Tuesday, August 5, 2014

Hair Loss

Hair Loss
American Academy of Dermatology

Hair has been called our "crowing glory". Society has placed a great deal of social and cultural importance on hair and hairstyles. Unfortunately, many conditions, diseases, and improper half care result in excessive hair loss. People who notice their hair shedding in large amounts after combing and brushing, or whose hair becomes thinner or falls out, should consult a dermatologist. With correct diagnosis, many people with hair loss can be helped.

Dermatologists, physicians who specialize in treating diseases of the hair and skin, will evaluate a patient's hair problem by asking questions about diet, medications including vitamins and health food taken in the last six months, family history of hair loss, recent illness and hair care habits. Hormonal effects may be evaluated in women by asking about menstrual cycles, pregnancies and menopause. After examining  the scalp and hair, the dermatologist may check a few hairs under the microscope. Sometimes blood tests or a scalp biopsy may be required for an accurate diagnosis. It's important to find the cause and whether or no the problem will respond to medical treatment.

Normal Hair Growth
About 90 percent of the hair on a person's scalp is growing at any one time. The growth phase lasts between two to six years. Ten percent of the hair is in resting phase that lasts two to three months. At the end of its resting stage, the hair is shed. When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again. Scalp hair grows about one-half inch a month. As people age, their rate of hair growth slows. Natural blondes typically have more hair (140,000 hairs) than brunettes (105,000 hairs) or red heads (90,000 hairs). Most hair shedding is due to the normal hair cycle, and losing 50-100 hairs per day is no cause for alarm.

Causes of Excessive Hair Loss
Improper hair cosmetic Use/Improper Hair Care- Many men and women use chemical treatments on their hair, including dyes, tints, bleaches. straighteners and permanent waves. These treatments rarely damage if they are done correctly. The hair can become weak and break if any of these chemicals are used too often. Shampooing, combing and brushing too often can also damage hair, causing it to break. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Use wide toothed combs and brushes with smooth tips.

Hereditary Thinning or Balding- Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother's or father's side of the family. Women with this trait develop thinning hair, but do not become completely bald. The condition is called androgenic alopecia and it can start in the teens, twenties or thirties. There is no cure, although medical treatments have recently become available that may help some people. One treatment involves applying a lotion, minoxidil, to the scalp twice a day. Another treatment for men is a daily pill containing finasteride, a drug that blocks the formation of the active male hormone in the hair follicle.

When confronted with thinning hair or baldness, men and some women consider hair transplantation, which is a permanent form of hair replacement. Anyone who has suffered permanent hair loss may be a candidate for hair transplantation. The procedure of hair transplantation involves moving some hair from hair-bearing portions (donor sites) of the head to bald or thinning portions (recipient sites) and/or removing bald skin. Because the procedures involve surgery as well as time and money, they should not be undertaken lightly.

Your dermatologist will help decide which method or combination of methods is right for you.

Alopecia Areata- In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. This disease may affect children or adults of any age.

The cause of alopecia areata is unknown. Apart from the hair loss, affected persons are generally in excellent health. In most cases, the hair regrows by itself. Dermatologists can treat many people with this condition. Treatments include topical medications, a special kind of light treatment, or in some cases pills.

Childbirth- When a woman is pregnant, more of her hairs will be growing. However, after a woman delivers her baby, many hairs enter the resting phase of the hair cycle. Within two to three months, some women will notice large amounts of hair coming out in their brushes and combs. This can last one to six months, but resolves completely in most cases.

High Fever, Severe Infection, Severe Flu- Illnesses may cause hairs to enter the resting phase. Four weeks to three months after a high fever, severe illness or infection, a person may be shocked to see a lot of hair falling out. This shedding usually corrects itself.

Thyroid Disease- Both an over-active thyroid and an under-active thyroid can cause hair loss. Your physician can diagnose thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.

Inadequate Protein in Diet- Some people who go on crash diets that are low in protein, or have severely abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hairs into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out by the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.

Medications- Some prescription drugs may cause temporary hair shredding. Examples include some of the medicines used for the following: gout, arthritis, depression, heart problems, high blood pressure, or blood thinner. High doses of vitamin A may also cause hair shedding.

Cancer Treatments- Some cancer treatments will cause hair cells to stop dividing. Hairs become thin and break off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.

Birth Control Pills- Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynecologist about switching to another birth control pill. When a woman stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.

Low Serum Iron-  Iron deficiency occasionally produces hair loss. Some people don't have enough iron in their diets or may not fully absorb iron. Woman who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron pills.

Major Surgery/Chronic Illness- Anyone who has a major operation may notice increased hair shredding within one to three months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely.

Fungus Infection (Ringworm) of the Scalp-  Caused by a fungus infection, ringworm (which has nothing to do with worms) begins with small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is most common in children and oral medication will cure it.

Hair Pulling (Trichotillomania)-  Children and sometimes adults will twist or pull their hair, brows or lashes until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occasionally is a sign of a serious problem needing the help of a mental health professional.

See your dermatologist - Excess hair loss can have many different causes. Hair will regrow spontaneously in some forms of hair loss. Other forms can be treated successfully by a dermatologist. For the several forms of hair loss for which there is no cure at present, there is research in progress that holds promise for the future.


October 2013
Skin & Allergy News

Eye Treatment
Redermic R eyes is available from La Roche-Posay to improve the appearance of lateral canthal lines (Cow's Feet) and dark circles under the eyes and promote firmer, smoother skin tone. The product features 0.01% pure retinol, plus a unique retinol booster complex designed to increase the effectiveness of the retinol while minimizing skin irritation. In addition, the product contains 0.2% caffeine to provide additional antiwrinkle benefits and to mitigate the appearance of dark circles under the eyes and contact lens wearers.

La Roche-Posay

Formaldehyde concentrations in hair straightening products may be health treat



Formaldehyde concentrations in Brazilian keratin hair straightening products may be high enough to serve as a health hazard, a recent study reports. 
Researchers in South Africa measured formaldehyde concentrations in seven commercial Brazilian keratin treatments marketed in South Africa in 2012 using a high-performance liquid chromatography with ultraviolet light detection after derivatization with dinitrophenylhydrazine. 
While the maximum safe concentration set by the U.S. Cosmetic Ingredient Review Expert Panel is less than 0.2 percent, the researchers found that six of the brands studied, five of which were labeled “formaldehyde free”, actually had levels ranging five times higher than this recommended level (0.96 to 1.4 percent). 
The authors tested each brand three times.  
“Industry monitoring is needed to improve compliance and protection of hairdressers and consumers,” the authors concluded
DermatologyTimes 2/2014

FDA Looking at safety of antibacterial hand soaps

The Food and Drug Administration has proposed a rule that would require manufacturers of antibacterial hand soaps to demonstrate that their products are safe and effective.

The FDA is conducting an ongoing review of the active ingredients in antibacterial soaps to ensure they are safe for long-term daily use and whether they are more effective than plain soap and water for preventing illnesses and the spread of germs, according to a news release.

“Some data suggest that long-term exposure to certain active ingredients used in antibacterial products — for example, triclosan (liquid soaps) and triclocarban (bar soaps) — could pose health risks, such as bacterial resistance or hormonal effects,” the FDA stated.

The proposed rule does not impact hand sanitizers, wipes or antibacterial products used in healthcare settings. The FDA noted that nearly all soaps labeled as “antibacterial” or “antimicrobial” contain at least one of the antibacterial ingredients addressed in the proposed rule.

“Due to consumers’ extensive exposure to the ingredients in antibacterial soaps, we believe there should be a clearly demonstrated benefit from using antibacterial soap to balance any potential risk,” Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research, said in the news release.
DermatologyTimes 2/2014

The Value Of Cosmeceuticals

Dr. Levine: There is a lot of misinformation out there about so-called cosmeceuticals, what they can do for our patients and how we should promote them. Can you explain what is a cosmeceutical, how is it different from a drug and how is it different from a cosmetic?

Dr. Draelos: Actually there is no such thing as a cosmeceutical. The FDA (Food and Drug Administration) does not recognize this term. The term cosmeceutical, in their eyes, is another word for cosmetics. I think if you ask the dermatologists what is a cosmeceutical, they would tell you that it’s a product that enhances the skin in some manner, different from a cosmetic that traditionally is thought to only scent, color, and adorn the skin, but there is no such thing as cosmeceutical from a regulatory standpoint.

There are three categories: there are prescription drugs; there are over-the-counter (OTC) drugs, which include such things as sunscreen, antiperspirants, and toothpaste; and then there are cosmetics. Cosmetics are a category that is currently unregulated. The over-the-counter drugs are regulated through a monograph and we are all familiar with how the FDA regulates pharmaceuticals.

Cosmeceuticals is a relatively new category. It’s a contraction of the word cosmetic and pharmaceutical that was coined by Dr. Albert Kligman. There are countries around the world where cosmeceuticals are recognized, such as Japan. In Japan they call cosmeceuticals quasi-drugs. Cosmeceuticals are basically substances that perhaps might alter the skin, but the marketing claims that are used are identical to cosmetics and all ingredients that are used in cosmeceuticals must be considered GRAS (Generally Recognized As Safe) ingredients.

Dr. Levine: So by definition if these are cosmetics, my understanding is therefore they can have no medicinal value?

Dr. Draelos: Exactly. If you look at the claims that are made for the efficacy of cosmeceuticals, they are all appearance claims. A drug claim would be “gets rid of wrinkles;” a cosmeceutical or cosmetic claim would be “improves the appearance of wrinkles.” As you are reading packaging and trying to decide exactly what this particular formulation does, you will notice that it says “improves the appearance of fine lines,” “improves the appearance of pores,” “improves the appearance of facial redness,” “smoothes the skin,” “makes skin more radiant,” “makes skin more luminous.” Those are all referring to appearance changes that could be induced by the product when it’s applied to the skin.

Dr. Levine: So does that mean that we as dermatologists have some obligation not to differentiate cosmeceuticals from cosmetics, or can we go beyond what FDA is interpreting as cosmetic?

Dr. Draelos: I think we can go little bit beyond the FDA, because we are actually seeing the entry into dermatology of many substances that actually are cosmetic drugs. One of the first ones was approved by the FDA this year for a product that reduces facial redness. It is temporary, like a cosmetic. It reduces facial redness for several hours depending on the individual. It is given to the patient in a form of a prescription. It is purchased at the pharmacy, but instead of “curing or altering the disease process,” it simply improves the appearance of facial redness.

We are starting to see in dermatology the entry of substances that improve appearance but are truly drugs, which is one end of the spectrum of cosmeceuticals. And then we also see products that are entering the marketplace, for example, things that are called line blurs or wrinkle reducers, and those are products that are also temporary, but they are purchased over-the-counter and they contain silicone. The silicone base fills in the undulations of the skin surface where the wrinkles are present, and by filling those in, (it) improves skin smoothness and diminishes the appearance of wrinkles. So it’s interesting that we have — in two very different categories — products to achieve the same thing, which is a temporary improvement in appearance.

Dr. Levine: So what do we as dermatologists do to find out which ones have some value and which ones do not?

Dr. Draelos: There is actually a lot of testing that goes into cosmeceutical development. Companies test cosmeceuticals looking for an immediate benefit: that’s the smoothness and the softness, because when a consumer purchases a product, she wants to see something immediate, which is something that pharmaceuticals traditionally do not deliver.

We usually tell a patient — for example, when they are using a topical rosacea medication — that one will need to use this product for four to six weeks before one will see a reduction in papules and pustules. But in the cosmeceuticals realm, people want to see immediate improvement. That’s where the moisturizer comes in that makes the skin smooth and soft.

Then there are botanical anti-inflammatories that could be added into a cosmeceutical formulation that indeed over time might reduce redness, not perhaps to the degree that a pharmaceutical would, but it still has some beneficial effect. Most companies are looking for significant market share with their products and will build in short-term benefits and long-term benefits. The long-term benefits will not be to the level of a pharmaceutical, but still they are consumer perceivable benefits, which might result in some redness reduction because of a botanical anti-inflammatory, such as bisabolol, which is a chamomile extract with an anti-inflammatory topical effect.

Dr. Levine: Of all these hundreds of agents, can you pick out a few that you really think have value over and above the others?

Dr. Draelos: Probably the most important one is sunscreen. Because the new sunscreen guidelines allow companies to make anti-aging claims based on the inclusion of sunscreen, we are going to see an increase in anti-aging claims because of sunscreen inclusion. The idea is that sunscreens prevent DNA damage, and when you prevent DNA damage, you prevent aging.

If a product contains a sunscreen, technically it does become an over-the-counter drug, but not only can SPF designations be placed on a label, companies can now make an anti-aging claim. You are going to see a whole new cadre of cosmeceuticals that have anti-aging claims, that may also contain sunscreen and mushroom extracts, but the sunscreen is the workhorse that’s providing the anti-aging benefit and the mushroom extract is along just for the ride. The product will say that it reduces the appearance of wrinkles substantiated by sunscreen inclusion, and then it will say contains mushroom extract.

When you make a claim that says “contains something,” that is basically a disclosure of the ingredient on the front of the package. They are not saying the mushroom extract does anything. But if you tell the consumer “this reduces the appearance of wrinkles and it contains mushroom extract,” sometimes the consumer will think mushroom extract is reducing the wrinkles, not the inclusion of sunscreen. This is an interesting area.

The second interesting area of ingredients is the introduction of retinol into products. Retinol, as you remember, is the vitamin version of vitamin A. It is a precursor to retinoic acid, which we know of as tretinoin. Retinol is actually a precursor of tretinoin and since tretinoin has anti-aging benefits, so does retinol. There are some studies that show that somewhere between 1 and 2 percent retinol can indeed improve the appearance of the skin by working through the retinoid receptor.

The third category to watch would be the anti-inflammatories. Now many of the new cosmetics that reduce redness and facial irritation actually contain 0.5 percent hydrocortisone, which makes them an over-the-counter drug. So it’s interesting that cosmetic formulations are tapping into OTC drugs to deliver some of their claims, but there are some licorice extracts such as Licochalcone A. There are some camomile extracts like I mentioned earlier such as bisabolol. There are also other plant sterols that are being used as anti-inflammatory agents and so anti-inflammatories is another category.

Certainly these are not anti-inflammatory agents that will reduce disease, such as facial dermatitis, but they might reduce redness and they might reduce some of the itching and stinging. Many of those ingredients like bisabolol are used in sensitive skin formulations and the idea is to include an anti-inflammatory that will allow people with sensitive skin to be able to wear those products.

Dr. Levine: Could you comment on the current rage about the use of the word “natural” in many of these products. What does that mean and is that important?

Dr. Draelos: The FDA actually has become very concerned about use of the word natural, because natural actually has no meaning whatsoever. “Natural” became a concern in food products because people were thinking that natural might somehow mean that these products didn’t contain any chemicals, they didn’t contain preservatives. In the cosmetics industry, people wanted to put “natural” on their products to imply that there weren’t any chemicals that were toxic, irritating, or might induce some other type of damage, such as the generation of reactive oxygen species.

Everything that is found on the earth is natural to this earth, whether it will be a pesticide or preservative or a celery extract, but not all those substances are beneficial to the skin. For example, celery extract actually contains a carcinogen and that is an area of controversy where many plants, in order to protect themselves from overgrazing by animals, will contain toxins. Those toxins will poison the animal so to speak if it overeats that particular product and that’s how the plant materials sustain themselves on the earth. There are many natural ingredients that could find their way into cosmetics that are not good for the skin.

For example, feverfew, which is an ingredient that is found in a number of facial products, actually has an allergen called parthenolide, The parthenolide had to be removed from the feverfew before it could be put in cosmetics. So, not everything that comes from plants is good for the skin. They are all natural, but natural is perhaps one of those words that doesn’t have a lot of scientific meaning, just like the word radiance. You will see a lot of topical cosmeceuticals say they improve skin radiance. Well, what is radiance? No one really knows. We think that it’s increased light reflection from the skin surface which is truly an optical effect, not implying any change in the skin itself, but if you tell someone you look natural and radiant, somehow those words have a connotation that make people feel they have an improved appearance.

Dr. Levine: Is there a way that we and consumers can sort out which manufacturers are reliable and which may not be reputable?

Dr. Draelos: Sorting out quality products can be difficult, but many cosmetic companies are now publishing the results of their research and those results are being published in dermatology journals, such as the one I edit which is the Journal of Cosmetic Dermatology. If you Google a new ingredient, you should be able to pull up some articles that actually substantiate the value of that ingredient. So looking in the dermatology literature for supportive articles can be helpful.

You will also see many companies that will put their data with their packaging. For example, their data will say “dermatologist tested,” and this is complemented by a bar graph that demonstrates efficacy. All cosmetic companies do some type of safety testing on their products, which is the Repeat Insult Patch Test (RIPT). This is done by the company or it could be done by the raw material supplier that provides the ingredients to the company.

Repeat Insult Patch Testing is where the product is applied to the back of volunteers to better understand if irritant contact dermatitis or allergic contact dermatitis might occur. RIPT testing is usually done not only on the raw materials that are put into the product, but also done on the final formulation. This type of testing is done routinely to prevent the introduction of products into the marketplace that could result in safety issues.

The second type of testing that is done is efficacy testing. Most of the large companies will do efficacy testing to prevent themselves from getting sued by the Federal Trade Commission over making false or misleading advertising claims. They will also do efficacy testing to prevent competitors from suing them and stating that they made false claims. So there are claims such as “dermatologist tested,” that now mean that some dermatologist who is board-certified in dermatology tested that product.
DermatologyTimes 2/2014