The Good Hair Day Campaign by: Dr Serena Cardoso DipPEC (SA), BHSc, MB BCh (WITS)

I got my hair cut this week. My hair dresser insisted there were split ends to remove. As usual this led to a rigorous back and forth which she won (she usually does) and half an hour later I was staring down at the concrete floor mourning the little spindles of dark brown tresses scattered about my chair.

I confess, I spend far too much time on my hair in the morning. You might not say it when you see me in a tied-up top-knot but that is because I have eventually succumbed to the inevitably of a bad hair day and scraped it out of my face in frustration. However, every now and then, either by force or fortuity I get it right and all is right in the world. There is nothing quite like the feeling of having really great hair that’s bouncy, shiny and beautiful.

Great hair hides a multitude of flaws. It can make a simple outfit chic and paired with good skin, who needs makeup? We all want to look effortlessly, beautiful and natural but natural takes hard work!

To understand how hair treatments work one needs to understand the basics of trichology. Each hair develops from a follicle – a pocket in the skin – that sits on top of a dermal papilla – a bud of nourishing, stem cell rich tissue that helps the hair grow. This is the area targeted in many hair-loss treatments.

Hair goes through three growth phases:

  1. Anagen – growth phase, last 2- 4 weeks.
  2. Catagen – transition phase, where the cells at the base of the follicle die, lasts a few days.
  3. Telogen – phase of no growth or resting and results in eventual shedding. Can last 2 days to 2 weeks depending on the cycle.

 

hair anatomy

 

Unfortunately, as our skin is susceptible to the elements and aging so is our hair, probably more so with the amount of bleach, products and heat it routinely takes. Aging of the hair is an inevitable process determined by an interplay of weathering from UV exposure, emotional stress, grooming habits including strong shampoos or overzealous brushing, your natural hair colour, hormones and nutrition. Hair follicles are very sensitive to stressors and they all contribute adversely to hair loss.

With increasing age, hair thins over the front and vertex of the scalp, there is a progressive decrease in thick terminal hairs and an increase in the shorter, thinner vellus hairs. An awful process called follicular miniaturization. Also, the growth phase of our hair follicles shortens from what starts out as years and becomes only months or weeks!

To the Drybar literate, you’ll be please to know there are various medical treatments to rejuvenate your crowning glory. We all want thick, lustrous, voluminous, resilient hair and will go to great lengths (excuse the pun) to obtain that. If you are a man experiencing genetic balding or a women who has ever gone through a great period of stress that’s driven almost all the hairs on your head into a telogen shedding phase you’ll know how upsetting hair loss can be.

What’s to be done about it?

The first step is to have your scalp assessed by a medical doctor. There are a wide variety of medical disorders that cause hair loss and require specific evaluation and diagnosis. We start with asking you a few questions, examine the hair and scalp and may possibly order blood tests before we recommend a treatment protocol. Response to treatment may be incomplete so starting treatment at an early stage, prior to the development of extensive hair loss is preferred and we encourage indefinite therapy to maintain the response.

One-third of women experience hair loss in their lives at some point. There is widespread thinning of hair as we get older, especially after the age of fifty with menopause. The main type of hair loss in women is called androgenic alopecia or female pattern hair loss (FPHL) where there is gradual thinning from the part line. However, there are many various causes of hair loss that include a variety of dermatological conditions like scarring alopecia, nonscarring alopecia and structural hair disorders.

Other contributing factors include: stress, medications, vitamin deficiencies, post natal hair loss, injudicious dieting, weight loss, diet, genetics, weathering and grooming, stress and PCOS to name a few.

Once those are treated then we can move onto a hair boosting cosmetic regimes!

We have been trialing a couple of new exciting hair protocols including PRP and peptide hair filler injections over the scalp and have seen some exciting results.

I am going to review two exciting treatments we have tested and have recently rolled out in our practice: PRP and hair fillers.

The latest addition to the good-hair day campaign is hair fillers which work to provide nutrients, vitamins, peptides and growth factors to the actual follicle. In the same way you may apply compost and flower food to your garden. Here we are growing hair. Prostaglandins have been found to increase hair density in men with androgenic alopecia[i].

PRP[ii] or Platelet Rich Plasma has been employed in various medical adjuvants including treatment of skin grafts, burns, scars, ulcers and in orthopaedics for its ability to aid in bone, tendon and ligament healing. It’s is your own personal supply of millions of growth factors and secretory proteins that enhance the activity of cells involved in tissue regeneration through very complex healing processes of recruitment, proliferation and differentiation. When we biopsy areas treated with PRP, weeks later we see thicker collagen bundles and better wound healing. Recent studies have shown medium treatment success with PRP. After around 6 months we see significantly more anagen (hairs in the fast growth phase) and telogen hairs (resting hairs).

PRP has been shown to clinically improve numbers of hairs and total hair density verses placebo. It has also been shown to increase the terminal hair density (the thickness or diameter) by 19%. And these findings have been replicated in confirmatory studies. When we examine the treated scalp under microscopy there is evidence of epidermal thickening, and an increase in the amount of hair follicles too. We attribute these clinical improvements to the α-granule proteins, including growth factors and cytokines, that promote cellular proliferation and differentiation, angiogenesis, and vascular modelling. In English, plump strong skin, rich in new baby cells and blood vessels – the perfect environment to heal damaged hair follicles and promote their growth.

The peak effect of PRP on hair density seems to be around 3 months with around 20% improvement -so we recommend getting your hair shots quarterly.

Some people are worried that if they stop doing the treatments one day that their hair will be worse than it was before but studies show that even a year after a single treatment the hair’s density never drops below the starting baseline, in fact it improves the baseline by at least 7%. Maintenance treatments will keep you from loosing more hair and will help with new hair growth and thicken hair already there.

If your hair loss is severe these treatments would be add-ons to medical treatments. They also help prime the scalp for any surgical hair treatments should they be required. In female pattern hair loss: minoxidil, is a treatment with robust evidence for hair gain, and works by dilating the vessels and helping blood supply to the tissue beneath the hair follicle (the dermal papilla). Anti-androgens benefit especially if you tend to have excessive male hormones (there are androgen receptors in the dermal papilla) and vitamin levels should be corrected. Should medication not achieve a satisfactory result, the next option is surgical hair transplantation: when we bathe harvested hair follicles in PRP before we implant them onto the scalp we find their survival rate increases by 15%, the PRP acts like a shield protecting and strengthening the hair.

If you don’t suffer from hair loss but just want more hair that’s thicker, stronger and more glossy hair then these follicular maximizing boosters will a beautiful addition to your hair care routine.

 

[i] Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol 2012; 66:794.

[ii] Giordano S, Romeo M, Lankinen P. Platelet-rich plasma for androgenetic alopecia: Does it work? Evidence from meta analysis. J Cosmet Dermatol 2017; 16:374.

Gupta AK, Carviel JL. Meta-analysis of efficacy of platelet-rich plasma therapy for androgenetic alopecia. J Dermatolog Treat 2017; 28:55.

Hausauer AK, Jones DH. Evaluating the Efficacy of Different Platelet-Rich Plasma Regimens for Management of Androgenetic Alopecia: A Single-Center, Blinded, Randomized Clinical Trial. Dermatol Surg 2018; 44:1191.

Gupta AK, Mays RR, Dotzert MS, et al. Efficacy of non-surgical treatments for androgenetic alopecia: a systematic review and network meta-analysis. J Eur Acad Dermatol Venereol 2018; 32:2112.

Alves R, Grimalt R. Randomized Placebo-Controlled, Double-Blind, Half-Head Study to Assess the Efficacy of Platelet-Rich Plasma on the Treatment of Androgenetic Alopecia. Dermatol Surg 2016; 42:491.