Hair Foundation Blog

In the Hair Foundation president’s and CEO’s book, Women and Hair Loss, Dr. Matt Leavitt begins his book by sharing a few facts about human hair. Additional excerpts will be included in this blog on an ongoing basis, but let’s first get started with some trivia.

Did you know?

• We have in excess of five million hairs on our body, most of these never growing more than one-half inch in length or exceeding .0035 inches in diameter.
• Hair on our head grows approximately one-half inch per month, or six inches per year reaching a maximum of forty plus inches in length over the course of its individual lifetime.
• Hair grows at the rate of .00000001 miles per hour, so if we placed end-to-end each fully grown hair we shed, it would extend over seven hundred miles!
• In any given 24 hour period, hair grows .039 mm at our temples and .044 mm at the vertex (top of our head).
• On our entire body, approximately 40 yards of new hair is grown every day.
• Hair cells divide every twelve hours.
• Women’s hair grows faster in the summertime than in winter by about one-quarter of an inch.
• With increased humidity, hair absorbs moisture, stretches and elongates, thus allowing it to vary in length by up to 2 1/2%.
• If our hair was twisted into a rope, it could pull a weight of 15 tons!
• We are born with approximately 100,000 hair follicles and some of these follicles have more than one hair in each sac.
• Persons with certain hair colors have more or less hair,depending on the particular color.
• The breakdown is as follows (all hair colors are not created equal):
• Blonde (about 140,000 hairs on the head), Brown (about 110,000 hairs on the head), Black (about 108,000 hairs on the head), and Red (about 90,000 hairs on the head)
• If a blonde wanted to count all of the hairs on her head, it would take 40 hours, or an entire workweek!

If you’re looking for some additional information on women and hair loss, check out Dr. Leavitt’s new Hair Foundation video, Women and Hair Loss.

This article was published in the March/April issue of Hair Transplant Forum International, the newsletter by Hair Foundation’s partner, ISHRS. It is a case report of scalp necrosis and subsequent scarring alopecia caused by a hair highlighting procedure; this illustrates a serious complication of a commonly performed hair salon process.

In this article, the Hair Foundation’s doctors William Parsley, Russell Knudsen, E. Antonio Mangubat, and Paul Rose shared their experiences with similar injuries caused by hair highlighting. Their responses came from an online discussion about the case as well as a review of the pathophysiology of this injury as previously reported in medical literature.

This is the conclusion of a three-part series.

Conclusion

Chemical burns of the scalp have been known to occur as a consequence of permanent wave and straightening products. Case reports have found scalp burns and ulcerations following hair highlighting procedures. These highlighting procedures involve an oxidation reaction between the active ingredients, which include hydrogen peroxide (concentrations up to 6% in the United States, 12% in Europe and other areas of the world), persulfates, and alkalizers.

The mixture apparently breaks down upon contact with hair keratin, which results in the activation and release of oxygen. The hydrogen peroxide in concentrations greater than 10% can cause blistering and burns. The persulfates, especially in alkaline conditions, facilitate hair dye absorption by making the hair porous.

They are themselves acidic.

In 2001, the Cosmetic Ingredient Review Expert Panel published a report on the safety of ammonium, potassium, and sodium persulfates and reviewed their toxicity. Each can cause allergic and irritant contact dermatitis.

The report found that these persulfate agents are “safe as used as oxidizing agents in hair colorants and lighteners for brief discontinuous use followed by thorough rinsing from hair and skin.”

The alkalizer used is sodium metasilicate, which is highly water soluble and has a pH of 13 in a 1% aqueous solution.

Although there were references to the possibility of either thermal or chemical burns, stemming from the ingredients and techniques used in hair highlighting procedures, in the case that was biopsied during the healing phase, there was no evidence of the type of coagulation necrosis and loose collagen bundles that are expected histologic changes seen in a thermal burn.

Instead, the collagen was normal, with the presence of granulation tissue in the ulcerated areas, and occasional foreign body type reaction, consistent with a chemical burn. In most of the reports, patients experienced discomfort within minutes of application of the solution and being placed under a hair dryer,and the scalp was initially intact but sloughed off later.

It appears that onset of pain is usually quite acute with either a thermal or chemical burn, but may be slightly delayed in some chemical burns.

In these reported cases, while many were treated with antibiotics, most did not show overt infection and the doctors concluded adequate treatment occurs with applications of white petrolatum gauze or similar dressing over the ulcerated areas, to maintain a moist environment during the granulation phase.

It can take many weeks before re-epithelialization of the ulcerated area occurs. In Dr. William Parsley’s review case, the final wound did not have a thermal burn keloid or hypertrophic scar.

It seems there may be merit and value to the public health in pooling and reporting the case experiences among our ranks to provide a larger study population of this event in order to illustrate a problem that may be avoided with greater education of this risk both to customers and hair stylists.

Given the apparent higher frequency of reported cases in younger patients and amongst patients with darker hair, the possibility of cofactors predisposing to this complication exists and may be further elucidated by sharing of information.

A further discussion of these approaches will be discussed in future posts.

This week, the Hair Foundation launched its new nine-part physician video series on its website. These videos include the Hair Foundation’s esteemed Board of physicians, Dr. Matt Leavitt, Dr. E. Antonio Mangubat, Dr. Dow Stough and Dr. Ken Washenik, as narrators along with the inclusion of the Hair Foundation’s partners’ products as visuals.

The videos range in two to four-minute lengths and viewers will find that the doctors offer advice, discuss topics, and describe patient stories through real-world examples and visuals.

Check out the videos on the Hair Foundations site:
Video: Types of Hair Loss
Video: Understanding & Living With Hair Loss
Video: Men and Hair Loss
Video: Women and Hair Lossn
Video: Children and Hair Loss
Video: Hair Loss and Self Esteem
Video: Hair Loss Diagnosis and Medical Treatments
Video: Hair Care and Maintenance
Video: Hair Disease and Treatments

In recent hair news, there’s been a lot of press about keratin hair treatments. While many customers are pleased by the results, there are some side effects that are causing a lot of discussion and proposed FDA changes.

For this two-part series, John Halal, president of the Honors Beauty College, discusses the keratin smoothing treatment, its risks and alleged unacceptable levels of formaldehyde in an article written for Milady’s online newsletter.

Keratin Smoothing Treatments

Keratin smoothing treatments, also called Brazilian keratin treatments, originated in Brazil and first appeared in the United States in 2006. Although there are differences in the application, the technology is essentially the same as the process that was first developed in the 60’s to create permanent press fabrics for the textile industry.

These treatments loosen curl and leave unruly hair smooth and frizz-free. It may seem like a dream come true for those with curly, frizzy and unmanageable hair, but the treatments are not without risk.

Oregon Occupational Safety and Health Agency (OSHA) and the Center for Research in Occupational and Environmental Toxicology (CROET) have concluded that there are meaningful risks from exposure to the high levels of formaldehyde that hairstylists and their customers are exposed to during the process.

Treatment Risks

Oregon OSHA and CROET have determined that the treatments (marketed under different brand names) contain unacceptable levels of formaldehyde; a known carcinogen as well as an irritant to eyes, lungs and nasal passages. Consumer and stylist complaints have ranged from difficulty breathing to skin irritation and nasal and throat problems.

The section below is from the Oregon OSHA, a Division of the Oregon Department of Consumer and Business Services and CROET at Oregon Health & Sciences University, report dated October 29, 2010.

The full report is available online at: http://www.orosha.org/pdf/Final_Hair_Smoothing_Report.pdf

A stylist at a Portland area hair salon contacted staff at the Center for Research in Occupational and Environmental Toxicology (CROET) at the Oregon Health Sciences University (OHSU) as a result of difficulty breathing, nose bleeds and eye irritation when using a popular hair smoothing product.

In evaluating the issue, CROET noted that the material safety data sheet (MSDS) accompanying the product listed no hazardous ingredients or impurities. The MSDS also indicated no respiratory hazards or related precautions.

CROET asked for Oregon OSHA’s assistance in collecting a sample and determining the content of the product. The Oregon OSHA laboratory analyzed the sample using five different test methods. Each of the five separate analyses concluded that formaldehyde was present well above regulated levels, with the quantitative methods producing respective results ranging from 6.3 to 10.6 percent. In analyzing samples of a newer “formaldehyde free” version of the product, Oregon OSHA’s laboratory found it contained roughly 8.5 percent formaldehyde.

Effects of Formaldehyde

The irritant effects of formaldehyde are well documented, with reports of eye, nose and throat irritation, loss of sense of smell, increased upper respiratory disease, dry and sore throats, respiratory tract irritation, cough, chest pain, shortness of breath and wheezing.

Adverse effects of formaldehyde on the central nervous system include headaches, depression, mood changes, insomnia, irritability and attention deficit. Impaired dexterity, memory and equilibrium have been reported from long-term exposure.

Special consideration regarding the exposure of pregnant women is warranted since formaldehyde has been shown to damage DNA.

The heat, up to 450 degrees fahrenheit, from a hairdryer and flat iron causes the aldehyde in the product to form oxymethylene crosslinks and side chains with the amino acids in the hair. These keratinous bonds are responsible for the majority of the softening and smoothing and are stable for three to four months, at which time the hair will revert back to its original configuration.

Although the aldehyde does not break disulfide bonds, the extreme heat does break disulfide bonds and accounts for some of the straightening and smoothing.

Unfortunately, the extreme heat also releases aldehyde vapors that present a health hazard to anyone in the room. Even in a well ventilated room, the release of aldehyde vapors could easily exceed the maximum concentration allowed by OSHA of 0.75 parts per million (ppm) over an eight hour period, especially with multiple services.

The American Conference of Industrial Hygienists (ACGIH) notes that “there is a substantial portion of the population, comprising up to 20%, for whom airborne formaldehyde at concentrations on the order of 0.25 to 0.5 ppm is troublesome” and that “it is plausible that a similar proportion (10% to 20%) who are more responsive, may react acutely to formaldehyde at concentrations as low as 0.25 ppm.”

ACGIH further states that in consideration of these reports, “individuals who may already be sensitized or otherwise unusually responsive to formaldehyde may not be adequately protected from adverse health effects caused by formaldehyde exposures at or below the recommended Threshold Limit Values (TLV) ceiling of 0.3 ppm.”

Although formaldehyde has been safely used as a preservative in cosmetics for decades, in 1984, the Cosmetic Ingredient Review (CIR) Expert Panel reported that cosmetics containing formaldehyde in excess of 0.2% are not safe.

Part II will discussed the expert panel’s findings and current options for this popular treatment

In this post about women and hair loss, Dr. Matt Leavitt, founder and current Hair Foundation president chairman, discusses misconceptions of hair loss, top questions on women and hair loss, what women can do to make their hair healthier, and available treatments.

Dr. Matt Leavitt (currently Executive Medical Advisor of Bosley), is a renowned authority on hair loss.

In his 25 plus years of practice, he has performed surgery on thousands of patients nationally and internationally, ranging from celebrities and statesmen to trauma/radiation patients and students.  He is a the recipient of the prestigious Golden Follicle award from the International Society of Hair Restoration Surgery and a former member of the Board of Governors for the society.

Leavitt is the founder and has been the Chairman of the Orlando Live Surgery Workshop for the past 17 years.  He is also a founder and a former Vice President of the American Board of Hair Restoration Surgeons, a Board-Certified Dermatologist and the Founder, Chief Medical Officer of Advanced Dermatology, the largest dermatology practice in the U.S. as well as Ameriderm, a company that provides contractual billing services for medical practices.

He is a clinical professor at Nova University, University of Central Florida and University of Florida.

Leavitt graduated from the University of Michigan and Michigan State University College of Osteopathic Medicine.

Question:What are some misconceptions of women’s hair loss?

Answer: There are numerous erroneous perceptions regarding feminine hair loss.  These can range from the onset of feminine hair loss (i.e. many women believe it is an age-related condition occurring in the 60s upward.  In reality it can happen at any age); to the incidence of women who experience hair loss (more than 50% of women less than 50-years-old experience some measure of hair loss).

Question:What are some of the top questions on women’s hair loss?

Answer: Most of the questions I receive on female hair loss can be categorized as noted below.  I will briefly address some of these points.

• What causes hair loss? Is it permanent?
• What can I do to keep my hair healthy?
• What treatments are available?

There are four major causes of hair loss: androgenetic alopecia (genetic), telogen effluvium (rapid and pronounced shedding), alopecia areata (autoimmune condition which ranges from patchy bald spots to complete loss of hair on the body and scalp), and traction/chemical alopecia (caused by severe hair styles/chemicals).

Question:What can women do to make their hair healthier?

Answer: Do not chemically mistreat hair; be careful regarding any bleaches/dyes, straighteners and permanents that are used. These harsh chemicals must be tested and applied very judiciously and should not exceed safe frequency guidelines.

Hair styles that pull tightly on hair can cause or contribute to permanent hair loss. It is inadvisable to pull hair into tight ponytails, braids or other styles on a continuous basis.  Take the hair out of the style daily/frequently and allow it to remain loose to relax the scalp and tension on the hair’s roots.

Good nutrition along with good shampoo and conditioning products are valuable.

If there is hereditary hair loss in the family, see a dermatologist if you suspect any hair loss. And if there is indication of some loss, the physician may recommend using minoxidil 2 or 5% and/or a lasercomb as options to slow down the loss.

Question: What are some treatments available?

Answer: Before treatments can be recommended, a dermatologist must first identify the reason for the hair loss, i.e. medical conditions, diet, stress, hair styles, hormonal, genetic, etc.

Once a diagnosis has been made treatments can range from the following:

• If medical condition, treat the thyroid or other cause.
• If alopecia areata, medical treatments
• If anemia, take some sort of iron/dietary changes and supplements
• If medication caused, switch medications
• If genetic (female pattern hair loss), prescribe minoxidil, lasercomb, camouflage
• If chemical / traction, change/discontinue the chemical causes
• Change hairstyles

On a last note, not all shampoos/conditioners are equal; the physician should advise on shampoo.

In a recent Real Beauty article, the Hair Foundation’s partner, P&G had its products mentioned in 33 Ways to Salvage Bad Hair.

The following products were included in the article:

• Dealing with dandruff? Try Head&Shoulders Dandruff Shampoo

• Want to help your thinning hair? Check out Pantene’s Pro-V Medium-Thick Hair Solutions Intensive Restoration Treatment

• Help your color from fading, try Clairol’s Week 2 Color Refresher

The article’s tips also includes how to battle hat hair, rain-soaked hair and flat hair.

In this ongoing series of posts from an article written by Hair Foundation’s former president E. Antonio Mangubat, MD, he gives an overview of HRS cosmetic and reconstructive options and applications for their use in implementing treatments for massive hair loss from devastating illness or injury.

Specifically, Mangubat focuses on the challenges of major scalp defect reconstruction in achieving a cosmetically superior result.

In today’s post, we’ll take a look at trauma case studies.

TRAUMA

Scalp burns are rela­tively common causes of hair deformities. Even a partial-thickness burn can destroy hair follicles and traumatic alopecia
will result. Burns result in large, irregular scars, and tissue expansion is ideal for these difficult patients. Often, tissue expansion is prolonged
because of scar rigidity, but despite the delay the expansion can be accomplished with little risk—as long as patient compliance is ensured.

Case 3: Large burn defect presenting after multiple failed treatment attempts.

This 35-year-old woman presented after having five prior procedures that attempted to repair a grease burn she suf­fered on her scalp as
a child. The proce­dures included two scalp reductions and three hair transplants using 4-mm punch grafts.

She has had to wear her hair long in order to camouflage the defect. The scar and surrounding tissue is thick and rigid, allowing little, if
any, movement that would permit excising the 25- x 8-cm defect.

Treatment consisted of placing a large, 1.3-L crescent-shaped expander in the occipital scalp directly adjacent to the defect. The extreme
rigidity of the tissue required more than 9 months to complete expansion. The process was prolonged because of pain resulting from the exces­sive tissue rigidity. The result was par­ticularly satisfying in that with two simple procedures the entire defect was closed.

This spring, the Hair Foundation’s doctors served as experts and helped film a nine-part video series for public use. They cover a variety of hair

Photo by hopefulfarm.com

topics and viewers will find many of their common questions answered.

Drs. Matt Leavitt, Dow Stough,E. Antonio Mangubat and Ken Washenik discussed the following video topics:

• Types of Hair Loss
• Understanding and Living with Hair Loss
• Men and Hair Loss
• Women and Hair Loss
• Children and Hair Loss
• Hair Loss and Self-Esteem
• Combating Hair Loss: Diagnosis and Medical Treatments
• Hair Care and Maintenance before Hair Loss Occurs
• Hair Disease and Treatments

These free videos run between two to four minutes in length and they include patients, real world examples and visuals.

Look for their availability soon on the HF website, YouTube and partners’ websites.

This article was published in the March/April issue of Hair Transplant Forum International, the newsletter by Hair Foundation’s partner, ISHRS. It is a case report of scalp necrosis and subsequent scarring alopecia caused by a hair highlighting procedure; this illustrates a serious complication of a commonly performed hair salon process.

In this article, the Hair Foundation’s doctors William Parsley, Russell Knudsen, E. Antonio Mangubat, and Paul Rose shared their experiences with similar injuries caused by hair highlighting. Their responses came from an online discussion about the case as well as a review of the pathophysiology of this injury as previously reported in medical literature.

This is Part II of a three-part series.

After a cyberchat, Parsley responded:

Parsley: [I agree with Paco] that if similar treatment is done to many clients, there should be more ulcers and burns. Unlike allergic contact dermatitis, irritant dermatitis would be very common if the treatments were all the same. I think that the differences may lie in the patient’s hair color and hairstylist mistakes. There are big differences in the bleach concentration used as well as time on the scalp, and both would be higher in women with dark hair.

Mistakes also may play a part.

For example, lye (sodium hydroxide) hair relaxers are the most caustic solutions used in hair salons requiring protective gloves. If it was inadvertently mistaken as bleach, when applied to the scalp, the scalp would have no protection and the heat would have been doubly bad. Lye relaxers can come in pH levels of 10-14, with 14 being the most caustic. A mistake like this could explain the rarity of this hair styling injury and hopefully this type of mistake would be very rare. It seems that most of these cases may be multifactorial with combinations of ingredient concentrations, ingredient volume, ingredient types, ingredient mistakes, air heat, foil heat, and length of heat.

Secondary infection could also play a role, but I think a secondary role. I agree that there is undoubtedly a spectrum of injury and that probably most cases are mild and therefore don’t get reported. It’s only when severe cases “make the headlines” that we become tuned in. I suspect the salons that do a lot of these procedures are well aware of this potential problem, and they probably see a lot more of it than we do.

Part III will be the conclusion.

On May 10, Unilever announced that it had completed its acquisition of the hair care company Alberto Culver Co. With this new company, Unilever is now the world’s largest maker of hair conditioner, the second-largest shampoo seller and the third-largest maker of hair styling products. Alberto Culver makes the personal care products under the TRESemme, Nexxus, St. Ives and Noxzema names and is a supporter of the Hair Foundation.

Alberto Culver donated in-kind products of TRESemmé Fresh Start Dry Shampoo to the HF’s partners, Childhood Leukemia Foundation and ISHRS, to include in CLF gift baskets given to patients and their families during their recovery from cancer treatments.