence of malassezia yeasts
Immunodeficiency and underlying medical conditions
Prognosis
Pityriasis responds to antifungal shampoo
Maybe considered the same as dandruff but its at the severe end of the disease spectrum.
Red flaky areas especially on the hairline and postauricular areas.
Yellowy scales (greasy or dry)is also a common sign
Also commonly found in other body areas such as face, chest and elbows.
Signs
Flaky scales
Scales can be dry or greasy
Crusting
Redness, especially hairline or around the ears
Oedema
Exudations
Excoriations
Associated signs
T-zone areas (seborrheic areas)
Eyebrows
Cheeks
Nasolabial folds
Chest
Back
Knees
Front of elbows
Symptoms
Itchiness and soreness
Causes
Genetic
Yeast infection
Stress-related
Temperature change- worse in winter
Sebum secretion
Common in people with compromised immune systems
Some skin care products
Additives-like colours (especially yellow)
Psoriasis of the scalp is common and soften affects the prosterior hairline and above the ears.
Sometimes scalp is initial site or only sight of involvement
It often does affect other regions of the body, which becomes useful in its diagnosis
Psoriasis exists on various points of a clinical spectrum.
At the mild end its often pink, silvery scaled plaques
At the severe end it appears asbestos like scales, a condition known as pityriasis amiantacea
Hair loss rarely occurs but when it does it is usually reversible and on a very rare occasion could result in scarring alopecia
Cells replacement in the skin is usually around 30 days but with psoriasis only 1 week which is 5 times the normal rate.
Signs
Red, mauve, raised plaques
Covered with silvery- white scales
Often on the back hair line and above ears
Severe cases can cause hair loss
Associated signs
Plaques may also typically be present on-
Knees
Back of elbows
Lower back
Nails
Symptoms
Sometimes itching (prutitis)
Tightness, discomfort (cement helmet feeling)
Compulsive picking causing tissue damage
Occasionally joint stiffness and pain
Cause
Genetic
Autoimmune
Stress related
Increased cell division in the stratum basale (of the epidermis) that is too fast for the rate of the skin shedding so dead cells build up, creating scales.
Prognosis
May be treated but not cured
Pityriasis amiantacea is an extention of psoriasis and also shares similaritie with seborrhoeic dermatitis
Signs
Thick asbestos- like sticky scales that are stuck to the scalp
Scales along the hair shaft (like tiles on a roof)
Scales flatten and trap hairs to the scalp
Thick plaques, yellowish and smelly at times
Hair loss with removal of scales
Rarely covers the whole scalp
Associated signs
Red, itchy, flaky areas to T-Zone (Seborrhoeic areas)
The T-Zone include
Eyebrows
Cheeks
Nasolabial folds
Ears
Symptoms
Itchiness
Soreness
Tightness
Hair loss
Causes
Genetic
Bacterial yeast infection
Reaction to trauma
Stress-related/ intense emotional stress
Prognosis
Responds to treatment
Can be removed temporarily (with relapses)
Can be removed permanently
More commonly called neurodermititis
Believed to be a neurological disorder that is driven by a desire to scratch
Such chronic scratching results in thick, leathery patches of skin that continues to cause irritation and therefore exacerbates the itch – scratch cycle
Signs
Thickened skin to anterior and posterior hair margin
Associated signs
Thickened skin to regions of the scalp
Shoulders
Forearms
Wrists and hands
Shins, ankles and feet
Vulval region
Perianal region
Symptoms
Chronic itching
Cause
Initial cause is unknown
Insect bite or stress skin irritation appear to play apart in the itch-scratch cycle
Prognosis
Topical steroids and moisturisers may help
Main intervention involved breaking itch cycle
Irritant contact dermatitis is a reaction that takes place when the skin –barrier is damaged after it is exposed to a chemical or harmful substance
Most common occurrence is on the scalp and hands o people who frequently use water and detergents
Causes
Lengthy exposure to detergents or water can remove the natural oils of the outer layers of the skin and cause irritation
If a damaging agent such as a chemical , penetrates the protective outer layers of skin, it comes into contact with the inner cells and tissues.
The body reacts by attempting to neutralise the invading agent and repair the damage.
Examples of substances can be shampoo, hair relaxers, hair dyes, acids, alkalis, surfactants, oxidising agents, reducing agents, bleaching and perming agents.
Symptoms and signs
Soreness
Redness
Inflammation of affected area
Skin may be cracked, dry and even weeping.
Prognosis and treatment
ICD is a temporary skin reaction usually calms when exposure to the damaging substance is avoided.
Damaged skin caused by mild ICD can be treated with emollient cream which makes the cream softer and or with moisturising cream
More serious conditions where the skin is inflamed may be treated by steroid creams
ICD is a common hazard in professions such as hairdressing, healthcare, engineering and construction and food preperation. ICD should not be confused with allergic contact dermatitis, although symptoms may be similar.
Allergic contact dermatitis is caused by the body’s reaction to a substance (known as an allergen)tp which it has become sensitised.
Whereas there are some treatment options for ICD , the only treatment for allergic contact dermatitis is to remove the substance and ensure the body is not exposed to it
Allergic reaction
An allergic or hypersensitivity reaction occurs when a person becomes unusually sensitive to a substance (called an allergen) that is typically well tolerated by the wider population.
There are four types of allergic reaction
The first three types are known as antibody mediated immune reactions and number 4 is cell mediated immune reactions which forms the basis of allergic contact dermatitis
Allergic contact dermatitis ACD is a result of repeated exsposure to small doses of an allergen (hapten). Common allergens in the hair and beauty products include hair dyes paraphenylenediamine and paratoluenediamine and the preservative methylisthiazolinone.
The condition results from a malfunction of the body’s autoimmune system. During each exposure, the dendric cells of the epidermis (langerhans cells) start to adapt and cause T lymphocytes to memorise the allergen- a process called sensitisation.
This causes an increase of T-cell production in local lymph nodes, which then circulate around the whole body. With subsequent exsposure, T-cells at the site where the allergen entered the skin trigger a local inflammatory response.
Sequence of events
Allergen (Hapten) breaches the skin barrier and is taken up by antigen –presenting cells such as Langerhans cells in the epidermis
Langerhans cells migrate to lymph nodes and present allergen to the T-cells
T-cells proliferate (increase in number)
Some of the T- cells return the the side of the allergen to entry and stimulate an inflammatory response
This process, from the allergen entry to inflammation takes between 12-72 hours and is referred to as a delayed response.
Signs and symptoms
The symptoms of ACD can vary, depending on the severity of the attack
Raw scaling and inflamed rash on the skin
More severe cases resulting in blistering and weeping
The signs and symptoms occur 12-72 hours after exposure to the allergens, which is the time the body’s cells take to respond to the allergen.
This is one way to distinguish ACD from irritant contact dermatitis (ICD) when a rash and inflammation occurs more rapidly after contact with the problem substance and also decays more quickly than ACD.
Treatment
The effects of allergic contact dermatitis outbreak may be treated with oral antihistamines and corticosteroids topical steroids to counter the inflammation.
Once the body is sensitised to the allergen, and the allergens has been identified, the most effective treatment is to avoid future exposure.
Tinea is the name of a group of diseases caused by a fungus. Types of tinea affect many parts of the body and include ringworm, athlete’s foot and jock itch.
When it affects the scalp it is referred to as tinea capitis.
Tinea capitis
Tinea capitis is ringworm of the scalp in which the basic feature is invasion of hair shafts by a dermatophyte fungus. (A fungal organism that requires keratin for its growth)
There are three types of tinea capitis, depending on the fungus involved.
Microsporosis fungi which cause invasion outside the hair cuticle – fungi are usually either microsporum audouinii and m.canis.
Trichophytosis fungi which invades inside the hair cuticle – fungus which produces this version of tinea capitis is Trichophyton tonsurans
Favus causes scutula which lead to crusting on the surface of the skin which is combined with hair loss.
Signs
Dry scaling – like dandruff but usually with moth –eaten hair loss
Black dots- the hairs are broken off at the scalp surface, which is scaly
Smooth areas of hair loss
Kerion- an abscess caused by a fungal infection
Favus- yellow crusts and matted hair
A circle growth of annulas arises from a single point , where the initial fungal spore germinated
The active part of the lesion is at the outline and leaves an area of damaged skin on the central portion of the lesion where infection has cleared up.
The outer circular pattern of active growth is where itching and secondary bacterial infection from scratching is likely to occur
Associated signs
Swollen lymph glands at the sides of the back of the neck
Untreated kerion and favus may result in permanent scarring (bald areas )
Tinea capitis often extends downwards from the neck to affect the shoulders or back where it is then called tinea corporis
On the neck it may be termed tinea nuchae
Tinea barbae is used only to indicate the presence of fungal infection in the beard area of an adult male
Symptoms
Itchiness, erthema and soreness.
Cause
Fungal infection
The infection can be from ringworm, sycosis, favus or kerion
Commonly known as hives, are red, raised , itchy welts. They appear, sometimes in clusters, on the face, trunk of the body and less often on the scalp, hands or feet .
Hives can change shape, fade, and then rapidly reappear. A single hive lasts less than 24 hours, but after an attack new ones crop up for up to six weeks.
20 percent of people will get hives at some point in their lives.
Hives can be but not always, an allergic response to something you touch, inhaled or swallowed
Causes
Common causes of hives include
Reactions to medications such as asprin, sulfa and penicillin
Animal dander, especially from cats
Cold temperatures
Emotional or physical stress including exercise
Foods, especially chocolate, nuts, shelfish or tomatoes
Infections
Inhalants especially pollen, mould spores or airborne chemicals
Insect bites
Rubbing or putting pressure on the skin
Exposure to chemicals
Malignant or connective tissue disease
Acne vulgaris (common acne) is a condition of the sebaceous glands of the skin. The sebaceous glands surround each hair follicle and produce sebum, an oily substance, to lubricate the hair. Almost every teenager can expext to experience acne to some degree during adolescent years although it is usually mild.
Signs
Inflamed papules and pustles and usually appears on the face, back and chest.
Secondary lesions of acne, which are partially healed spots or scars, may appear like other infections or disorders, such as folliculitis, but they do not normally extend into the scalp. The bacteria that cause acne are present on the skin of almost everyone, so it is not considered to be infectious.
Just as with malassezia, which is also resident on the skin of most people, some people develop intolerance to the micro-organisms while others don’t.
Cause
Genetic factors and family history is linked to early onset and more severe cases
Acne follows a surge in androgenic hormones associated with adolescence, therefore mostly in teenagers.
Affects boys more than girls
Acne could be a consequence of polysystic ovaries
Long term condition where areas of skin lack melanin .
As its lacking in pigment, there are patches of pale white skin.
Can affect any area of the body but most common is face, hands, neck and skin creases. Also, underarm, groin, genitalia and inside the mouth.
If scalp is affected, it can produce grey hair in affected area.
There are two main types of vitiligo
Bilateral vitiligo – more common, where patches appear in a generalised pattern on both sides of the body.
Unilateral vitiligo- less common, where patches are localised and appear on one side of the body.
More rarely vitiligo can affect the entire body – a condition known as universal or complete vitiligo
Cause
In vitiligo there are insufficient working melanocytes to the affected areas although the exact cause is unknown.
In cases of bilateral vitiligo are thought to have an autoimmune origin, whereby immune cells attack melanocytes
The onset of this is more likely if other family members suffer with vitiligo.
It is also associated with other autoimmune conditions, such as hyperthyroidism. However , not everyone with vitiligo will develop these conditions.
Progression and prognosis
The presentation and progression varies in different individuals , some get a few small white patches while others get bigger white patches that join up across large areas of their skin. White patches are usually permanent.
Atopic dermatitis –eczema
Most common form of dermatitis (eczema). Atopic means a sense of being sensitive to allergens and dermatitis means skin inflammation.
So, atopic dermatitis is inflammation to the skin that occurs after contact with an allergen.
It often coexists with other conditions such as asthma and hay fever and can run in families.
Its common in babies under the age of one, but it can present in adults.
Signs
Patches of dry, sore, cracked, red skin most often affecting the hands, insides of elbows, backs of the knees and the face and scalp in children.
Cause
The exact cause is no known, although clear triggers include-
Soaps
Detergent
Stress
Weather
Food allergies- especially in young children.
People with eczema usually have alternating periods of remission and flare ups. There are treatments that can improve symptoms but no cure.
| Test | Abbreviation | What’s it testing | Healthy levels | Optimum levels |
|---|---|---|---|---|
| Serum Ferritin | Serum Ferritin | Iron Storage which is a important part in supplying oxygen for hair growth. IMPORTANT for hair growth as drop in red blood cells decreases blood supply to tissues. Unable to supply enough Oxygen resulting in diffuse hair loss. | Male- 25-350 Women 10-300 | 200-300 for hair health |
| Erythocyte sedimentation rate | ESR/C Reactive protein | Measures inflammation If raised would half ferritin | Females 1-3 mm/hr Males 1-20 | 100 is definite infection |
| Vitamin B12 | B12 | Nutrient helps keeps body’s blood and nerve cells healthy , helps prevent anemia. Cell production . Deficiency can cause numbness in hands or feet | 160-950 | 300 minimum 400-500 for good hair. |
| Zinc | Zinc | Protein Synthisesis Immune system Wound healing and clotting Thyroid function. If deficient, doesn’t have enough to make hair. Can start off looking like psoriosis | 80-120 mcg/dl below 70 in women and 74 in men is deficient | Men Take 11mg per day Women take 8 mg per day |
| Full blood count | FBC | Broad screening to check disorders such as Anemia, infection, general health of red, white blood cells and platelets, nutritional status | Male 4.50-6.50 Women 3.80-5.80 | |
| Luteinizing hormone | LH | Follicle stimulating hormone produced and released by cells in pituitary gland to balance ovulation and sperm count. Stimulates testoterone release High LH could mean peri menopause . If low could indicate malnutrition, putuitary gland not working properly If high it could mean menopause or pituitary gland not working or polysystic ovary | Men 1.24 – 7.8 IU/ml Women before menopause 5-25 IU/L After menopause 14.2-52.3 IU/L | Eatrogen replacement therapy |
| Follicle stimulating hormone | FSH | Manages menstrual cycle, checks for polycystic ovary syndrome | If level are 30 ml or higher it usually means menopause | Optimum Age 33 or under less than 7.0 IU/L 33-37 7.9 38-40- 8.4 41 and over 8.5 |
| Thyroid stimulating hormone | TSH | Tells body how much hormone to make. Hyperthyroidism Regulates body’s motabolism Underactive means T4 T3 levels fall Overactive means T4 T3 go up Can mean excess shedding of hair | 0.4-4.0 mLIU/L above 4.5 mU/L indicates underactive thyroid which is hyperthyroidism Too low means overactive so hypothyroidism | |
| Serum folate or B9 (same thing) | Serum folate | Makes red blood cells which carry oxygen around the body | 400 | 600 for hair health |
| Vitamin D | Vitamin D | Vital for growth and helps immune system Lack of vit D is linked with autoimmune, alopecia areata and TE, causes keratinocytes in hair follicles which then have trouble facilitating new growth. | 30-50 | Minimum 100 Start on 1500-4500 IU Can use spray |
| Copper | Copper | Can be a sign of anemia or thyroid problems Kidney or gastro problems | 62-140 mcg/DL |
| Name, Role and effects of ingredient | Benefits of in ingredients for skin | Specific safety precautions |
|---|---|---|
| Detergent Cleanse skin and scalp. Break up oils and separate debris from skin and scalp. Cleanse area allowing for filling. Lower surface tension. Allow product to slip across skin. Can adapt the pH. | Cleanses skin and hair . | Store away from heat and direct sunlight. Can be a risk of initiating an irritant contact dermatitis. Wear gloves when applying in you are coming into regular contact with detergents, for example, Shampooing hair many times throughout the day. |
| Emulsifier Keeps oil and water solutions well mixed together. Breaks up oils droplets and immerse throughout water. Works as a binding agent Provides stability and texture to lotions and cream. Can act as a barrier cream | Heavier cream which is good as a night cream. Gives a smooth even finish. | Store in a cool dry place with lids on. Store away from heat and direct sunlight. Not recommended for thin or sensitive skin, they could start breaking down natural intercellular lipids. |
| Emollients Sits on skin surface to prevent water loss. Acts as a vehicle to spread ‘performance ‘ ingredients Helps product stick to the skin Serves as a protectant | Gives hair and skin a smooth soft feeling. Fills in texture gaps. Thermal protector. Prevents frizz. Helps detangle. | Store in a cool dry place with lids on. Store out of direct sunlight. Do not expose to extreme temperatures. Wash hands before application. Use a spatula if scooping product from a pot to avoid cross contamination. Wash clothing, bed sheets etc that come into contact with emollient to avoid them becoming inflammatory. |
| Humectant Keeps things moist. Attracts an holds water to the skin. Can create a film over the surface of the skin helping to retain water. Helps performance ingredients penetrate. Increases performance ingredient activity time. Counteracts dehydration property of an active/ performance ingredient. | Nourishing and moisturising helping skin and hair to look hydrated | Store in a cool dry place with lids on. Store away from direct sunlight. Avoid contact with eyes. |
| Buffering agent Adjusts pH of product. Helps maintain skin and hair’s natural pH. Causes less irritation. | Close and smooth hair cuticle. Hair feels soft. Hair looks healthy. Can help maintain treatment of skin. Diseases in aged skin . | Store in a cool dry place with lids on. Avoid contact with eyes Avoid spilling |
| Chelating agent Removes build up and residue such as chlorine. Improves efficiency of a preservative protecting the formula. Breaks down bacteria. Attaches to impurities helping them rinse away. Stabalises product. | Improves the feel and appearance of the skin. | Store in a cool dry place with lids on. Avoid contact with eyes Harmful if swallowed. Take care as some chelating agents can irritate the skin. |
| Hydroxy acids Promotes collagen production in the dermis. Breaks down dead skin. Boosts product absorption. Increases blood flow | Brightens skin. Plumps and thickens skin. Anti ageing effects by encouraging formation of a new stratum corneum. | Store away from direct sunlight Avoid using every day as product can build up on sensitive skin |
| Preservatives Inhibit growth of microorganisms such as bacteria, fungi and yeast. Prevents discoloration and preserves product and helps keep it fresh. | As preservatives are used to ‘preserve’ the other ingredients in the products, it doesn’t directly effect the skin or hair , however it looks after the performance ingredients so they can do their job, thus, Promoting healthy skin. | Store in a cool dry place. Store product with lid on. Use a spatula to scoop product to limit contamination. Take care as some preservatives can cause irritation. |
| Antioxidants Prevents oxidization. Prevents discoloration and product turning rancid. Stabilizes product. Detoxes Help prevent sun damage. Helps skin repair itself. Some antioxidants can stimulate collagen production. | Gives skin a youthful glow. Brightens skin tone. | Store in a cool dry place with lids on. After reading and researching about antioxidants there doesn’t appear to be any reliable information for special safety precautions. |
| Liposomes A delivery system capable of holding other ingredients and releasing them once absorbed into the skin. Carries performance ingredients into deeper layers of the epidermis. | Very effective delivery of active ingredients. Hydrates skin for longer. Naturally attracted to the skin. | Store in a cool dry place with lids on. |
| Proteins Retains, attracts and holds water. Loses water slowly. Conditions and bonds hair. | Keeps hair hydrated. Gives strength. Softens hair. Reduces static and flyaway’s. Improves feel and luster. Gives a better curl definition. Improves elasticity and flexibility. Adds shine to hair. Reduces frizz. Good on fine hair. Oil free. | Store in a cool dry place. Avoid using larger proteins such as quinoa and jojoba on coarse wiry hair and hair with a large diameter which can overload. |
| Enzymes Maintains healthy appearance of skin by penetrating through stratum corneum to help activate enzymes present. Resurfacing and skin smoothing Prevents skin damage. Promotes cell growth and renewal. Prevents bacterial effects. Can act as an exfoliate by removing dead skin cells. Slows signs of aging and environmental effects. Helps relieve ache and congestion on epidermis. Protects against free radicals, oxidation and environmental damage. | Maintains skins healthy appearance. Brightens skin leaving a fresh and vibrant look. Can give firmer, plumper hydrated skin. | Store in a cool dry place with lids on. After reading and researching about Enzymes there doesn’t appear to be any reliable information for special safety precautions. |
| Polymers A delivery system which helps spread other ingredients evenly across the skin. Helps adhere product to the skin surface. Helps to penetrate performance ingredients. Preserves product. Stablises product . Forms a film in hair fixants Thickens the product helping for example hair colour to stay where you place it. Adds rigidity to product. Increases viscosity. | Feels nice on the skin. A non-greasy feel. Makes skin and hair softer and smoother. Reduces static on the hair. Minimize frizz and flyaway’s, | Store in a cool dry place with lids on. Take care as can be an irritant to the skin. |
| Occlusives Increases moisture level by providing a physical barrier to epidermis. Prevents water loss. Helps keep irritants, allergens and other harmful particles from being able to enter the skin. May help to treat Eczema. | Skin has a soft hydrated feeling | Store in a cool dry place with lids on Because Occlusives are fairly heavy, its best to avoid them with oily or acne prone skin |
| UV absorbers Protects against UV to reduce light absorbed . Reduces colour fade in hair Also helps to improve light stability of alcohol fragrances, gels and colours. | As UV absorbers protect the skin and hair they don’t actually ‘ improve ‘ the hair or skin however they protect it from degrading and fading. | Take care, as some UV absorbers can be an irritant to the skin. |
| Name, Role and effects of ingredient | Benefits of in ingredients for skin | Specific safety precautions |
|---|---|---|
| Detergent Cleanse skin and scalp. Break up oils and separate debris from skin and scalp. Cleanse area allowing for filling. Lower surface tension. Allow product to slip across skin. Can adapt the pH. | Cleanses skin and hair . | Store away from heat and direct sunlight. Can be a risk of initiating an irritant contact dermatitis. Wear gloves when applying in you are coming into regular contact with detergents, for example, Shampooing hair many times throughout the day. |
| Emulsifier Keeps oil and water solutions well mixed together. Breaks up oils droplets and immerse throughout water. Works as a binding agent Provides stability and texture to lotions and cream. Can act as a barrier cream | Heavier cream which is good as a night cream. Gives a smooth even finish. | Store in a cool dry place with lids on. Store away from heat and direct sunlight. Not recommended for thin or sensitive skin, they could start breaking down natural intercellular lipids. |
| Emollients Sits on skin surface to prevent water loss. Acts as a vehicle to spread ‘performance ‘ ingredients Helps product stick to the skin Serves as a protectant | Gives hair and skin a smooth soft feeling. Fills in texture gaps. Thermal protector. Prevents frizz. Helps detangle. | Store in a cool dry place with lids on. Store out of direct sunlight. Do not expose to extreme temperatures. Wash hands before application. Use a spatula if scooping product from a pot to avoid cross contamination. Wash clothing, bed sheets etc that come into contact with emollient to avoid them becoming inflammatory. |
| Humectant Keeps things moist. Attracts an holds water to the skin. Can create a film over the surface of the skin helping to retain water. Helps performance ingredients penetrate. Increases performance ingredient activity time. Counteracts dehydration property of an active/ performance ingredient. | Nourishing and moisturising helping skin and hair to look hydrated | Store in a cool dry place with lids on. Store away from direct sunlight. Avoid contact with eyes. |
| Buffering agent Adjusts pH of product. Helps maintain skin and hair’s natural pH. Causes less irritation. | Close and smooth hair cuticle. Hair feels soft. Hair looks healthy. Can help maintain treatment of skin. Diseases in aged skin . | Store in a cool dry place with lids on. Avoid contact with eyes Avoid spilling |
| Chelating agent Removes build up and residue such as chlorine. Improves efficiency of a preservative protecting the formula. Breaks down bacteria. Attaches to impurities helping them rinse away. Stabalises product. | Improves the feel and appearance of the skin. | Store in a cool dry place with lids on. Avoid contact with eyes Harmful if swallowed. Take care as some chelating agents can irritate the skin. |
| Hydroxy acids Promotes collagen production in the dermis. Breaks down dead skin. Boosts product absorption. Increases blood flow | Brightens skin. Plumps and thickens skin. Anti ageing effects by encouraging formation of a new stratum corneum. | Store away from direct sunlight Avoid using every day as product can build up on sensitive skin |
| Preservatives Inhibit growth of microorganisms such as bacteria, fungi and yeast. Prevents discoloration and preserves product and helps keep it fresh. | As preservatives are used to ‘preserve’ the other ingredients in the products, it doesn’t directly effect the skin or hair , however it looks after the performance ingredients so they can do their job, thus, Promoting healthy skin. | Store in a cool dry place. Store product with lid on. Use a spatula to scoop product to limit contamination. Take care as some preservatives can cause irritation. |
| Antioxidants Prevents oxidization. Prevents discoloration and product turning rancid. Stabilizes product. Detoxes Help prevent sun damage. Helps skin repair itself. Some antioxidants can stimulate collagen production. | Gives skin a youthful glow. Brightens skin tone. | Store in a cool dry place with lids on. After reading and researching about antioxidants there doesn’t appear to be any reliable information for special safety precautions. |
| Liposomes A delivery system capable of holding other ingredients and releasing them once absorbed into the skin. Carries performance ingredients into deeper layers of the epidermis. | Very effective delivery of active ingredients. Hydrates skin for longer. Naturally attracted to the skin. | Store in a cool dry place with lids on. |
| Proteins Retains, attracts and holds water. Loses water slowly. Conditions and bonds hair. | Keeps hair hydrated. Gives strength. Softens hair. Reduces static and flyaway’s. Improves feel and luster. Gives a better curl definition. Improves elasticity and flexibility. Adds shine to hair. Reduces frizz. Good on fine hair. Oil free. | Store in a cool dry place. Avoid using larger proteins such as quinoa and jojoba on coarse wiry hair and hair with a large diameter which can overload. |
| Enzymes Maintains healthy appearance of skin by penetrating through stratum corneum to help activate enzymes present. Resurfacing and skin smoothing Prevents skin damage. Promotes cell growth and renewal. Prevents bacterial effects. Can act as an exfoliate by removing dead skin cells. Slows signs of aging and environmental effects. Helps relieve ache and congestion on epidermis. Protects against free radicals, oxidation and environmental damage. | Maintains skins healthy appearance. Brightens skin leaving a fresh and vibrant look. Can give firmer, plumper hydrated skin. | Store in a cool dry place with lids on. After reading and researching about Enzymes there doesn’t appear to be any reliable information for special safety precautions. |
| Polymers A delivery system which helps spread other ingredients evenly across the skin. Helps adhere product to the skin surface. Helps to penetrate performance ingredients. Preserves product. Stablises product . Forms a film in hair fixants Thickens the product helping for example hair colour to stay where you place it. Adds rigidity to product. Increases viscosity. | Feels nice on the skin. A non-greasy feel. Makes skin and hair softer and smoother. Reduces static on the hair. Minimize frizz and flyaway’s, | Store in a cool dry place with lids on. Take care as can be an irritant to the skin. |
| Occlusives Increases moisture level by providing a physical barrier to epidermis. Prevents water loss. Helps keep irritants, allergens and other harmful particles from being able to enter the skin. May help to treat Eczema. | Skin has a soft hydrated feeling | Store in a cool dry place with lids on Because Occlusives are fairly heavy, its best to avoid them with oily or acne prone skin |
| UV absorbers Protects against UV to reduce light absorbed . Reduces colour fade in hair Also helps to improve light stability of alcohol fragrances, gels and colours. | As UV absorbers protect the skin and hair they don’t actually ‘ improve ‘ the hair or skin however they protect it from degrading and fading. | Take care, as some UV absorbers can be an irritant to the skin. |