Did you know, it takes a minute for blood to travel around the whole body!?
The human circulatory or vascular system is amazing, carrying an assortment of hormones, proteins, nutrients and also exchanging gases like oxygen and CO2 from cellular respiration e.g. from energy production in the electron transport chain of the mitochondria and the by products of cell growth!
As you can get a glimpse of from the slightly gory image here from Operating Theatre Live, that shows this system injected with resin, the vascular network starts with larger blood vessels that decrease in size to become the tiny complex network of micro capillaries that supply each of the 100,000 hair follicles on the scalp.
In some hair loss conditions such as androgenetic alopecia, also known as male or female pattern hair loss, part of the physiological change reported is the diminished blood supply and subsequent lower oxygen levels reported here as compared with non-affected areas of the scalp.
Many treatments for hair loss aim to improve blood flow and oxygenation to the hair follicles in a variety of different ways and mechanisms to improve and sustain growth of the hair fibre!
The more I understand about the pathology of hair loss the more complex it becomes and I realise how much more there is to learn. Scratch the surface and there is a whole extra level that needs to be understood to be able to do this!! The hair is actually a complex mini organ and I want to know it all and be able to contribute to research to answer all those unanswered questions.
I love being able to help my patients with my knowledge, logic, evidence and have the best interests for your well being and needs. It sounds a bit corny, but it is really rewarding to help others – ok so, hair loss isn’t life threatening in most cases but it is emotional and worrying; especially when there is action that can be taken, and understanding what is happening and why; it is my ‘thing’.
I hate the misconception that trichologists are quacks or snakeoil salesmen; the stereotype must have come from somewhere and I still hear various stories where my patients have been elsewhere first and had a negative experience and in some cases a borderline unsafe experience due to the advice they were given – probably as the profession is currently unregulated, but this is as far away from how I practice as can be; putting my patients needs, safety , clinical reasoning and honesty at the centre of everything I do.
“I love being able to help my patients and share my knowledge”
But where do trichologists go when they want to learn more and develop their professional selves? This is why I find myself in the middle of a biomedical science degree (and loving it)! And why the creation of a robust and rigorous higher levels of qualification is key to me, and that those qualifications and future careers are supported and enforced through professional standards of proficiency, clinic standards, CPD and ethical conduct, to create accountability and excellent standardised practice. The bar needs to be raised.
Why are you scared about what is happening to your hair? What does your hair mean to you? What is the worst thing that could happen? Hair loss is scary when you don’t understand it, it can still be scary even when you do understand it!! The important thing to do is to take action and not let your fears take over.
Many people may say their biggest fear is losing all their hair and I get it – our hair is our crowning glory – the first thing that people see about us and it is hard to hide a bad hair day! In society today and throughout history, people look at our appearance and make assumptions about who we are, how attractive or youthful we are and in my brain this somehow equates to how liked or successful we are!! And to be completely honest I dislike that about myself – I do not consider myself to be a superficial person, yet there it is, although definitely realising this is less important as I get older and wiser!!
I get that it is entirely easy to (over?) react to any changes we see – ‘what does it mean? Where will it end?’… I had patches of alopecia areata last year and this week I counted 6 eyelashes that came out in one day… very odd and immediately my brain then goes to ‘maybe it’s coming back…’
BUT I am a Trichologist. I know what causes alopecia areata. I know what my triggers were. I know that I addressed them. I know that rationally, 6 fallen eyelashes do not mean alopecia areata. I also know the fear when you start to see hair coming out, exactly where your brain goes to!
So let me tell you that alopecia areata is the one that ‘can’ lead to total hair loss, but affects only 2% of the population. Let me also tell you it is certainly not the most common condition I see when there are cases of excessive hair shedding and you feel the need to start counting the hairs coming out. I don’t think it takes away the concern entirely as the principles of ‘self’ are complex, but having someone to confirm the diagnosis, the likely triggers and truthfully discuss all your options for exactly what you are dealing with can certainly help.
So face your worries and fears. Deal with what is happening. Dig deeper into your subconscious; what’s the worst that could happen? Not dealing with it!!
Fear of the unknown is always worse than the known, as your brain likes to play tricks on you. It may not actually be what you are thinking or anywhere near as bad as you thought. If your ‘worst’ is confirmed, it is far better to know and take the action needed to deal with it both physically and mentally whatever the diagnosis is, so you can move forward with your life with nothing holding you back.
I am pleased to announce that in collaboration in Higgins Lab at Imperial College London, our work on the scalp microbiome in alopecia has been chosen for funding by the Alopecia UK Patient’s Choice for 2020. This is a fascinating area of research with still a lot to be discovered; it is apparent in many skin conditions such as atopic dermatitis that there is a dysbiosis in the resident populations of microbiota and that it can contribute to inflammatory responses in the host (us!). Topical ‘pro and post-biotics’ products are already starting to appear on the market and this is an area that is expected to see huge growth over the coming years. Our research project will help to inform further research as to the implications of any variations in the resident populations of bacteria found in hair loss conditions and also novel therapies that can help to target them.
Thyroid hormones (thyroxine (T4) and triiodothyronine (T3) stimulate the production of specific enzymes to be made; this includes a key enzyme in energy production called cytochrome oxidase that is needed for cellular energy production in the electron transport chain of the mitochondria. The mitochondria are directly related to the availability of energy (ATP) in every cell to produce energy for cell growth and normal metabolic rates. This is why when thyroid hormone production is reduced, the clinical features are fatigue, cold intolerance, weight gain and constipation to name a few as the bodies metabolic processes slow down.
T4 is produced in much larger quantities by the thyroid gland and is converted into T3 in tissues in the body, which is up to 4 times more potent than T4.
In the hair follicle, a reduction of thyroid hormones results in excess shedding of hair and a dry, brittle texture, but conversely an excess of thyroid hormones can also produce excess hair shedding, a reduction in hair shaft diameter, brittleness but also with greasiness from the sebaceous gland over-stimulation.
Hair follicles express thyrotropin-releasing hormone (TRH) and thyrotropin (TSH), and have receptors to thyroid hormones T3 and T4. Here are some of the cellular mechanisms that these hormones impact on the hair follicle:
T4 stimulates keratinocyte proliferation in the hair matrix
T3 and T4 inhibit apoptosis of the keratinocytes in the hair matrix
T3 and T4 prolong the duration of anagen
TGF-B2 is inhibited by thyroid hormones (TGF-B2 inhibits anagen, interestingly this is upregulated in androgenic alopecia and in retinoid-induced hair loss)
T3 and T4 stimulate hair follicle pigmentation
T3 and T4 reduces reactive oxygen species formation and increased amount of ROS scavengers.
T3 and TSH increase follicular heat production
Beek N et al, (2008), Thyroid Hormones Directly Alter Human Hair Follicle Functions: Anagen Prolongation and Stimulation of Both Hair Matrix Keratinocyte Proliferation and Hair Pigmentation, The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 11, 1 Pages 4381–4388,available from https://academic.oup.com/jcem/article/93/11/4381/2627273
Marshall. W et al. (2017) ‘Clinical Chemistry; Chapter 11 The Thyroid Gland’, Elsevier UK
I have made the difficult decision to cease face to face working in the clinic. Well… it wasn’t so difficult – lets face it… public health must come first and I want to do my bit. At the moment, we are preparing for the worst. hoping that it won’t really come to what they are saying it will, or the death toll won’t rise as high as it has done in other countries, and that our amazing NHS will be able to cope…
Nobody knows at the moment. Its easy to forget what’s going on outside, sitting at home at the moment with the blue skies and sunshine all around… just my sons hacking cough to remind me why we’re all here!!
Hair loss is scary and your concerns are real and deserve to be discussed, often talking them through with someone who can give you the facts can help to alleviate some of those worries. An itchy scalp is irritating and seemingly endless. there are simple things you can do to help relieve some of this until we can get to the bottom of the cause once all this goes away (fingers crossed!)
I will be posting blog updates with hints and tips of the coming months, as well as some interesting nuggets of info that I come across from my biomedical degree as I find them.
Remember, social distancing doesn’t have to mean a black hole of isolation. I am here for an email or a chat between homeschooling my two kiddies!
Stay safe out there and see you on the other side!!
I am proud to be part of the Trichology Professional Development Programme. We are group of well qualified and enthusiastic individuals who are instigating improvements within the Trichology Sector. We want there to be robust regulation, accredited qualification and adherence to occupational standards by all Trichologists to not only improve the professional standing of Trichology, but also public safety. We will have more to say at our official launch in May 2020! If you are a professional or wanting to get into Trichology, please see www.tpdp.co.uk to register your interest for updates.
Looking forward to speaking for the third time at the BAHRS conference at Aesthetic Medicine at the weekend. This year I’ve been asked to talk about the future of Trichology to the audience of hair transplant surgeons and aestheticians. I’ll let you into a secret… there are some exciting times ahead!