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General - FAQ
Author: adminSite Admin
Post Sun Jul 06, 2003 9:58 am
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General - FAQ

Here is a general FAQ compiled by Joy from the many messages on this board.

General – FAQ

Q) Kevin, what kind of doctor are you?

A) A question I ask myself every day! I am a scientist – a Ph.D. I am not a clinical dermatologist. My research focuses on hair follicles, how they work, and what happens to them in diseases such as alopecia areata.

Q) Kevin, can you give me a diagnosis?

A) No! As I am not a clinical dermatologist I have not been trained to diagnose hair diseases. Without knowing your full medical history and without being able to make a full examination or run tests it is not possible for anyone to make diagnoses over the internet.

Q) Where can I find photo's of hair loss on the net?

At the moment there are no web image databases that focus exclusively on hair loss, but there are some dermatology databases that include images of hair loss conditions.<=e

Q) Where can I get information on hair research?

A) All the hair research societies are represented through a common gateway web site. See; The European Hair Research Society has a web site listing their annual conference details including the abstracts for the scientific and clinical presentations. See; The North American Hair Research Society also provide a similar web site. See; The Australasian hair and wool research society has its web site. See;

Q) — What does anagen mean?

A) Anagen is the active growth phase of a hair follicle. In a normal, healthy human scalp, up to 90% of follicles are in the anagen phase at any one time. During anagen the hair fiber is connected firmly to the scalp, and grows approximately 0.35mm a day. Normal follicles tend to remain in anagen for 3-10 years.

Q) — What does catagen mean?

A) The catagen phase is a short deactivation period where follicles prepare to enter the resting phase. Categen only lasts about 2-4 weeks.

Q) — What does telogen mean?

A) Telogen is the resting or inactive phase in the cycle of a hair follicle. In a normal human scalp 10-15% of follicles are in telogen at any given time. The hair in a follicle that has entered the telogen phase is less firmly rooted to the scalp, and can be easily pulled out by combing, shampooing or brushing. Hair follicles may remain in telogen for 30-100 days. All the hairs of telogen follicles are destined to fall out. In a follicle that is cycling normally these shed hairs are quickly replaced by a new hair.

Q) — What is a terminal hair?

A) A terminal hair is a large, fully pigmented hair fiber. Terminal hairs are found all over the body and are easily visible (e.g. scalp hair, eyebrows, pubic hair, beards, etc.)

Q) — What is a vellus hair?

A) Vellus hair is short, fine, soft and usually unpigmented hair. It is commonly found in places such as the cheeks and nose. In some hair loss conditions terminal hair may gradually turn into vellus hair.

Q) — What is an intermediate hair?

A) An intermediate hair is one that is in transition between being either a terminal or vellus hair. Intermediate hairs are half way in terms of their physical properties. Intermediate hairs are usually fine and may be shorter than terminal hairs. Pigmentation of intermediate hairs is variable, they may be normal to light in color.

Q) — Can I tell if a hair that fell out was in the anagen or telogen phase just by looking at it?

A) Sometimes, but you have to look very closely. A microscope makes it much easier to see the differences between anagen and telogen hairs. Anagen hairs eventually become telogen hairs, they are one and the same thing, just at different stages of the growth cycle. When the hair is in anagen and it is plucked out of the scalp it often takes part of the soft unpigmented root sheath with it. So plucked anagen hair will have a sleeve of tissue, up to 1 centimeter in length, around the part of the hair that was previously in the scalp. Telogen hairs are much easier to pull out of the scalp which is one good indicator that the hairs are indeed in telogen. Telogen hairs do not generally have living tissue on them when the fall out. However, they can have a sleeve of sebum around the lower part that can sometimes be confused with sheath tissue by the inexperienced. Classic telogen hairs have a lump of keratin on the end of them. This acts as an anchor to help keep the telogen hair in the follicle for a while. However, eventually all telogen hairs must be shed.

Q) — Some of my telogen hairs have white bulbs and other black bulbs. What does this mean?

A) Nothing. Sometimes the telogen hairs are made with a pigmented bulb and sometimes the bulb is unpigmented and look white. It makes no difference, they are all normal telogen hairs.

Q) — What is an anagen to telogen ratio?

A) This ratio measures the number of hair follicles containing an actively growing hair fiber (anagen) compared with follicles containing a resting hair fibre (telogen). The ratio is not necessarily conclusive, as one might have a normal ratio, but still be experiencing a rapid cycling of the follicles through the phases, that is causing frequent hair shedding. A normal ratio is between 8-2 and 9-1, anagen to telogen.

Q) — Is this the same as a terminal to vellus ratio?

A) No. The terminal to vellus ratio measures the number of big, pigmented, terminal hairs growing in the sampled area, compared to the number of small, unpigmented, vellus hairs.

Q) — What are the normal ranges for blood tests?

A) Normal laboratory ranges vary slightly from laboratory to laboratory. There is no method of calibration between the different laboratories so it can be difficult to directly compare results from different places. For an approximate guide to normal ranges for blood tersts please see some of the pages in the diagnosis / decisions section of

Q) — What is a miniaturized follicle?

A) Sometimes when people talk about miniaturized hairs they actually mean intermediate hairs or vellus hairs. This is not always the same thing as a miniaturized hair follicle. The follicles are the structures in the skin that make the hair fibers. A miniaturized hair follicle has become less active, shrunken and eventually will produce vellus hairs. True miniaturization of follicles mostly occurs in androgenetic alopecia (AGA, also called pattern baldness). In chronic telogen effluvium (CTE) a small amount of follicle shrinkage can occur, but the two follicle states are different and can be distinguished via a scalp biopsy if necessary.

Q) — Why has my hair become fine/thin?

A) Fine hair fibers with a smaller diameter than usual (these are called intermediate hairs) are usually found in chronic telogen effluvium (CTE) and androgenetic alopecia (AGA) and sometimes in other diffuse forms of hair loss as can occur with alopecia areata. These intermediate hairs can grow to be quite long and may still be normally pigmented. Depending on the diagnosis, these follicles can be persuaded to switch back to growing thicker terminal hairs again.

Why intermediate hairs grow is not clear. It seems that the hair follicle is still active but it is not fully active, such that it only grows a fine hair. The size of the hair fiber that comes from a hair follicle is controlled by a small group of cells at the bottom of a hair follicle in a structure called the dermal papilla. The more cells a dermal papilla has the bigger the hair fiber produced. In intermediate hairs the number of papilla cells in the follicle are fewer and probably also less stimulatory.

Q) What is a 'dystrophic' hair?

A) Any hair that is abnormal (kinked, grooved, patchy cuticle, etc) is in some way is dystrophic. The hairs could be anagen, telogen, terminal or vellus. Mildly dystrophic hairs usually contain enough strength to continue growing. Severely dystrophic hair fibers may be weakened or poorly anchored in the hair follicles in which case they might break or fall out.

Q) — Why is my hair tapered at the ends?

A) A hair that tapers at the tip (furthest from the scalp), has grown from the scalp and not yet been subjected to a haircut which makes the ends blunt. These hairs are produced by hair follicles that are cycling through short growth periods. Sometimes when people talk about tapered hairs they are referring to the root end (in the scalp). Tapered roots on catagen to telogen hairs are fairly common. In some conditions there can be a significant increase in tapered root hair fibers as can occur in alopecia areata. But it is normal for all individuals to have some hair fibers with tapered ends particularly if the hair has been pulled out of the scalp. In this event, the tapered root hairs are hairs from catagen stage hair follicles.

Q) — I've got short hairs, tapered at the end, falling out – what condition do I have?

A) Unfortunately short, tapered hairs are not diagnostic for a specific condition and can occur in nearly all forms of hair loss. If there are lots of these short tapered end / uncut hairs falling out it suggests your hair follicles are in a truncated growth cycle. They only produce hair for a short period of time before entering a resting telogen state again. These truncated hair growth cycles can be seen in many chronic hair loss conditions including telogen effluvium, androgenetic alopecia, and alopecia areata.

Q) Can the hair change thickness in mid-stream?

A) No. The follicle has to stop making one hair fiber, switch into a new mode, and make a brand new hair fiber. This is a problem because it means that when treatment is applied to defective hair follicles, they cannot improve the hair fiber they are currently growing. Rather, the hair follicles must stop growing the old, sick hair fiber, go through a telogen rest period and then reform and start growing a new improved hair fiber. This situation relates to the size of the dermal papilla structure at the base of the hair follicle. Dermal papilla cells cannot divide and make new cells while the hair follicle is producing a fiber. They can only proliferate when the hair fiber is entering an new anagen state after being a telogen state. At this time there is a brief window when more proliferating cells can be recruited into the dermal papilla. The more cells and the bigger the dermal papilla, the bigger the hair fiber that will grow from the hair follicle.

B]Q) My hair is thinner right near the root end – what does this mean?[/B]

A) Some catagen and telogen hairs are tapered or thinner at the root end. This just means the follicle wound down rather than switched suddenly into a resting state. It is normal for all individuals to have some hair fibers with tapered ends particularly if the hair has been pulled out of the scalp. In this event, the tapered root hairs are usually hairs from catagen stage hair follicles.

Q) What is an 'exclamation point' hair?

A) An exclamation point or mark hair is one that has been broken off just above the skin surface but the hair keeps growing such that it looks like an exclamation mark (!). These hairs are most often seen in alopecia areata, but the can be seen in other hair loss conditions such as toxin induced hair loss or through cosmetic over processing of hair.

Q) What parts of the scalp are 'bi-temporal', 'vertex' and 'occipital'?

A) Bi-temporal means the hair above the temples on the left and right of the face. Frontal scalp means that part of the scalp at the front and center. The vertex is on top and towards the back of the scalp. It is the “eye” of the “whorl pattern” of your hair growth. The occipital scalp or occiput is that part of the scalp at the back between your ears. The parietal scalp area is that part of the scalp above the occiput, but behind and below the vertex.

Q) What's the difference between "Telogen Effluvium" and "Anagen Effluvium"?

A) In telogen effluvium more hair follicles then normal enter a telogen resting state. This results in an increased shedding and a gradual diffuse thinning of the scalp hair. In anagen effluvium there is a severe insult on the hair follicles such that they suddenly stop making hair fiber. The hair follicles are still in anagen but they are in a state of suspended animation. This leads to a very rapid and usually extensive hair loss. Anagen effluvium is most commonly seen in patients taking cytostatic drugs as in chemotherapy.

Q) My scalp has a burning/creeping feeling – why?

A) There can be several reasons for this. The most common cause is seborrheic dermatitis or sometimes a contact dermatitis. In these cases, there is usually some redness to the affected skin. Sometimes there is also flaking like dandruff but more usually the skin does not flake but looks a bit “crusty”. Often, just after washing the affected area, you can scratch a yellow or dirty gray “gunk” from the skin. This is dead skin and sebum. It is not clear what seborrheic dermatitis is exactly, but it seems to be more prevalent when androgens are active and it can be further exacerbated by skin fungi and bacteria. It can be a very persistent condition that is difficult to get rid of. Treatment most commonly involves a medicated shampoo like Nizoral and sometimes topical corticosteroids to reduce the inflammation and maybe antibiotics or antifungals if the dermatitis is exacerbated by an infection.

Another cause of burning and creeping sensations is “burning scalp syndrome” or “scalp dysthesia”. This is a newly recognised condition, but it is poorly understood. It seems that as hair follicles enter telogen there is a change in the production of neuropeptides in the skin. When a lot of hair follicles all enter telogen together, as in telogen effluvium and sometimes in androgenetic aloepcia, this change in neuropeptide levels activates sensations of burning and even pain. Treatment usually involves anti depressants and other sensory modulatory drugs.

Q) What is 'folliculitis'?

A) It is inflammation of the individual hair follicles. It looks a lot like acne but on the scalp. You may see red bumps in the middle of which may be a hair fiber. Folliculitis is some kind of irritation to the hair follicle. It can occur for a variety of reasons from an infection to a reaction to a shampoo or other chemical.

Q) Give it to me straight – am I going to go completely bald?

A) Probably not. Most forms of diffuse hair loss rarely ever reach a state of total baldness. More patterned forms of hair loss, like androgenetic alopecia in men or alopecia areata, can progress to extensive baldness, but statistically speaking it is still fairly rare to reach this stage. For men, an extensive form of pattern baldness is usually associated with early onset in teen years and extensive baldness often runs in families. Men who start losing their hair later, and don’t have a family history of extensive baldness, can expect to lose a fair amount of hair loss, but will probably not reach the most extensive degrees of alopecia.

Women rarely go completely bald. Mostly women are affected by diffuse forms of hair loss like female pattern alopecia or telogen effluvium. While the hair can become quite thin, it is rare to reach this degree of alopecia and total baldness is almost never heard of. For as long as some kind of hair is growing, such as intermediate or vellus hair, there is the possibility of promoting these hair follicles to start producing normal terminal hair again.

Q) What are ferritin levels?

A) Serum ferritin levels are a measurement in a blood test that show the level of iron stores in the body. Ferritin levels are believed to be connected to the maintenance and healthy growth of hair, but are NOT the same as haemoglobin iron levels (which are looked at to establish anaemia). It is not unusual to have a completely normal haemoglobin level combined with lowered storage iron (serum ferritin). When there is hair loss, whether it is telogen effluvium, androgenetic alopecia or something else, and the ferritin levels are low, raising serum ferritin levels to above 70 ng/ml for at least 3-4 months is recommended to improve the chances of hair growth. If low ferritin levels are the only underlying cause of telogen effluvium, raising the ferritin levels to above 70 can lead to full regrowth of hair. Recently it has been found that increasing ferritin levels is also helpful for those who are being treated for androgenetic alopecia and it is suspected it may help with treating other conditions.

Q) What does 'truncated growth cycle', or 'rapid cycling phase' mean?

A) Follicles may not spend a normal amount of time in each part of the growth cycle. For example, a short anagen phase might mean that hairs enter the resting phase more quickly than normal, and thus get shed before they have had a chance to grow very long. In these instances the hair follicles are described as being in a “truncated growth cycle”. A normal anagen phase for scalp hair follicles would last 2 to 5 years. Significantly shorter anagen growth phases can be found in several hair loss conditions including telogen effluvium, androgenetic alopecia, and alopecia areata.

Q) Have I got AGA or TE?

A) It can be difficult to tell the conditions apart, especially in women. The pattern of hair loss and an analysis of the state of the follicles are the usual ways of confirming a diagnosis either way. It is however possible to have both conditions at the same time – Chronic TE can occasionally kick start androgenetic alopecia (AGA) loss, and AGA can be sometimes be masked by a bout of TE. As a rough guide, if the hair loss is just on the top of the head, but not at the sides, the problem is most likely AGA. If the hair loss is more all over and affects the sides to some degree too (although it need not affect the sides as much as the top) then the problem is more likely to be telogen effluvium.

Q) Is my shampoo or hair product making my hair fall out?

A) It is very unlikely that your hair product is causing your hair loss and you should not consider reducing the frequency of washing and general hair care. Some dermatologists recommend washing hair every day to keep scalp oils to a minimum. Secreted oils contain dihydrotestosterone (DHT) which might contribute to the progression of androgenetic alopecia. Very occasionally a person may be allergic to one or more of the ingredients in a shampoo or conditioner. If this is the case, a contact dermatitis may develop. This will involve an itchy, and sometimes flaky, scalp and if it is severe enough it may promote a diffuse hair loss. An allergic reaction is more likely to occur with “herbal” shampoos. As with environmental allergies, plant extracts in shampoos are more likely to be allergens. Occasionally people can be allergic to the cleaning detergents in shampoos. If you suspect this to be a problem, switching to a different shampoo can often resolve the problem.

Q) Did my hairdresser ruin my hair?

A) If chemicals used in a dye or perm solution burned the scalp there is a possibility that this may have affected the hair follicles. In the case of a severe chemical burn the hair follicles can be irreversibly damaged - but this is a very rare event, and the result would have been felt immediately. More commonly, bleach, hair dye, or relaxing agents are left on the hair too long or are applied in too concentrated form. When this happens the hair fiber may be permanently weakened and liable to break off. This most often occurs in those who decide to use do-it-yourself at home kits rather than a salon, but sometimes even the professionals get it wrong. Where the problem is weak, damaged hair and breakage, the condition is not permanent and eventually the damaged hair will be replaced by new hair. It may take several months for the damaged hair to be replaced. In the mean time, cutting the hair short is a good idea to remove as much of the damaged hair as possible. Regular trims to remove split hairs also helps.

Q) Can drinking water or mold in the environment cause hair loss?

A) This is a very rare problem, but it is theoretically possible that persistent exposure to toxic elements in the environment could induce hair loss. In this instance, more than one family member is likely to be affected. Testing for contaminants in water or mold is treated differently in different countries. Check with your local council for an environmental safety office who may be able to advise on how to get tests done. Tests to rule out toxicity in water might include, substances such as lead, copper, zinc, aluminium salts, bacteria or pesticides. For several affected members in one household, other options to look at might be fungal or bacterial conditions, hereditary conditions and changes in diet.

Q) Can men get TE?

A) Yes, but most cases of hair loss in men are androgenetic alopecia.

Q) Is it normal for a women to grow facial hair, if so, how much?

A) Yes it is normal for women to grow a few terminal hairs in androgen-sensitive areas of the face (e.g. the chin and above the top lip). If the change is sudden, widespread, or seems to occur with other symptoms like acne or scalp hair loss, it might be worth seeing a doctor to check on hormone balance, and rule out conditions such as Polycystic Ovarian Syndrome (PCOS).

Kevin - The management -

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