Tag Archives: haircare

Understanding hair fall

We have all, at one point in time, dealt with excessive hair fall that alarmed us enough to either self treat with DIY/home remedies or to seek a dermatologist’s opinion.

Let us understand the normal physiological process that our hair goes through which is called “Hair cycle”.

Hair cycle is divided into 3 main phases :

  1. Anagen (90% of the hair are in this active growing phase ) which proceeds to:
  2. Catagen (resting phase), which then progress to :
  3. Telogen (regressing phase)–> the hair then eventually falls out (exogen) as the hair follicle enters a new anagen phase.

As you can see that as new hair grows, the existing hair in that particular hair follicle has to fall out. So hair fall should not necessarily alarming, and this normal hair shedding is seen to be 50-100/day and in some individuals it could be upto 150/day as well.

When to seek a dermatologist’s opinion?

When the hair fall exceeds what was mentioned above, or you start noticing recession of the hair line or thinning of hair in crown (in men), thinning of the hair and a more visible scalp along the part line (in females), or patches of hair loss.

Common causes of hair loss:

1. Telogen effluvium: Presents with a more diffuse hair loss of >150/day. Occurs 2-4 months after any systemic illness such as infections (malaria, typhoid etc), childbirth, surgeries, crash diet, thyroid disorders, psychological stress etc.

The condition is completely reversible and the hair loss starts improving in 4-6 months once the underlying factor is corrected.

Female pattern hair loss

2. Androgenetic alopecia ( also called male pattern baldness or female pattern baldness in men & women respectively due to the characteristic pattern of hair loss). It is genetic disorder, in which susceptible hair follicles either have a higher response to the hormone testosterone, or have a higher amount/activity of the enzyme ( 5 alpha reductase) which converts testosterone into a more active form.

Male pattern hair loss

This result is the normal terminal hair (thick , black scalp hair) is transformed into vellus hair (thin, fine, light coloured hair mostly found in other parts of our body).

The overall effect is gradual thinning of hair. The disorder can be inherited from either maternal or paternal side

Image: DermNetnz

3. Traction alopecia:

Caused by the excessive constant stretching of the hair shaft from hair styling such as tight braids/ ponytails

4. Alopecia areata: Considered an autoimmne disease normally seen in children and presenting with localised patches of hair loss, rarely it can affect adults and be of a more diffuse nature.

Usually self limiting i.e hair regrows back even without treatment.

There are more causes of hair loss, but the ones mentioned above are the commonest ones experienced by individuals.

Treatment for the different types of hair loss may vary with some requiring no specific treatment at all such a telogen effluvium whereas others have specific therapy such as alopecia areata and androgenetic alopecia.

A dermatologist’s take on DIY skincare

As a dermatologist, I’m a firm believer in evidence based medicine. We study dermatological issues and their treatment options throughout our training. We study molecules used in skin or hair care products religiously, reading the research available on them, which active ingredient works, how they work, the dosage, their benefits and side effects and how effective they can be for a particular condition.

Therefore, I personally do not advised nor can I validate the popular culture of “DIY” (do it yourself) or home remedies for skin or hair care.

Yes, dermatologist keep saying that the basics to skin care are ABC (Vitamin A, Vitamin B, Vitamin C), and many of the active ingredients used in skincare are plant derived, this can be confusing to many of us. One can find the “ABC’s” easily in one’s kitchen, pantry, or garden so why shed your money buying expensive products containing the same?

Let me break it down for you in simple terms:

The skin has three layer, the epidermis (uppermost), the dermis (middle) and the subcutaneous tissue (fat and lowermost). the diagram on the right is the epidermis, which is composed of several layers.

The upper layer of the skin (epidermis) is described as resembling a “brick and mortar” structure.

The main function of the skin is acting as a barrier, protecting our body from various environmental substances and it does a pretty good job at it too.

This means many of the DIY’s of tomato paste, lemon juice, etc may not even be able to reach the inside of your skin through that “brick wall” to perform the functions you are expecting them to do.

This is why we have well formulated creams, ointments, serums etc because they contain other agents that help deliver the desired active ingredient (be it vitamin A, B or C etc) to cells in the skin.

Secondly, vitamins are present in various forms, for example for vitamin A we have beta carotene, retinol, retinal, and the most active form retinoic acid. Retinoic acid is the one that binds to receptors present in the cells of our skin to bring about beneficial changes such as anti ageing, anti acne etc.

Simply applying a paste of vitamin A rich fruits such as papaya does not achieve the same result, because vitamin A in fruits & vegetables are in the form of beta carotene.

Thirdly, DIY,s could potentially be doing more harm than good. A common example is a condition called “PHYTOPHOTODERMATITIS” where patients develop an irritant dermatitis when the skin is exposed to certain plants/citrus fruits and sunlight.

Patients develop a red rash on areas of exposure, burning sensation and may develop fluid filled lesions as well. The rash would then heal with pigmentation.

Left image is also called “Margarita burn” -phytophotodermatitis due to the limes present in a margarita cocktail followed by sun exposure. Right image– pigmentation left behind when the irritation subsides.

Just because DIY/Home remedies are all natural does not necessarily mean they are completely harmless and safe

Lastly, even though some skin care products use active ingredients such as various forms of vitamin A, B or C, they have been extensively researched in the labs, animal and human studies. Scientists study the active form of these vitamins, the strength at which these ingredients that have been proven to be effective to produce a desired effect (eg: niacinamide- vit B3, strength of at least 4 % works to reduce pigmentation, repair skin barrier, vitamin C of 20% works as an anti-oxidant, anti ageing, salicylic acid of at least 2% helps unclog pores and so on and so forth).

Simply grinding vegetables, or whisking eggs making a paste for your skin, is not going to achieve the same result

How does one know the strength of the vitamin present in that paste?

Yes, Cleopatra may have bathed in milk to maintain a beautiful youthful skin. We now know that milk has lactic acid which helps in exfoliation of the skin, and we have products designed particularly for that now with or without lactic acid, so people wont have to be bathing in milk for a glowing youthful skin.

Photo by ian dooley on Unsplash

The only time dermatologist advised on using ingredients available at home is for coconut oil. We advised coconut oil application for patients with conditions causing dryness of their skin, who are not able to afford regular moisturisers.

Consuming fruits and vegetables provides you with more nutrients that can be beneficial for skin & hair rather than external application of various DIY concoctions of eggs/lemons/mango etc

Hair oils: Science behind its use in hair care

Hair oil application has been the basic hair care remedy for beautiful, black, luscious hair especially in Indian females (and for some males who groom their beard religiously :P). We’ve been taught at a very early age about hair grooming, mothers would be seen applying and massaging layers of oil into their daughters scalp while enjoying the afternoon sun.

I remember during my time living in Kerala (southern tropical state in India, where the inhabitants use coconut il for everything, from cooking to hair grooming). Girls there has long thick hair touching their knees, but it was always covered in coconut oil so I could never appreciate the overall health status of their hair. I couldn’t tell if the shine was natural or because of the layer of oil, the split ends were beautifully hidden as well. But this was the norm there, they love having oil on their hair day and night and it seems to work for them.

Personally for me, as someone with fine hair, which can get oily pretty quick even just after a day post hair wash, hair oiling never played an important part in my hair grooming process.

Individuals with thin fine hair do experience oiliness of the hair quicker than those with thicker hair, as the sebum produced in our scalp can be transmitted to the hair shaft easily.

As a dermatologist, I often get question on which oil is best to use, how frequently is it to be used, is pre or post shower hair oiling better and so on and so forth.

Honestly, there is no right answer to these questions, as there are very few scientific studies done to compare between the various hair oils or their methods of application.

Lets see which hair oil actually have science backing up its claim

Coconut oil

Studies have found that coconut oil is able to penetrate the hair shaft and this can be enhanced by application of warm oil. The oil coats the hair, prevents absorption of moisture into the hair and thus prevent the recurrent swelling and shrinking up of hair cortex which is responsible for hair fragility and breakage.

Coconut oil has been found to be the only oil to prevent protein loss from the hair shaft, thus providing more stability to the hair.

Photo credit: Photo by Marvin Meyer on Unsplash

Sunflower oil

Though this oil also provides hydration to the hair similar to coconut oil by forming a film coat on the hair . It however cannot prevent protein loss from the hair shaft due to its bulky nature and presence of double bonds that prevent penetration into the hair fibre.

Articles that claims its beneficial effect on hair are based on the study of the effect of Vitamin E on hair growth. A study of 39 patients (note- small sample size) showed that oral vitamin E supplementation for a period of 8 months had positive outcome on patients suffering from hair loss. Sunflower oil is also rich in Vitamin E, but it doesn’t necessarily mean that topical application of a vitamin E rich oil will also achieve the same result as daily oral supplementation.

Moroccon argan oil

Another oil rich in vitamin E, the argan tree is endemic to Morocco, has emerged as the most expensive essential oil and as a popular hair cosmetic from shampoos, to conditioners to hair oils.

Is it worth the hype?

There are no scientific evidence for its use in hair care so far, the only reason for its popularity is that its rich in Vitamin E (a potent anti-oxidant) and the study mentioned above, of Vitamin E positive effect on hair growth.

Almond oil

Again rich in Vitamin E, though it has lots of health benefits when consumed. The effects of almond oil in hair, except for its emollient action i.e coats an oily film on the hair and prevents breakage, no other scientific data available for stimulating hair growth.

Olive oil

Compound found in olive oil such as oleuropein (promotes anagen hair growth -active growing phase of hair, in mouse skin. No human studies yet.

Oleocanthal an anti-inflammatory phenolic compound found in olive oil, when consumed orally is known to help reduce inflammation. Again no data on its effect when applied topically.

image credit:Photo by Roberta Sorge on Unsplash

Rosemary oil

Unlike other oils which lacks strong scientific evidence backing up their claims in promoting hair growth, rosemary oil actually helps improve microcirculation ( improves blood flow to skin). It has been compared to be equally effective to 2% minoxidil in the treatment of androgenetic alopecia (male pattern hair loss). Increase in hair count were seen only after 6 months of daily application.

Whether minoxidil can be completely replaced by rosemary oil, the answer is still “NO”. Because though it was seen to be as effective as 2% minoxidil, we normally prescribe a 5%-10% strength of minoxidil in dermatology.

Hibiscus oil

An animal study concluded that extracts from the leaves of hibiscus plant does promote terminal hair growth. No new hair follicles were formed.

Image credit:Photo by Georgia de Lotz on Unsplash

Onion Juice extract

Crude onion juice extract was used in a study of patients with alopecia areata (auto-immune condition causing patchy hair loss) which is different from diffuse hair loss from other causes. Daily topical application of onion juice to the area of hair loss showed significant improvement in the form of new terminal hair (dark, thick hair) at the end of 6 weeks.

How it works is thought to be by “antigenic competition” ( my fellow dermatologist will understand this term.:P

To summarise

Hair oils (all types; from coconut, almond, olive, vegetable oil etc) are beneficial in a way that they form an oily film on the hair shaft and prevents excess moisture absorption from the environment and prevents water loss from the hair cortex. This is important because the recurrent swelling (from absorbing water) & shrinking (from losing water) of the hair cortex is responsible for the fragility, split ends and eventually breaking off of the hair from its weakest point (which can be seen as hair fall).

Oiling hair can prevent split ends, strengthen the hair (coconut oil) and reduces the friction that arises when combing the hair. Thus, helps manage frizzy hair, gives the hair shine and tames the fly aways.

With regards to stimulating hair growth, only rosemary oil has scientific data backing up its claim.

Olive oil could have potential based on the studies available. Still no conclusive data yet as a topical application.

Heat i.e warm oil application helps the oil to penetrate into the hair fibre and leaving just a thin film on the hair shaft, giving a less oily appearance.

Regarding how to use hair oils, frequency, duration, sadly I do not have the right foolproof answer for this. My personal advice based on my understanding of the research on this topic is :

Coconut oil is definitely the hero here, its the best, safest & cheapest option, especially if you have dry, frizzy, splits ends, apply it on you hair from root to tip. It has the additional advantage of preventing protein loss from the hair. There is actually no need to apply to the scalp, as your skin produces sebum naturally. But go ahead if you have dry scalp or if you enjoy the head massages.

Since we all do not like walking around with oily hair, and since we have products like conditioners & hair serums to use post showers, to make our hair more soft, shiny and manageable, reserve hair oil application for pre-showers. Applying too much & leaving the hair oil for too long will only attract more dirt to your hair which will make it difficult washing the oil out from the hair. Extra manual effort of massaging the shampoo will only cause more friction which can lead to increase falling of hair in the shower.

You can use hair oils as frequent as you like, all the studies reporting positive effects is based on daily hair oil application. I know its impossible to keep up with this in real life, so be flexible, go with your flow. ( I know, not a very scientific advise, but there is no clear cut science behind it yet!! )

Do not depend on hair oils to fix all your hair issues. It should only be a complimentary step to your already existing hair care (shampooing, conditioning, serums, or hair treatment such as minoxidil).

And lastly, if you have straight, non frizzy hair and you’re not in the habit to apply hair oil, then thats also okay. You do not need to follow the crowd.

A taste of Coffee for your skin and hair

Coffee and tea has become the key to a great day. Majority of us start our day with either a cup of coffee or a cup of tea. Recently there has been a surge in the availability of caffeine based skin and hair care products. There are caffeine based eye creams, coffee scrubs, serums and the lists goes on.

So is there a logical scientific explanation to this trend or is it just false advertising exploiting consumers using the magic term “natural ingredient” for your skin and hair?

I have just completed a three year course in dermatology and I never read or studied these active ingredients during my tenure as a junior resident. This is because we have a huge syllabus to cover most of which are related to medical conditions and we are less focussed on less studied ingredients used in skin care. So when patients asks me their opinion on these caffeine or tea based products, I was not 100% sure if there is actual scientific evidence to back up the claims of these products.

What I found from digging around for studies on caffeine and its role in our skin

Lets take a look at the science behind caffeine based skin care products

Animal studies has shown that caffeine (coffee) consumption was associated with decrease risk of skin cancers (melanomas, basal cell carcinomas, squamous cell carcinomas). Human studies have also confirmed this negative association. People who consume >3 cups of coffee/ day have decrease risk of skin cancers. Caffeine present in tea, chocolates also reduced the risk of skin cancers. Decaffeinated coffee was not found to have similar negative association which means caffeine in coffee is the important active ingredient that could prevent skin malignancies.

An increase in coffee consumption of one cup per day was associated with a 3% reduction in melanoma risk

Another study found that daily intake of coffee ( >6 cups) caused a 30% reduction in the prevalence of non-melanoma skin cancer in Caucasian women

As great as the the results look, merely increasing coffee consumption does not guarantee an absolute protection from skin cancers. Sun protection is still the first line defence against any skin malignancies.

Are topical applications of caffeine based products beneficial to our skin?

For any active ingredient to work when applied topically, the agent has to be able to penetrate the skin barrier. Laboratory studies both in mice and human skin have show that caffeine can effectively penetrate the skin if formulated in an aqueous base or as microspheres. So, if the caffeine based creams, scrubs etc are well formulated, topical application of about 3-5% caffeine can be beneficial to our skin.

Cellulite also referred to the “orange peel” appearance of the skin which is due to abnormal localised deposition of fat cells which bulge into the dermis (middle layer of skin) and is seen in the buttocks and thighs of mostly females.

Few studies using animal model to study the effectiveness of caffeine for cellulite, showed that daily caffeine gel application combined with ultrasound improved the appearance of the orange peel skin.

Image courtesy

Caffeine gels, creams, scrubs can temporarily help improve the appearance of cellulite by increasing fat breakdown (lipolysis) and improves blood circulation in the skin.

Caffeine acts as a stimulant, thats why most of us (including me) need a cup of coffee to start the day. Caffeine improves microcirculation (blood flow) in the skin. As the main reason for dark circles is due to increase fragility of the blood vessels in the skin below the eyes which when they break cause haemoglobin to leak into the skin and breaks down forming a pigment. Another important reason for dark circles is poor circulation (blood flow) which results in pooling of deoxygenated blood under the skin giving the area a bluish purplish appearance (note- oxygenated blood is red while deoxygenated blood is bluish in colour). Topical application of caffeine to the under eyes can improve blood flow and help deliver oxygenated blood to the area which makes the skin look more fresh, hydrated, more elastic with less dark circles.

Caffeine also help in the proper lymph drainage in the skin, therefore can reduce collection of tissue fluid in the area as well, thereby helps reduce puffy eyes.

So theoretically caffeine is a great ingredient for tackling dark circle and puffy eyes. But in reality, this is far from true. Studies using human patients did not show significant improvement in the appearance of dark circles. This could be explained by understanding that the reasons behind dark circles are multifactorial, with genetics,stress and facial bone structure also attributing to the cause and caffeine by itself cannot completely reverse the condition.

With that said, caffeine based skin products can help improve the appearance of dark circles and puffy eyes in certain individuals and its important to remember that the results are not permanent.

The ordinary has a serum containing 5% caffeine and EGCG ( active component in green tea, will talk more on this in subsequent posts).

Multiple laboratory studies on mice skin have shown that both oral intake and topical application of coffee enhances the apoptosis (death) of UV induced mutated cells which would otherwise divide and cause skin cancers. Therefore if caffeine is incorporated in sunscreens it can provide additional sun protection benefits. Thus stemmed the marketing strategies of “caffeinated sunscreens”.

However detailed well controlled human studies to test this theory is not available yet. A study using 12 human volunteers to test the benefits of addition of caffeine to sunscreens showed that 2.5% caffeinated sunscreens provided a higher spf value than a non caffeinated sunscreens.

Few sunscreens which also contain caffeine as one of the ingredients

Angrogenic alopecia (AGA) is a common cause of baldness especially in males. AGA is due to the increase sensitivity of the hair follicles in the scalp to a hormone called dihydrotestosterone-DHT (an active form of testosterone). DHT causes the hair to enter the telogen phase (resting phase) of the hair cycle which eventually causes the hair to become thin and fine and ultimately falls off.

How caffeine helps combat this hair loss?

  • In vitro studies, have shown that caffeine inhibits the enzyme 5 alpha reductase which is responsible for converting the inactive testosterone to its active form DTH.
  • As mentioned earlier, caffeine helps improve microcirculation in the skin. This means caffeine application can increase blood flow to the hair follicles which can then receive more nutrients required for hair growth.

Caffeine based hair products in today’s market

A study comparing the effectiveness of 0.2% caffeine liquid lotion to the standard FDA approved antihypertensive drug (drug for lowering blood pressure) – 5% Minoxidil solution in the treatment of androgenic alopecia showed that both were equally effective at the end of a 6 month observation period. This study highlighted the potential of caffeine for treating hair loss.

So would I personally recommend treating your hair loss with some coffee?

I would have to answer NO. I would not recommend caffeine as mono therapy for hair loss.

There are various types of hair loss, and the science behind caffeine for hair loss is stressed on a specific type of hair loss call Androgenetic alopecia (see the pictures above) and even for this condition, not many well controlled human studies are available yet to support the use of caffeine for hair loss. Though dermatologist also see and treat many hair issues, hair loss is one of the commonest reason why patients seek dermatologists consultations. Hair loss could be of various causes, and a proper evaluation about the potential etiology is necessary prior to the start of any treatment.

Many other well documented treatment options are available now for the treatment of hair loss such as Minoxidil lotions, Finasteride, Platelet rich plasma etc. Incorporating caffeine based shampoos could add as an adjunctive therapy to the above.

Hair products with caffeine

Take home message

photo credit: pexels.com

Some of these studies make caffeine look like a star ingredient for your skin and hair. These hair and skin products are based on in vitro (laboratory tests done in well controlled environment which is far from the reality), and few animal studies and well designed human studies are still lacking. So keep this in mind when you buy these products in the market with these huge claims and promises such as “cure for your hair loss” etc.

Note that a certain % of caffeine is necessary to achieve the desired results mentioned above and this has to be formulated in a bases that enables the caffeine to penetrate into the skin. Therefore DIY coffee scrubs, creams may not beneficial to your skin or hair at all as the % of caffeine maybe too less or worst if its too much, unwanted side effects may occur.

In fact, scrubbing your skin with coffee may be too harsh on your skin especially if you have sensitive skin or are using various other active ingredients such as retinoids, glycolic or salicyclic acid etc.