Maintaining a healthy scalp and healthy hair can prevent many causes of pattern hair loss and encourage the growth of transplanted hair follicles.
Many men and women will develop pattern hair loss during their lifetimes. The pathophysiology of many hair-thinning disorders has been well documented and treatment options, although not entirely guaranteed, have been developed. One of the easiest ways to help prevent most causes of pattern hair loss and encourage the growth of transplanted hair follicles is by maintaining a normal, healthy scalp and hair.
Hair Loss in Men Compared to Women
There are several classifications for male and female pattern hair loss, with the most recognized for men being the Hamilton Classification and, for women, the Ludwig Classification. With these classifications, there is a genetic predisposition for certain hair follicles to undergo miniaturization in response to hormones and other factors that lead to male and female pattern hair loss. Treatment options for men and women include medical and surgical methods.
However, there are significant differences in hair thinning between women and men. Women have a different pattern to their hair loss, generally experience it at a later age and are more emotionally impacted by its occurrence. The same treatment benefits of finasteride (Propecia) are not seen in women as compared to men, demonstrating that there are other hormonal issues at play in female pattern hair loss.
Women also use more chemical treatments on their hair and have certain nutritional requirements for normal hair growth. The pathology of hair thinning in women is less well understood than in men, although miniaturization of the hair follicle growth cycle is seen in both, as well as changes in the epidermis and dermis in the same area where hair loss has been identified.
The Scalp’s Role in Hair Growth
Scalp skin can be viewed as a variant of normal skin in that it has an epidermis and dermis, but it also has a greater concentration of large, terminal hair follicles. It is well known that the hair follicle has a growth cycle that can be altered by hormones, medications, diet, illness and many other factors. Volumes have been published regarding hair growth and the hair follicle, dermal papillae and germinal center (hair follicle stem cells). It would appear that the health of the hair, scalp epidermis, dermis and subcutaneous tissue is related to good nutrition and hair care products, which can play a major role in hair growth, hair shaft thickness and the survival and growth of normal as well as transplanted follicular units.
As the science of the dermal papillae and the follicular bulge unfold, the integrity of the epidermis, dermis, hair follicle and adjacent fatty tissue and their roles in healthy, normal hair growth has become apparent. It has been observed that transplanted follicles grow better in healthy scalp skin than in scarred areas.
Improvement in the structural and functional integrity of the scalp epidermis, dermis and hair follicle should improve hair growth. There are several observations that would suggest the scalp is analogous to topsoil – that is, the thicker the topsoil, the better the grass will grow. This may be the case in the scalp. Healthy scalp skin with a normal pH and normal thickness of the epidermis and dermis will improve hair growth and/or decrease hair shedding.
Most hair transplant surgeons agree that preservation of the follicular unit is critical for survival of transplanted hair. Normal, healthy hair growth requires healthy, intact follicular units. Observation suggests that normal follicular units transplanted to scalp skin with significant actinic damage, traumatic scar tissue and related issues produce decreased overall graft survival as well as poorer follicular growth. Poorer follicular unit growth is demonstrated by finer and thinner hair shafts of the transplanted follicular units.
Maintaining Healthy Hair and Scalp to Improve Growth
In men and women with pattern hair loss, there are many things that can damage the scalp and hair. Sun damage causes thinning of the epidermis and dermis. Hair care products and treatments may cause damage to the hair shaft and scalp skin. There are specific nutritional and metabolic requirements needed for healthy scalp skin and hair follicle growth as well.
Any scientifically proven ingredient that can directly stimulate the hair follicle matrix cells will stimulate hair growth and increase hair volume, thickness and density. There are no quick fixes or hair fertilizers to create growth, but there are things men and women can do to improve and maintain a healthy scalp and encourage hair growth.
Sun protection is important for normal scalps as well as scalps with pattern hair loss. The greater the predisposition for pattern hair loss, the more important the need is for sun protection. It is a myth that hats make hair fall out and lead to baldness. On the contrary, a hat can help protect the scalp and hair from UV sun damage, which accelerates the thinning hair process.
The natural protection from sun damage provided by an individual’s hair decreases with greater levels of pattern hair loss (finer, thinner hair with more exposed scalp). The front, top and vertex of the scalp are the most vulnerable due to proximity to the sun’s rays. Sun damage to the scalp can result in damaged stratum corneum cells, atypical epidermal cells, a thinned epidermis and a damaged dermis.
There are agents that have been shown clinically and histologically to improve the health of the epidermis, dermis and hair follicle. Generally, these agents have been used on non-scalp skin. They include glypoic complex, minoxidil, retinoic acid and others. On a clinical basis, there is improvement in skin texture, color and tone with use of these ingredients and even improvement in scalp hair growth.
These ingredients also cause flattening of the stratum corneum, increased thickness of the epidermis, increased cellularity and vascularity of the dermis, overall thickening of the dermis and the development of larger hair follicles, which leads to thicker, longer hairs. Physiologically, there is increased cell growth of the epidermis, improved epidermal exfoliation, increased glycosaminoglycan production, increased collagen synthesis and stimulation of the hair follicle matrix cells, thus increasing the hairs in the active growth phase and decreasing the number of hairs in the resting phase. This helps to increase the length, thickness and volume of the hair.
The ideal situation is when hair care products with the right ingredients, appropriate pH and proven results lead to the development and maintenance of a healthy scalp and hair growth. An individual’s overall nutrition and the use of proven follicle stimulators to help maintain and prevent pattern hair loss are extremely important.
The scalp and hair have a pH of 4.5 +/- 0.5. Maintaining the normal pH of the scalp and hair is important for normal structure and function. Shampoos that contain ingredients to promote healthy scalp and hair, such as Rx Systems PF’s Volumizing Shampoo, are designed to clean dirt, sebum, oil and dead skin cells from the scalp, promote normal scalp skin stratum corneum exfoliation and maintain the normal acidic pH of the scalp. Conditioners that contain ingredients to promote healthy scalp and hair, such as Rx Systems PF’s Volumizing Conditioner, are designed to restore the normal acid pH of the scalp skin, reduce tangle and restore the normal moisture content of the hair shaft. The moisture retention of the hair shaft is pH-dependent. Acidic pH causes the cuticle cells to flatten and seals the moisture into the hair shaft. Safe chemical treatments to the hair shaft do not have a negative impact on the scalp, hair follicle or hair growth. They work only on the hair shaft above the scalp skin and do not have a negative impact on the hair follicle, matrix cells of the hair follicle or the dermal papillae. Nutrition plays a role in healthy scalp skin and hair shaft growth. Scalp skin and hair are composed of keratin protein, with hair consisting of 97% protein. Keratin proteins are amino acids linked end-to-end and cross-linked with sulfur bonds from the amino acid cystine. Cystine and glutamic acid make up 30% of the amino acid content of human hair.
Red meat and eggs contain significant cystine, but many people have decreased intake of red meat and eggs to lower blood cholesterol levels. To avoid unhealthy dietary changes, it is more efficient to take a multivitamin and an amino acid supplement on a daily basis to improve scalp skin and hair growth. For individuals at greater risk for genetic pattern hair loss or conditions with increased telogen loss, a daily nutritional support for normal hair growth is important. These patients are at greater risk to have poor hair growth without adequate nutritional supplements.
Minoxidil (Rogaine), at a concentration of 2%-5%, has been shown to stimulate hair follicle growth. It has a direct effect on the hair follicle, although the exact mechanism is not well understood. The hair follicle is one of the few tissues that contain pluripotent cells that can divide and differentiate when influenced by substances produced by cells of the dermal papilla of the hair follicle, matrix cells of the hair follicle or external applied follicle stimulators.
The hair follicle is a small structure, but, due to the large number of different cell types involved in its function, its complexity is enormous and there is much to be learned about the function of follicle stimulators. Minoxidil appears to shorten the telogen (resting) phase of the hair growth cycle, returning the hair follicle to the anagen (growing) phase. Male and female pattern hair loss is characterized by a low anagen:telogen ratio on scalp biopsy. Minoxidil follicle stimulators increase the anagen:telogen ratio, creating thicker, fuller scalp hair. Scientific data suggests that topical minoxidil stimulates matrix cells of the hair follicle to reactivate, thus producing thicker, longer hair independent of hormonal influences.
Creating and maintaining healthy, normal hair growth and scalp skin is a daily activity that requires a lifestyle change to maintain the benefits of a good hair care program. With the right knowledge and products, positive improvements can be made. n
Dr. Samuels is Chief of Dermatology at St. Luke’s Hospital in St. Louis, MO and founder of the professional skincare product line Rx Systems PF.
Disclosure: Dr. Samuels is the founder of the Rx Systems PF product line.