Hair loss is a completely normal process. Every day we lose about hundreds of them. The problem starts when that number grows sharply. Where to go for help What does a dermatologist and a trichologist do? Who treats scalp diseases and hair problems? These and other questions are answered by Dr. Małgorzata Maj, a dermatologist from the Dermatology Clinic of the Medical University of Warsaw in Warsaw.
Edyta Kolasińska-Bazan, Medonet: “Trycholog to specjalista zajmujący się skórą głowy i włosami. Jego zadaniem jest dokładna analiza stanu skóry głowy, cebulek włosów, schorzeń związanych ze skórą głowy (jak np. łupież, łojotokowe zapalenie skóry głowy, łuszczyca), ustalenie przyczyn wypadających włosów oraz dobranie odpowiedniego, indywidualnego, sposobu pielęgnacji włosów» – jak informuje jedna z prywatnych clinic, zajmująca się problemami włosów i skóry głowy. Uśmiecha się Pani, dlaczego?
dr Małgorzata Maj, dermatologist: It’s good that you started the conversation with such an important topic! It is worth explaining at the outset that in medicine such a specialization as “trichologist” does not exist.
But…
Going to the trichologist is fashionable these days. However, you should know that anyone who completes training in this field, regardless of education, can become a trichologist – so there is no need to complete medical studies and the resulting knowledge, among others human anatomy and physiology. The course can be done on-line or stationary. After its completion, you receive a certificate. I do not know a doctor who is a trichologist, because it is not a medical specialty. But not only that is important.
And what is?
Osoba nie posiadająca wykształcenia medycznego, tytułu lekarza, nie może zajmować się diagnostyką chorób – w tym postawieniem rozpoznania oraz leczeniem chorób włosów i skóry owłosionej głowy. Natomiast to, co jest również istotne, może wspomagać leczenie poprzez wspomagające postępowanie pielęgnacyjne.
Why do you emphasize it so much?
This may be associated with the human drama of delaying diagnosis and treatment. The later we recognize some disease entities, the more severely our patient will feel it.
What do you mean exactly?
The later the diagnosis of the disease is made, e.g. in the case of scarring alopecia, the more hair will be lost irretrievably by the patient. This will distract him from diagnosis and appropriate treatment. Time is extremely important! After that, you won’t be able to get your lost hair back!
Does a dermatologist treat the scalp and hair?
Yes. A dermatologist makes a diagnosis and implements treatment, and care treatments complete this process and are often not to be overestimated. They are important because they improve the patient’s quality of life, the condition of his hair and scalp. The ideal situation would be the cooperation of a dermatologist and an experienced trichologist.
Zobacz: Alopecia areata – a disease of young women
What problems do patients come with most often?
When it comes to the hairy scalp and hair, the most common of the so-called increased hair loss, i.e. various types of alopecia as well as seborrheic dermatitis and psoriasis.
Who comes more often?
Definitely women.
What tests are important in the diagnosis of hair loss problems?
The most important is a detailed interview about the patient and his family, during which we can partially find out if there has ever been a problem with alopecia in the family. This information is very helpful in diagnosis and taking therapeutic measures.
For a successful visit, it is worth getting ready in advance?
It is definitely worth considering since when is increased hair loss present? Does it occur seasonally or is it permanent? Are there any times when there is an improvement? How is / was / in the ancestors? Is the patient permanently (or temporarily) taking medications (and what kind)? Has it been treated so far – if so, with what preparations? Does he have any chronic diseases? For example, diseases with endocrine disorders are important. And, of course, it is very important to have the scalp and hair examined by a doctor.
Trichologists also study …
However, only a doctor can make a diagnosis, interpret additional tests and administer adequate treatment. Yes, trichologists view the scalp using cameras, but professional trichoscopy (qualitative and quantitative) with a dermoscope and / or videodermoscope is performed by a doctor. Trichoscopy (created by the Polish dermatologist Prof. Lidia Rudnicka!) Is a non-invasive test used to diagnose and monitor many types of alopecia, including androgenic (genetically determined), telogen, plaque and scarring. On the other hand, the trichogram consists in taking / pulling out about 10 hairs (from three to five parts of the head) and examining the hair papillae (commonly known as “bulbs”) under a microscope. You need to be prepared for the trichogram, i.e. you cannot wash your hair for 3 to 5 days before the examination and you cannot comb it out on the day of the examination.
Dlaczego?
Czesanie może zaburzyć wynik – badanie wówczas będzie niewiarygodne, możemy nie rozpoznać choroby. Trichogram pozwala na rozpoznanie m.in. Lysienia telogenowego.
Hair loss is a physiology, to what point?
100-150 hairs fall out a day. These are hair in the so-called the telogen phase, i.e. those that are already prepared for falling out (they fall out within 2-4 months from the transition from the previous phase, i.e. catagen) and on average account for about 10 percent. scalp hair. If this percentage increases, then we observe the so-called telogen effluvium.
What could be a sign of telogen effluvium?
For example, tangling, static in the hair.
What are its causes?
There are many of them, for example: vitamin D3 deficiency, ferritin deficiency, i.e. protein that binds iron in our body, folic acid deficiency, both hypothyroidism and hyperthyroidism. Autoimmune diseases of the thyroid gland, such as Hashimoto’s or Graves’ disease. Hyperprolactinemia, hypercorrhization. Additional factors are stress, temperature changes in the form of sunburn or frostbite. Medications, including anesthetics used during surgery, can also cause telogen effluvium.
Zobacz: Ranking of hair supplements – the best hair growth pills
What care mistakes can cause hair loss?
Prasowanie włosów, nieprofesjonalnie wykonane zabiegi farbowania, rozjaśniania, czy trwałej ondulacji. Nieleczone: grzybica, łuszczyca, czy łojotokowe zapalenie skóry mogą doprowadzić do wypadania włosów, jak i świąd skóry spowodowany np. wszawica.
XXI century and head lice?
It usually appears seasonally – after group trips (winter camps, summer camps). It is enough for one participant to have lice. Therefore, let’s not exchange hats or use a common comb. If the head itches, you need to see a dermatologist. The dermoscope will not overlook the nits and the dermatologist will not confuse them with dandruff, e.g. in seborrheic dermatitis.
What is it characterized by?
The disease occurs in 2 to 10 percent. people in the world. It is a type of hypersensitivity to the microorganism of the genus Malassezia (formerly Pityrosporum), found on the human skin (not only the head, but also other areas of the body rich in sebaceous glands). It is manifested by inflammation with erythema, peeling (so-called oily dandruff), itching and / or burning.
Trichologists recommend a scalp scrub? Is it worth doing?
It is a care treatment that can effectively support dermatological treatment in people with both dry and oily dandruff. It is important to correctly choose the composition of the peeling according to the type of problem and skin type.
Check it out: Scalp scrub – what does it do and is it worth using?
Let’s go back to baldness. What About Hair Loss That Affects Breastfeeding Women?
It is physiological postpartum telogen effluvium, which occurs in the postpartum period and during lactation. It may also occur after childbirth in women who are not breastfeeding. It is a complete norm, although we know that it is sometimes the cause of female malaise.
Nature gives abundant gifts during pregnancy, then to take them away?
Unfortunately, yes, during pregnancy we get beautiful hair as a bonus, and then the “excess” nature compensates.
And usually the body returns to normal after a few months. Worse if the condition lasts an alarmingly long time and the intensity of the hair loss increases?
Then you need to find the cause, because the fact that we know that alopecia is telogenous (we find out, among others, on the basis of a trichogram), does not indicate a specific cause – the trichogram will not give the cause of baldness.
Because hair loss signals that something abnormal is going on in the body?
Just like that. We have to find the cause. There are several hundred diseases manifested by alopecia, one of them is androgenetic alopecia, which occurs more often in Caucasian people.
Androgenetic alopecia is related to age?
Mostly with genes, but it actually worsens with age.
Mainly affects men?
It affects men more often, but women have the same disease. There are two types of baldness in them: the male type – when there are receding hairlines and baldness at the top of the head, and the so-called feminine with a symptom of a Christmas tree – sparse hair on the top of the head and thicker – the closer to the poll and the ear area. This is not due to an overabundance of testosterone, but an over-reactivity of the androgen receptors in the hair follicles, which is genetically determined.
How to fix it?
It is an incurable disease, but we can slow its progression and regain some of the already lost hair. The sooner we start therapy, the better the results we can get.
What do you recommend?
Certainly be patient, because there is no universal medicine – the “magic pill” that will solve the problem, and dietary supplements do not cure this disease. You can support yourself with supplementation in case of seasonal hair loss. In each case, the patient is approached individually. As in the case of the aforementioned telogen effluvium, where the most important thing is to establish the cause at the beginning: make up for the deficiency or treat the disease resulting in baldness.
I am asking for an example.
In the case of hyperprolactinemia, hypothyroidism (with or without Hashimoto’s disease) or hyperthyroidism, we collaborate with endocrinologists who diagnose and treat these diseases, and we deal with alopecia. If we have a deficiency of ferritin, we supplement with iron preparations. Iron itself does not have the diagnostic value of ferritin.
Dlaczego?
Ferritin is a protein that stores iron in the human body, from which the hair draws its resources, while the state of iron results mainly from the current diet. If the warehouse is empty, the first organs necessary for life are supplied with iron: the heart, brain, liver, kidneys. In the process of evolution, hair is secondary, or even third planes (next to nails or teeth). So, if we have a small amount of ferritin in the body, hair may fall out, nails may split …
Read: Siwe włosy – przyczyny, sposoby, usuwanie. Dlaczego siwiejemy?
What ferritin standards are taken into account?
To są kwestie indywidualne – trzeba brać pod uwagę: wiek pacjenta, stan zdrowia, przyjmowane leki (niektóre mogą zaburzać proces wchłaniania żelaza), u kobiet – miesiączkę, podczas której tracimy sporo żela.
Could Low Ferritin Resources Be Due to Disease?
Yes, and many. It is also worth emphasizing that one type of alopecia does not exclude the coexistence of its other types, and so, for example, there are patients with telogen effluvium and androgenetic alopecia at the same time.
I am asking for an example.
Some over-the-counter preparations can stimulate hair growth in andrgoenic alopecia and at the same time intensify hair loss in telogen effluvium.
There are believed to be 3 types of hair: normal, dry and oily. How is it really?
We are talking about the scalp, bearing in mind that the hair, apart from the hair nipple located in the scalp, is a dead structure.
As?
If we pinch a hair, it doesn’t hurt. Therefore, we can talk about the type of hair (dry or oily) based on the amount of sebum secreted on the skin surface, and this depends on the functions of the sebaceous glands, which is closely related to the entire body, including hormonal regulations. We know that there are diseases that predispose to seborrhoea, such as Parkinson’s disease, hyperprolactinemia, hypercortisolemia and other endocrine disorders.
And we go back to the sick thyroid gland again?
These are closely related topics. Some (severe) post-traumatic conditions and some medications (e.g. neurological, psychiatric etc.) also predispose to seborrhoea. On the other hand, there are also diseases that cause excessive dryness of the skin and dry dandruff (dandruff is not a disease, but a symptom!), Such as atopic dermatitis, psoriasis and some systemic diseases such as metabolic disorders.
The happiest situation is when the excess sebum or the dryness of the scalp do not bother. How often should we wash our hair?
When the hair requires it, i.e. its appearance indicates the need to wash it – oily hair, even every day, and dry hair rarely enough not to excessively dry the skin and often enough to properly care for it – that is, as needed.
Does what we eat affect the hair?
What we eat affects the entire body, including hair. “I am what I eat”. The proof of the influence of the diet on the condition of the skin is, for example, the influence of alcohol and a diet rich in omega acids on psoriasis. More than one book can be devoted to the topic of the influence of diet on the course of skin diseases. Certainly, we must introduce elimination diets wisely, and preferably under the control of an experienced dietitian.
Do we risk deficiencies when using them?
If they are not properly balanced, they can result in deficiencies of micro and macro elements, including e.g. iron. If we want to give up something, we need to know what we have in place.
Since the diet is important, is the composition of cosmetics (shampoos, conditioners) important? What is harmful to the skin and hair?
It is an interdisciplinary question that should be addressed to a dermatologist, allergist, as well as a hairdresser or a trichologist. A dermatologist is primarily concerned with the vital structure of the hair that ensures the hair’s proper growth. From the point of view of a dermatologist and allergist, it is important that the preparations used are not aggressive, do not contain preservatives, dyes and fragrances that may cause irritation or allergic reactions.
Parabens are synthetic preservatives used in the cosmetics and pharmaceutical industries to extend the shelf-life of products. SLS and SLES are cheap synthetic detergents, used in industry for degreasing and washing e.g. devices, cars and rooms.
Hair dyes also hide an “allergic trap” – those that dye brown or black may contain a strong allergen p-phenylenediamine. I would like to add that an allergic reaction to this allergen does not occur immediately, but develops over time – eczema-like changes gradually develop on the hairy scalp, manifested in the form of itchy skin eruptions.
The offer of Medonet Market includes cosmetic products such as a set of hemp cosmetics for strengthening and hair loss or a set of Delpos dermocosmetics for hair loss.
How do hair bleaching preparations affect the scalp?
They dry them out and can irritate the scalp.
Eyelashes, eyebrows – these are also hair. What to do to make them beautiful or… be at all? I am asking because it happens that they disappear.
Thank you for this question. Eyebrow structure disorder is one of the criteria for the diagnosis of the disease, in some systemic and dermatological diseases, e.g. Hertoghe’s symptom (thinning or loss of 1/3 of the outer eyebrow) may signal atopic dermatitis or hypothyroidism. On the other hand, itching in the eyebrows and in the lash line may be a symptom of demodicosis caused by the Demodex folliculorum parasite. Alopecia areata can also involve the eyebrows (madarosis) and / or the eyelashes (milyphosis). I would also like to add that in frontal scarring alopecia (a disease that occurs most often in women in the perimenopausal period), where the hairline shifts backwards, the eyebrows are also thinned.
Is the hair thinner after falling out?
It’s a bit like a growing tree – it’s thin at first. However, in people who suffer from androgenetic alopecia, one of the criteria for diagnosis is the miniaturization of the hair follicles, which means that the hair grows thinner – this is not physiology anymore.
Gray hair bothers both women and men.
It is genetically determined. As we age, we lose melanocytes, the cells that produce melanin (a pigment that occurs in the skin and hair). But gray hair can also be caused by diseases such as the adrenal glands.