Researchers May Have Identified Why Stress Can Induce Hair Loss

Over the course of this past year, a number of times, we have touched on the importance of de-stressing, as we always knew that stress could cause hair loss.  As April is Stress Awareness month, we are excited that there may be some good news when it comes to hair loss from stress.  In a study released on March 31st, researchers from Harvard believe they have identified why hair loss occurs due to stress.  While the study was conducted on mice, they hope it will provide greater understanding for why this phenomenon occurs in humans, with the goal to help with prevention in the future.

Hair loss caused by stress is known as Telogen Effluvium.  Telogen Effluvium is the second most common form of hair loss.  Telogen Effluvium typically presents as diffuse thinning, meaning coming from all parts of the scalp and most woman will experience an increase in shedding of their hair. While it is normal to shed between 50 and 100 hairs a day, during a Telogen Effluvium episode you can notice more excessive shedding.  The telogen phase of the hair cycle is the resting phase, which is when shedding normally occurs, however, during a Telogen Effluvium either the telogen phase is extended or an abnormal number of hairs enter this phase.  This can be caused by pregnancy, rapid weight loss, protein deficiency, physical illness, surgery, trauma, some medications, and of course stress. Fortunately, it is usually reversible and complete regrowth occurs in about 1-2 years.

So why does stress cause a Telogen Effluvium to occur?  According to the researchers, they found that sustained exposure to stressors increased the amount of the stress hormone corticosterone in mice, which is the equivalent of cortisol in humans.  The researchers found that an increase in the stress hormone led to a shortening of the growing phase and a lengthening of the resting phase, which is consistent with shedding and telogen effluvium.  Initially the scientists thought the stress hormone was directly affecting the stem cells responsible for regenerating the follicle and hair.  However, the scientists realized that instead, the increased levels of the stress hormone were preventing secretion of a certain molecule, called Gas6, which plays a key role in regenerating the follicle and the hair follicle cells.  More importantly, the scientists found that manually increasing the molecule Gas6, could activate hair growth even when stress hormone levels were increased.[i]

While this study was only conducted on mice and research has a long way to go before we will know if there is potential to apply this to humans, it is important for us to better understand the mechanisms behind the causes of hair loss.  Stress management is so important for many reasons and the health of your hair is one of them.

Posted by Your Medi Tresse Team

[i] Choi, S., Zhang, B., Ma, S. et al. Corticosterone inhibits GAS6 to govern hair follicle stem-cell quiescence. Nature 592, 428–432 (2021). https://doi.org/10.1038/s41586-021-03417-2

What Does Female Hair Loss Look Like?

If we were to poll 10 random people and ask them what male hair loss looks like, they would probably all give similar answers about starting as receding in temples, with thinning in the crown, and eventually balding on top with a ring of hair around the head.  If we then asked those same 10 people what female hair loss looks like, I am pretty confident we would get 10 different answers.  This is one of the complexities about female hair loss.  For many women, it is hard for them to realize if they are experiencing it since it can differ so much from person to person.  It can even be hard for some medical practitioners to properly diagnose as its causes and presentation are so varied.

On our website there is a questionnaire that visitors can fill out that asks them various questions about their experience with hair loss.  With over 1000 responses, it provides a pretty good snapshot of what our patients are experiencing.  As expected, the experiences vary widely.

If people think they may be experiencing hair loss, often their first thought is to consider their family history.  While the myths talk about different grandfathers, the truth is that genetic hair loss can come from anyone in your family.  However, of the survey respondents only 55% felt there was a history of it in their family, which means that 45% did not believe that they had a family history of hair loss.  While genetics can play a big role in causing hair loss, it is only one potential factor.

Often times our perception of hair loss is rapid sudden shedding happening over a short period of time.  However, only 22% of the respondents felt their hair loss was sudden, while 78% felt that it had been gradual over time.  Unfortunately, with gradual hair loss it has probably been happening longer than you thought, as it takes time to notice, which is why it is so important to seek treatment once you feel you are experiencing hair loss.

As we noted above, male hair loss is fairly consistent, but there was pretty big variation in how the respondents described their hair loss.  The percentages below do not equal 100% as respondents were asked to select all that applied.  Below is what patients felt they were experiencing, from most common to least common:

Lastly, 63% of the survey respondents had never received a diagnosis for their hair loss, while 37% had.  If you think you are experiencing hair loss, it is so important to get a diagnosis from a practice that is trained in evaluating and treating female hair loss.  If you have received a diagnosis from a dermatologist or primary care physician, make sure you meet with a hair loss specialist who can get you started on a treatment plan right away.  Most important, if you think you are seeing any signs of hair loss, know you are not alone and there are great treatment options available.

Posted by Your Medi Tresse Team

Our Diets and Our Hair

If you attended our webinar last week, “How Our Nutrition Impacts Our Hair”, you know how strongly I believe that a healthy diet can play an important role in the health of our hair.  In this blog, I want to look at not just the vitamins and nutrients needed for healthy hair, but the overall types of diets.

The hair follicle is an extremely complex structure and made up of some of the most metabolically active cells in the body.  Due to the complexity of the follicle and the fact it is made up of metabolically active cells, the hair follicle requires proper nutrition to function properly and grow healthy hair.  The problem is that many of the nutrients that the hair follicle needs to be healthiest, vital organs of our body also need, so when we are deficient in these vitamins and nutrients, the body diverts them to places it feels are more important for survival, and our hair suffers.

One of the biggest issues with the diets that most Americans consume, not only are they deficient in key vitamins and nutrients needed for hair health, the foods are also highly processed, high in sugar, and high in fat.  While we know that these foods are not healthy, these foods are now known to be pro-inflammatory, which means they are activating our immune system to respond.  Normally our immune system gets activated when it recognizes foreign substances like bacteria, viruses, chemicals, plant pollen, and then acts to neutralize them and protects us from harm.  This is a good thing.  However, if inflammation is chronic, it can lead to or aggravate disease.  Alopecia Areata and Scarring Alopecia are two types of hair loss that are caused by immune disorders.  Inflammation has also been noted on biopsy in the early stages of Androgenic Alopecia (Female Pattern Hair Loss).

This does not mean that eating junk food will automatically cause hair loss, but it is important to understand that unhealthy diets can impact our bodies in ways we may not realize.  Research has repeatedly shown the negative impacts of a pro-inflammation diet and the positive impacts of anti-inflammatory diet.  What is great about anti-inflammatory diets, is that when followed these diets also include many of the vitamins and nutrients that are important for hair health.  Some of the best anti-inflammatory foods are:

The anti-inflammatory diet is very similar to the Mediterranean diet, which is consistently found to be the healthiest diet recommended by physicians.  The focus is on limiting processed foods and red meats and making fruits and vegetables the foundation of your diet.

Lastly, it is important to remember, when it comes to hair health, it is important to be on a hair health supplement.  The truth is that even when following a healthy anti-inflammatory diet, most people do not get enough of each of the necessary vitamins and nutrients needed that are key for the health of our hair.  I strongly recommend that all of my patients get utilize a good hair loss supplement, like our Tresse Rx line.

Posted by Dr. Mary Wendel

Psoriasis and Gut Health

I recently came across some research in the Journal of Family Medicine and Primary Care called “The Role of Gut Microbiodome in the Pathogenesis of Psoriasis and the Therapeutic Effects of Probiotics” that I felt was quite interesting and pertinent for our patients for a two reasons.  First, we see a number of patients with psoriasis of the scalp, which leads to temporary hair loss.  I myself suffer from psoriasis.  Secondly, it really reinforced the importance of taking a systemic treatment approach, which I will expand on shortly.

For those that are not familiar with psoriasis, psoriasis is an autoimmune disease that affects up to 7.5 million Americans.  Psoriasis is a chronic disease that most commonly presents as red scaly patches on the skin and psoriasis flare ups come and go.  Unfortunately, there is no cure, but there are ways to manage the flareups when they occur and decrease their likely hood of experiencing them through lifestyle changes.  While psoriasis can occur on all parts of the body, psoriasis of the scalp is one of the most common, with a 2016 paper estimating that 80% of those with psoriasis will have a flareup on the scalp[i].  Psoriasis itself does not cause hair loss, however, it can be quite itchy and when you itch the scalp you can damage the follicle and hair leading to loss.

What the “The Role of Gut Microbiodome in the Pathogenesis of Psoriasis and the Therapeutic Effects of Probiotics” found was there may be link between our gut health and the immune response that causes psoriasis.  When the bacteria in the gut is out of balance, it can cause a condition known as bacterial dysbiosis, which is known to cause chronic inflammatory conditions in the skin.  While we often use treatments that specifically target the affected area, the researchers felt that we should consider treating systemically as well, which in this case would be through targeting the bacteria in the gut with probiotics.

Anyone that has been treated at Medi Tresse knowns that we are strong believers in utilizing a multi-therapy approach that also include systemic treatments that focus on nutrition and gut health.  The health of our scalp and hair are directly affected by the total health of our bodies.  While utilizing treatments like Optimal Platelet Concentration Therapy and Low Level Laser Therapy that directly target the scalp, it is important to support these treatments with a systemic approach through the use nutritional and gut health supplements.  Our bodies are complex and extremely intertwined.  While we are only scratching the surface on the importance of gut health, it is becoming more clear that it plays a strong role in the health of our hair.

Posted by Dr. Mary Wendel

[i] Blakely, Kim and Melinda Gooderham. “Management of scalp psoriasis: current perspectives” Psoriasis (Auckland, N.Z.) vol. 6 33-40. 29 Mar. 2016, doi:10.2147/PTT.S85330

Ketoconazole Shampoo

We receive a lot of questions from patients about shampoos and there is one in particular that comes up often, ketoconazole shampoo.  It is important to understand that most shampoos are not going to significantly regrow hair, regardless of what they advertise.  Many of these products will have ingredients that are known to help with hair loss, like DHT blockers or proteins, but it is not known how much of this is really absorbed in scalp.  This does not mean that there is no benefit to these shampoos.  While they will most likely not regrow hair, there is the potential to get healthier hair, less dry hair, or even increased volume.  In terms of what should be in the shampoo, ones that have panthenol and proteins can make hair appear thicker. Some shampoos have dihydrotestosterone (DHT) blockers in them, which brings us to ketoconazole shampoo.

Ketoconazole shampoo is a potent DHT blocker and is sold under the brand Nizoral. Excessive DHT has been found to be one the causes of androgenic alopecia.  It is important to note, that you would not want to use ketoconazole shampoo every day, and most people would only use it once or twice a week. Ketoconazole shampoos come in two strengths, over the counter, which is 1% strength and prescription, which is 2%.  When would we recommend these types of shampoos?  The over the counter Nizoral can be a good option for anyone with androgenic alopecia, also known as Female Pattern Hair Loss.  It is believed that ketoconazole shampoos may also have anti-inflammatory benefit, which could possibly help with other types of hair loss.  The over the counter strength can also be used for patients with a dry scalp or dandruff.  We often prescribe the 2% strength ketoconazole shampoo to patients experiencing severe dryness or seborrheic dermatitis.  Ketoconazole shampoos have been known to dry out hair, so it is really important to use a good conditioner with it.

In short, ketoconazole shampoo with an added conditioner once or twice a week is a good choice for any woman with known androgenic alopecia.  As always if you have any questions, we recommend consulting with a female hair loss specialist.

Posted by Your Medi Tresse Team

 The content contained herein is for education only and should not be considered medical advice.  Medical advice may only be given through a one-on-one, private consultation with an appropriate licensed medical provider.

Alphaeon Eyelash Serum is Back!

Patients that have been with our practice for a few years may be familiar with Alpheaon Eyelash Serum, which was discontinued in 2018 due to some restructuring withing the Alpheaon organization.  The Alphaeon Eyelash Serum was a big hit with our patient’s and staff, and we were all very sad to see it go.  Well we have some great news; the product is back under a new brand name AlphaLash™ and new company Almond Blossom!

AlphaLash™ was developed to hydrate, condition and strengthen lashes, resulting in the appearance of longer, fuller eyelashes.  AlphaLash™ is fortified with peptides to help stimulate hair growth, plus biotin to encourage growth and prevent lashes from becoming dry and losing volume.  Pumpkin seed extract, rich in fatty acids and essential minerals, helps to nourish, while sodium hyaluronate, a form of hyaluronic acid, helps to condition and moisturize.  Also, unlike Latisse®, AlphaLash™ will not cause lashes to grow in irregular and crooked directions or cause discoloration of the eyelid.

AlphaLash™ is a great treatment for both the eyelashes or eyebrows.  If you are interested in learning more about AlphaLash™ please contact our offices today!

Posted by Your Medi Tresse Team

2020 New Year's Resolutions

With New Year’s Eve quickly approaching, many of us are using these last few days to come up with a few resolutions for 2020 that we hope to follow through on.  If you are thinking of making the health of your hair a part of your 2020 resolutions, we got you covered.  We revisit a past blog post with some New Year’s resolution for your hair health that should hopefully not be too hard to keep.

For Those That Have Never Seen A Hair Loss Specialist

For Those That Have Not Been Back to Their Hair Loss Specialist

For Those Currently Treating Their Hair Loss

For Everyone

We hope you have a safe and exciting New Year!

Posted by Your Medi Tresse Team

Get to Know Our Team - Dr. Mark DiStefano

We are starting a new blog series called "Get to Know Our Team" where we are highlighting members of our team.  The first team member we are highlighting is Dr. Mark DiStefano who recently took on a larger role at our practice when he was named Chief of Surgery of Medi Tresse.

What is your role at Medi Tresse?

I am the Medical Director of Medi Tresse Westchester, which is a role I have held since March of 2018. In August, due to patient demand, Medi Tresse made the decision to start offering hair restoration surgery and I was named the Chief of Surgery of Medi Tresse.  As Chief of Surgery I see patients at the Medi Tresse Boston, Medi Tresse Worcester, and Medi Tresse Scarsdale offices.

What is your experience treating hair loss and specifically female hair loss?

I started treating hair loss over 25 years ago and have treated thousands of patients both men and women. I have performed over 10,000 surgical hair restoration procedures, of which roughly 1,500 of those procedures were performed on women.

You have performed significantly more surgical procedures on men than women, is there a reason for that?

There are really a couple of reasons for that. The first is that in my experience hair loss in men is more accepted in society, so men feel more comfortable seeking treatment.  Many of the female patients I have met with often share stories of trying to hide their hair loss for years before finally deciding to seek treatment.  The second reason is that surgery is often a better option for male patients than for female patients, especially with some of the great non-surgical options now available to women.  Female patients used to make up 20% of my surgeries just 15 years ago, but now they only make up between 5-10%.   For many women Optimal Platelet Concentration™ Therapy, Platelet Rich Plasma (PRP) Therapy, or Low Level Laser Therapy are better options.

Why are non-surgical options better for many women?

Women have diffuse hair loss which is more responsive to medical treatment versus surgical treatment. Men tend to have the horseshoe pattern and this is less amenable to medical therapies, so surgery is often a better option.

Are any women good candidates for hair restoration surgery?

Absolutely, but we need to make sure the patient has a strong donor area, which is where we take the hairs from to transplant. As many women experience diffuse thinning, or hair loss throughout, we need to make sure that the donor area has enough density to transplant from.  A hair transplant is the only way to get hair in a place it did not exist before, so for patients looking to add density to an area or move their hair line, a hair transplant can be a very good option.

Do you enjoy what you do?

I have been blessed because for the last 27 years I have had the privilege to practice hair restoration, which has given me the opportunity to help thousands of people restore their hair, but more importantly their confidence. I have been fortunate enough to train 15 physicians throughout the world in hair restoration and I have taught at conferences all over the world.  This has allowed me to meet physicians and patients from all walks of life. Hair restoration has been my passion and the journey was so much more rewarding than I could have ever imagined.

In August 2019 Medi Tresse began offering hair restoration surgery with Mark DiStefano, MD.  Dr. DiStefano is a Certified Diplomate of the American Board of Hair Restoration Surgery, a Fellow of the International Board of Hair Restoration Surgery, and member of the European Society of Hair Restoration.  Dr. DiStefano has specialized in the treatment of hair loss for over 25 years and has treated more than 2,500 women for hair loss.  He is world-renowned and has been described by his peers as one of the best hair transplant surgeons in the world.  If you are interested in having a hair transplant consultation with Dr. DiStefano contact our office today.

Can Melatonin Help with Hair Loss?

When people think of melatonin, they often think of it as a sleep aid, but some studies have shown that it could potentially be beneficial for the treatment of hair loss.  So what is melatonin? Melatonin is a hormone that is naturally produced in the body and regulates the sleep cycle.  Melatonin levels typically increase at night, which is why some patients that suffer from insomnia take melatonin orally to help elevate their levels and hopefully sleep better.  However, some studies have shown that when used topically, melatonin can actually help treat hair loss.

In 2012, an article in the International Journal of Trichology reviewed 5 clinical studies on the use of topical melatonin for the treatment of androgenic alopecia, also known as male or female pattern hair loss, on both men and women.   The studies were quite favorable as they showed a decrease in the severity of hair loss, especially with women, an increase in density, and an increase in negative hair-pull tests (a test used to determine active shedding).  It is important to note that patients in these studies showed good tolerability of the treatment with minimal side effects. [i]  It is believed that using melatonin topically works in the treatment of hair loss, because it is a powerful anti-oxidant and hair appears to be impacted by oxidative stress, specifically premature loss.  Cells within the skin and the hair follicles also have melatonin receptors, which leads us to believe that melatonin plays a role in the hair life cycle.

Even with the positive studies, topical melatonin has not caught on in the US as a treatment for hair loss.  Minoxidil has become the sole recommendation for most providers, as it is the only FDA approved topical treatment for hair loss.  However, minoxidil can be quite irritating for some patients.  At Medi Tresse we have been reviewing topical melatonin products currently on the market to see if there are any that meet our strict evidence based requirements so that we can find an option for patients that found minoxidil irritating or may be looking for a more natural option than minoxidil.  We will certainly keep you updated, but we are excited at the prospect of being able to offer another great treatment option to our patients.

Posted by Your Medi Tresse Team

[i] Fischer, Tobias W et al. “Topical melatonin for treatment of androgenetic alopecia.” International journal of trichology vol. 4,4 (2012): 236-45. doi:10.4103/0974-7753.111199

Ways to Camouflage Hair Loss this Holiday Season

While we are always looking for instant gratification, with medical treatments for hair loss the results can take time.  As hairs only grow around a centimeter per month, it takes at least a few months for new hairs to grow in and be visible.  With the holidays just around the corner, patients often ask if there is anything they can do today to provide immediate results.  While there are no medical treatments available that will work in time for the holidays, there are things you can do to mask the appearance of thinning hair.

Medical Micropigmentation & Microblading

Medical micropigmentation and microblading are semi-permanent procedures where pigment is placed into the epidermal layer of the skin to provide the illusion of hair.  Utilizing tools made specifically for this treatment, highly skilled micropigmentologists are able to create a natural look due to their refined technique.  At our Medi Tresse Boston office, our micropigmentologist Nellie uses the combined hand and digital machine method, which provides the most natural looking results.  Not only does Nellie help patients camouflage their scalp, but she also offers microblading, which is specific to the eyebrows. (Currently we only offer medical micropigmentation and microblading at our Boston office, but we are working to offer it at all locations in the near future.)

Hair Fibers

Hair fibers have come a long way over the past few years and look quite natural.  You would be surprised how many people, especially those on television, use hair fibers.  Hair fibers are a useful product for those who want to add instant volume to the hair or want to hide visible scalp. When you sprinkle hair fibers on your hair, the long-lasting fibers instantly cling to your hair like millions of tiny magnets, making each strand of hair look thicker.  At Medi Tresse we offer the XFusion Keratin Hair Fibers, which are made of all-natural keratin protein and are offered in 9 different colors.

Coloring Your Hair

Coloring your hair can help hide the appearance of thinning hairs in a couple of ways.  As a reminder it is important to make sure that you are always using an ammonia-free or low-ammonia formula.  Ask your stylist about the most follicle-friendly options they have available at your salon.  So how does coloring mask thinning hair?  While there are no hair health benefits to coloring your hair, coloring your hair can give the appearance of thicker hair.  First, if your hair is thin and there is some scalp visible, graying roots will often give the illusion of even more scalp.  Secondly, coloring your hair can also make your hair feel and appear slightly thicker as certain components of the hair dye can thicken the hair strands.

It is important to remember that none of these options will treat your hair loss or prevent further loss, but they are ways to help camouflage the problem with some relative immediacy.  Many patients utilize these options in the short term, while they wait for the results of the medical treatments.  All of these options are also safe for the scalp and follicle.  You will notice that we did not include hair extensions on this list.  While using hair extensions for a single evening would be OK, we strongly recommend against utilizing hair extensions long term due to the harm they cause to your hair.

Posted by your Medi Tresse team.