My Blog List

Monday, May 10, 2010

HAIR CYCLE---TELOGEN EFFLUVIUM




The Hair Growth Cycle
To understand telogen effluvium, we need to have some knowledge of the hair growth cycle. Hair does not grow continuously on the human scalp. The anagen (growing) phase for terminal hair can extend 3 to 7 years and is a reflection of the size of the hair follicle. Catagen is the transitional portion of the hair growth cycle, between anagen and telogen and lasts only 1 to 2 weeks. During this time, there is a rapid involution and regression of the hair follicle. The hair follicle then enters the telogen phase, which is a relatively fixed period of time, approximately 100 days, regardless of the size of the hair follicle. There is no growth of the hair shaft during this phase. It is at the end of the telogen phase that the entire hair shaft, also often referred to as the club hair, will spontaneously shed, while a new hair shaft is forming within the hair canal. The white bulb at the end of the hair, along with the loosely attached collection of friable debris gives the shed hair its characteristic appearance.In the scalp of the healthy, young human adult, approximately 90% of the hair will be in the anagen (growth) phase and approximately 10% will be in the telogen (dormancy) phase. Less than 1% will be in the catagen (transitional) phase. When you consider that the scalp contains 100,000 hairs, with 10,000 in the telogen (dormancy) phase... and 1% of those hairs in the telogen phase will be at the end of the 100 day long phase, you can easily understand why it is normal to shed 100 hairs per day.

When excessive amounts of hair simultaneously switch from anagen (growth) into telogen (dormancy) and subsequently shed several months later, the phenomenon is referred to as a telogen effluvium. Rarely are more than 50% of the hairs on the head involved. Telogen effluviums can be acute or chronic. When the shedding lasts more than six months or persistently recurs, it is referred to as a chronic telogen effluvium. Chronic telogen effluviums have been reported mainly in women. No racial predilection exists.
Although telogen effluvium can affect hair on all parts of the body, generally, only loss of scalp hair is symptomatic. The exact prevalence is not known and getting accurate statistics would be very difficult, but the condition is quite common.
Telogen effluvium can occur at any age. It is likely that most adults have experienced an episode of telogen effluvium at some point in their lives and, unbeknownst to most people, everybody has experienced the phenomenon early in life. In fact, mothers have been more aware of telogen effluviums in newborns and babies than most doctors have ever been. It is typical for a band like area of occipital hair follicles to enter the first telogen close to the time of birth and for these hairs to shed 2 to 3 months later. In the human infant, waves of hair growth occur before establishment of the mosaic pattern, which is usually present by the end of the first postnatal year.
What causes Telogen Effluvium?
In order to cause a large number of hair follicles to simultaneously switch from the anagen (growing) phase into the telogen (resting) phase, the body has to undergo some systemic insult. A telogen effluvium is not caused by topical medications. But because there is a required time lapse of several months between the inciting cause and the excessive shedding of hair, the exact cause of the telogen effluvium is often not positively identified.
A typical and common case of telogen effluvium would be the episode of severe shedding of hair that may occur approximately 100 days after a woman has given birth. The inciting factor is probably the abrupt hormonal changes that occur at the end of pregnancy. All of the hair grows back within a year.
Other causes of telogen effluvium include illness, major physical trauma, menopause, crash diets, severe psychological stress, major surgery (especially with general anesthesia), hypo- or hyperthyroidism, anemia's, acute and severe blood loss, heavy metal poisoning, etc. Chronic illness such as malignancy, and any chronic debilitating illness, such as systemic lupus erythematosus, end-stage renal disease, or liver disease can cause telogen effluvium. Immunizations also have been reported to cause acute hair shedding. Even jet lag and job changes have been reported to cause a telogen effluvium. In the United States, oral medications may very well be the most common cause of telogen effluviums. The list of medications associated with telogen effluviums is extensive and includes retinoids, beta-blockers, anticoagulants, SSRI’s, non-steroidal anti-inflammatories, calcium channel blockers, etc. In any and all cases, the common factor is metabolic or physiologic stress several months before the start of the hair shedding.
How do I know if I have TE?
Making the diagnosis of a telogen effluvium is usually quite straightforward. A ‘hair pull’ will determine whether or not a disproportionate number of hair follicles are in the telogen phase. And this is a test, which the patient can do himself or herself. Pinch a bunch of hair between your thumb and middle finger. You will have approximately 25 to 30 hairs within the pinch. Give the bunch of hair a sharp tug. Repeat this tug in several places over the scalp. It would be normal to dislodge one or two hairs with each pull, because approximately 10% of the hairs on the scalp are in the telogen phase. The hairs that are dislodged should have a small, friable, whitish bulb on the scalp end. If you pull out more than 4 or 5 hairs in each pull, it’s likely that you are having a period of telogen effluvium. For an accurate pull test, it is important that you have washed your hair regularly, i.e. daily or every other day. With infrequent washing, more hair than normal may pull out giving an erroneous interpretation. Since a telogen effluvium is not limited to the hair follicles at risk for MPB or FPB, shedding can involve hair on any part of the scalp (and even body hair). The underlying scalp has a normal appearance without scarring or inflammation and there should not be any areas of complete alopecia. A close examination of the scalp may reveal a higher than expected number of short new hairs growing in.If there is an obvious history of an inciting event and the time elapsed between the inciting event and the excessive shedding is consistent with the approximate length of a telogen phase, laboratory studies are of little use in making the diagnosis. Although a scalp biopsy can be performed to confirm the diagnosis, it would seldom be necessary if the history is characteristic and a ‘hair pull’ produces numerous telogen hairs.
There are no signs or symptoms, which allow you to anticipate the shedding from a telogen effluvium.Treating Telogen EffluviumBecause acute telogen effluvium is in reality a normal process, which occurred prematurely in a synchronized manner to a large number of hair follicles, and which resolves spontaneously, treatment can be limited to reassurance. The identifiable inciting factor should be avoided or discontinued or treated, whichever is appropriate. Assuming there is no intervening pathological process, all of the hair will be replaced in six to twelve months and the replacement hair should be identical to the hair that was shed. Telogen Effluvium and Miniaturization
Unfortunately, a telogen effluvium can be the harbinger of the onset of Male Pattern Baldness or the initial event in a period of accelerated MPB. In these cases, which are fairly common, the hair also grows back, but the hair may be significantly finer and smaller, because the hair follicles affected have miniaturized by the MPB process. While 5% topical minoxidil is not proven to promote recovery of hair in telogen effluvium, this medication has a theoretical benefit because minoxidil acts directly on hair follicles and promotes anagen growth. Patients who are eager to play an active role in their treatment may wish to use a 5% minoxidil solution. The use of DHT inhibitors is not recommended for the treatment of telogen effluvium.
In ConclusionChronic telogen effluvium is more likely to be caused by a chronic metabolic abnormality and is less likely to resolve rapidly. The underlying cause or disorder should be avoided or discontinued or treated, whichever is appropriate, and the patient should have reassurances that the hair loss will not progress to baldness.Hair transplantation is not a recommended treatment for telogen effluvium.

how to take care of skin in acne

Gently Cleanse Acne-prone Skin
· Limit washing to twice a day – and after perspiring. Once in the morning and once at night as well as after perspiring heavily should be the limit. Perspiration, especially when wearing a hat or helmet, can make acne worse, so the skin should be gently cleansed as quickly as possible after perspiring.
· Use a gentle, non-abrasive cleanser. Wash the face and other acne-prone areas with a gentle, non-abrasive cleanser that does not contain alcohol.
· Use your fingertips. Apply the cleanser and wash with your fingertips. This reduces skin irritation. Using a washcloth, mesh sponge, or anything else can irritate the skin and lead to breakouts.
· Never scrub the skin. Scrubbing the skin clean does not clear acne. In fact, scrubbing irritates the skin and can make acne worse.
· Rinse with lukewarm water. Be sure to thoroughly rinse away the cleanser with lukewarm, not hot, water.
· Shampoo regularly. If you have oily hair, shampoo daily.
Avoid Acne Skin Care Taboos Astringents, rubbing alcohol, and tanning do not help clear acne nor keep acne-prone skin free from blemishes. Dermatologists recommend that their patients with acne and acne-prone skin avoid the following:
· Astringents, exfoliators, masks, and toners. These products do not help clear acne. In fact, these can aggravate the skin and make acne worse. These products also may make it more difficult to tolerate prescription acne medications, so it is best not to use these when treating acne.
· Greasy hair-care products. Oily hair-care products, such as oil-containing gels and pomades, can drip onto the skin and clog pores. This can cause acne.
· Picking, popping, and squeezing pimples. People pick and pop pimples to get rid of them quickly. The truth is this prolongs healing time and increases the risk of scarring.
· Rubbing alcohol. Some people apply rubbing alcohol in order to dry out the oily skin. This will not help clear acne nor prevent breakouts. It can irritate the skin and cause breakouts.
· Tanning. Some people claim that their acne clears with sun exposure. The truth is that tanning does not clear acne.



· Touching the skin throughout the day. Dermatologists advise their patients with acne and acne-prone skin not touch their skin frequently. This can cause flare-ups.
Select “Noncomedogenic” Cosmetics and Skin Care Products Many acne patients are surprised to learn that makeup, moisturizers, and sunscreen are okay to use while treating acne. The key is to select products labeled “noncomedogenic.” This means the product does not clog pores. Just because a product says “noncomedogenic” does not mean that it works for everyone. You may have to experiment with different noncomedogenic products before you find one that works for you.
Makeup. The truth is makeup can be worn when treating acne — even when using topical medications. Just be sure to follow these guidelines:
· Choose oil-free cosmetics that are labeled “noncomedogenic” (won’t clog pores).
· Apply makeup after applying acne medication.
· If you have trouble finding makeup that can be used with acne medication, consult a dermatologist.
Moisturizer. Did you know that moisturizer can help calm irritated acne-prone skin? If your skin feels dry and you want to moisturize, follow these guidelines:
· Use a moisturizer that is oil-free and says “noncomedogenic” (won’t clog pores).
· If you use a topical acne medication, apply the moisturizer after applying the acne medication. If your skin still feels dry or stings, try applying the moisturizer before applying the acne medication.
Practice Sun ProtectionDermatologists recommend sun protection, which includes but is not limited to regular use of sunscreen, for all their patients, including those with acne. Research shows that most cases of skin cancer can be prevented with sun protection. Sun protection also can help prevent sunburn in patients using topical retinoids, which increase the skin’s sensitivity to the sun. The American Academy of Dermatology recommends that everyone protect their skin by following these sun-protection practices:
· Generously apply sunscreen to all exposed skin. Use a sunscreen that has a Sun Protection Factor (SPF) of at least 30 and provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and after swimming or perspiring. People with acne or acne-prone skin should use a sunscreen labeled “noncomedogenic” (does not clog pores) and apply it after applying topical acne medication.
· Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses, where possible.
· Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m.
· Use extra caution near water, snow, and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn.
· Get vitamin D safely through a healthy diet that includes vitamin supplements. Don’t seek the sun.
· Avoid tanning beds. Ultraviolet light from the sun and tanning beds causes skin cancer and wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
· Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.
Shave with CareMen know that shaving when you have acne can be a challenge. Here are some dermatologists’ tips that can help give you a clean shave.
· Before shaving, soften the hairs. Wetting the face thoroughly with lukewarm water can help soften the hairs.
· Experiment. Try shaving with electric and safety razors to see which works best for you.
· Make sure the blade is sharp. This helps prevents nicks from a safety razor, which can irritate the skin and lead to breakouts.
· Shave lightly. This can help avoid nicking acne lesions, which can make acne worse.
· Never try to shave off the acne. This aggravates the condition and makes the acne worse.
If after following these guidelines, you are not satisfied with the results, be sure to see a dermatologist. Today, virtually every case of acne can be effectively treated.
If you are using a topical retinoid (adapalene, tretinoin, or tazarotene), it is especially important that you protect your skin from ultraviolet (UV) light. The sun, tanning booths, and sun lamps all emit UV light. It is important to avoid these because topical retinoids cause the top layer of skin to thin, making a person more sun sensitive. Stopping the medication for a few days does not eliminate the skin’s sensitivity to the sun. However, not applying the medication for a few days can reduce its effectiveness in treating acne.