Normal hair grows through a hair cycle that has three stages. The growth phase, or anagen phase, is the longest phase of the hair cycle, with 80 to 90% of the hair on our scalp in this phase. In the next stage called the catagen phase, the hair bulb detaches from the blood supply and is pushed from the scalp. In the last stage, the telogen phase, shedding occurs as the hair is released, leaving behind an empty follicle.
Each hair follicle is independent, going through the cycle at different stages as the other hairs. Hair problems occur when there is a disruption in the hair cycle.
What are the causes of hair loss?
Hair loss can be caused either by an isolated problem or a combination of factors including genetics, chronic medical diseases such as a thyroid problem or underlying anemia (low blood count), poor nutrition, etc. Chemical treatments performed in hair salons, such as hair dyes, bleaching, perming and rebonding hair, can cause a form of hair loss from breakage of the hair shaft.
In the hospital setting, patients undergoing chemotherapy usually suffer from a form of temporary hair loss, caused by the hair follicles entering into the resting phase whereby they are shed.
Namely, as our hair growth cycle goes through 3 main phases — active growth caused by anagen, transitional growth caused by catagen and inactive growth and shedding caused by telogen — an impact in any of these stages caused by the abovementioned factors can lead to loss in hair density due to less hair on the scalp present in the growth or anagen phase.
Hair loss shampoo
What constitutes a good shampoo? Caring for one’s hair is just as important as caring for one’s face, but often gets less attention. Understanding what constitutes a good hair loss shampoo is an important part of making sure your hair stays healthy and voluminous.
To help you navigate the world of shampoo products, we introduce you to the basics you need to know.
How should a shampoo function?
A shampoo is a viscous liquid (liquid with texture that tends to be thick). Its primary purpose is cleansing the scalp and hair of dirt, sebum, sweat, dead skin cells and environmental pollutants. It does so by dissolving oil-soluble dirt, which is water-insoluble and hence, cannot be removed by solely rinsing with water. A hair loss shampoo should also remove greasy residues from hair care products such as oils, gels and sprays. The overall effect is that of cleansing to maintain a good hygiene level to reduce the chance of scalp irritation, inflammation and odour.
While most shampoos can accomplish a thorough cleanse, the real challenge lies in removing just enough sebum to allow the hair to be clean without drying it out.
This explains why most shampoo formulations have a secondary function of smoothing the hair’s surface and imparting lustre, smoothness, buoyancy and volume.
Certain types of hair loss shampoos also treat the scalp with medicated ingredients, such as those targeting dandruff, a common scalp disorder caused by a yeast known as Malassezia.
The Copper Peptide Hair Regrowth Deep Cleanse Shampoo is formulated for hair loss and sensitive scalps. It has degreasing, soothing, and anti-hairloss effects. It also contains amino acid surfactant for sensitive scalps, zinc pyrithione for anti-dandruff action, and copper peptide for healthy hair growth.
Types of surfactants
A surfactant is often amphiphilic, meaning its molecules contain both lipophilic (oil-attracting) and hydrophilic (water-attracting) parts. The oil-attracting parts bind to sebum while the water-loving sites parts to water. Such a mechanism allows sebum to be removed when in contact with water.
The type of surfactants used in hair loss shampoos is classified according to their hydrophilic polar group. The four common categories of shampoo surfactants are anionics, cationics, non-ionics and amphoterics. Most shampoo formulas rely on two types of surfactants.
The surfactant listed first in a shampoo’s ingredient list denotes the primary cleanser and also the ingredient in the highest concentration. The surfactant listed second is the secondary cleanser; this is often added to offset the weaknesses of the first surfactant.
Anionic surfactants Anionic surfactants are named for their negatively charged hydrophilic (water-loving) parts. Derived from fatty alcohols, they are good at removing sebum from the scalp. However, excessive cleansing with anionic surfactants leaves the hair harsh, rough, dull, frizzy and prone to tangling. Examples include sodium laureth sulfate, ammonium laureth sulfate, sodium lauryl sulfate, and ammonium lauryl sulfate.
Cationic surfactants In contrast to anionic surfactants, cationic surfactants have a positively charged element. Cationic surfactants are poor cleansers and do not lather well. They are also not compatible with anionic surfactants. However, they are excellent at keeping chemically damaged hair soft and manageable. As a result, shampoos for damaged or coloured hair often include cationic surfactants. Examples include long-chain amino esters, ammonioesters, and cetyltrimethylammonium chloride.
Amphoteric surfactants With both positively and negatively charged groups, amphoteric surfactants foam well and condition the hair. They help with the formation of micellar emulsion, improving the lathering ability of the shampoo, resulting in a thick liquid which is efficient to use. In addition, they do not cause stinging in the eyes and are gentle on the skin/scalp barrier, making them ideal for mild shampoos. Examples are cocamidopropyl betaine, sulfonate betaine, amphoteric acetate/diacetate.
Nonionic surfactants Nonionic surfactants do not have a charged group and hence are compatible with any surfactant. Nonionic surfactants are the mildest type of surfactant. Such surfactants are often used in baby shampoos. Examples are fatty alcohol ethoxylates, cocamide MEA, sorbitan ether esters, and alkyl polyglucosides.
The Scalp Microbiome
The scalp is one of the thickest parts of the skin on the body, with on average about 100,000 hairs growing on it at a given time. It high production of vitamin-rich sebum (oil) and an unusually humid environment, which gives rise to microbes and microorganisms that aren’t found on any other part of the body.
The scalp microbiome is the balance of healthy microorganisms that work together and contribute to our scalp health. Just like our skin microbiome, if the delicate microbiome is thrown off balance, skin conditions can develop, causing symptoms of flaking, itching, and irritation.
Keeping the scalp microbiome health: Shampoo
Research has shown that zinc pyrithione medicated shampoo is a safe and effective way to treat dandruff. By fighting off Malassezia, it is a beneficial way to restore the health of your scalp microbiome.
The Copper Peptide Deep Cleanse Shampoo contains amino acid surfactant for gentle cleansing of sensitive scalps, zinc pyrithione that has anti-dandruff properties, and copper peptide that helps to promote healthy hair growth.
Since ancient times, plant extracts have been widely used for hair growth promotion in the traditional Ayurveda, Chinese and Unani systems of medicine. One of the most potent sources of these plant extracts would be the oil extract of safflower (Carthamus tinctorius L.).
Historically, safflower has mainly been used in traditional medicine to treat different medical conditions and as dyes for flavouring and colouring in Italian, French and British cuisines.
Interesting fact? Safflower seeds and garlands have also constantly made their appearance in the presence of mummies across ancient Egypt. In the treatment of skin conditions, safflower can be used to treat skin patches and baldness based on Iranian traditional medicine.
Use of safflower oil in the prevention and treatment of hair loss
In a 2011 study published in the Journal of Ethnopharmacology by Naphatsorn Kumar, the mechanisms involved and the effectiveness of hair loss treatment using plants were examined by determining the relationship between the activities of the 5α-reductase enzyme inhibition and hair growth promoting activities. When tested for 5α-reductase inhibition using enzymes from rat livers and hair growth promoting activity in mice, safflower extract was found to be the most potent inhibitor of the enzyme and the strongest hair growth promoter among 17 Thai plants traditionally used for hair treatment.
“Our team worked on this basis to incorporate Safflower Oil into our existing haircare and scalp care routine to stimulate hair follicles and also to heal the hair shaft.” Accredited Dermatologist, Dr. Teo Wan Lin
How does safflower oil promote hair growth and fight hair loss?
Safflower florets have traditionally been used for hair growth promotion. In the study by Naphatsorn Kumar, the potential of safflower extract on hair growth was examined both in vitro and in vivo.
It was found that safflower oil encourages hair growth by promoting the proliferation of both dermal papilla cells and HaCaT and by stimulating hair growth-promoting genes such as the vascular endothelial growth factor and keratinocyte growth factor. At the same time, it suppresses the expression of the hair loss-related gene, the transforming growth factor‐β1. As a result, the treatment of hair using safflower extract significantly increased the length of cultured hair follicles and stimulated the growth of hair.
Are there any side effects?
There are no known side effects except for allergic contact dermatitis which is extremely rare.
How can it be incorporated in your haircare regimen?
Male pattern hair loss, or androgenetic alopecia, is exceedingly common. Hair thinning and hair loss can begin as early as late adolescence and progress with age. Understanding why it happens, including its strong genetic element, can help men counter its effects.
Characteristics of male pattern hair loss (MPHL)
MPHL typically begins first with bitemporal recession – triangular, usually symmetrical, areas of recession at the frontal hairline. Thinning starts in the temples as well as the crown/vertex and slowly progresses to encompass the entire top of the scalp.
The disease onset and progression vary from person to person. Initial signs of male pattern hair loss usually develop during teenage years and lead to progressive hair loss and thinning of the hair across the scalp.
Causes of male pattern hair loss
A genetic predisposition is considered a major risk factor for male pattern hair loss, as genetics determine the activity level of the androgenic hormones that lead to MPHL. However, this condition can also be present even in individuals without a family history.
In the hair follicle cells, a male hormone called testosterone converts into an active form and binds to the androgenic receptors in the hair follicle. Individuals with male pattern hair loss have abnormal sensitivity of hair follicles, allowing easier binding to receptors.
This specific bonding triggers cellular processes that cut short the anagen phase of the hair cycle, the stage where hair follicles grow. For this reason, the hair follicles enter the telogen phase earlier where programmed cell death happens.
In normal hair follicles, the duration of the anagen phase lasts from two to seven years. Individuals with male pattern hair loss have an anagen phase that ranges from a few years to just weeks.
With the decreased duration of the anagen phase, more hair follicles enter the telogen phase. Telogen hairs are more easily plucked than anagen hairs. Thus, individuals will notice increased hair shedding as they comb their hair.
An increased amount of androgen also causes hair follicles to be transformed into thin, vellus-like hairs. As a result, hairs are finer and lack pigmentation.
Topical and oral treatments
Topical and systemic drugs are often used in treating MPHL. The most common topical drug is minoxidil. Originally developed as an oral medication for hypertension, its common side effect of excessive hair growth has led to its use as a treatment. Minoxidil 2% or 5% solution is often used in topical application to prolong the anagen phase.
Other anti-androgen drugs include fluridil and finasteride. A topical application of fluridil helps suppress androgen receptors in hair follicles. Finasteride is available as oral medication and reduces the conversion of testosterone into its active form. Finasteride has also shown to reverse the effects of follicle miniaturization.
Copper peptide is another ingredient that stimulates hair regrowth. Made up of amino acids, copper peptides have regenerative properties that work to increase hair follicle size and reduce hair loss. By fighting inflammation and free radicals, copper peptides also protect the hair follicles from being damaged.
All treatments for MPHL are for long-term use, which means stopping the treatment will cause your hair loss condition to return. Before committing to any topical treatment, it is recommended to consult an accredited dermatologist for professional advice.
Light therapy as treatment
Low light, intense pulsed light, and red light treatment can initiate hair regrowth. Red light treatment, with wavelengths between 630 to 670 nm, stimulates an enzyme called cytochrome C. This enzyme encourages our genes to produce more hair and lowers the cell death of hair follicles.
Using a laser comb for 15 minutes, three times a week, also increases the number of hair follicles in the anagen phase, the stage in which our hair grows. The comb is available as a stand-alone or adjunctive therapy.
Seborrhoeic or seborrheic dermatitis is a common, chronic or relapsing form of eczema/dermatitis. The condition mainly affects the sebaceous, gland-rich regions of the scalp, face, and trunk. There are infantile and adult forms of seborrheic dermatitis. It is sometimes associated with psoriasis (sebopsoriasis). Seborrheic dermatitis is also known as seborrheic eczema.
Dandruffalso known as pityriasis capitis is considered to be an uninflamed form of seborrheic dermatitis. Scattering within hair-bearing areas of the scalp, dandruff of such presents as itself as bran-like scaly patches.
Although the cause of seborrheic dermatitis is not completely understood, it is associated with proliferation of various species of the skin commensal Malassezia, in its yeast, non-pathogenic form. Its metabolites (such as the fatty acids oleic acid, malssezin, and indole-3-carbaldehyde) may cause an inflammatory reaction. Differences in skin barrier lipid fuction and content may account for individual presentations.
Adult seborrheic dermatitis tends to begin in late adolescence. It is less common in females than in males and most common amongst young adults and in the elderly.
Factors sometimes associated with severe adult seborrheic dermatitis:
A family history of psoriasis or familial tendency to seborrheic dermatitis
Oily skin (seborrhoea)
Lack of sleep, and stressful events.
Immunosuppression: organ transplant recipient, human immunodeficiency virus (HIV) infection and patients with lymphoma
Neurological and psychiatric diseases: congenital disorders such as Down syndrome, depression, epilepsy, facial nerve palsy, tardive dyskinesia, parkinson disease, spinal cord injury
Psoralen and ultraviolet A (PUVA) therapy used in treatments for psoriasis
Infantile seborrheic dermatitis is the type of seborrhoeic dermatitis that affects babies under the age of 3 months and usually resolves by 6–12 months of age. It causes cradle cap, the diffuse greasy scaling on scalp. The rash may spread to affect armpit and groin folds resulting in a type of napkin dermatitis. They are characterised by their flaky or peeling salmon-pink patches. Since it is not itchy, babies often appear undisturbed by the rash, even when generalised.
Typical featuresof seborrheic dermatitis
Often affects the upper trunk, facial areas such as within eyebrows, around the nose and behind ears and scalp
Winter flares, improving in summer following sun exposure
Minimal itch most of the time
Combination oily and dry mid-facial skin
Ill-defined localised scaly patches or diffuse scale in the scalp
Blepharitis: scaly red eyelid margins
Ill-defined, thin, scaly and salmon-pink plaques in skin folds on both sides of the face
Ring-shaped or petal-shaped flaky patches on anterior chest or hair-line
Rash in armpits, under the breasts, in the groin folds and genital creases
Superficial folliculitis (inflamed hair follicles) on cheeks and upper trunk
Pityriasiform seborrhoeide is a form of extensive sebrrhoeic dermatitis that affects the scalp, neck and trunk.
Seborrheic dermatitis is often diagnosed by its clinical appearance and behaviour. This is because Malassezia is a normal component of skin flora. Due to this, their presence on microscopy of skin scrapings is often not diagnostic.
Histological findings specific to seborrheic dermatitis are as follows:
Although skin biopsy may be helpful, it is rarely indicative.
superficial perivascular and perifollicular inflammatory infiltrates
parakeratosis around follicular openings.
Treatment of seborrheic dermatitis often involves several of the following options:
Keratolytics can be used to remove scale when necessary, eg salicylic acid, lactic acid, urea, propylene glycol
To reduce Malassezia, topical antifungal agents such as ketoconazole, or ciclopirox shampoo or and/or cream are applied. It is important to note that some strains of Malassezia are resistant to azole antifungals. In such cases, it is advised to try zinc pyrithione or selenium sulphide, under a dermatologist supervision.
Mild topical corticosteroids are prescribed for 1–3 weeks to reduce the inflammation of an acute flare
Topical calcineurin inhibitors (pimecrolimus cream, tacrolimus ointment) are indicated if topical corticosteroids are often needed, as they have fewer adverse effects on facial skin
In resistant cases in adults, oral itraconazole, tetracycline antibiotics or phototherapy may be recommended. Low dose oral isotretinoin has also been shown to be effective for severe or moderate seborrheic dermatitis.
Anti-dandruff shampoos containing zinc pyrithione and salicylic acid such as the Deep Cleanse Shampoo should be used daily.
Other medicated shampoos containing selenium sulfide, coal tar, ciclopirox and ketoconazole should be used twice weekly for at least a month.
Steroid scalp applications are seen to reduce itching. These should be applied daily for a few days every so often.
Calcineurin inhibitors such as tacrolimus can be used as steroid alternatives.
Coal tar cream can be applied to scaling areas and removed several hours later by shampooing.
Combination therapy is often advisable.
Treatment for face, ears, chest and back
Using a non-soap cleanser, cleanse the affected skin thoroughly once or twice each day.
Apply ciclopirox cream or ketoconazole once daily for 2 to 4 weeks, repeated as necessary.
Hydrocortisone cream can also be used, applied up to twice daily for 1 or 2 weeks. Occasionally a more potent topical steroid may be prescribed.
Topical calcineurin inhibitors such as pimecrolimus cream or tacrolimus ointment may be used instead of topical steroids.
A variety of herbal remedies are commonly used, but their efficacy is uncertain.
Regular washing of the scalp with baby shampoo or aqueous cream is followed by gentle brushing to clear the scales.
White petrolatum may be useful.
Depending on the extent of the rash, topical antifungals are often prescribed.
In the third instalment of my series on dealing with hair loss in Singapore as a dermatologist, I’m going to discuss dandruff and scalp sensitivity. This is one of the commonest scalp complaints that my patients have in conjunction with hair loss symptoms and leaves many of them wondering if it is the cause of their hair loss problem.
1. What is dandruff and what causes it?
Flaking on the scalp and white scales found on one’s clothes are one of the first symptoms of dandruff. This is lay speak for any form of scalp inflammation that causes the cell turnover rate on the scalp to increase abnormally. Dead skin cells, which are rapidly shed from the cell turnover, in turn constitute the white scales observed as the primary symptom of dandruff. There are several medical conditions that can result in this, the commonest being the following: scalp psoriasis, seborrheic dermatitis and scalp eczema.
2. Do I have a sensitive scalp or is it a symptom of another condition?
Do you have itch, redness or pain on your scalp? You may have an undiagnosed inflammatory scalp disease. Scalp “sensitivity” without any underlying scalp condition is a very rare condition attributed to abnormal nerve sensations known as scalp dysaesthesia. It is far more common to have an underlying cause such as seborrheic dermatitis, which is due to proliferation of a yeast known as malessezia furfur in an individual with excess production of oil. It is also commoner in tropical and humid climates such as Singapore, as it encourages this yeast to grow.
Otherwise, malessezia is an inhabitant of one’s skin and scalp. Under normal conditions, it does not cause any issues. However, under humid and sweaty environments, this yeast can proliferate to cause scalp inflammation and flaking. Dandruff is observed as a result. If you have scalp flaking which does not respond to over the counter anti-dandruff shampoos, such as those containing zinc pyrithone which is anti-fungal, promptly seek the care of an accredited dermatologist rather than self medicate or DIY.
Other causes of scalp inflammation would be scalp eczema, which is due to an excessively dry scalp/skin condition. For example, scalp psoriasis, which may be the case especially if one has a family history of psoriasis or rashes on the body. If you have been in contact with a ringworm infected cat or dog, also do have your scalp and skin checked by a dermatologist as these infections are contagious and could also cause a form of scalp inflammation presenting as a red, scaly and itchy patch with hair loss.
3. Is my sensitive scalp and dandruff causing hair loss?
Most cases of scalp inflammation due to eczema, seborrheic dermatitis, scalp folliculitis or psoriasis should not cause hair loss. However severe inflammation can push the hair growth cycle into a stage of telogen effluvium which is when hair reaches the end of its cycle and falls out, similar to hair loss that occurs after a major illness or post-pregnancy. In addition, if one picks and peels off crusted areas over the scalp this can also cause damage to the hair root and lead to hair loss.
There are other causes of hair loss such as alopecia areata, which is an autoimmune disorder causing one’s immune system to attack hair follicles, leading to hair loss. This usually has no symptoms other than the appearance of round patches of hair loss over one’s scalp. Scarring causes of hair loss include folliculitis decalvans, which is the end-stage of a type of scalp folliculitis, whereby the hair follicles themselves are constantly inflammed and infected. Children may be more susceptible to tinea capitis, which is a fungal scalp infection that can lead to scarring hair loss if untreated.
Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins). These work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals, Dr.TWL Dermaceuticals, which include sensitive scalp and hair loss treatments.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email [email protected]. Alternatively, you may fill up our contact form here.
By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
In my practice, I have seen many men and women who are beset with hair-loss, which can occur at any age and is extremely distressing. It is unfortunate that many go the route of medi-spas and scalp treatments by aestheticians before deciding to see a dermatologist, by which time a large part of their hair has already been lost.
I’ve also seen so many expatriates who are convinced that only since moving to hot and humid (and stressful) Singapore they have started developing scalp problems and hair-loss. Also with stories that their friends have developed the same issues since moving to Singapore, leading some to even conclude that the water supply must be the cause. So if you’ve moved to Singapore recently, started having hair fall and feeling panicky, fret not because I’m about to share some top dermatologist tips (the first of a series) on hair-loss happening on this sunny island.
Ever since the media brouhaha about certain hair-loss treatment centres’ tactics on selling beleaguered customers their “anti- hair loss” packages, I’ve been wanting to share my dermatologist expertise on this troubling topic, hoping it will help many out there who are searching for an answer to their hair-loss woes. So I’ve decided to pen down some the top tips dermatologists offer to hair-loss patients in a series, starting with the first.
1. Hair-loss is not caused by a wrong shampoo, hair care products or even water supplies
Hair-loss is not caused by using the wrong kind of shampoo. Period. The science of all shampoos is that it contains lathering agents, like sodium or ammonium-laureth sulfate based detergents, in varying proportions, to grab dirt, grime, bacteria and oil from the surface of the scalp and hair and the foam is then rinsed off with water. The ones which promise to degrease and deep-cleanse are simply those that contain higher proportions of Sodium Laureth Sulfate (SLS). Put simply, all shampoos perform a similar function and the main difference would really be how well they cleanse the scalp without drying out hair ends.
It is a total myth that what’s in your water (assuming we are speaking about potable water in the first place) can affect the condition of your scalp. Unsanitary water would be teeming with bacteria so using that on any part of one’s body can indeed increase chances of infections but that’s never the case in Singapore. Hence there’s no possibility that the water you are using to shower is causing your hair-loss and there’s also no need to spend extra money on specially treated water for showering!
2. Chemical hair treatments like rebonding, perming and bleaching can cause hair-loss, but a specific kind
It’s a question that almost every patient with hair loss asks me, “ Is my hair-loss caused by bleaching my hair last year?” The truth is bleaching is detrimental for the hair shaft( which is made from keratin, a dead material) but unless one has an allergic reaction ( i.e. allergic or irritant contact dermatitis ) due to the bleaching agent that occurs on the scalp( which is the “living component” where the hair follicles are), bleaching itself should not cause hair to fall out from the roots, which is true hair loss.
What bleaching and other chemical treatments i.e.perming, rebonding, hair dyes, actually does is to alter the structure and the bonds of the hair via chemical reactions so that it’s appearance is changed. Essentially, these chemical processes damage the hair shaft, leading to parts of the hair shaft being broken off and causing hair-loss by breakage. If you have bleached or permed hair, you should adopt grooming practices such as a wide-toothed comb and soft bristled brush using gentle detangling motions rather than harsh combing which can result in even more breakage.
3. Certain hairstyles can trigger and worsen hair-loss
Do you always tie your hair in a tight bun or pony tail? If you find your hairline receding or are experiencing tightness or even a headache around your hairline at the end of the day, beware. Dermatologists counsel that wearing such hairstyles persistently can cause a form of hair loss known as traction alopecia, whereby continued pulling and pressure over the hair roots causes the hair follicles to weaken, miniaturise and if over an extremely long period of time, even die.
If you are having hair-loss concerns, use a scrunchie or a hair tie that does not rip at the hair or tie it overly tightly. You may want to keep a shorter hairstyle while your hair-loss concern is addressed by your dermatologist.
Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email [email protected]. Alternatively, you may fill up our contact form here.