Non Scarring
Non-scarring refers to a type of healing where the skin or tissue recovers without leaving a permanent mark or scar. This happens when the body repairs itself in a way that doesn’t damage the deeper layers of the skin. Non-scarring healing usually occurs with minor injuries, like small cuts or rashes, where the skin is able to close up smoothly. It is the opposite of scarring, where the body forms a thick, visible mark as part of the healing process.
The hair generally grows in three phases
- Anagen (growing)
- Catagen (resting)
- Telogen (Shedding)
Normally, 85-90% of the scalp hair is in the anagen phase, 2-3% is in catagen, and 10-15% is in telogen. Therefore, we should normally shed an average of 100-150 hairs daily. However, if a stressor occurs up to 4-6 months later, the hair cycle can shift so that 20-40% of the scalp hair sheds. The more common stressors include any thyroid abnormality, iron deficiency, hormonal changes including pregnancy and menopause, medication change,hospitalization, or serious illness. This usually manifests as significant shedding and decreased overall hair density. Telogen effluvium is typically temporary, with the hair shifting back to normal cycling 6-12 months after the inciting stressor has been corrected. Rarely, telogen effluvium can be ‘idiopathic’, meaning no cause is found and may be chronic.
Androgenetic Alopecia
Also known as Male and Female Pattern Hair Loss, this form of alopecia is the most recognizable and some consider a normal variant of aging. With each hair cycle, this entity leads to progressive miniaturization or thinning of the hairs in the affected area, until the hair can no longer grow back. The best treatment of androgenetic alopecia is preventative!! It is better to prevent or slow down the hair loss, than to wait until the hair loss becomes noticeable to the public. At that point, it is more difficult to achieve regrowth with medication and may warrant treatment with surgical hair restoration. Without treatment, the hair loss can become permanent or irreversible.
Alopecia Areata
Alopecia areata is an autoimmune condition, in which the immune system attacks the bulb of the hair follicle, causing the hair to fall out often rapidly. It can leave large completely bald circular patches or complete hair loss of the scalp, eyelashes and eyebrows. The clinical course is very unpredictable and the prognosis can be more challenging if:
- Presents in childhood
- Involve the entire scalp or just the back of the head
- The episode has been greater than 8-10 years duration
Fortunately, there are now FDA-approved painless, systemic treatments that are effective.
Traction Alopecia
Also known as Male and Female Pattern Hair Loss, this form of alopecia is the most recognizable and some consider a normal variant of aging. With each hair cycle, this entity leads to progressive miniaturization or thinning of the hairs in the affected area, until the hair can no longer grow back. The best treatment of androgenetic alopecia is preventative!! It is better to prevent or slow down the hair loss, than to wait until the hair loss becomes noticeable to the public. At that point, it is more difficult to achieve regrowth with medication and may warrant treatment with surgical hair restoration. Without treatment, the hair loss can become permanent or irreversible.
How to Fix Those Edges!
As a dermatologist with a special interest in hair conditions, it consumes me how many women I see with permanent hair loss from our own styling practices!! One common form of hair loss is called traction alopecia.
Traction alopecia can be a permanent, sometimes scarring form of hair loss that typically occurs around the hairline and crown. You do not need to be a dermatologist to diagnose this. We have all seen it on girlfriends, family members, and, unfortunately, many prominent celebrities.
Cause
It is thought to be caused by hairstyling practices that pull hair tightly away from the scalp, such as braids, weaves, and locks. Similar to trauma that happens elsewhere on the skin, the body senses the insult, sends inflammatory cells to the site of trauma, and tries to heal it with a scarring pro- cess. This is exactly what occurs with traction alopecia. The tight pulling leads to inflammation around the hair follicle and if the inflammation remains untreated, fibrosis or scar tissue form sand the hair is permanently lost. This condition is most common in females of African descent, but can be seen in anyone with traumatizing hairstyling practices. For example, in India, many Sikh males that wear their hair in tight buns under their turbans and can also suffer from this problem. Ballerinas that pull their hair back tightly can experience this, as well.
Prevention and Treatment
Luckily, there are ways to prevent traction alopecia and also ways to treat it. Most importantly, do not let allow the hair to be pulled too tight!!!! Yes, we all love to see our friends flaunt a great weave down their backs, so I will never be one to restrict wearing these types of hairstyles. HOWEVER, I cannot stress the importance of being able to recognize signs of when the hair is being pulled too tight. This includes any pain, tenderness, burning or itching.These are signs of inflammation!
Secondly, see the previous paragraph… It’s that important. Many of my patients will tell me that they did not notice the hair loss until months toyears after wearing braids or a weave. So it is very important to pick up on signs of inflammation as soon as possible, so that you have a possibility of being treated and holding onto the hair that you have. As far as treatment options are concerned, the most important first step is seeing a dermatologist as soon as you notice any problem. The longer you wait for an evaluation, the more time for scar to form and for the hair loss to become permanent.
When you are seen, likely a biopsy will be per- formed to determine if there is any inflammation left to treat or if scar is already present. If there is inflammation present, treatment may include steroid injections to the scalp, topical steroids, or oral antibiotics. Even if there is scar present and the hair loss is felt to be permanent, hair transplantation is a fantastic option to help restore the hairline.
In summary, women love to experiment with a myriad of fabulous hair styles. Unfortunately, many of these styling practices can lead to per- manent hair loss and deflated senses of self.
Therefore, it is of the utmost importance to recognize when the hair is being traumatized to prevent traction alopecia from occurring.
Chemotherapy-Associated Hair Loss
Anagen Effluvium
Anagen Effluvium is the abrupt, rapid form of hair loss experienced during certain chemotherapy regimens. It causes the hair to break at the root and is typically reversible, although the hair may grow back with a different texture or color. At times, anagen effluvium can unmask or further worsen existing hair loss.
Permanent Chemotherapy-Induced Hair Loss
If the hair does not completely recover after chemotherapy, it is referred to as permanent chemotherapy-induced alopecia. It is more likely to occur after taxane-based and/or endocrine-based therapies.
How to Address Hair Loss after Breast Cancer Treatment
Unfortunately, breast cancer is not an uncommon condition. Most Americans know someone who has been affected by this malignancy. In the United States, one in every eight women will be diagnosed with it in their lifetime. Over 220,000 women are diagnosed every year and it is the second leading cause of death. Fortunately, due to early detection, deaths from breast cancer have been decreasing, and now there are more than 2.9 million breast cancer survivors in our country today. Although being diagnosed with breast cancer can be foreboding, often many of my patients express that it is the fear of losing their hair with treatment that also concerns them. Chemotherapy treatments for breast cancer work by interfering with rapidly producing cells, which is ideal for destroying cancer cells. Unfortunately, hair is rapidly producing as well.
Chemotherapy can lead to a condition called anagen effluvium. All body, facial, and scalp hair stops growing altogether and breaks off at the surface, resulting in a smooth, hairless appearance that can be commonly seen in these patients. Some of my patients express to me that they feel this appearance can be seen as a stigma. If it were not for their extensive hair loss, it would not be obvious that they are undergoing cancer treatments. The hair loss is an outward manifestation or sign of what is happening internally. For many women, this notion can affect them more emotionally than even the breast cancer diagnosis itself.
Thankfully, while undergoing chemotherapy, there is a plethora of options to mask hair loss. Many women choose to purchase a wig (link to wig), which tends to be covered by insurance. Others wear colorful scarves. Finally, there is now a movement to embrace the fully bald scalp.
After the chemotherapy regimen has been completed, most women’s hair will return in full. It may not look the same as before, however. Often the texture and color may vary. I will often recommend over-the-counter minoxidil 5 percent foam or solution to help directly stimulate new hair growth or the oral minoxidil formulation.
It is possible that the hair may not return to full. This may be a result of some breast cancer treatments affecting hormonal influences on the hair. In these instances, I often recommend platelet-rich plasma, or PRP, growth factor treatment, an autologous preparation of the patient’s own blood. There are cells around the hair bulb that are needed for normal hair cycling and growth. When those cells start to diminish from hormonal influences, the hairs start to thin. The growth factors from PRP treatment directly signal those cells to amplify, thus enhancing thicker hairs to grow.
In summary, breast cancer affects millions of women in this country. Thankfully, more are surviving than in years past. Although receiving a diagnosis of breast cancer is quite difficult, many women are even more distraught about losing their hair along with the chemotherapy treatment. Fortunately, there are many options to address this concern.
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