Can Hair Grow Back After Scarring Alopecia (Cicatricial Alopecia)?
Alopecia Areata: Causes and Treatment
Alopecia areata refers to hair loss that’s restricted to a few localised areas. The common symptom is spontaneous patches of hair loss.
There is a hair loss condition that has consistently remained present in society and yet not been addressed. A condition that is utterly preventable and yet incredibly prevalent. It is called Traction Alopecia and now research is finally being done to clearly illustrate the damaging effects of aggressive styles such as weaves, braids, locs and tight ponytails that cause it.
Now, John Hopkins University researchers have published a study in the journal of the american academy of dermatology that identifies significant association of tight hairstyling with hair loss. The study is one of the first to finally illustrate the importance of having a strong knowledge of hair styling techniques applied to the hair, to understand the causative factors of hair loss and therefore how to best manage the condition and provide invaluable advice ongoing.
Here at the Fulham Scalp & Hair Clinic we’ve known that the continuous pulling force put on the follicle can cause it to produce weaker and weaker hairs, before eventually giving up completely leaving scarred follicles behind.
We’ve also known that aggressive styling on chemically processed and heat damaged hair can lead to even faster hair loss and breakage.
All this damage is preventable if patients are willing to change the way they style their hair and seek treatment sooner rather than later.
For years and years we continue to see patients arrive at our clinic, in desperation for their edges and hairline, and the number of traction alopecia diagnoses we reach every week hasn’t diminished, stemming mainly from black women.
Afro hair is more fragile but is by no means less healthy or able to grow than european hair. When both hair types are put under tension from heavy extensions and damaged by heat they both become fragile, however these aggressive styling techniques are currently far more common amongst black women, and as a result this group suffers disproportionately from traction alopecia.
We need to change this and it starts with educating ourselves and being clear about what will and wont cause damage to our hair.
Tight hairstyles day in, day out WILL cause damage to the follicle.
Single braiding the hair, particularly with long/heavy braids WILL cause damage to the follicle.
Weaves and extensions, attached tightly and left in WILL cause damage to the follicle.
Direct heat to the hair from blow driers and straighteners WILL weaken the hair shaft and result in breakage.
Chemical relaxers, perms and permanent colours applied incorrectly and at too high a strength WILL weaken the hair shaft, result in breakage and may also result in chemical burns.
Think about how many of the above you may be guilty of all at the same time. Now ask yourself, does your hair really feel as healthy and strong as it should?
Early intervention in treating traction alopecia can have incredible results and hair can regrow once more, but if left untreated it can scar and hair loss will be permanent. If you are worried about your hair and suspect you may have traction alopecia, please get in touch so that we can offer clear, expert advice.
Let us avoid the avoidable and enjoy strong hairlines and beautiful growth.
Our best wishes,
Teresa and Eleanore
Following the huge hormonal fluctuations that can occur in a woman’s body after pregnancy, a number of changes can be seen that includes hair loss. We call this hair loss post- partum telogen effluvium.
During pregnancy the hair can appear to grow thicker and longer than usual, this is due to the impact of increasing oestrogen levels in the expectant mothers body. Increased levels of oestrogen are believed to hold hairs in the growing phase (anagen) of their life cycle.
Whilst this is great during pregnancy, after birth oestrogen levels dramatically drop back to normal and this can be a shock for the hair. Where the hair was once being held in a growing phase, it now shifts sharply to the resting phase (telogen), awaiting its time to be shed. Cyclical shedding is normal, however the proportion of hairs that shift to this phase all together after birth is much greater than normal.
What does this mean for new mums?
It can mean a drastic amount of shedding roughly 3 months (the length of the telogen phase) after birth which can come as quite a shock. We frequently see patients here at the clinic most commonly suffering this type of hair loss to their front hairline and temples, but general density of hair can also thin and the effect can be even more stark following a cesarean delivery due to the stress of surgery and greater blood loss.
Having just given birth, recovery and caring for your new baby are priority, but noticing your hair start to fall out can be deeply distressing and emotionally draining. Do Not Panic.
This hair loss is caused by erratic changes in your hormone levels so as they start to return to normal, so will your hair cycle. Mothers may notice that in the 5th or 6th month post birth, hair begins to REGROW.
For mothers breastfeeding, they may find the shedding occurring 3 months after breastfeeding has stopped. Once again, do not worry as hair growth will return also.
How to encourage the fastest recovery?
Make sure as a new mum you are managing your stress well, as stress can play a role in hair loss. Also make sure you are taking time to enrich your diet with a variety of vitamins and minerals. This is fantastic for your hair but also so incredibly important in keeping you healthy to look after and nourish your new baby.
You may feel desperate to camouflage the thinning by creating volume with curling irons or adding extensions, but please don’t! Post pregnancy shedding is temporary and will recover, but the damage from direct heat and traction from extensions can be permanent.
So please don’t add hair worries to the stress of being a new mum. If you think the shedding has been going on for longer than usual or the hair loss is patchy and seems unlike what I have described about then please do get in touch with us for a consultation or speak to your GP as there may be another causative factor at play.
Teresa and Eleanore
When we scratch our scalps we’re not thinking about the state of our fingernails, the sensitivity or our scalp or the breakage we may be causing to our hair. All we care about is instantly satisfying that itchy, irritating sensation, and therein lies the problem. With such a short term goal of relief in mind it’s hard to weigh up the long term effects of constantly itching one’s scalp.
Dirty fingernails are the worst offenders, but they don’t deserve all the blame. Over the years I have seen combs, keys, pens and pencils, clips, pins, chop sticks, credit cards and even scissors being used to scratch an itch. None of these objects are known to be thoroughly cleaned all the time (although one would hope that the chopsticks are on the top of the list), so the likelihood that they are harbouring harmful bacteria to be transferred to the scalp is also high. Severe scratching can break the skin and transfer harmful bacteria, resulting in a messy, smelly and uncomfortable bacterial infection of the scalp.
My top tips for an itchy scalp
1. Don’t let it fester
Just because your friend says their scalp itches all the time and it’s no big deal doesn’t mean it’s normal. If your scalp is itchy, there will be a reason for it. Get it treated and the itch will go away and you will have reduced you chances of getting a bacterial infection to zero.
2. Get it diagnosed
Itching may feel all the same, but the causes can vary greatly, from sensitivity of the scalp to an oil to head lice infestations. Knowing what is causing your itch means you know the best way to treat it in the fastest time. There are specific products to be used on fungal infections such as ring worm and dandruff, bacterial infections such as folliculitis and infestations such as head lice and mites. Using the right product and treatment plan is paramount to treating the itch fast and preventing any further effects.
3. Know your scalp
If you have suffered from an itchy scalp in the past and have figured out the cause, it’s simple logic to avoid that in the future. If you are prone to a sensitive scalp there are a few things that you should consider avoiding as it can lead it irritation, such as oils or heavy hair dressings and perfumed shampoos and conditioners. If a product doesn’t say hypoallergenic on it, even if it is organic and “natural” it can still cause irritation if you are prone to allergies.
The more your scratch an itch, the more inflamed and irritated the skin becomes and the itchier it remains. The “itch scratch cycle” can exaggerate a relatively simple and treatable condition into a serious infection that, if left untreated, can result in scarring and hair loss. Nobody should lose hair over an itch!
Teresa Angelina Richardson, MIT
Mr Keith Hobbs is a white man, but he knows almost every afro hair condition going, and he knows how to treat it too. If as a professional you have worked with Afro-Caribbean patients and are comfortable with handling and treating afro hair then by experience you will have more knowledge and expertise on the matter of afro hair than someone who isn’t. Being Afro-Caribbean yourself isn’t a prerequisite.
I have heard it discussed that some Afro-Caribbean patients and customers would only trust fellow Afro-Caribbean hairdressers, or would only buy their products from Afro-Caribbean vendors.
I understand that buying a product off someone who looks like you, has hair like you and who says they have used the product themselves may put you more at ease than someone you cannot relate to. However, the important screening factor has been lost. If you want to make sure that you hair is in good hands, you need to be asking that hairdresser/ vendor/ trichologist,
“What is your experience is with my hair type?
How many years have they been working with afro hair?
Where did you study and what are your qualifications?”
It is at this point when you realise whether the person standing in front of you actually knows what they are talking about. Hair dressers and trichologists both require a deep technical knowledge, trichologists need a scientific understanding of hair and scalp physiology, microbiology, chemistry and nutrition to name but a few disciplines. If this cannot be demonstrated then knowledge, not race, is the factor that should make you question trusting the professional.
Afro hair is ethnicity specific but learning about its anatomy and physiology isn’t. If they are willing to study hard and educate themselves through the certified channels, anyone can learn about and gain expertise in afro hair or any other ethnicity of hair for that matter.
So always choose your hair specialists wisely, but remember not to limit you circle of choice.
My best wishes until next time,
Teresa Richardson MIT
The show had a welcoming audience and I got the chance to meet hundreds of fabulous women who wanted to know the truth about the health of their hair. After examining a number of scalps and analysing hair under my microscope, it was clear that there was a trending of bad habits that had been adopted purely out of a lack of information and education. That is no-one’s fault and it is difficult to get clear and truthful tips on how to look after one’s hair in such an advice saturated market, where everyone has a favourite brand they are willing to recommend.
The first bad habit I noticed was: Too Much Product!
Products are being used over excessively on the hair, with very little actually being absorbed into the hair shaft. Others are layered on so thickly that it rubs off on anything that touches the hair. You need to stop and think;
“If a product is leaving residue in my hand every time I touch my hair, is it really managing to penetrate the hair?”
Body Moisturisers do not leave our body greasy and sticky, so why should our hair products?
The second bad habit I noticed was: A Clogged Up Scalp!
I noticed many visitors who came to see me were specifically asking me what products could they moisturise their scalp with?
I have two comments for this; Firstly, if your scalp is healthy your natural sebum production should be plentiful enough to moisturise your scalp. Not only is sebum perfectly pH balanced for our scalp, it is also anti-fungal and keeps the scalp hygienically and moisturised.
Secondly, if your scalp is dry and flaky, how do you know you aren’t actually suffering from a scaling condition that needs medicated treatment and good management?
I meet many patients, who come to me thinking they are silly to ask about their dandruff when in actual fact, following a trichological examination, I can determine that they are actually presenting with seborrhoeic eczema or psoriasis or even contact dermatitis. You should not have to put up with a flaky/dry/itchy scalp and please do not think that applying product directly to the scalp is going to solve your problem. Always seek specialist advice if you notice your scalp is scaling and itchy as treatment can help to eliminate or manage the condition.
The third bad habit I noticed was: Massaging Your Hair Away!
Thinning hair and bald patches are common sight from the aftermath of weaves, extensions and tightly worn hairstyling. Thin hair density and balding can also be genetic , dietary or even autoimmune. But some visitors attempts to regrow this hair and encourage improved circulation through massage (rubbing at the hair and scalp) was actually doing more damage than good. Blissfully unaware and always with the hope to improve their hair growth rather than hinder it, these visitors have unknowingly been rubbing hair away in the exact places they were hoping it will grow back.
Just as the backs of our socks become threadbare after rubbing against our shoes day-in day-out, hair can become weaker and weaker when presented with direct mechanical trauma (scalp rubbing). A follicle can only put up with so much injury before it ceases to produce hair and becomes atrophied. When a follicle gets to this stage there is nothing one can do to regrow the hair apart from transplant surgery. Please, please don’t let it get that far. If you have a weak or receding hair line, a parting that has become exaggerated or bald patches that you hope to fill, seek specialist advice and DO NOT RUB!
Finally, I want to say thank you now to Wunmi Akinlagun for executing an exciting and professional event. I look forward to more.
Teresa Angelina Richardson MIT
Here are my 3 top tips;
1. Condition, Condition, Condition. Hair may have been roughed up by hats, blown silly by the wind or dried out by all the central heating resulting in dull, dry, frizzy hair that is unmanageable. The more unmanageable hair becomes, the more likely you may be to reach for your straighteners, blow dryers and brushes, which can start off the vicious cycle of heat induced hair damage (see our first blog post).
The easiest way to infuse moisture into the hair shaft and keep hair feeling smooth and healthy is to make a real effort when conditioning your hair. Smoothing it over your hair whilst you’re in the shower and then rinsing off is not going to make an impact.
Take the time whilst you’re in a steamed up bathroom to make sure the conditioner has covered the hair from root to tip. Gently comb the hair, using a smooth, wide toothed comb, to tease out tangles and ensure an even distribution of conditioner….then rinse out.
Once a week I would suggest a steam treatment. At our clinic we use our rich conditioning masks and professional hair steamers to nourish and help repair damaged hair, making a difference to the softness and manageability.
3. Stay moisturised!
I cannot emphasise the need to moisturise enough!
Hair, particularly chemically processed hair (dyed, permed, straightened) will have a degree of porosity, meaning water can move into the hair but also out of the hair. If our environment becomes more weathering (strong winds, rain, and high central heating), then our hair will lose more moisture and it is up to us to replace it.
Dry hair means, less elasticity which means easy breakage and split ends, leaving hair looking unhealthy.
Our favourite moisturiser is our best-selling Leave- in Hair Protector. It has a high protein content which nourishes the hair and is hypo-allergenic so wont irritate the skin, keeping it moisturised and strong. For drier European hair, only a little bit is needed after washing to seal the ends of the hair which can become more weathered. For Afro hair, which is more porous and can easily become dry, you can apply it as and when you feel it’s necessary, to soften and moisturise the hair, this could be daily.
Good luck with the weather.
Teresa Angelina Richardson MIT
2. Protective styles.
It is common sense that we wrap up our hands in the cold and we must do the same to the vulnerable extremities of our hair too.
For longer hair, I am a big fan of French plaits when tied loosely. It protects the hair by keeping the majority of it covered under the plait, and when loose, doesn’t pull at the hair line or small sections of the hair causing traction. The trick is to keep the plait large so that surface area of exposed hair is kept to a minimum.
If hair is shorter, a silk scarf can be a blessing to protect hair from the elements whilst limiting the amount of rubbing the scarf does on the hair itself.
For afro hair, try to avoid wool hats as these rub on drier, brittle hair causing friction and breakage. If you can, try to find a silk or satin lined hat to reduce rubbing on the hair.
Hair dressing is a challenging trained skill, with a level of artistry and creativity involved. There will always be the immediate finished product in mind; the cut, the colour, the volume. When a client leaves the hairdressers, it’s with a new level of self pride and confidence at the result they take away with them. The focus is always on the outward appearance and not on the unnoticed sometimes forgotten health of the hair.
Trichology is a completely different profession that just happens to work on the same area of the body. As a trichologist I have studied hard for over 4 years to thoroughly understand the physiology of the hair and scalp and the biochemistry involved with the products we use as treatments. As a profession we are going beyond the appearance of the hair and looking intently at the health of the hair and scalp. You could say that trichology is to hairdressing, what podiatry is to pedicures. Both professions are skilled and are involved in the same body area, but the definition of each job is incredibly different.
When I opened the Fulham Scalp and Hair Clinic three years ago, I made a conscious decision to combine my two strengths, my passion for trichology with my extensive experience I acquired as a hairdresser. This meant I could offer treatments of the highest standard for my patients, whilst offering gentle maintenance after-care so that patients left my clinic with more confidence and pride about their hair than when they arrived.
As a busy trichologist, my most important moment with a new patient is their first consultation. This one-on-one meeting allows me to understand what the patient’s needs are, examine the hair and scalp myself and also go through dietary and medical history. I have the chance to address any bad habits or hair myths and actually explain why a condition is present. No “quick-fix remedies” are offered but realistic advice and a treatment plan are discussed. As a result consultations can take up to an hour and are instructive as well as emotional.
Until next time,
Teresa Angelina Richardson MIT
Welcome to our first blog post.
This and subsequent blog posts aim to highlight common hair problems that I see on a daily basis with patients who come to my clinic. I will offer possible solutions, explain what is the truth and what is myth and also hopefully initiate discussion on the topics. Importantly I want our audience to be able to contact us with comments and questions as receiving feedback ensures that the Fulham Scalp and Hair Clinic can continue to offer tailored and relevant advice.
As a Clinic that specialises in afro hair, many topics may revolve around the damage, treatment and maintenance of afro hair, but if your have a question about a different hair type we are still more than able to help so don’t feel discouraged to contact us.
Today I want to start discussing some common bad habits that leave hair with much to be desired. Blow drying and straightening are techniques that many people over indulge in when changing the look of their hair, but the subsequent damage can build up and cause hair breakage as well as reducing hair length.
Blow drying and straightening have the obvious weapon in common of direct and intense heat. Their use requires the application of a high temperature on a small amount of hair. However, this is essentially desiccating the hair, stripping all moisture from it and in some instances burning it completely.
There is also the effect of the round bristle brush which is often forgotten. Bristle brushes, by the nature of their uneven but natural texture, can scratch and shred the hair shaft making it easier for the hair to dry out and break, forming split ends. When that is followed by high levels of heat from hair-dryers or straighteners then you can be sure that you have dragged out every last drop of moisture from the hair shaft.
If this treatment is infrequent the hair might be able to withstand the damage, but when a habit is made of it, the effects are clear and noticeable.
What is left of the hair is similar to straw; dry, inflexible and easily breakable and this effect of heat on the hair is really enhanced in Afro hair as it is more porous than European and Asian hair types and so more easily dries out.
I understand that, particularly with very curly or Afro hair, one can end up relying on their straighteners and dryer to style their hair. Yet the more you use these pieces of equipment, the drier the hair gets and the more difficult it becomes to style it without them. It’s a vicious cycle, one which can leave men and women’s hair addicted to their heat stylers.
As prolonged use sets in, many start to notice sever hair breakage, loss of sheen and vitality and a real difficulty to achieve and maintain length with their hair. The hair’s growth is battling against the breakage at the ends, giving the impression that the hair has stopped growing. It hasn’t stopped growing of course, but when the ends are constantly fraying and breaking, it’s like taking one step forward with growth but one step back with damage, giving the impression that length is remaining the same.
It’s at this point that we get many patients coming to my clinic, upset that their hair has changed from what they remembered it to be and depressed that it won’t grow.
Those that haven’t sought out my help either have sense enough to cut off the damaged hair and start again without or with less heat, whilst others may go in the opposite direction and apply extensions or weaves to hide the lack of growth and provide versatility for styles. The use of extensions and weaves are a contentious subject for me, but I’ll leave that for another post in the future.
When I see this type of damage in the hair of my patients and have explained to them how and why it’s occurring, the recovery process begins. Damaged hair should be regularly trimmed and then the hair should be thoroughly steam treated with a rich and nourishing mask to rehydrate the hair. I would introduce more gentle approaches to drying hair after washing if naturally drying your hair isn’t feasible. My personal preference is the use of rollers and a hood dryer.
Until the next post, all the best
Teresa Angelina Richardson MIT