Ever wanted long hair like a mermaid?

Question:  How come I just can’t seem to grow my hair long? It just never gets past a certain length and then either breaks off or never gets longer. Why is that?

shutterstock_197763182Answer:  Every little girl and subsequent teenager has, at some point or another, wanted to grow their hair out as long as possible.  Many characteristics about how your hair grows are fixed and genetic and then there could also be some environmental reasons your hair is not growing as long as you wish.

To grow your hair as long as possible, it helps to understand that hair growth occurs in a regular repeating cycle which can be disrupted by many things.

The normal hair growth cycle:

  • Anagen Phase: This is the active growing phase of your hair which lasts for an average of 3 years (1000 days), but can be anywhere from 2-6 years and determines the length of your hair. The longer the growth cycle, the longer hairs can grow before being shed. The reason you cannot see hair growing is because the average growth rate is just 0.37mm per day.
  • Catagen Phase: During this time, lasting 1-2 weeks on average, hair follicles undergo a transition from the growing phase to a resting phase during which all growth activity ceases. Whatever length the hair is, it will not grow any longer.
  • Telogen Phase: This is the final resting phase and hair follicles remain in this phase around 3-4 months, or 100 days on average, before they are pushed out by new hairs growing underneath or pulled out by a hairbrush or other mechanical action causing friction such as shampooing.

Your scalp normally contains 100,000 hairs, and the average number of hairs shed daily is 100-150.  Hair (unlike nails) does not grow continuously but stops growing after a pre-determined period of time and is replaced by new hair. While many things can disrupt the normal growth cycle, halt hair growth and increase fall out, nothing, including medications, shaving techniques or menstruation can make hair grow faster. And, since the number of hair follicles is pre-determined in utero and does not increase after birth, there’s nothing you can do to increase the amount of hair that you have, despite what many websites and products may have you believe.

Hair grows normally, and at different rates, on all skin surfaces except palms, soles of hands and feet and specific genital areas. In addition, terminal (dark, course) hair is always present on men’s face, chest and abdomen. The duration of hair growth cycles (and hair length) vary with the anatomical location of the hair, for example, scalp growth lasts for 3-5 years and the eyelash cycle averages just 3-5 months.

Lifestyle factors that can affect your hair growth cycle

Aside from a genetic set point that determines your personal hair growth cycle and hair length, here are some other factors that may be inhibiting your hair’s growth and health:

  • Unnecessary roughness. Sometimes hair doesn’t appear to be growing because it breaks off in the middle or at the ends. This can be caused by rough treatment in shampooing, toweling wet hair, combing and brushing, tight pony tails and braids and use of heated appliances all causing hair to weaken as it ages (the ends) and simply break off. Any injury such as a burn or laceration to the scalp can also cause a scar resulting in permanent hair loss to the area contributing to a shorter look.
  • Telogen Effluvium. Any physical or emotional trauma can shock your body (and your hair follicles) which halts the hair growth phase and pushes it straight to the telogen phase causing a shedding of a larger than normal amount of hair (which thankfully and  usually reverses).  Some of the most common causes are extreme crash diets, child birth, menopause, chemotherapy and even a prolonged high fever along with emotional traumas such as death of a loved one or a traumatic divorce or other life change.
  • Hair loss diseases. Systemic, skin disease and deficiencies can affect the scalp, the hair shaft and the hair follicles. These include folliculitis (an infection of the hair follicles which can involve just one inflamed follicle or spread to others), autoimmune conditions such as alopecia areata, psoriasis or lupus that result in patchy hair loss, seborrheic dermatitis, fungal infections and even trichotillomania (a compulsive disorder characterized by a secret compulsion to pull hair out from the head and body parts), among other skin and hair diseases.
  • Medications. Some medications are known to have the side effect of diffuse (all over the head) hair loss.  These include beta-blockers (blood pressure medications), certain oral birth control pills, isotretinoin (for treatment of acne), antidepressants (serotonin reuptake inhibitors, or SRIs) and some cholesterol-lowering drugs. Hair loss will not occur in everyone, but if you experience it, work with your doctor to evaluate different medications and dosages to improve or stop the hair loss.

How a dermatologist diagnoses hair loss conditions:

  • Hair care and lifestyle evaluation. We can determine the causes of telogen effluvium or medication side effects and educate you about treating hair gentler.
  • Hair pull test. If a gentle tugging of the hair produces more than 6 hairs at a time we consider that an abnormal hair loss condition.
  • A thorough visual examination. This is how we rule out skin and scalp hair loss diseases.
  • Scalp biopsy and culture. If we notice any lesions, papules or pustules we will culture and biopsy the area to rule out scalp infections, fungal infections and carcinomas.

So, while you may never have hair as long as a mermaid, you can make the best of the hair you have by maintaining a healthy lifestyle of nutrition and exercise and being gentler on your hair at all times.

-Jodi

 

If you get a sore or scar on your scalp does it always cause permanent hair loss?

Question:  I’ve noticed more hair fall out than usual recently, so, upon looking at my scalp and feeling around more closely, I’ve found several different areas with  around my scalp where there is no hair. Some areas of hair loss feel smooth with no hair in them and some are sensitive and painful, as if a sore is there or has healed. HELP!

Answer:  Clinically, we call that cicatricial alopecia which is the medical term for hair loss due to scarring.

Once a sore has formed the hair follicle may be damaged and hair falls out. Once a scar is formed, hair will usually not grow again and hair loss will be permanent, called scarring alopecia.

Sores, inflammation and scars on the scalp for any reason can cause hair follicles to die, and resulting hair loss can be permanent!

Since scars, sores or inflammation  occur due to many different causes, you should head directly to your dermatologist so you can have your scalp examined and a diagnosis made. The sooner you figure out the the source, the sooner you can begin treatment to cure any lesions (sores) so they don’t scar and cause permanent hair loss. Once  hair loss occurs, hair does not usually grow back because the scar tissue has killed the hair follicle.

How we diagnose cicatrical alopecia, or scarring alopecia

It’s a process that starts with many questions. We will ask you about any recent illnesses, injuries, allergies, your lifestyle, medications and your haircare regimen. We will closely examine your scalp using a magnifying glass and a special light to determine if the lesions have bacterial or fungal causes. We will feel your entire scalp and any lesions feeling for inflammation, sores or scales to determine the exact nature of the lesions and how they appear at different stages and locations. We will also document any hair loss that has occurred and take pictures for future reference. Often, we will take a biopsy of the sore or scarred area to determine the exact cause (if bacterial or fungal) and also to examine the health of the hair follicles to ascertain the severity of the condition. (We use a 4mm punch biopsy to provide an adequate specimen from an active lesion. Sometimes we will also take another sample from an unscarred area.)

inflamed, causing hair loss

inflamed, causing hair loss

Any type of scalp reaction or injury resulting in a lesion that causes a scar can cause death to the hair follicles and permanent hair loss and we call that scarring alopecia. Lesions that cause scars and hair loss can be caused by any of the following conditions and diseases:

UNKNOWN ORIGIN & AUTOIMMUNE

  • Discoid lupus erythematosus (DLE):  A chronic skin condition characterized by inflamed sores that begin as  a red, inflamed patch with a scaly and/or crusty look and feel. The patches leave noticeably discolored, raised scars. Hair follicles are damaged first by the sores and then the resulting scar tissue causes permanent hair loss.
  • Lichen planopilaris: Also called follicular lichen planus, this a rare inflammatory condition results in patchy progressive permanent hair loss. Initially you may notice some small or spiny red bumps around involved follicles which may or may not be itchy. This eventually forms larger reddish lesions (resembling a lichen pattern) and scar tissue which damages hair follicles and causes hair to fall out and not grow back. Additionally, Frontal Fibrosing Alopecia appears to be a variant of lichen planopilaris. This occurs in mostly older women and appears in a band-like pattern in the frontal and temporal areas of the scalp. Often, a patient’s eyebrows are also affected.
  • Sarcoidosis: This disease, also with unknown origin,  causes collections of mixed inflammatory cells (granulomas) which form lesions resulting in scarring at many different parts of the body, including the scalp.

FUNGAL

  • Seborrheic dermatitis:  We believe this condition is an inflammatory reaction related to an over-abundance of a normal  yeast species  found on the scalp called M. globosa. It produces toxic substances that irritate the scalp causing a scaly rash.
  • Ringworm (tinea capitis): On the scalp, this common fungal infection characterized by itchy red rings can result in scaling and hair loss  in children, and can progress to folliculitis, too (see below).

BACTERIAL

  • Folliculitis decalvans: Simple folliculitis is any bacterial infection of the hair follicles. But when hair loss is caused by  redness, swelling and pustules surrounding hair follicles that appears to be spreading, it is called folliculitis decalvans. Another type of scarring alopecia, hairs shed as follicles are completely destroyed by the inflammation. A resulting scar is left behind where hair will no longer grow.  Simple folliculitis (one sore) can stem  from a bug bite or a scratch and flare-up or spread if infected with the bacteria Staphylococcus Aureus but recently we have found Methicillin Resistant Staphylococcus Aureus (MRSA) in some lesions and boils, so we always want to take a culture in any open lesions on the scalp, especially those that are spreading. In additiona variant of folliculitis decalvans occurs in African Americans who present with ingrown hairs of the beard (pseudofolliculitis), acne keloidalis (a destructive folliculitis of the back of the scalp) and scarring alopecia.

TRAUMA

  • Central Centrifugal Cicatricial Alopecia (CCCA): Usually seen in African American women, this type of scarring alopecia usually develops on the crown and spreads peripherally to form a large oval of hair loss on the scalp. Originally, this type of hair loss was thought to be caused by hair straightening with a hot comb or due to the hot petrolatum used with the iron; however, was also found to take place in patients without the use of hot combs or straightening methods.

How we aggressively treat lesions that cause scars…

permanent scars & hair loss

permanent scars & hair loss

Once we know what may be causing the lesions, we can treat them to minimize spreading, scarring and any resulting hair loss, using any of the following treatments or combinations of treatments:  

  • Oral and intra-lesional steroids
  • Topical corticosteroids
  • Oral retinoids (isotretinoin)
  • Antimalarials (hydroxychloroquine)
  • Antibiotics (tetracycline, doxycycline, minocycline)
  • Antifungals (itraconazole)
  • pioglitazone
  • Immunosuppressants (cyclosporine, mycophenolate mofetil)
  • DHT blockers (dutasteride internally and minxoidil topically to -induce hair growth if follicles are alive.)

I have found that most patients experience hair loss very gradually (and cannot see the back and top of their head) and the prolonged course of the disease may cause a lack of necessary action. You need to know that the progressive destruction of hairs will result in ever-expanding areas of permanent hair loss.  So, no matter what, go see a dermatologist as soon as you feel any sores, pimples, pustules, pain, itchiness, scaliness or inflammation on your scalp, whether or not they have already caused hair loss, because they need to be treated ASAP and aggressively as possible.

-Jodi

 

Does minoxidil cause facial wrinkles?

Question: I have been using Rogaine for 6 months and I have recently noticed several deep wrinkles forming under my eyes, specifically the side I sleep on.  I know there are some testimonies on the internet and on Wikipedia about minoxidil causing collagen depletion so I’m wondering if this is true or just an internet rumor?

Answer:  So, I dug down to the research for your answer. Minoxidil has been shown in cell culture (outside of the body, also called, in vitro) studies to have range of inhibitory effects on skin fibroblasts (a type of cell that produces collagen). It has also been reported that minoxidil hinders collagen synthesis and inhibits the effects of specific growth factors, substances that are capable of stimulating cellular growth, in cultured hair dermal papilla of rats (yes, rats, not humans!) But applying these results obtained in cell culture studies or rats to the use of minoxidil in humans is uncertain.

There are no human studies demonstrating that minoxidil causes collagen depletion or wrinkles as a side effect (and there are many studies of minoxidil effects on humans). Even though there are anecdotal reports online stating this, minoxidil has been used for over 25 years and there are no real complaints or published reports in clinical practice (with patients).

You are smart to ask a professional when faced with internet rumors, especially when it comes health issues, because side effects of medications and even over-the-counter products are largely personal. Also, facial wrinkles are known to form in response to repetitive muscle movements such as facial expressions and patterns over time, such as the side you sleep on. A good idea would be to schedule an appointment with a dermatological practitioner to review your age, medical history, lifestyle (such as sun exposure) and skin and hair loss condition as well as your usage of minoxidil to see if any alterations (a weaker percentage or foam instead of liquid) or additions to your treatment plan need to made.

 

Are you at risk for this common spot for skin cancer?

Question: My hair has been thinning considerably for several years now, and my hairdresser recently found some  strange spots on my scalp. What are they?

Answer: Watch out for basal cell carcinoma (BCC), the most common, treatable form of skin cancer, on your scalp, especially if you are balding or your hair is noticeably thinning.

Think about it:  The top of your head, forehead (and also your nose) is exposed to the sun’s harmful rays more than any other part of the body. Once you lose the cover of your thicker hair, your scalp is highly vulnerable.

The tricky thing about BCCs is that those who have had one BCC are at an increased risk for developing more tumors later  in the same area or elsewhere on the body and you may also be at risk for other types of skin cancer. And the recurrence of scalp BCCs is even higher within the first two years after surgery because of the constant sun exposure.

No matter where you (or someone else) notices any type of strange lesion (there are 5 warning signs of a BCC), check in with a dermatologic practitioner regularly so your entire skin surface can be examined, especially in places like the top of your head that you cannot easily see yourself...and wear a hat!

Has anyone else ever found strange spots on you? What did they turn out to be?

 

 

 

Are you making these top sunscreen mistakes?

This is how much sunscreen you should be applying to your body when spending the day in the sun...every two hours!

Question: I recently went out for a day on a boat with friends and even though I used SPF 50 sunscreen all day, I still got burned. What did I do wrong?

Answer: There’s a lot of news in sunscreen ingredients and thinking these days so lets update how you buy, use and apply sunscreen so you don’t get burned again (or needlessly exposed to the rays that cause aging, wrinkles and skin cancer):

Mistake:  Not applying enough sunscreen

The current guideline is to apply a shot glass-worth, one full ounce, of sunscreen to your body when spending the day in the dun. And, the most important part, you should reapply this amount of sunscreen  every two hours regardless of the SPF noted on the bottle, so you could go through half of an eight-ounce bottle in one day in the sun!

Mistake:  Believing that sunscreens are “water-proof”

The FDA, in its new labeling guidelines, has declared that the use of the term “water-proof”  misleading and banned brands from using it. The word will need to be removed from labels by December 2012.  Now, the guideline is that sunscreen is “water-resistant” and only for a tested time limit of 40 or 80 minutes when spending time in the water, after which the product will need to be re-applied.

Mistake: Applying the sunscreen when you get there

The best way to allow sunscreen to do it’s work is to apply it a full 30 minutes before going into the sun, so it has time to bond to skin, instead of getting immediately rubbed off by a towel you lay on or washed off by jumping directly into the water.

Mistake:  Not protecting your skin from UVA rays

It used to be that sunscreens only protected against UVB (the burning rays) but now a slew of new chemicals can absorb UVA rays (the ones that penetrate deeper to cause aging, wrinkles and skin cancer).  Choose a sunscreen with the new designation “broad spectrum” because these have been tested by the FDA to provide protection against both UVB and UVA rays. Consumer Reports recently tested and rated sunscreens according to the new FDA labeling requirements and found these three top-rated choices:

  • All Terrain AquaSport SPF 30 (for athletes and outdoor workers)
  • Coppertone Sport High Performance Ultra Sweatproof SPF 30 (for athletes and outdoor workers)
  • No-Ad with Aloe and Vitamin E SPF 45 (for the budget minded, every-day body user)

Mistake:  Thinking the higher the SPF, the better the protection…

According to Consumer Report’s recent ratings, top-rated sunscreens are between SPF 30-45. The new thinking is that higher SPF does not really not afford more protection. Here’s why:  an SPF 15 filters out approximately 93% of all incoming UVB rays, SPF 30 filters out approximately 97% and SPF 50 filters out approximately 98%. No sunscreen can block out 100% (which is why the FDA has also banned the use of the word “sunblock” on labels) of all UV rays so after an SPF 30, you can see the difference in filtering is negligible. The old  thinking:  If your skin starts reddening in 20 minutes when exposed unprotected to sunlight, using an SPF 15 should prevent your skin from turning red for 15 times longer (approximately 5 hours). The new thinking: No sunscreen protection lasts more than 2 hours. Choose an SPF 30-45 and reapply one ounce every two hours for real protection.

Mistake:  Ignoring your scalp

Most people protect their eyes with sunglasses and slather on the sunscreen but completely ignore their scalp. This is very dangerous, especially if you have any hair loss or thinning issues. Apply sunscreen to any areas experiencing hair loss (a widening part-line, bald spot or receding hair line) and definitely wear a hat!

Mistake:  Believing that the sun does not affect your face every day

I advise everybody to apply a basic “broad-spectrum” sunscreen every day to face, underneath makeup or in makeup for women,  especially to protect against photo-aging and skin cancer that you cannot see happening. One that I personally recommend, that was also recommended by the Consumer Reports Ratings, is La Roche-Posey Anthelios 40 with Mexoryl SX SPF 40.

Have you made any of the mistakes on this list recently? Tell us your worst sunburn story in the comments!

Inaugural post … and croissants!

Wow…today is the inaugural blog…I don’t really know what to say. I guess, Welcome! Welcome to my blog! I will certainly try to give you my honest opinion, feedback and of course, answers to your skin care concerns and questions. Anything having to do with skin, hair and nails are up for grabs here…so ask away! Additionally, I will try and keep you up to date with the latest news and media reports on dermatology. I hope you enjoy it all!

BTW…today is National Croissant Day! In addition to being a skin care guru, I’m also a foodie. At our office, we love to celebrate anything having to do with food. No food holiday goes unnoticed!