June 2006 - Posts
Hair loss among children can occur as a result of a common, but usually unrecognized, behavioural disorder known as trichotillomania, where hair loss is a side effect of the condition. It manifests itself as uncontrollable hair pulling, similar to impulsive disorders such as pyromania or kleptomania. The disorder usually presents itself in males at the age of 8 and in females at the age of 12 and has a prevalence of about 1%.
Sufferers of trichotillomania generally spend about an hour per day pulling their hair out, for a few seconds or minutes, or for prolonged periods of time. Some may try to resist the urge, but some are unaware of its occurrence, pulling hair absent-mindedly while driving, reading or watching television. Many also engage in oral behaviour while pulling as well, such as touching the lip. Another occurrence associated with trichotillomania is trichophagy, where the patient eats the hair, resulting in the development of bezoars (hair balls) in the stomach and small intestine.
While the disorder itself is a stressful and complicated condition, the hair loss that may result is an unfortunate, additional complication that affects many children and teenagers psychologically and emotionally. The hair loss that occurs is usually focused on the scalp, but also occurs among the eyebrows, lashes and pubic region. Hair loss is usually patchy, irregularly shaped and occurs predominantly on the side of the body that coincides with the person’s predominant hand. Most sufferers of trichotillomania try to hide their hair loss, prolonging diagnosis and complicating treatment.
A significant side effect of this disorder is the loss of self-esteem and compromised social development. A child or teenager coping with this disorder is likely to feel embarrassed or ashamed of the habit. Furthermore, most parents misinterpret the condition as bad behaviour, responding with criticism, anger and punishment. It is important that all family members are educated in the disorder and are involved in the treatment.
Treatment for trichotillomania includes behaviour therapy and/or medication. Possible drugs may include clomipramine, sertraline, citalopram, paroxetene, venflaxafine, naloxone, as well as mood stabilizers, anxiolytics (drugs that work on the central nervous system to relieve anxiety), neuroleptics (also known as antipsychotics) and topical agents including steroids.
However, behavioural therapy has been found to be superior to drug therapy, especially if the hair pulling has only been occurring for less than six months, and because there is as of yet no clear guidelines for how drugs should be used to treat trichotillomania. One of the most effective types of behavioural therapy is ‘habit-reversal-training’. This method involves the patient identifying common patterns in the hair pulling including what triggers the urge. The patient can then anticipate when the urge is about to occur and can take steps to prevent it. To do so, he or she performs a competing response, such as tightening the fist, which should interrupt the urge to pull their hair.
With help, sufferers of this behavioural disorder, and its subsequent hair loss, can slowly but surely overcome the condition. If it is taken under control, further hair loss can be prevented and the child or teenager can resume their normal lives without worry of uncontrollable urges or hair loss.
- Gerstein, Betty F., M.D. “Trichotillomania: A hair-raising dilemma”. Patient Care Canada. Vol. 17, No. 2. February 2006. pp. 27-34.
Alvi Armani specializes in hair transplants that combine scientific methodology and artistic ability, perfected into the Alvi Armani Hair Transplant Technique, so that you, our patients, may benefit from Dr. Antonio Alvi Armani’s acquired experience and expertise in the field of hair transplantation.
The Alvi Armani Hair Transplant Technique offers patients of Dr. Antonio Alvi Armani something that other surgeons in the field cannot. People who choose to invest in a hair transplant from Alvi Armani will not only receive a hair transplant that utilizes the best of advanced hair transplant procedures, they will also receive a hair transplant that looks natural and appealing because extra care is taken to design the hair line and temple areas so that it is uniquely suited to the individual.
The design of the hairline is based on the basic principles of the face as defined by Leonardo Da Vinci. The distance from the eyebrows to the hairline is half the distance from the eyebrows to the chin. By following this formula, the hairline is guaranteed to appear natural and attractive.
In order to further naturalize the hairline, single-hair follicular units are used in a soft, and even, distribution along the front of the hairline. Two- and three-hair follicular units are then blended in to create greater density as the hair moves away from the frontal hairline. This gentle blending of different-sized follicular units is essential to creating a natural appearance; it is also essential that the transplanted hair be carefully blended in with the pre-existing hair.
The principles of hairline design do change somewhat depending on the age of the individual. For those mature patients who wish to have a higher hairline, in order to establish a more mature look, Alvi Armani does offer this as an option.
The region where your hairline meets your temples is a very important area of your hair transplant, as well. The way the hairline meets the sides of your head forms a frame around your face and is very important to the overall look of your hair. Unfortunately, many hair transplant surgeons neglect the design of this area and the temple angles look awkward and unnatural. This is due to the technical difficulty of angling the transplanted hairs in this area, and the time it takes to implant the hairs. At Alvi Armani, however, the temple angles are considered to be an absolutely necessary component of the hair transplant, and care is taken to ensure the attractiveness and natural-look of the temple angles, regardless of time, effort or cost.
At Alvi Armani, we believe that a hair transplant is not just a matter of restoring hair. It is equally important that your Alvi Armani hair transplant look natural and attractive. Dr. Antonio Alvi Armani can provide you with a hair transplant that is completely natural, not only because it uses your natural hair, but because it is suited to your individual face shape, and looks natural for you.
Hair loss due to ringworm is more common than you may think. Ringworm is a contagious fungus infection that can infect anyone, and that occurs differently based on the part of the body that it infects. The four different types of ringworm include the kind that affects the scalp, the kind that affects the nails, the kind that affects the feet, and the kind that affects any other part of the body (particularly the groin). If ringworm of the scalp occurs, the symptoms will likely include partial, but temporary, hair loss.
The hair loss that accompanies ringworm of the scalp results from an infection that manifests itself on the scalp as a small pimple, which grows larger and leaves scaly patches of baldness. The areas can be described as yellow, crusty areas and the infected hairs become brittle and break off, resulting in hair loss. This type of ringworm is more likely to affect children from the ages of 4-14, though it can occur with adults. It also is more likely to infect a child with a weakened immune system, such as those with AIDS, cancer or diabetes.
The other types of ringworm affect the other areas of the body in different ways. Nails that have been infected with ringworm become thicker, brittle and discoloured. They might also become chalky and disintegrate. Ringworm of the feet is better known as athlete’s foot, which is characterized by the skin becoming scaly and cracked. Finally, the ringworm that infects the rest of the body appears as a flat, round rash on the skin that is often itchy. The rash will gradually expand, and the centre will become clear, creating a red ring. This is where the term ‘ringworm’ comes from.
Ringworm is spread in one of two ways: via direct contact with a person or pet, or through an object or surface that an infected person has come in contact with. It is more likely to occur in overcrowded, urban areas. It is caused by several different fungus organisms, all belonging to the group ‘Dermatophytes’. The fungi that cause ringworm of the scalp live in humans and animals; the fungi that cause ringworm of the nail and feet only live in humans; and the fungi that cause ringworm of the body live in humans, animals and in the soil. Symptoms of scalp ringworm generally appear in 10 to 14 days after contact, while symptoms of ringworm of the body usually appear 4 to 10 days after contact.
Treatment of ringworm can be taken either orally or as a topical cream that is applied directly to the infected area. A failure to treat the infection, or inadequate treatment, can result in a chronic infection. Ringworm is unfortunately very contagious and difficult to prevent. However, preventative measures can include keeping common-use areas clean, and not sharing clothing, towels, hairbrushes or other personal items.
Thankfully, ringworm of the scalp only causes partial and temporary hair loss. Nonetheless, precautious behaviour may save you from the unpleasant experience that accompanies any type of hair loss.
Hair transplants, and you, will soon be able to benefit from such scientific, medical advancements as cloning, gene therapy and donor hair research. Such advancements aim to use what we already know about the structure of hair and use it to further the field of hair transplantation.
Hair transplants are being researched and developed that involve two current methods of cloning. The first method is called in-vivo cloning. It involves cutting the hair follicle at different levels to produce more than one follicle. By cutting the follicle midway at the stem cell level, two follicles can be reproduced from one. The new growing hair is thinner in diameter than the normal hair follicle. The cutting must be made very accurately at a very specific level, transversely, to produce very specific stem cells.
The other cloning method being researched is called in-vitro cloning. In this method the stem cells from the hair follicle are taken and grown in a Petri dish. In this way, new duplicate cells are cloned. Later, these new cells can be inserted back into the scalp instead of follicles with hair. It is believed that hair may be able to grow from the cells themselves. The perfection of this technique of cloning would mean that even the man or woman with very few hairs could have thousands of cells replicated in a Petri dish. From a single hair, or just a few, thousands of hair cells can be grown in a lab that can later be injected into the scalp to grow hair.
Another method to restore lost hair that is likely to emerge in the near future is gene therapy. Gene therapy promises the potential to grow new hair follicles, as opposed to just stimulating dormant follicles to grow hair again.
The idea behind gene therapy is to correct an inherited or acquired condition that prevents hair growth by introducing a DNA sequence (a genetic chemical) into the balding scalp. The introduced DNA sequence itself does not correct the problem causing balding, but it creates a sequence of chemical transactions that enter into the patient’s cells. The cells then start producing the proteins necessary to give the skin the ability to produce new hair follicle cells.
A third advancement involves the concept of donor hair therapy. Usually, hair transplantation occurs in the same individual, from one part of the body to another. This is referred to as auto-transplantation. However, allo-transplantation of hair occurs when hair is transplanted from one individual to another. Traditionally, allo-transplantation has not been an option because hair is considered strongly antigenic; this means that the scalp of the individual receiving the transplant will likely reject the hair. Recently, however, advancements have been made in follicle cell transplants in incompatible hosts that give hope for allogenic hair transplants. Research and tests done with allogenic hair transplants have revealed what obstacles prevent allo-transplantation from working. And further work is being done to overcome those obstacles in order to advance the way we understand and perform hair transplants.
Hair loss can occur as a result of thyroid disease, which may present itself as either hyperthyroidism (hyperactivity of the thyroid gland) or as hypothyroidism (inadequate activity of the thyroid gland), both of which can cause hair loss.
Hair loss due to thyroid disease is not the only danger of an overactive, or underactive, thyroid gland, however. The thyroid gland resides in your neck and the hormones it produces are involved in many of your body’s functions, your metabolism in particular, making its proper functioning vital to your overall health.
In regards to thyroid disease and hair loss in particular, an example of the thyroid affecting hair growth can be seen in a condition referred to as ‘congenital hypothyroidism’ (the term ‘congenital’ means that the condition is present at, or since, birth). The condition includes a thinning of the hair on the scalp and total hair loss of the armpits and pubic area. The condition results from a lack of thyroxin, specifically, which is a hormone produced by the thyroid gland that regulates metabolism.
When hypothyroidism develops in a young person or adult, however, there is just a slight thinning of the hair on the scalp. Treatment will usually stimulate a re-growth of the hair unless there has been follicular atrophy or the hair loss has been accelerated by other causes.
Other symptoms of hypothyroidism include fatigue, weakness, weight gain (or increased difficulty losing weight), dry skin, intolerance to the cold, muscle aches or cramps, constipation, irritability, depression, memory loss, abnormal menstrual cycles and/or a decreased libido. The presence, severity and combination of these symptoms for each individual is dependent on the severity of the hormone deficiency and the length of time that the body has gone without an adequate amount of the hormones.
An underactive thyroid gland may become enlarged due to a bombardment of thyroid-stimulating-hormone (TSH) produced by the pituitary gland, which is produced to try to entice the thyroid to produce hormones. The result is the creation of a ‘goiter’.
The most common cause of hypothyroidism is a previous (or ongoing) inflammation of the thyroid gland that leaves a large percentage of the gland’s cells damaged or dead, and therefore incapable of producing enough hormones for the proper functioning of the body. The most common cause of this kind of inflammation is autoimmune thyroiditis, which is caused by the patient’s own immune system. Hypothyroidism may also be a result of certain medical treatments that, indirectly or directly, affect the thyroid gland.
Hyperthyroidism may also cause thinning of the hair on the scalp, as well as the hair in the armpit. Other symptoms may include: palpitations, intolerance to heat, nervousness, insomnia, breathlessness, increased bowel movements, light or absent menstrual periods, fatigue, increased heart rate, weight loss, trembling hands, muscle weakness and warm, moist skin.
Hyperthyroidism may be caused by a condition called Graves’ disease, which is caused by an overactive thyroid gland as a result of antibodies produced by the patient's immune system which attach to specific activating sites on thyroid gland which in turn cause the thyroid to make more hormone. It is characterized by overactivity of the thyroid gland possibly manifesting in a goiter, swelling around the eyes due to inflammation and a thickening of the skin over the lower legs. These symptoms vary in severity. Hyperthyroidism may also be caused by a single, overactive nodule in the thyroid gland. It can be treated with drugs, radioactive iodine and surgery.
In either case of hypothyroidism or hyperthyroidism, the symptoms of a malfunctioning thyroid gland are numerous and possibly dangerous. It is estimated that half of the people who have thyroid disease are unaware of the cause of their condition. It is worth the trip to the doctor to determine whether or not you have thyroid disease if you display any or all of the possible symptoms, including hair loss.
Hair loss can result from the use of many chemicals frequently in therapeutic use, though the hair loss is usually diffuse.
Hair loss due to thallium:
Thallium salts were once used to remove hair from scalps that were infected with ringworm. The chemical causes hair loss by disrupting keratinisation, which is the process by which proteins called keratin form your hair. It becomes absorbed into the hair follicle during the growing, or anagen, stage of hair growth. Many of these hairs break within the follicle. An irregularity of the dark keratogenous zone and air bubbles within the shaft near the tapered tip give a distinctive appearance. Many other hairs, meanwhile, enter the catagen phase of the hair cycle, where the hair stops growing, prematurely.
After about 10 days of diffuse shedding of abnormal anagen hairs. The hair loss may rapidly become complete, or with lower doses of thallium, the initial diffuse hair loss may be followed by a gradual shedding of club hairs over a period of 3 to 4 months.
Hair loss due to thyroid antagonists:
A patient may develop diffuse hair loss when give anti-thyroid drugs to combat hyperthyroidism (overactive thyroid gland), converting the condition into hypothyroidism (underactive thyroid gland), which is known to cause diffuse hair loss.
Hair loss due to anticoagulants:
All anticoagulants, also known as blood thinners, will induce hair loss. The highest dose, not the duration of exposure, determines the degree of hair loss. Normal club hairs, which are non-growing hairs formed during the transitional stage between the growing and resting stages of hair growth, have been known to fall out 2 to 3 months after the blood thinners have achieved the effective blood level. A full recovery should follow slowly after the drug is stopped.
Hair loss due to cytostatic agents:
Many cytostatic drugs cause hair loss. A cytostatic drug is one that inhibits cell growth. Included with these are the drugs used to treat cancer, the most common of which is chemotherapy.
Hair loss due to an excess of vitamin A:
Both a deficiency and an excess of vitamin A can result in hair loss, specifically a slowly progressive thinning of the scalp and body hairs, eyebrows and eyelashes. An excess of vitamin A also leads to other symptoms, including dryness, irritability and sometimes pigmentation of the skin. Also, weight loss, fatigue, anaemia and bone pain are frequent and the liver and spleen are sometimes enlarged.
Hair loss due to boric acid:
Boric acid, also known generically as borax or chemically as sodium borate, is used in a variety of products, including detergents, water softeners, pesticides, soaps, disinfectants, enamel glazes, glass and hand-cleaner for industrial workers. It is also used as a food additive in some countries, making an appearance in French and Iranian caviar, for instance. Occupational exposure to this substance has caused diffuse hair loss.
These are just some of the many chemicals, or drugs, that can cause hair loss.
Hair transplants for women are inherently different from specifically male hair transplants for a variety of reasons. To begin, female pattern hair loss (FPHL) is perceived and treated socially much differently than male pattern hair loss. Reactions to FPHL are often dismissive and ignorant to the many options women have to combat their hair loss, including medical therapy and hair transplantation. Also, while hair transplantation was once thought to be nearly impossible for women, due to the unique nature of their hair loss, thanks to the recent advancements in follicular unit transplantation, they can now benefit from surgical treatment.
Hair transplants for women have come along in recent years. The emergence of follicular unit transplantation has allowed women to benefit from hair transplantation along with men. In earlier decades, hair transplantation consisted of transplanting large groups of hairs usually measuring 2 to 4 millimeters. Because of the usually diffuse nature of FPHL (meaning that the hair was generally only thinning) there was not enough room between pre-existing hairs to transplant these large grafts, so this earlier version of hair transplantation was not possible for women. But because of follicular unit transplantation, where smaller groups of hair measuring fractions of millimetres are used, women can now partake in the benefits of hair transplantation.
The diffuse nature of FPHL also changes the nature of the hair transplantation process itself. Women generally have more stable hairlines, meaning that placing the majority of one- to three-hair grafts in the frontal third of the scalp will take care of the ‘see-through’ appearance of the frontal hairline (which most women with FPHL complain of) and will reduce the risk of effluvium. For women with stable hairlines, the newly transplanted hair in this frontal area should remain cosmetically appropriate indefinitely.
There are also promising medical treatments available for women with hair loss. So far only minoxidil, which is found in Rogaine, is the only FDA-approved medication for the treatment of FPHL. Realistically speaking, the success of Rogaine on FPHL relies on compliance and reasonable expectations. It is important to recognize that it generally takes 6-8 months before the patient may be satisfied with the results of the drug. Rogaine can also be taken in conjunction with hair transplantation. Also, proper hair care is very important as to not sabotage the efficacy of the treatment. Minimal tension on the hair follicles and excessive chemical use should be avoided.
A common reason for women to seek hair transplantation is to correct damaged hairlines resulting from face-lifts. Fortunately, a large number of one- to three-hair grafts at the natural angle of the hair in the hairline region makes a substantial difference and is generally more than satisfactory.
It is clear that women have many more options for their hair loss than was previously available. Using the scientific and technological advancements that have occurred in hair transplantation, specifically follicular unit transplantation, women do not have to suffer silently with their hair loss any longer; they have more options than was previously available, whether it be medical treatment or surgical treatment via a hair transplant.
Boric acid is a mild acid, derived from boron or sodium borate, which is often used as antiseptic, insecticide, flame retardant and as a precursor of other chemical compounds. It has also been used in nuclear power plants to control the fission rate of uranium. It exists in the form of colourless crystals or a white powder, which dissolves in water.
Boric acid, and its chemical cousins sodium borate and boron, are also used in countless other consumer products, including: detergents, mouthwash, laundry additives and water softeners. And while it is often used as an insecticide for cockroaches, it is considered to be relatively harmless to humans and animals and is, in fact, understood to be not that much more toxic than table salt.
That being said, when boric acid has been used in mouthwash it has been known to cause diffuse hair loss. Occupational exposure to sodium borate, like that found in industrial hand-cleaner, has also caused diffuse hair loss.
It is disturbing how many of the chemicals we are in contact with in a daily basis have unexpected and unfortunate affects on our well-being. If you are suffering from diffuse hair loss (thinning of your hair) it is possible that substances that you encounter in your daily life could be affecting you in ways you cannot predict. You should always be aware of the chemicals you handle everyday and always follow the precautionary instructions provided with all consumer products.