A Warm Welcome

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I’ve revamped the blog for all my old readers and also my new readers. Trichology is a specialised branch of dermatology, specialising in conditions that appear in hair bearing regions. To my astonishment I found that there are many diseases, conditions, infections and infestations that are specific to your hair or scalp. In this blog you can find a wealth of verified information on hair loss and scalp conditions from a licensed clinical trichologist (yours truly.)

Make sure you follow me on social media (to your left), and write to me for advice. If you want to contribute to this blog in any way or have a story you want to share concerning your own experience with hair loss, you can also write to me. 

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Melanoma of the Scalp Kills Twice As Fast, So Why Aren’t Hairdressers Spotting Them?

I am on a personal campaign to show the world that barbers and hairdressers can save lives. When I worked as a hairdresser I saw health warnings on the top of people’s heads that only a hairdresser was best placed to noticed. However, I was ignorant to the signs and fearful of addressing something that didn’t seem like my area of expertise. I’m talking about a myriad of signs and symptoms on the scalp denoting a number of underlying health concerns. But a little brown spot is by far the most ominous sign of them all.

melanoma1

Little brown spots bearing certain characteristics can actually be melanoma of the scalp. I didn’t know this until I became a trichologist. Clinical Trichology is a specialist branch of dermatology that is dedicated to the diagnosis and treatment of hair and scalp conditions. Trichologists investigate things like hair loss conditions (which have many causes), eczema and psoriasis of the scalp, infections and infestations on the head and more. One of the most powerful things I learnt while training as a trichologist is the ability to differentiate a cancerous mole of the skin from a benign one.

Melanoma is a type of skin cancer that arises from melanocytes, which are the cells in the skin that produce pigment (melanin). It is most often caused by excess UV light from the sun or tanning beds. According to cancer research UK, this is the 5th most common cancer in the UK, with over 15,000 new cases each year, rising 7% year on year in the UK. Melanoma almost always begins with a mole or freckle, which can appear on the scalp too. In fact, a study published in the dermatology journal of the American Medical Association (JAMA Dermatology) found that while 6% of melanomas were originating from the scalp or neck yet they accounted for 10% of deaths from melanoma. They went on to show that scalp or neck cancers had a death rate that was almost 2 times higher than melanomas arising from other places. This suggests that scalp or neck melanomas are the most lethal and researchers suggest that this increased risk is down to delayed diagnosis. This is a wonder to me because surely, a man or women who visits the salon or barber even just once or twice a year should not have to worry about melanoma of the scalp.

A story titled ‘How my Hair Dresser Saved my Life’ was reported on the Today Show, and it chronicled how a hairdresser saw an oversized freckle on the back of her clients scalp that she’d never seen before. She knew that this was an ominous symbol and suggested that her client see a dermatologist about it. It turned out to be stage zero melanoma, easily fixed by surgery. But the sister of this hairdresser works in dermatology and had given her sister this level of awareness, meaning this was not the ordinary hairdresser.

That’s why I advocate that all cosmetologists learn how to differentiate these moles or freckles the way trichologists and dermatologists do. In this way cosmetologists can become truly competent as a safeguard for health and wellness. It’s actually as simple as ‘ABCDE.’ Quite literally, ‘ABCDE’ will show you how to differentiate a mole or freckle from a cancer. ‘A’ means it will be ‘asymmetrical’ in shape. ‘B’ means it will have an irregular as opposed to smooth ‘border’. ‘C’ means it will have more than one ‘colour’, or an uneven distribution of colour. ‘D’ means the ‘diameter’ will be more than 6mm most of the time. Lastly ‘E’ means ‘evolution’, this is to say when a mole or freckle has changed in size or colour, bring it to the attention of your GP immediately. Understandably, if its hidden by your hair, you may never know, and your doctor hardly ever has a reason to examine your scalp. But there’s no spot on your head that your hairdresser or barber won’t see. So why don’t they know their ABCDEs?

Abcdemelaonoma

 

orginal study about melanoma of scalp or neck:
https://jamanetwork.com/journals/jamadermatology/fullarticle/419633

 

 

Scalp Conditions Triggered by Excess Heat From the Sun

2018 has been among the hottest summers on record since records began in 1910.

Is your scalp suffering as a result? There are still conditions that can flare up on your scalp because of heat, sweat and UV radiation. I am a trichologist, which means I work in a specialist area within dermatology, where my job description entails diagnosing and treating hair loss and scalp conditions. The following are a few common conditions you should look out for towards the end of a long hot summer. These conditions are scalp folliculitis, seborrheic dermatitis and melanoma.

scalpfolliculitis

above: scalp folliculitis

Scalp folliculitis may be aggravated during a hot summer because heat and sweat may allow a warm and moist environment for bacteria to thrive in your hair follicles. It basically looks like acne around your hair follicles. Here’s an interesting insight into medical terminology, if you see ‘itis’ at the end of a word, it’s referring to the ‘inflammation’ of the thing before it. So folliculitis literally means inflammation of the follicle, which refers to the cavities in your skin from which hair is produced. Inflammation refers to a process that the body initiates to protect you from infection. Folliculitis is caused by certain bacteria (mostly likely staphylococcus aureus) thriving inside your follicles, which can become very hospitable to bacteria when you’re warmer and more moist than usual. In general men are more affected by this condition than women, especially those that have acne-prone skin. Pseudofolliculitis barbae and Sycosis barbae are two kinds of folliculitis that many men with beards will be familiar with. They target facial hair and are caused by general irritation of the hair follicles caused by shaving and ingrown hairs. These spots can be very itchy, sore, red and crusty and may leave depressed scars in extreme cases. Treatment is possible using antibacterial shampoos and light therapy. Some folliculitis cases can be very serious in that they are characterised by recurring or spreading infection, boils under the skin and scarring alopecia due to follicle damage, which causes permanent hair loss. For this, a doctor might prescribe a form of antibiotic. Note that antibacterial agents will not work if you have pityrosporum folliculitis, which is a fungal infection and therefore requires an antifungal medication.

 

Seborrheic dermatitis, which causes extreme dandruff, can also be aggravated by hot weather for a similar reason. The likeliest cause of this condition will be a fungus called Malassezia globosa, which thrives on your sebum (natural oils) especially when you’ve been warm and sweaty. Dermatitis describes inflammation of the skin and seborrheic dermatitis describes inflammation that results from excessive secretion of sebum from your skin. This is why seborrheic dermatitis targets the oiliest areas of the skin such as the scalp and the sides of the nose. On the scalp it may look like excessive dandruff (patches of whitish, greyish flakes) and will be itchy and red. This can disappear on its own but may be treated by topical antifungal medications prescribed by a doctor and commercially available shampoos like Nizoral if the problem is relatively mild.

serbohicdermatitis

above: seborrheic dermatitis

 

Now you might believe that your hair will protect your head from UV but this isn’t always 100% effective, because you still maintain a considerable surface area of gaps on your head, such as your parting, and melanoma only takes one rogue cell. Now have you ever realised that these areas are the most exposed to UV and don’t get any sunscreen? If you are in the process of losing your hair, such as if you have male pattern baldness, I sincerely hope you don’t forget your head when you’re applying sunscreen or you wear a hat. Melanoma is a type of skin cancer that arises from melanocytes, which are the cells in the skin that produce pigment (melanin). It is most often caused by excess UV light from the sun or tanning beds. Melanoma almost always begins with a mole or freckle, which can appear on the scalp too. The Journal of the American Medical Association (JAMA Dermatology) found that scalp or neck cancers had a death rate that was almost 2 times higher than melanomas arising from other places on the body. Researchers suggest that this increased risk is down to delayed diagnosis. I strongly suggest that after a summer like this you should monitor your moles or freckles for the next few months by checking them using the ABCDE’s of melanoma, including your head too. ‘ABCDE’ will show you how to differentiate a mole or freckle from a cancer. ‘A’ means it will be ‘asymmetrical’ in shape. ‘B’ means it will have an irregular as opposed to smooth ‘border’. ‘C’ means it will have more than one ‘colour’, or an uneven distribution of colour. ‘D’ means the ‘diameter’ will be more than 6mm most of the time. Lastly ‘E’ means ‘evolution’, this is to say when a mole or freckle has changed in size or colour, bring it to the attention of your GP immediately.

 

 

 

Pediculus Capitis

pedicul

Introduction

Pediculus Capitis is the infestation of which reside on the scalp and hair shaft. Pediculus Capitis can be referred to as head lice or informally as cooties. These are little but visible organisms that live on the human scalp. These tiny parasites survive by feeding from human, getting their nutrients from sucking human blood for 4 to 5 times a day. Their way of sucking blood can irritate and cause discomfort by way of itching to the scalp. This itching can be especially uncomfortable at night during sleeping. Patients affected by pediculus capitis do not experience itching immediately but they usually feel the symptoms after a period of four to six weeks.

Head lice can spread easily from one infected person to another non-infected person through head to head contact, and also head through comb sharing, bed linen, clothes and towels etcetera. The spread of head lice is very common with children in schools. Pediculus Capitis is not a life threatening, but causes great discomfort and sometimes can secondary infections to the scalp due to excessive scratching.

Life cycle and morphology

 The life cycle of a head louse begins with an egg, which is referred to as a nit. Nits are produced and laid by a female head louse after mating with a male member of the species. These nits are laid in a group of 3 to 4 eggs per day. The eggs have an oval shape of around 0.8mm length and they are laid close to the scalp where they can get the right temperature for development. The female head louse releases some form of glue like substance, which attaches the nit to the hair shaft.

Nymphs are the second stage in the life cycle; they hatch from the eggs as immature head lice. The growth of a head louse can take 12 to 24 days depending with the blood supply. An adult head louse can grow to a size of almost 2 to 3mm long.  They have a lifespan of up to thirty days. Head lice cannot survive for more than three days out of its host.Head lice have no wings, so they neither fly nor jump. Head lice usually prefer to dwell in darker areas where there is less light like nape of the neck or behind ears.The colour of head lice could depend on the environment they resides on, but in most cases they are grey in colour.

Epidemiology

Pediculus Capitis has grown to be a worldwide concern, since the 1960s. The numbers has risen to millions per year affecting mainly children between the ages of 3 to 13 years.  There was at least one outbreak reported by 80% of American primary schools affected by head lice in 1997. This was a higher incidence rating than chicken pox in children. In United States as whole, the estimate is that 6-12 million children receive treatments every year for lice infestation. Girls in general, are infected more frequently than boys, perhaps as consequence of keeping longer hair.

African Americans are the least affected in the United States. The condition of head lice is not common in afroid hair due to the texture and density of the hair. In certain parts of Africa all manner of lice are known to spread diseases, namely typhus. In the case of typhus the louse acts as a vector, which defines a larger organisms that commonly carries and transmits a smaller disease causing organisms, which is Rickettsia bacteria in typhus. Typhus kills 10 to 60% of those affected without treatment.

Psoriasis Of The Scalp

psoriasis

Introduction and Epidemiology

Psoriasis is a chronic dermatitis of the skin, a consistent hyperactive growth of cells appearing on the integumentary system. Psoriasis is an inflammatory autoimmune disease that alters the life cycle of skin cells, shortening them from a month to a week of cell production. These dead cells are thick, dry and silvery with overlapping flaky scales that can resemble dandruff. The condition is not contagious and can range from mild to severe cases of inflammation of skin. The disease is thought to be the result of genetic susceptibility with environmental influences.

The five main manifestations of psoriasis include erythrodermic, pustular, guttate, inverse and plaque psoriasis (see table 1). Plaque psoriasis is seen in approximately 90% of cases as patches of white scales under which there is a red area, it is also known as psoriasis vulgaris. Pustular psoriasis can be seen as pus-filled blisters. The gluttate form presents as ovular lesions and the inverse form describes the red patches seen in skin folds. Erythrodermic is an advanced from where the psoriasis is affecting most of the body sites including the face, likely as multiple forms. Typically the area affected are the forearms, shins and around the midriff but 50% of those diagnosed have scalp psoriasis perhaps solely or as an addition. For the purpose of this piece the psoriasis mentioned will assumed to be psoriasis vulgaris of the scalp.

There is often a mild to severe pruritus that comes with psoriasis, along with the visibility this can cause emotional distress, anxiety and low self-esteem to certain individuals. There has not yet been a cure for psoriasis but there are over counter medications and prescriptions that could be used to alleviate the disease symptoms. Three quarters of cases can be managed with creams. The disease affects 2-4% of the western population with no particular preference between men and woman, it can begin at any age but 33% will be diagnosed before twenty.

Aetiology

The function of the immune system is to recognise and neutralise non-self antigens, but autoimmunity occurs when there if a failure in supressing self-antigens, leading the targeting of a tissue type. This is what occurs in psoriasis, and the cells that have been implicated are T cells, they are believed to mediate an immune response against living skin tissue, but only in restricted areas. The life cycle of cell production should last between three to four weeks under normal circumstances but this process is reduced by three to seven days, due to the inflammatory environment, which includes a lot of death inducing molecules as well as offensive attack by immune cells. There is an increased development of cells in order to repair the dead cells. This results in an excessive proliferation of cells that quickly die, thus they accumulate in layers of dry scales on the surface of the skin. Psoriasis can be triggered by anything that has an impact on the immune system like stress, skin injury, certain infections like throat infection, some medications like antimalarial  and excessive intake of alcohol and smoking. HIV patients are prone to be affected by psoriasis due to their immune impairment.

As previously mentioned, the disease is thought to be the result of genetic susceptibility with environmental influences. Genome wide association studies is a technique that attempts to find similarities within the genomes of patients suffering from a disease, similarities that don’t exist when compared to unaffected individuals. These areas, named loci are said to be linked to the disease. There have been nine such loci found for psoriasis and they have been named ‘psoriasis susceptibility’ PSORS 1-9. Within these areas are genes known to be part of the inflammation pathway and some of the genes are known to be involved in other autoimmune conditions. Interestingly the HLA genes (human leukocyte antigen) have been seen to have strong linkage with the disease, and these are the self-antigens on body cells that interact with T-cells in order to communicate that they are infected, leading to a T-cell mediated immune response that leads to the death of that cell.

 

 

Pityriasis (seborrhoeic dermatitis)

Introduction

 Pityriasis, seborrheic dermatitis or seborrheic eczema is a chronic inflammatory skin disorder that causes dandruff. This is a disease that targets body areas with excess production of sebum from the sebaceous glands; primarily the scalp but can also include the face and centre of chest. The initial stages of seborrheic dermatitis are redness and inflammation of the skin or scalp. This stage is followed by a build-up of dry and itchy scales. A mild form of seborrheic dermatitis of the scalp is known as dandruff, which is much more common. Cradle cap is the name used to describe seborrheic dermatitis in infants younger than three months. It appears on the scalp as well as the nappy area, is not usually itchy and will disappear after a few months. Seborrheic dermatitis though chronic is usually manageable, using treatments and precautions discussed later in this essay.

Aetiology

Seborrheic dermatitis is a condition prompted by a number of factors. Malassezia globosa is a fungus that resides harmlessly on the surface of the skin. This is a yeast that that thrives on sebum. Its overgrowth, which is thought to be prompted by the overproduction of sebum, is believed to cause the inflammation. The yeast affects patients with a low resistance to Malassezia, such as patients with immunodeficiency like HIV or a lack of zinc. Seborrheic dermatitis can also affect patients with nervous system issues like Parkinson’s disease and stroke victims. Stress and fatigue can also be a trigger to the condition.

Seborrheic dermatitis is also thought to be genetic in nature and environmental factors such as cold weather can trigger the condition. Changes occurring during puberty can aggregate the condition, primarily the increase in sebum production that occurs on the face and scalp. Insufficiency of the vitamin B group are also thought to cause seborrheic dermatitis, these are biotin, pyridoxine and riboflavin. Too much intake of vitamin A has also been seen to cause seborrheic dermatitis in children. However, the BAD states that the condition is not related to diet.

Epidemiology     

Seborrheic dermatitis affects almost 4% of the U.K population according to the British Association of Dermatologists (BAD), Bupa puts this number at 5%. It usually affects adults between 30 and 60 years of age. The BAD also states that the milder form of seborrheic dermatitis (dandruff) can affect almost half of all adults. The condition appears to affect more men than women. In infants the diseases is referred to as cradle cap or infantile seborrhoeic dermatitis but is short-lived. Seborrhoeic dermatitis can start anytime after puberty, possibly due to an increase in sebum production that usually occurs during and after puberty.

 

Languno, vellus, androgenic and terminal hair- a journey of hair!

                                        

 The forms of hair appearing throughout life!

Lanugo hair is the first to be produced by the follicles. This usually un-pigmented, very fine hair grows from the foetus at around 20 weeks and it falls off approximately 36 weeks from conception, which is nearly full term. This means that infants are not usually born with the lanugo hair but sometimes it remains present, especially in premature births. This baby will ingest this lanugo hair as part of the amniotic fluid so it can be found in the meconium, a sticky green substance found in the gut that forms the babies first poo.

Lanugo has the purpose of holding the vernix caseosa on the skin. This is a white substance, often compared to cheese and primarily made up of sebum from the sebaceous glands at around 20 weeks from conception. This substance is hydrophobic, meaning it repels water, a quality that seems central to its purpose. This has led to the theory that its function is to prevent evaporative heat loss after birth. Others add that it also lubricates so as to facilitate passage through the the birth canal. Lanugo hair is not only found on the foetus and some newborns but it can also be found on patients of anorexia and bulimia nervosa as it is a sign of malnourishment.

After birth lanugo hair is replaced by vellus hair which is even finer and less noticeable than lanugo hair. It does not grow long (2-4cm), it doesn’t often have pigment and it is not associated with sebaceous glands. The name for this hair comes from the latin meaning ‘a fleece’, or ‘wool.’ This seems appropriate since its function is thermoregulation; this hair is associated with arrector pili muscles which when contracted cause the vellus hair to stand up. This holds a layer of insulating air on the body which slows down the rate of heat loss though radiation.

Eating disorders such as anorexia nervosa can also increase the vellus hair on a person as well as hormonal imbalances. For example in Cushing’s Syndrome the over production of cortisol, a steroid hormone produced by the adrenal glands, causes the over abundance of vellus hair. Vellus hair can also be found on the scalp of males with androgenic hair loss as modified testosterone (DHT) causes the terminal hair follicles to miniaturise such that vellus hair is produced instead.

Androgenic hair is body hair which is acquired as of puberty, this hair is thicker, coarser and darker than the other types. This hair, sometimes known as pubic hair starts of as vellus hair and then becomes androgenic hair which is often subcategorised with terminal hair (the hair growing from the head) though they are not quite the same. The two are differentiated by appearance and texture (androgenic is coarser and darker) and also by differences in growth cycles. Androgenic hair has a shorter anagen (growth) phase and a longer telogen (rest) phase. In terminal hair the growth phase lasts 2-7 years and the rest phase lasts 3 months whereas in androgenic hair the growth phase lasts several months and rest phase is approximately a year. This explains the difference in length between terminal and androgenic hair, the androgenic is growing for less time so does not grow long.Androgenic hair turns into terminal hair because of the elevated androgen levels during puberty, which are male sex hormones. It’s noteworthy that these also exist in females, as a precursor to female hormones (named oestrogens.) They are converted from one to the other by the enzyme aromatase, especially testosterone. It is thought that men exhibit more androgenic hair than women because they have more androgens than women.

Terminal hair is the hair that grows from the scalp, it grows the longest and is the strongest.

This is part of a recent essay submitted as part of  my trichology course.

Authored by Agnes Marufu (Wadzie Claire)