From Root to Tip:

Hair Loss Essentials

Written by
Experts from Scandinavian
Biolabs & Ahmad Fayyaz
Chaudhry (M.B.B.S. (Punjab) R.M.P)

This e-book was written to be a

support and information for all
those who suffer from hair loss or
are interested in the topic.
 DISCLAIMER
The information contained within this book should
neither be confused with medical advice nor used to
diagnose or treat any illness, disease, or health problem.
If a reader chooses to implement any recommendations
from this book, they must first consult with a physician.
Using and applying the information contained herein is
at the sole risk and choice of the reader. The information
in this book is not and does not replace any medical,
legal, or professional advice. Please use this information
at your own risk. Always consult your doctor before
trying anything you read online (including content from
this book).

Copyright © 2022 by Scandinavian Biolabs

All rights reserved. This book or any portion thereof may
not be reproduced or used in any manner whatsoever without
the express written permission of the publisher except for
the use of brief quotations in a book review.

Design Credits
Graphic Designer: Simone Baraldi
Art Direrction: Montaine Perraudin & Alessia Micol Minotti
 Table of Contents

INTRODUCTION I

1 WHAT IS HAIR? 7
The Anatomy of Hair 11
The Hair Growth Cycle 32

2 UNDERSTANDING 39
HAIR LOSS
The Manifestation of Hair Loss 42
Types of Hair Loss 48
Diseases and Hair Loss 71

3 DIET AND HAIR HEALTH 82

4 MEDICAL TREATMENTS 110

FOR HAIR LOSS

5 ALTERNATIVE SOLUTIONS 121

FOR HAIR LOSS
Scalp Massage 122
Microneedling 129
Cosmeceutical 148

CLOSING WORDS III

 Introduction
How are you? I’m glad you’re here. You may
be wondering why I wrote this book, “From
Root to Tip: Hair Loss Essentials.” Well, it’s
simple really. I want to help people suffering
from hair loss, just like I had.

I understand what it’s like to feel desperate

for a solution. Scrolling endlessly through
social media, reading conflicting information
online. Not knowing which sources to trust…

But, there’s hope for all of us.

There are effective solutions available today,
both conventional and alternative and with
the right knowledge and support, anyone can
see improvement in hair growth and reclaim
self confidence.

I
 So if you’re struggling with hair loss, rest
assured, you are not alone.

That’s why I wrote this book - to empower

you to be in charge of your situation, and
equipped with the most valuable and up-to-
date information on hair loss and solutions.

Start reading “From Root to Tip: Hair Loss

Essentials” today, and let’s get on the road to
recovery together.

Sincerely,
Ahmad Fayyaz Chaudhry
M.B.B.S. (Punjab) R.M.P

II
 Hair can reflect our identity, our attitudes
and our personalities. But, it also plays an
essential role in sensation and body protection.

Hair covers our scalp from the sun and

protects it from external damage. Eyelashes,
eyebrows, and the hair in our nose and ear
keep out foreign objects, while the hair on our
body helps to regulate our body temperature.

The visible part of the hair is called the

“hair shaft,” which is rooted in deeper layers
of the skin and surrounded by the hair follicle.
Each hair follicle is connected to nerves.
They regulate the hair’s function by activating
associated muscles that raise the hair to
detect movement.

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 The hair root forms what is referred to as
a hair bulb and encloses the hair papilla, the
control center of “hair growth”. It is located at
the base of the hair follicle, controlling the hair
cycle and growth by enabling nutrition and
oxygen transfer from the capillaries (= blood
vessels) to the hair follicles.

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10
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 The Anatomy of Hair
The hair’s structure is composed of around
80% keratin, a fibrous structural protein,
10% water, and 5 to 10% pigments and lipids.
It grows throughout our life, renewing itself
constantly.

Biologically speaking, the hair we see on

our heads is dead. The only part of it that is
alive is the root embedded in the scalp. As
such, any damage or split ends that occur
along the length of the hair strand cannot be
repaired by the hair itself.

However, there are steps you can take to

minimize and prevent further damage. Good
hair care practices can help maintain the
health and appearance of your hair.

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 Some tips include:

1. Regular Trimming:
Getting regular hair trims helps remove split
ends and prevent them from traveling up
the hair shaft, minimizing the appearance of
damaged hair.

2. Gentle Handling:
Avoid excessive brushing, harsh combing, or
using heat styling tools at high temperatures,
as these can cause mechanical damage and
weaken the hair shaft.

3. Moisturizing and Conditioning:

Using moisturizing shampoos and conditio-
ners, as well as hair masks or leave-in treat-
ments, can help nourish and hydrate the hair,
making it more manageable and less prone to
damage.

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 4. Protecting from Heat and UV:
Apply heat protectant products before using
hot styling tools, and consider wearing hats or
using UV-protective sprays when exposed to
prolonged sun exposure.

5. Balanced Diet:
Eating a balanced diet with sufficient protein,
vitamins, and minerals can support overall hair
health.

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 I. THE HAIR FOLLICLE
The hair follicle is a small structure within
the skin. In the lower part of the hair follicle,
also known as hair bulb, keratinocytes are
produced. Keratinocytes actively divide and
differentiate. Think of keratinocytes as versatile
workmen that can transform into various
skilled workers in a construction project.
Through differentiation, these cells acquire
specific roles, like bricklayers, electricians, or
painters, and contribute to building a strong
and functional structure, just as keratinocytes
contribute to the formation and maintenance
of the skin and hair.

After keratinocytes have acquired their

specific role, they undergo a process called
keratinization, where they produce and
accumulate keratin proteins. These keratin
proteins form the bricks of the hair and skin.

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 As the keratinocytes in the hair bulb
continue to divide and produce keratin, the
older keratinocytes are pushed upward,
elongating the so-called hair shaft. In other
words, that’s how hair grows.

That’swhyfollicleshaveacrucialroleinhair
growth. To be able to produce keratinocytes
and grow hair that’s strong and healthy, the
follicles need to be nourished properly.

Keratinocytes in the hair follicle also

interact with other cells, such as melanocytes.
Melanocytes transfer “melanin pigment” to
the keratinocytes, these are small compounds
that are giving the hair its color.

Another function of melanin is to absorb UV

light from the sun. When UV light penetrates
the hair shaft, melanin helps to prevent it from
reaching the underlying skin.

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 This protective role helps to minimize the
damaging effects of UV radiation on the hair
itself and on the scalp. People with darker hair,
generally have more natural protection against
UV radiation compared to those with lighter
hair, such as blonde or red.

Have you ever wondered why your hair

gets lighter in the summer? or if it really gets
lighter or just appears to be?

Here’s the answer:

One of the primary reasons for hair lightening
in the summer is the action of sunlight on the
melanin. Melanin gives hair its colour, and when
exposed to UV radiation from the sun, it can
undergo a process called photodegradation.
That means that UV radiation breaks down
the melanin in the hair, leading to a gradual
lightening effect.

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 Additionally, sunlight can also have a
bleaching effect on the hair. The combination
of UV radiation and heat can alter the chemical
structure of melanin, resulting in the oxidation
and breakdown of pigments. This process can
lead to a lightening of the hair colour, especially
in individuals with naturally lighter hair tones.

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 During winter, melanocytes can get some
rest and regenerate for next summer – a reason
to look forward to the colder months.

II. THE HAIR SHAFT

is the visible part of our hair mainly composed
of tightly packed keratinocytes that have lost
their nucleus and hence any metabolic activity.
The nucleus is the core of the cells where it
holds information about the cell and acts as a
control center. You can think of it as the brain
of the cell. It’s important to note that there are
other keratinocytes in the body which retain
their “brains”. But hair is special in this regard.
The removal of the nucleus serves two
important purposes that allow for the unique
properties and structure of hair.

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 First, it allows the keratinocytes to become
packed with keratin protein. Remember, that
is the major component of the hair shaft. The
absence of the nucleus creates more space
for the keratin fibers to be tightly packed
together, making the hair strong and resilient.

Second, the removal of the nucleus in

hair cells helps in making the hair more
transparent. This gives hair its characteristic
shiny and glossy appearance.

The hair shaft can furthermore be divided

into three distinct layers: the medulla, cuticle,
and cortex.

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 1. Medulla:
The innermost layer of the hair shaft, which
consists of a soft, oily substance.

2. Cuticle:
A thin, protective layer that contains the
nutrients essential to hair growth.

3. Cortex:
This is the main component of the hair that
contains long keratin chains, which give the
hair elasticity, resistance, and shine.

Both the cortex and the medulla hold the

hair’s pigment, you remember the melanin?!

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Hierachical structure of hair under various magnifi-
cations. The size range accessible to the respective
thest method is also indicated in the figure.

4 5
1 3
2

7 8

1_Keratin 2_Tetramers 3_Intermediate Filament

4_Macrofibril 5_Cortical Cell 6_Medulla 7_Cortex
8_Cuticle 9_Lipid Layers

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 Have you ever wondered why the hair all
over your skin looks different from the hair
on your head, eyebrows, and eyelashes?

Well, that’s because they are different

types of hair. Let’s explore the differences
and discover more about the hair on our body.

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 I. TERMINAL HAIR:
We all recognize terminal hair as the thick, long,
and pigmented hair that grows in specific re-
gions like our scalp, eyebrows, and eyelashes.
It stands out because it has a deeper root and
undergoes a longer growth period compared
to other types of hair on our bodies. Terminal
hair can go through noticeable changes in co-
lor, texture, and thickness throughout different
stages of our lives. Its growth is influenced by
hormones and genetics, resulting in variations
such as naturally thick and full terminal hair or
finer and sparser terminal hair.

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 II. INTERMEDIATE HAIR:
In areas such as the underarms, pubic region,
mustache, and sideburns, you’ll find interme-
diate hair. It’s not as robust as terminal hair,
exhibiting decreased thickness and someti-
mes less pigmentation.

III. VELLUS HAIR:

Now, picture a delicate, wispy veil gently co-
vering various parts of your body. That’s vel-
lus hair! It has a fine texture, short length, and
light pigmentation. You can find vellus hair on
your arms, legs, face, and even your back and
chest.

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 1 2

1_Vellus
2_Terminal

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 Imagine f.e. When a baby is born, the type
of hair that typically grows on the scalp is
vellus hair. In the first few months of a baby’s
life, the vellus hair on the scalp may appear thin
and sparse. Over time, as the baby grows, the
vellus hair gradually transitions into a different
type of hair called terminal hair also during
puberty, hormonal changes can cause the
transformation of vellus hair in certain body
areas, such as under the arms, in the genital
area, and in the beard area, into intermediate
or terminal hair.

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 These transformations are normally driven
by androgens, including testosterone, which
are naturally more abundant in males than
females. As a result, men tend to have more
intermediate and terminal hair compared to
women.

In some cases of hair loss, there can be a

reversal of this transformation process, where
terminal hair reverts back to vellus hair. This
typically occurs due to hormonal imbalances.

Vellus hair may seem unnecessary, but

despite its thin diameter, it plays a vital role in
maintaining healthy skin. It acts as a protective
layer, helping to regulate body temperature and
safeguard your skin from external elements.

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 These hair types not only differ in
appearance but also in the composition and
duration of the hair follicle cycle. Vellus hair
follicles have a shorter growth phase and
hence thinner diameter, while intermediate
and terminal hair follicles have a longer growth
phase and a thicker diameter. These variations
in follicle structure and cycle contribute to the
distinct characteristics of each hair type.

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The hair’s
structure is
composed of
80% keratin
10% water
and 5 or ot 10%
pigments
and lipids
 The Hair Growth Cycle
At the very beginning, during the
embryonic stage, specifically around the 9th
to 12th week of pregnancy, the first follicle
(hair roots) is formed. It looks like a sac and is
located under the skin. There is a tiny opening
in the skin that is a tissue formed from a follicle
and where it pokes its head from beneath the
skin. The process continues throughout fetal
development and beyond birth. By the time of
birth, the scalp usually contains a considerable
number of hair follicles, although the hair
produced during this period is typically fine
and called vellus hair as we have heard before.

The transformation to thicker, terminal

hair occurs gradually as the child grows older.

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 Fun fact: Interestingly, the human body
contains more follicles than the body of animals
like chimpanzees and gorillas. As our hair is
lighter in appearance, it gives off the illusion
that they have more hair!

After the formation of follicles, three

different phases occur: the anagen, catagen,
and the telogen phase. Every hair on our body
goes through these three main stages of
growth over and over again.

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 1

4
3 5

1_Hair Shaft
2_Hair to Fall Out
3_Hair Follicle
4_Dermal Papilla
5_Hair Matrix

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 I. ANAGEN PHASE OR ACTIVE HAIR
GROWTH PHASE
Anagen is the period of active cell proliferation
and noticeable hair growth. Throughout hair
cycling, about 90% of all follicles are in the
anagen phase and can remain in this phase
anywhere from 2 to 8 years.

Note: Cell proliferation refers to the process

of cell division and reproduction, leading to an
increase in the number of cells

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 II. CATAGENIC OR REGRESSIVE PHASE
In the Catagen phase over 2 to 3 weeks,
cell production is halted, and the hair follicle
shrinks. The hair shaft begins to separate from
the bottom of the follicle and forms, what is
referred to as, club hair.

III. TELOGEN PHASE OR REST PHASE

In theTelogen phase, the hair is ready to fall
out because it is no longer associated with
the dermal papilla.

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 Derived from the Greek “telo” meaning
end, and “gen” meaning produce, the telogen
phase marks the end of hair production as the
follicle undergoes dormancy or cell quiescen-
ce. The follicle can remain dormant for several
months with the hair bulb intact, and the pro-
cess of growing new hair begins.

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 People who experience stress, tension,
or illness for an extended period often are
at this stage for a longer time, resulting in an
increase in hair loss and a lower rate of re-
growth.

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 Hair loss can occur at varying degrees,
and can be triggered by a multitude of factors.

Notably, hair loss is one of the most common

complaints seen in the field of dermatology.

Hair loss can be triggered by genetic

factors, but we should also remember that
hair is an indicator of overall health. If your hair
starts behaving differently than normal, this is
usually a signal that your body is ‘holistically’
out of balance.

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 The key question you should ask yourself
if you are experiencing hair loss is: “what has
changed ?”.

Have you moved location, changed jobs,

or changed your diet?

An individual change or combination of

changes can have an impact on your overall
health.

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 The Manifestation
of Hair Loss
Hair loss can manifest itself in a number of
different ways and it’s difficult to distinguish
them visually, but the pattern of hair loss can
be helpful in narrowing down possible causes,
and making initial assumptions about the
type of hair loss. The manifestation also helps
to describe the degree of hair loss; typically
the Hamilton-Norwood (for men) and Ludwig
(for women) scales are used for this.

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 So let’s start with a brief explanation of the
different manifestations:

1. Generalized thinning:
As we age, our hair naturally gets thinner.
For this reason, you should take preventive
measures to slow down this process and
maintain the integrity of your hair. You should
also be wary that rapid-paced (> 150 hairs/
day) hair loss is not a sign of age-related hair
thinning. This could have several reasons like
some kind of malnutrition or nutrient deficiency.

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 2. Sudden hair loss:
While the above can be seen with the aging
process, a sudden loss of >150 hairs per day
or larger patches of hair loss may be indicative
of unnatural treatable forms of alopecia such
as alopecia areata or other illnesses.

3. Thinning of the crown area and

receding hairline:
is usually one of the first signs of hair loss
people notice and very common in almost
all people affected by androgenetic alopecia
(AGA). If it is diffuse, it can be described as a
manifestation of ‘female pattern hair loss’ and
if it is more gradual - it is called ‘male pattern
hair loss’.

4. Loss of hair on the top:

Losing hair on the top of your head is a classic
sign of male pattern baldness. Several men
who deal with this type of baldness often end
up with significant hair loss on the top portion
of their heads.

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 5. Wider partings:
When your partings start to get wider, it is
a sign of hair loss. This sign is particularly
useful for individuals who may not notice
that their hair is thinning. Therefore, if your
hair is thinning out in your parting area, you
should consider consulting with your doctor
for further investigation.

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 6. Front temporal hair loss:
If your hair loss is mainly in the front temple
area and you often have your hair in a ponytail
or similar tight hairstyles, this indicates the
presence of Traction Alopecia (TA).

If the strong traction causes small wounds

and scarring, the hair loss can also be
permanent. Therefore, when styling the hair,
care should be taken to handle the hair gently.

In addition to the manifestations, it is

important to be aware of the different hair loss
types. In the following I will introduce a few of
them.

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Men’s Hair Loss Stages

1 2 3

4 5 6

7 8

Women’s Hair Loss Stages

1 2 3

4 5 6

7 8
 Type of Hair Loss
There are numerous forms of hair loss
(alopecia), which can affect hair anywhere on
the body. I already mentioned some of them,
but now I want to go into more detail.

All forms of alopecia differ in causation

(aetiology) and severity, which can only be
diagnosed by a medical provider.

Alopecia can be subdivided into two main

categories: non-scarring and scarring.

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 1. Scarring hair loss
(cicatricial alopecia):
involves the destruction of hair follicles and
permanent replacement with scar tissue,
resulting in irreversible hair loss.

2. Non-scarring hair loss

(non-cicatricial alopecia):
refers to temporary or reversible hair loss
where the hair follicles remain intact, allowing
for potential regrowth once the underlying
cause is addressed.

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 The most common type of non-scarring
hair loss is known as androgenetic alopecia,
or more simply, male and female pattern hair
loss.

Androgenetic alopecia is a common type

of hair loss, according to reports, it affects up
to 50% of men and 40% of women by the age
of 50.

The main reasons behind androgenetic

hair loss are thought to be factors such as
genetics and hormones, including DHT.

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 I. ANDROGENETIC ALOPECIA
Androgenetic Alopecia (AGA) is the most
common form of hair loss in both men and
women. It is best known as hereditary hair loss.

Many people affected by AGA have a fa-

mily history of hair loss. Typically, men have a
more localized hair thinning of the frontal and
vertex scalp (That is the highest point on the
scalp where the hair growth pattern conver-
ges), or complete baldness, meanwhile wo-
men mainly have diffuse hair loss. Factors
which are known to mimic AGA are auto-im-
mune disorders and nutrient deficiencies,
but also factors which are modulating the te-
stosterone and dihydrotestosterone system
in the body.

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 Changes in the AR (Androgen Receptor)
gene can be associated within androgenetic
alopecia.

Variations in the number or types of DNA

building blocks in that gene are responsible
for the prevalence of AGA.

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 As these genetic changes, once developed,
are hereditary; a family history, regarding
hair loss, is often recorded when affected
individuals see a doctor.

The treatment can range from caffeine

shampoos to topical minoxidil solutions to oral
(normally tablets) or topical (normally a serum)
finasteride. The latter is mainly suitable for male
patients, and is only available on prescription
in most countries, because of the high and
severe side effects. The exact modes of action
and side effects of the different treatment
methods will be explained in more detail in the
following chapters.

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 II. ALOPECIA AREATA AND ALOPECIA
TOTALIS
Alopecia areata can affect all types of hair,
from the terminal to the vellus hair. Alopecia
totalis is a subtype of alopecia areata
characterized by the complete loss of hair
on the scalp. While both alopecia areata and
alopecia totalis are autoimmune conditions
causing hair loss, alopecia areata manifests
as patchy hair loss in discrete areas of the
body, including the scalp, while alopecia totalis
involves the complete loss of hair on the scalp,
resulting in total baldness.

Furthermore, when the whole body is

affected, it is called alopecia universalis.

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 As of now, the exact biological mechanisms
behind alopecia areata are not fully understood,
but research indicates it is the result of
autoimmunity with genetic components. The
appearance starts as circular bald spots
spreadingintoacentrifugalpattern.“Centrifugal
pattern” means that hair loss starts at a central
point and progressively spreads outward in a
circular or radiating manner.

As mentioned above, the main factors

are autoimmune diseases, including atopic
eczema, Hashimoto’s thyroiditis, Graves
disease and vitiligo. It remains a mystery how
hair a few centimetres away from an areata
bald spot grows normally, yet sometimes
spontaneous remission occurs and sometimes
the baldness persists.

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 About one third of those affected have
their baldness spontaneously disappear
within six months, and as many as 50-80%
are asymptomatic after only one year. As the
baldness can spontaneously disappear, no
special therapy is recommended in mild cases.
Zinc and other antioxidants can be taken as
immune modulators to support the body.

Local therapy with high-dose steroid

foams in the affected area can lead to
significant improvement in worse cases of
alopecia areata. Injection of triamcinolone into
the affected area or taking steroids may also
be helpful. If the cause of alopecia areata is
an autoimmune disease, then initial treatment
can also reduce baldness.

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 In any case, the chosen method of therapy
should be carefully discussed with the treating
physician and a second and third opinion
sought if necessary.

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 III. TELOGEN EFFLUVIUM
Telogen effluvium (TE) is an additional form of
non-scarring alopecia that arises from a shift
in one’s natural hair growth cycle towards a
cycle with a shorter anagen phase and longer
telogen phase.

The name “Telogen effluvium” is derived

from this cycle shift towards the telogen phase.
The quotient of hair follicles in the anagen
phase to follicles in the telogen phase is a
suitable diagnostic method for TE called the
A/T ratio and also broadly used to assess the
efficacy of hair growth related products.

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 Normally the amount of follicles in the
anagen phase should be above 80 % of the
total follicles on the scalp. The other 20 %
should be in the catagen and mainly telogen
phase.

The A/T ratio should thus be greater than

4 indicating a balanced hair growth cycle. A
further distinction can be made between the
chronic and acute form. The acute form is
mainly triggered by temporary physical and
mental stressors such as; anesthesia and
surgery, infections, extreme diets or dietary
changes, psychological stress such as
depression or stress and various medications.
If the factors remain temporary, the hair loss
can also be reversible and transient.

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 However, if these factors persist for a
longer period of time, or if other factors such
as chronic diseases (e.g. hyperthyroidism)
are added, then the acute form can become
chronic or develop into a chronic and slowly
progressive TE. The appearance of TE is
indistinguishable from pattern hair loss, and
they are often not differentiated.

Many therapies are doomed to fail, purely

because they do not aim at the actual cause.

IV. ANAGEN EFFLUVIUM

Anagen effluvium is an abnormal diffuse hair
loss, occurring during the anagen phase.
This happens because mitotic and metabolic
activity of the hair follicle is interrupted.

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 One common instance is hair loss after
chemotherapy. Around 65 % of patients
treated with chemotherapy get diagnosed
with anagen effluvium afterwards. DNA and
cell cycle disruptors and intercalators like
cyclophosphamide, doxorubicin, allopurinol,
and more can impair the hair cycle. Cell cycle
disruptors are substances that disrupt the
normal process of cell division and growth,
while intercalators are molecules that can
cause changes in the structure of DNA. These
disruptions and changes can impact the
regulation of cell division in the hair follicles,
potentially leading to hair growth abnormalities
or inhibition.

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 Other medical or inflammatory conditions
such as mycosis fungoides or pemphigus
vulgaris can lead to anagen effluvium. The hair
loss normally begins days to weeks after the
root cause (chemotherapy, infection, etc.) and
increases until it is most apparent (normally
after one or two months). The hair loss is
normally reversible with the regrowth of hair
after stopping with the offending agents and
needs normally no additional treatment.

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 V. TRACTION ALOPECIA
Hair loss from traction alopecia usually occurs
in the front temporal area, although it can vary.
Eliminating the stressor or source of traction
on the hair, commonly cures the problem and
returns hair growth to normal.

Several small case reports suggest that

topical treatment can be beneficial. In rare
circumstances, chronic traction can start a
process of folliculitis and subsequent scarring
that can result in permanent hair loss to the
affected area. However, the general rule (for
traction alopecia) is that hair loss is reversible
with less tight hairstyles and strengthening
of the hair strands with topical products and
sufficient nutrient supply.

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 VI. TRICHOTILLOMANIA AND
TRICHORRHEXIS NODOSA
Trichotillomania is called an impulse-control-
led disease mainly present in adolescents.
Hair loss is caused by consciously and uncon-
sciously pulling, twisting or twirling the hair.
Since the cause of this disorder is psycholo-
gical, the treatment options include cognitive
behavior therapy and serotonin enhancers.

Trichorrhexis Nodosa or better known as

traumatic alopecia, describes hair loss and
breakage along a trauma or fragile hair. It
mainly affects the proximal or distal hair shaft.
The proximal hair shaft refers to the part of the
hair strand closest to the scalp, while the distal
hair shaft refers to the part of the hair strand
that is farther away from the scalp, towards
the ends of the hair.

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 The traumas leading to this type of hair
loss can be caused by excessive scalp
scratching, brushing, heat applications, tight
hairstyles, and excessive exposure to salt
water or chemicals used on the scalp and hair.
The treatment is mainly cause-related, which
means identifying and stopping the cause(s)
can help to reduce the hair loss.

VI. TINEA CAPITIS

Tinea capitis is a fungal (dermatophyte)
infection of the hair shaft and follicles that
may cause bald spots, flakiness, broken hair,
and other inflammatory signs in the scalp.

It primarily affects children and people

living in North America. The fungus can be
transmittedthroughperson-to-personcontact,
from animals or by contaminated accessories
as the fungal particles may remain viable for
several months.

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 Although the whole scalp can be infected,
patients with tinea capitis normally present
patchy alopecia with inflammation related
symptoms. Skin scraping can help to identify
and diagnose the fungus by microscope and
cell culture.

Since antifungal agents hardly penetrate

the hair follicles, systemic treatment is normally
preferred. Terbinafine, itraconazol, fluconazole
and griseofulvin are common treatments for
Tinea Capitis.

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 Disease and Hair Loss
Besides hereditary predisposition, there
are other diseases that are often observed
in connection with hair loss. Here are some
possible diseases, and the mechanisms
through which they could be responsible for
hair loss.

I. HORMONE IMBALANCE
There are several different diseases reflected
in hormone imbalance and hair loss.

Hyper- and Hypothyroidism; Hypercorti-

solism and Hyperandro- enemia are the most
common ones.

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 II. HYPERANDROGENEMIA
Hyperandrogenemia refers to an excessive
level of androgens (male sex hormones) in
the bloodstream. Hyperandrogenemia is
commonly associated with conditions such as
polycystic ovary syndrome (PCOS), which is
characterized by multiple cysts on the ovaries
in female patients,and prostate cancer in
men, also with irregular menstrual cycles, and
symptoms like acne, hirsutism (excessive hair
growth on specific parts of the body), and is
often connected with male-pattern hair loss.

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 Other possible causes of hyperandroge-
nemia include adrenal gland disorders (another
hormone production site in the body), ovarian
tumors, and certain medication side effects.
Also this is a highly underestimated cause of
female pattern hair loss.

It was investigated that about 38 % of

women experiencing hair loss have elevated
androgen levels. Less or no pubic hair is a very
common symptom of hyperandrogenemia.
The hair texture was often found to be very
thin (vellus) and symptoms can include acne,
seborrhea and hirsutism (male-like hair
growth in women).

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 III. THYROID DISEASES
Severe thyroid disease (e.g., hypothyroidism,
hyperthyroidism) can lead to hair loss.

Usually, the baldness is diffuse, including

the entire scalp area and appears several
months after the onset of the thyroid disease.
As a result, half-truths spread, such as that
the medicines used to treat thyroid diseases
cause hair loss. However, this is usually not
true!

People, affected by thyroid disease, report

that their hair appears uniformly sparse. Luckily,
the treatment of the underlying thyroid
disease is generally sufficient to reverse the
hair loss; however, it may take months before
any results are apparent.

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 Patients with autoimmune thyroid disease
are more likely than others to develop other
autoimmune conditions, e.g. alopecia areata,
lupus erythematosus, which can lead directly
or indirectly to hair loss. You may remember
alopecia areata, the autoimmune disorder
showing itself in circular areas of hair loss.

IV. RHEUMATIC DISEASES (LUPUS

ERYTHEMATOSUS)
Rheumatic disorders are conditions that can
cause pain and swelling in joints, such as lupus
erythematosus can also lead to hair loss in
over 50% of the patients at some point of the
disease history.

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 The hair loss can be non-scarring during
acuteflaresorbecomescarringandirreversible
with discoid lupus erythematosus.

Normally, the remaining hair fibers count

less than 50 % and they are dry and fragile
with shorter length at the frontal margins.

V. SCALP PSORIASIS
Scalp psoriasis is a very common skin
disease leading to inflammation of the
skin manifesting itself in redness, itching,
hair shedding and dandruff and is caused
by different pathogens. Pathogens are
microorganisms, such as bacteria, viruses,
fungi, or parasites, that can cause diseases
in humans.

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 Among several bacterial infections, a
bacterium called Treponema pallidum can
manifest hair loss in approximately 5 % of
syphilis-infected patients.

The hair loss manifestation can range from

a diffuse, patchy pattern or both. It mainly
affects the scalp and is often confused with
alopecia areata at first glance, but laboratory
tests can easily distinguish between the two
different causes.

Viral infections like Eppstein-Barr virus

(EBV), hepatitis C, varicella zoster virus,
and more, can induce cicatricial (=scarring)
alopecia. This is hair loss that occurs due
to destroyed hair follicles by inflammation,
causing scarring and permanent hair loss.

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78 C2
 VI. DERMATOMYOSITIS
Dermatomyositis is a connective tissue di-
sorder, causing non-scarring and diffuse hair
loss. Normal therapies include immunosup-
pressants and the hair loss can be reversible
after several months of therapy.

VII. SARCOIDOSIS
Sarcoidosis is defined as causing small patches
of red and swollen tissue, called granulomas,
to develop in the organs of the body.
It usually affects the lungs and skin. Cutaneous
(=affecting the skin) sarcoidosis can occur
in combination with systemic (affecting the
whole body) sarcoidosis or alone. Red, small
and swollen patches on the scalp are a rare
manifestation of the disease and initially
present as erythema, scaling, and atrophic
area of hair loss.

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 Local destruction from sarcoidosis, if
untreated, could lead to scarring of hair
follicles, akin to cicatricial alopecia. According
to current guidelines, oral prednisone (a type
of medicine) is the recommended treatment
that aids by reducing inflammation.

VIII. CORONARY HEART DISEASE

It was investigated that coronary heart disease
(CAD) patients have significantly higher scores
for baldness.

In particular, vertex balding (where hair

can recede along the temples or crown) can
be connected with an increased risk of CAD. It
is also known that androgenetic alopecia and
CAD are connected.

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 IX. OTHER
Hair loss can also be related to poisoning,
nutritional deficiencies, medication, cancer
therapy, high-stress levels (excessive sports,
childbirth, anaesthesia, surgery etc.) or work-
related, such as increased friction and pulling
on hair by wearing headgear (helmets, caps,
hats, etc.) or tied hair.

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82 C2
 In most instances, a healthier diet is not an
end-all cure for hair loss.

Unless you have a proven nutritional

deficiency, significant changes in your diet will
not leave you with instantly thicker hair.

What a healthy varied diet does provide,

are the nutrients to keep your body in top
condition and therefore, better the chances
of experiencing the benefits from any other
treatments or methods.

In the late 1990s, it was first discovered

that one major cause of hair alopecia was
a nutritional deficiency, more specifically, a
deficiency in vitamin B3.

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 Since then, advances in public health have
ensured that most are covered, by means of
nutritional fortification. Nonetheless, there are
reasons why the food you put into your body
is critical for building hair health.

What do iron, oxygen, hydrogen, nitrogen

and sulphur have in common? They are all
components of the hair, and an adequate
supply of blood containing these minerals is
essential for keeping the hair growth cycle
going.

Many different minerals and vitamins are

responsible for building new blood vessels
during the anagen phase, and stimulate hair
growth by different mechanisms.

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 These are some of the more important
vitamins and minerals, their specific way of hair
care and protection and how to supply these
precious nutrients with our daily diet.

85 C3
 Let’s start with some agents improving
blood supply to the hair and scalp.

I. RIBOFLAVIN (VITAMIN B2)

Riboflavin is a coenzyme in several oxidation
and reduction functions. A coenzyme is a
non-protein component of enzymes. It helps
enzymes to catalyse (accelerate) important
reactions in the body by binding to it for a short
time.

It is also needed for niacin (Vitamin B3)

formation of the amino acid, tryptophan, and
Vitamin B6 function needs riboflavin.

Due to its versatile tasks as a coenzyme,

riboflavin is multifaceted and indispensable
for almost all body cells. Notably, a permanent
undersupply of riboflavin can result in dermatitis
(skin dryness), which can be a cause of hair
loss if the scalp is affected.

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 The WHO recommends a riboflavin inta-
ke of 1.1 - 1.3 mg/day, which is easily achieved
through a balanced diet. Riboflavin is found in
many foods such as milk and dairy products,
meat and green vegetables.

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 II. NIACIN (VITAMIN B3)
Niacin is a co-substrate for hydrogen transfer
(in summary, it is a path of energy transfer/
production) in multiple pathways.

In the 1900s, the deficiency in niacin was

termed pellagra, and is now primarily extinct;
due to the fortification of foods in developed
countries. The activated niacin (called NAD) is
an important cofactor for hydrogen transfer
reactions to keep our cells’ respiratory chain
running. It also plays a role in DNA repair as
part of the transport and transform system for
the DNA building blocks.

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 Vitamin B3 plays a major role in fatty acid
and steroid construction, and for the pentose
phosphate pathway (another metabolic pa-
thway to convert carbohydrates into energy)

A deficiency of Vitamin B3 can trigger a

severe form of dermatitis. The conversion of
L-Tryptophan (an essential amino acid found
in proteins) to niacin requires Vitamin B2 and
B6.

Therefore, a deficiency of Vitamin B3 is

often connected with a lack of Vitamin B2
or B6. A daily intake of 14-16 mg of niacin
(equivalents) is recommended in the WHO
guidelines. Niacin can be found in lean meat,
liver, grains and legumes.

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90
90 C2
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 III. ASCORBIC ACID (VITAMIN C)
Ascorbic acid is one of the most important
natural anti-oxidants and electron donors
in our body. Multiple enzymes with different
functions in the biosynthesis of hormones,
collagen production or carnitine biosynthesis,
require ascorbic acid for functionality.

Collagen is the most common protein

in humans. It gives structure and stability
to multiple body parts, such as teeth and
bones, by being part of the connective tissue.
Collagen improves our skin’s elasticity, known
as an “anti-aging” protein by supporting skin
structure.

Carnitine is perhaps not as known as col-

lagen, but certainly no less important. It is the
delivery vessel of our cells and carries fatty
acids for energy metabolism.

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 But what is an Antioxidant?

Antioxidants are the security men for our

cells. They bind to highly aggressive molecules
and ensure that they do not damage our cell
tissues. These aggressive molecules, called
free radicals, are a product of cell metaboli-
sm, stress, excessive sport, sunlight, toxins
amongst other factors.

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 Antioxidants, like ascorbic acid, help to
keep your body healthy by preventing and
repairing cell damage. Vitamin C is also the
most important uptake enhancer for iron, and
therefore assists the blood and oxygen supply
chain. You will read about this in more detail in
the Iron section.

Unfortunately, the body cannot produce

ascorbic acid itself, but it is found in many
different vegetables and fruits and especially
in citrus fruits. The WHO recommends five
portions of fruits and vegetables (or 400 g) to
reach the ascorbic acid requirement of 20-30
mg/day.

There is no upper limit - any excess of

Vitamin C will be excreted.

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 IV. TOCOPHEROL (VITAMIN E)
Vitamin E is an antioxidant protecting our cells
from aggressive radicals.

Unlike Vitamin C, Vitamin E prefers a fatty

environment. Instead of wandering around, it
prefers to join the cell wall fats and ensures
that they remain intact.

Vitamin E is so efficient in taking care of its

neighbour lipids that it needs just 1 molecule
per 2000 fat molecules, although it is very
likely that other antioxidants help. Vitamin
E needs other fats and salts from bile to be
absorbed through the gastrointestinal tract,
which positions around vitamin E and carries
it through the intestinal wall.

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 Vitamin E is exclusively obtained from the
diet. Since it is naturally present in plant-based
and animal products, there is not a big risk of
deficiency.

One thing should be considered: oil and

fat contain and improve the absorption of to-
copherol and are important to eat as well.

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 V. ZINC
Zinc acts as a stabiliser for cell components
and membranes. Zinc is our body’s caretaker
by maintaining cell and organ integrity.

It also has an essential role in polynucleotide

transcription. Polynucleotides are our DNA,
the building instructions for all our cells and
proteins. Transcription is simply the biological
process of our DNA being turned into RNA.
The RNA transcript is not as stable as DNA, but
can be read by special enzymes which build
up corresponding proteins or molecules. Zinc
is also important for our immune system, and
in the metabolism of other micronutrients.

One of the many effects of zinc deficiency

is alopecia, also known as hair loss.

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 Since the body is not able to produce zinc
by itself, it must be obtained through diet. The
absorption of zinc from solid food is less effi-
cient than intake of liquid solutions, which is
more efficient with around 60-70% of the to-
tal zinc content. The body has no possibility to
store zinc, therefore, it should be delivered to
the body daily.

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 In a major emergency, zinc can be
released from bone and tissue catabolism
(destruction). The best food sources of zinc
are lean red meat, whole grain cereals and
legumes. However, phytates, which are mainly
present in whole-grain cereals and legumes,
decrease zinc absorption. They have a strong
potential for binding to zinc, and therefore
making it impossible to pass through the
intestinal wall into the blood. Phytates are
the phosphate and energy storage of many
plants, and can be useful antioxidants. Usually,
the phytate intake shouldn’t be a serious issue
to affect zinc levels. As dietary proteins and
animal proteins improve zinc absorption from
phytate-containing sources, all meat lovers
and colourful eating vegetarians and vegans
are very safe.

98 C3
 VI. IRON
Similarly to zinc, iron is responsible for several
functions in the body.

Iron is famous for delivering oxygen to
all tissues, transporting electrons, and an
important part of various enzyme systems.

Most of the iron in the body is present in

haemoglobin. Haemoglobin is a protein cluster
composed of four parts. Each part can (but
does not have to) enclose an iron molecule.
Oxygen can also be trapped in this protein
cluster, but only if iron is present.

This oxygen-haemoglobin-iron complex

can deliver oxygen to all tissues and cells, but
also to the keratin synthesising cells. Keratin
is the protein that mainly makes up your hair,
skin and nails.

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 The enzymes responsible for electron
transfer to the energy production facility of the
cells called “mitochondria” use iron as electron
storage.

Some iron-dependent enzymes can also

be part of steroid hormone production (e.g.
androgens, which are important for hair growth
as well) or detoxification.

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 One has to discriminate the two main iron
sources in food:

1. The haem iron :

Mainly derived from meat, poultry and fish. It
is contained in blood, and therefore derived
from living beings.

2. The non-haem iron:

Mainly derived from cereals, pulses, fruits
and vegetables. Its absorbance is inhibited by
calcium, phytate, iron-binding phenolic com-
pounds, which are contained in caffeine and
related compounds.

101 C3
 The recommendation of the daily intake of
iron varies depending on gender, body surface
and bioavailability, but should be around 10-30
mg/day for adults according to the WHO.

The uptake of the haem-iron contained in

meat can vary but is around 25 %. If the haem-
iron meat is cooked for too long or at very
high temperature, it will be converted to non-
haem iron. Non-haem iron is the main form of
dietary iron. Ascorbic acid (Vit C) is the most
potent enhancer of non-haem iron absorption,
and is also subscripted to one of Vitamin C’s
physiological roles.

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 Having less energy and physical working
capacity can be an effect of iron deficiency.

Iron deficiency leads to oxidative

metabolism in the muscles with increased
formation of lactic acid. The deficiency can
cause pain in random parts of the body and may
lead to irreparable brain damage if it occurs in
the early stages of brain development.

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 VII. BIOTIN
The name biotin probably sounds familiar to
you, but do you know the story behind it?

Biotin is a cofactor for carboxylases that

catalyzes an essential step in intermediate
metabolism. Intermediate metabolism refers
to the sum of processes, converting nutritive
material into cellular components.

To summarize: biotin supports the

construction of cells and synthesis of cell
parts, and also helps break down dead or very
damaged cells.

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 The main reason for deficiency may be
the prolonged consumption of raw egg white,
which contains biotin-binding avidin. The
symptoms are among others erythematous
and seborrheic types of dermatitis, which
cause hair loss due to scalp dryness.

The recommended intake of biotin,

according to the WHO, is 30 µg/day and can
be consumed through liver, eggs, yolk, soy
flour and cereals, which all have a good-to-
moderate biotin content.

Since the avidin from raw egg white is the

main inhibitor of avidin, one should be very
careful regarding eating raw eggs.

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106 C3
 VIII. AMINO ACIDS
Many have heard that amino acids are the
building blocks of proteins.

More specifically to hair, L-cysteine,

L-glycine, L-phenylalanine, and L-proline, are
involved in the formation of the protein keratin.
L-methionine has also an essential role as an
amino acid.

Eating lean meat gives you a fantastic

source of protein, while there are also some
plant-based sources of protein.

Let’s dive deeper into two of the twenty

amino acids:

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 1. Cysteine:
Is a asulfur-containing amino acid, enabling
a powerful antioxidative function by trapping
reactive oxygen species. It is also promoted as
an anti-aging active ingredient. It is not often
contained in skin care products, because of
its low stability and peculiar smell.

2. Methionine:
Is one of the nine essential amino acids. Apart
from its role in initiation of translation from RNA
into proteins, it is assumed that methionine
gives structure to the protein by forming a
hydrophobic (water avoiding) core with other
hydrophobic amino acids.

108 C3
 Years of research investigated that
methionine serves as an important cellular
antioxidant, as it stabilizes the structure of
proteins and participates in the recognition of
protein surfaces. Furthermore, it can act as a
regulatory switch through reversible oxidation
and reduction reactions needed for several
metabolisms.

With the recognition of all these functions

related to methionine residues in proteins, it
is not surprising that a lack of methionine has
also been associated with several diseases
like dermatitis and alopecia.

Tokeepawayreactiveoxidativesubstances
from the cells and cell walls, it is important to
have enough powerful anti-oxidative agents
distributed in all parts of the body.

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110 C3
 As we have already learned, the causes of
hair loss are very diverse and are often related
to other diseases. Thus, in the last decades,
various medical methods and medicines have
been brought onto the market to treat hair
loss. In the following, I would like to briefly
introduce the most widespread ones, perhaps
you already know one or the other medication
if you have been dealing with hair loss for a
while.

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 I. FINASTERIDE
Finasteride is a prescription drug used to treat
hair loss. It can be incorporated in a tablet and
capsule for oral administration or also in sprays
for topical use.

Normally for Alopecia the brand name

product “Propecia” is prescribed which are
film-coated tablets with an amount of 1 mg
Finasteride per tablet. Normal doses range
from 1-5 mg/day.

Finasteride works by decreasing the

amount of the hormone, dihydrotestosterone
(DHT), which is often connected with
androgenetic alopecia. It lowers the DHT-
level by blocking the enzyme binding site from
5 alpha reductase (enzyme) which converts
testosterone into dihydrotestosterone.

112 C4
 Finasteride has a very similar structure to
testosterone, which is why it fits perfectly into
the binding site of the enzyme.

Finasteride has a higher affinity for

5-alpha reductase than testosterone and
therefore accumulates at the binding sites.
If testosterone cannot bind to 5-alpha
reductase, it is not converted into the more
active form dihydrotestosterone. In short,
by taking finasteride, the testosterone level
increases within a few hours and at the same
time the dihydrotestosterone level decreases.
If this “new” hormone level occurs only once
or only irregularly, it has rather less effect. A
permanent change in hormone levels, on the
other hand, leads to a reduction in the size of
the prostate and reduced hair loss. Both of
these are usually desired effects.

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 Undesirable effects of finasteride are a
loss of libido and erectile dysfunction, both of
which can be explained by the lowered level
of DHT. Finasteride is not intended for use in
women because the risk-benefit ratio is often
difficult to assess.

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115 C4
 II. MINOXIDIL
Minoxidil is an over-the-counter drug that is
normally issued as an oral tablet or a topical
formulation. It became “famous” as Rogaine/
Regaine, a topical (applied to the skin) cream or
foam with 2-5% Minoxidil.The effect is different
from finasteride. Instead of interfering with the
hormone levels, minoxidil acts as a potassium
channel activator, which leads to a widening
of the blood vessels. Minoxidil is a so-called
“vasodilator” and indirectly ensures a better
supply of nutrients and growth factors to the
hair follicles (when applied topically to the
scalp).

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 Besides treating high blood pressure,
minoxidil is approved by the United States Food
and Drug Administration (FDA) as a treatment
of hair loss.

Side effects of the topical treatments
are often allergic reactions such as itching,
redness, skin flaking, due to minoxidil or other
ingredients. In addition, the colour of the hair
may change.

III. SPIRONOLACTONE
(CAROSPIR, ALDACTONE)
Spironolactone is a diuretic that treats fluid re-
tention and high blood pressure.

In recent years, doctors have used this

drug to treat female pattern hair loss induced
by androgenetic alopecia.

117 C4
 Spironolactone is often used as second-
line therapy when minoxidil does not work. It
slowsdowntheproductionofandrogens,which
later turn into DHT – the primary hormone that
triggers androgenetic alopecia.

IV. ORAL DUTASTERIDE

(AVODART)
Dutasteride is a prescription drug belonging
to the same family as finasteride. It also treats
androgenetic alopecia by inhibiting the action
of 5-alpha-reductases. As a result, the levels
of DHT drop in your blood, which improves the
signs of hair loss. This drug also helps people
with enlarged prostates.

118 C4
 V. ANTHRALIN (DRITHOCREME)
If your hair loss is caused by an inflammation
of skin, you may already know this type of
drug. Anthralin, also called Drithocreme or
Anthraforte, is a drug that treats psoriasis,
hair loss, and several other dermatological
conditions. The mechanism of actions are
still under investigation, but the effectiveness
of anthralin as an anti-psoriatic, anti-
inflammatory and anti-proliferative agent has
partly been attributed to its abilities to induce
lipid degradation and to reduce levels of other
molecules, which are elevated in psoriatic
patients.

119 C4
 VI. JANUS KINASE INHIBITORS
Janus kinase (JAK) inhibitors have a clear
effect on alopecia areata. The mechanisms
involved in this process are still unclear.
However, several scientific studies confirmed
their positive effects on hair loss.

VII. CORTICOSTEROID INJECTIONS

AND CREAMS
Corticosteroids are a class of drugs that have
anti-inflammatory and immune-regulating
properties. These drugs may be beneficial for
some cases of hair loss, especially the ones
that involve active inflammation of autoimmune
reactions (e.g., alopecia areata).

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121 C4
 SCALP MASSAGE
When you massage your scalp, it has a
number of benefits for your scalp, hair and
blood circulation.

Scalp massaging helps to loosen and

remove built-up oil and debris from the scalp,
which can clog pores and lead to hair loss.

A scalp massage is a type of massage

that helps to relax the muscles and tissues in
the scalp. It can be done using the fingertips,
fingers, or a special device. Scalp massaging
can help to increase blood circulation to the
head, and promote relaxation of the muscles
of the head and neck. It is often used as a
treatment for tension headaches and other
types of headaches.

122 C5
 The proper way to massage the scalp is to
use your fingertips in a circular pattern on your
head, for at least five minutes per day. There
are multiple scalp massaging techniques that
can be useful in improving the thickness of
your hair. Poking, rubbing, and vibrations are
all effective methods that can be used in order
to achieve the goal of having fuller hair.

A scalp massager is a device that is used

to massage the scalp. It can be used to help
stimulate blood circulation and promote
relaxation. There are a variety of different types
of scalp massagers available on the market,
ranging from manual handheld devices to
electric machines.

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124
124 C5
 Some scalp massagers come with built-
in heaters, which can help to further relax the
muscles in the head and neck, and widen the
blood vessels for better blood circulation and
nutrient supply.

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 No matter what type of scalp massager
you choose, it is important that you feel
comfortable with it and follow the instructions
for use. This will help you to avoid any potential
injuries and ensure that you get the most out
of your massage.

When it comes to scalp massages, the

frequency and duration is the key.

For best results, scalp massages should be

performed at least three times a week for five
minutes at a time. More frequent massages
may be necessary if you have a particularly
dry or oily scalp. The duration of the massage
can also be increased if desired.

126 C5
 However, it is important to note that scalp
massages should not be too vigorous, as this
can actually lead to increased oil production.
Instead, aim for a gentle, circular motion. After
a few weeks of regular massaging, you should
notice an improvement in your scalp health.
Your hair will be softer and more manageable,
and your scalp will be less prone to flakes and
irritation.

People who have used this method

correctly have observed better hair growth
and a profound reduction in stress hormones.

127 C5
128 C5
 MICRONEEDLING
Microneedling is a cosmetic procedure
that is popular in the aesthetic industry, due to
its efficacious results in restoring skin issues.

This minimally invasive aesthetic procedure

is increasingly being used to resolve a myriad
of issues like:

1 Acne
2 Hyperpigmentation
3 Hair loss
4 Large pores
5 Stretch marks
6 Skin elasticity
7 Scars
8 Fine lines
9 Sun damage
10 Wrinkles

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 Recently, its regenerating abilities have
been used in stimulating hair growth in people
suffering from hair loss. This procedure is
gaining traction and proving to be very effective,
especially in cases of progressive hair loss like
androgenetic alopecia that affects both males
and females.

This type of hair loss is commonly seen

due to both genetic and hormonal factors.

More than 90% of people experience this

form of hair loss, due to hormonal fluctuations
and aging, however microneedling has been
proven effective in restoring some level of
thickness.

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 The positive effects encourage the use
of microneedling to support hair growth and
decrease hair loss in the majority of cases.
It is thought to support the regeneration of
follicles, and induce basal cell generation and
production, which would result in the growth
of new hair.

I. HOW DOES MICRONEEDLING

IMPACT THE SCALP AND HAIR?
This cosmetic procedure is traditionally carried
out in a clinical setting; however, a number of
different at-home microneedling devices are
readily available in the market.

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132
132 C5
 During the process, one goes over the
intended area of the scalp with a roller or roller
like instrument with microneedles on it.

The needles are usually about 1 millimeter

to a few millimeters in length, and distributed
evenly on the roller’s surface, which is rolled
along the area that needs to be treated.

The needles help to stimulate the skin by

improving the blood circulation to its surface.
This process can stimulate growth factors
that encourage hair growth and also directly
stimulate the follicles.

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 The procedure time depends on the
area that needs to be treated, but in most
cases, a session requires only 10 minutes of
microneedling. The mild redness produced by
the needles on the scalp is usually hidden by
the existing hair.

II. THE SCIENCE BEHIND MICRONEE-

DLING AND HAIR GROWTH
It has been observed through a number of
studies that the interplay of epithelial and
mesenchyme cells present under the scalp
plays a very important role in hair growth and
regrowth process.

134 C5
 Inductive signals from the dermal papilla
activate the epithelial stem cells present in
the follicle, leading to the formation of stem
cells that further divide into complex follicular
products that make up part of the growing hair
strand like the hair shaft and sheath.

During these procedures and cell

differentiation, a plethora of growth factors
play a vital role in follicle maturation.

135 C5
 The factors include:

1. Fibroblast growth factor

2. Epidermal growth factor (EGF)

3. Hepatocyte growth factor (HGF)

4. Insulin-like growth factor (IGF)-I

5. Transforming growth factor- beta

families

These signaling molecules, along with

many others, play an active role in the normal
hair cycle.

Through the activation of pathways like Wnt/

beta-catenin/Lef1, Sonic Hedgehog(Shh), and
STAT3, they can aid in the transition of follicle
cells from the telogen phase to anagen phase.

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 The stimulation produced by micronee-
dles can activate the skin’s healing mecha-
nism, which could lead to a rise in the abo-
ve-mentioned growth factors, as well as stem
cell differentiation in the scalp. It is said to also
stimulate hair growth-related genes, which
in turn, increases the hair growth potential of
the hair follicles.

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 Here are some mechanisms through
which microneedling potentially induces hair
re-growth:

1. Through skin wound regeneration

mechanism and platelet activation, the
epidermal growth factor, as well as a platelet-
derived growth factor is released, stimulating
hair regrowth and basal cell activation.

2. The stimulation of the microneedles

actites the stem cells present in the hair bulge
area as the healing mechanism of the body
is activated. This leads to thedifferentiation
of stem cells into hair shafts and sheaths,
leading to an increase in hair count.

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 3. The microneedling procedure brings
about the activation of hair growth-related
genes that play a pivotal role in hair regrowth.

These genes are most commonly:

1 B catenin
2 Vascular endothelial growth factor
3 Wnt10 b
4 Wnt3a

IV. THE EVIDENCE BEHIND MICRO-

NEEDLING AND HAIR GROWTH
The dermal papilla is where almost all of
the hair growth-related genes present their
expression.

There has been a lot of research on whether

the wound growth factors or growth factors
stimulated through minor insults to the basal
cells can stimulate dermal papilla associated
stem cells effectively enough to encourage
hair growth.

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 As microneedling also works by using the
injury as a mode of stimulation of stem cells
and induction of growth factors, many studies
have put this procedure under the microscope
to understand its efficacy and rate of results.

The result of these studies indicate:

1. Increased and faster hair (re-)growth,

especially in combination with topical treatment
of hair loss

2. Increased total hair count number

3. Improvement of several different types

of hair loss in both men and women

140 C5
 V. MICRONEEDLING COMBINED WITH
OTHER TREATMENTS
Many options can be used to encourage hair
growth and regrowth.

Treatments like:

1. Platelet-rich plasma

2. Systemic tablets
(Finasterid, steroids, etc.)

3. Topical shampoos, serums, solutions

or lotions
(Steroids, minoxidil, caffeine, etc.)

All of these are very popular in the hair

care industry, and are used frequently by the
public.

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 Studies have revealed that using micro-
needling in conjunction with these treatmen-
ts can produce more efficient results, com-
pared to using these treatments alone. The
penetration of topical treatments is enhan-
ced, leading to an increased and faster ac-
cess to the target cells when used with mi-
croneedling.

VI. SIDE EFFECTS OF MICRONEEDLING

Although minimally invasive, microneedling
may cause:

1 Redness
2 Bruising
3 Swelling
4 Oozing from the wounds
5 Pain
6 Scarring

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 The area treated may show signs of
inflammation for a few days, but according
to the American Academy of Dermatology
(AAD), these adverse effects vanish within a
week or less after the treatment.

Microneedling is generally safe and

harmless, but it is advised to consult your
doctor before going through this process if you
have any concerns related to the procedure
or any of the following issues:

1. Any condition that halts the process of

healing e.g diabetes

2. You are taking blood thinners

3. If you are pregnant

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144
144 C5
 After care and cleaning are very important,
as the scalp can be very sensitive to infections
and environmental factors that might come
in contact with the treated area and cause
irritation.

VII. AT HOME VS. IN CLINIC

MICRONEEDLING
Aside from in-clinic microneedling, there are
handheld microneedling devices available in
the market that people can purchase and use
at home to stimulate hair growth.

People get these microneedling devices

to save time and additional cost, as self-
administering a treatment feels much more
convenient and easy.

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 However, there are some technical
downsides of using microneedling devices at
home by oneself:

1. The wrong size of needles and over

enthusiastic use might lead to excessive
injury.

2. Difficulty in reaching certain areas like

the back of the head

3. Lacking professional accuracy

4. Improper usage may lead to excessive

injury or unsatisfied results

All of the above mentioned points might

make the treatment ineffective and might not
provide the desired results, but can be limited
by good user instructions and adherence to
high quality standards.

146 C5
 In cases of being insecure about the proper
usage of the microneedling device, going to
a professional is a good idea. This way, you
will be able to learn how to effectively use the
device to enjoy optimum and desired results.

Microneedling is a procedure that is taking

the cosmetic industry by storm. The promising
results in terms of hair loss, even in cases of
androgenetic alopecia, could make it a very
effective treatment, especially in combination
with other topical treatments.

Before

After

147 C5
 COSMECEUTICALS
Cosmeceuticals are products intended
to enhance health and beauty, therefore
bridging the gap between cosmetics and
pharmaceuticals.

A new trend is the usage of plant-derived

natural active ingredients in cosmetic products
to improve their efficacy and safety in especially
skin and hair health.

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 Here are some of the newest trends on
the market:

I. APPLE AND GRAPE SEEDS EXTRACT

It was found that procyanidin is an active
ingredient contained in high amounts in apples
and grape seeds.

It promotes hair epithelial cell growth and

the induction of the anagen phase.

Procyanidin is very popular, as it has been

demonstrated to be one of the most effective
and safest natural compounds in promoting
hair growth in humans by topical application.
On the molecular level it has a polyphenolic
structure with beneficial effects on kreatin
production, hair growth and hair density.

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150 C5
 Polyphenols are also known to be
essential antioxidants for humans. Further
investigations showed oligomeric procyanidins
are successfully restricting the catagen
induction of the follicle and instead promoting
hair growth and keratin production to form
thicker hair strands.

By looking at the different pathways of

action, procyanidins showed to be effectively
protecting the hair follicle undergoing self-
induced cell death. This is through special
factors called transforming growth factors
(TGF) ß1 and ß2.

There is evidence that procyanidin

upregulates the expression of some kinases
(special enzymes which support important
reactions in the body) called MEK - ½ which
are also indirectly protecting the cell from
apoptosis.

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 II. TURMERIC, CARDAMOM
AND GINGER
Turmeric, cardamom and ginger are all belon-
ging to the same family called Zingiberaceae.

They are rich in vitamins and minerals and

very well known for their anti-inflammatory
and anti-oxidative effects preventing cells
from damage.

They showed a beneficial effect on hair

growth in patients with Alopecia Areata
(Autoimmune disease) as well as male and
female pattern hair loss.

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 Curcuma longa (turmeric) was found to
increase hair density and hair growth by pro-
moting the follicles entering and staying in
the anagen phase and rebalancing the Ana-
gen to Telogen ratio. There is also some evi-
dence that they support the delivery of growth
factors to the hair follicles and scalp.

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 III. VITAMINS
(ESPECIALLY A, B, C AND E)
Vitamins such as the Retinoids (Vitamin A)
and Vitamin C have been found to induce the
production of collagen for better skin and
scalp conditions.

Vitamin E and C are very effective as

epidermal antioxidants and UV-light protectors
(Vitamin E). Vitamin C is also well known as Anti-
aging Vitamin because of its impressive cell
protecting and anti-inflammatory properties.
Vitamin B3 or also called Nicotinamide has
been shown to improve the skin barrier function.
Vitamin B increases the lipid and protein
content in the skin to support its resistance to
irritation and external factors and by reducing
the transepidermal water loss. It was also
found that especially Vitamin B smoothens
the hair and scalp if topically applied.

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 IV. PEPTIDES (AMINO ACIDS)
Since collagen (skin) and keratin (hair) both
require peptides for their synthesis, amino acid
complexes are very well known to be effective
cosmeceutical active ingredients. Especially
for damaged areas on the skin or hair the amino
acids are particularly important to restore the
integrity and strengthen the repaired area to
prevent further damage.

V. HYDROLYZED PROTEINS
Hydrolyzed proteins and gluten from wheat
are used frequently in cosmeceuticals for hair
and skin care.

Their ability to support recovery of
damaged hair surfaces, by reconnecting the
outer and inner structure of the hair strands
is very useful.

155 C5
 They are the main driving forces to stren-
gthen human hair, by creating hydrophobic
interactions and disulfide bonds between
small peptides and human hair keratins. That
means that they are reconnecting and buil-
ding hair filaments.

They are also beneficial, because they are

available in large amounts, and at a relatively
low price and well studied in terms of safety.

Cosmeceuticals have gained more and

more attention in the last few years as they are
claimed to be safer and have less side-effects
compared to pharmaceutical treatments.
They are finding more and more users and
supporters especially in early treatments of
skin and hair problems

156 C5
 Closing Words
So, you see, hair loss is very complex when
it comes to the details. But this also means
that the most diverse treatment methods can
both have a positive effect on hair growth. You
(together with a medical professional) have to
find out which methods are the best and most
promising for you. Now you already know what
is on offer and maybe you have tried one or
the other and can already rule it out. I can tell
you in any case, there are many ways and a lot
of hope, just don’t give up and don’t lose your
patience.

You are certainly just a small step away

from having fuller hair.

III