Interesting facts about the topic scalp scalp Facts about the skin What are the main functions of the skin? Human beings have a skin surface of approx. 2 m2. Its total weight is between 10 Skin contact and gentle touching are extre- and 12 kg. Each square centimetre of skin mely important for the healthy development contains approximately: of new-born babies. If there is no such inten- sive contact with the mother, the child is li- s 6.000,000 cells kely to suffer from emotional problems or s 1 m of blood vessels even illness in later life. This clearly shows s 4 m of nerve fibres that the skin is in more than one way the s 5 to 50 hairs part of our body that a most directly con- s 100 sweat glands tact with the environment it thereby fulfils s 15 to 40 sebaceous glands basically four functions: s 25 pressure receptors s 2 cold receptors s 7 heat receptors Protection of the body: s 200 pain receptors The skin protects our body from loss of water and against damaging influences from outside our body (for example microorganisms, che- mical substances or UV radiation). Temperature regulation: In connection with the blood circulation sy- stem, the skin regulates our body temperatu- re to around 37 °C. Communication: The skin signals to others now we feel, for exam- ple by being blushed or pale: On the other hand, it keeps us in touch with the outside world, as physical touch, the outside temperature, pain and other sensations are signalled by peripheral nerve endings in our skin to the brain. Reservoir: The skin is an important energy reservoir for metabolism. It contains approx. 50% of our entire fat reserves. In addition, it stores an processes a number of other vital substances such as water and salts. scalp Structure of the skin The human skin (cutis) consists of three epidermis main layers: the subcutaneous layer (subcu- tis) is the base of the skin and provides phy- horny layer sical protection to the body and also serves as a nutrient deposit for metabolism. The germinal layer centre layer of the dermis is composed of a network of elastic and collagen fibres and sebaceous gland gives the skin its firm structure. The epider- dermis mis is the outer layer of the skin and pro- tects the body against damaging influences. arrector pili muscle The subcutis – protective cushion and hair follicles deposit sweat gland The loose and highly elastic connective nerves tissue of the subcutis connects the skin with subcutaneous layer the muscles and organs of the body The subcutis contains fat lobules that serve as blood vessel energy deposits and provide a protective and heat-insulating layer. The subcutis con- Appendages of the skin are incorporatet into the dermis. tains a dense network of blood vessels and nerves that branch off into the dermis. The blood vessels bring the necessary nutrients other, they play a major role in the regula- and oxygen into the skin, ensuring that it tion of a number of functions of the skin can regenerate itself. They also transport the and its embedded features (hair follicles, substances required for hair growth sweat and sebaceous glands). The dermis – fibre network providing The epidermis - protective shield against structure and firmness hostile elements in the environment The dermis consists mainly of connective tis- The epidermis does not consist of connec- sue composed of loosely connected collagen tive tissue but mainly of cells that are conti- fibres and elastic protein, collagen and ela- nuously produced in the basal layer. When stin fibres. This connective tissue retains mo- they move towards the surface, they harden, isture and is made up of 70 to 80 % water. become horny and are finally shed. A heal- It therefore gives the skin firmness and sup- thy epidermis thereby regenerates itself ap- pleness. proximately every 30 days This layer does not contain blood vessels and its living cells Blood vessels from the subcutis branch into are supplied with nutrients and oxygen from the dermis and form a network of extremely the dermis that lies below the epidermis. fine capillaries that reach to the basal cell layer of the epidermis, supplying it with nu- The main function of the epidermis is to pro- trients and removing waste products The tect the organism against hostile or dama- blood vessels have also an important func- ging influences from the environment. The tion in connection with the regulation of the epidermis fulfils this function by shielding body temperature. the body from physical impacts (pressure, friction, and radiation) as well as by detec- Here, we also find the peripheral nerve en- ting and isolating substances that are fo- dings coming up from the subcutis. On the reign to the organism (potential antigenic one hand, they make the skin one of the substances). most important sensory organs: on the scalp The epidermis consists of two distinct cell In addition to the actual skin cells, the epi- layers: dermis contains a number of highly speciali- 1. the basal cell layer (stratum germinati- sed cells. There are cells that are responsible vum) for the triggering off of allergic reactions 2. the outer layer of “dead” horny cells that are part of the immune system of our (stratum corneum) body. In this layer, we also find pigment cells (melanocytes) that are responsible for The basal cell layer is again built of two the darkish colour of our skin, providing an layers: effective protection against damaging UV 1. a) The basal cell layer is located directly radiation. at the top of the dermis. Here, new cells are continuously produced by divi- ding stem cells. 1. b) The adjacent prickle cell layer (stratum spinosum) contains the basal cells that move upwards and are keratinised. These cells show virtually no division and are gradually flattened. The horny layer, also referred to as the corneal layer, again consists of two distinct layers: 2. a) The stratum corneum conjunctum is located directly at the top of the basal layer. It consists of flat, keratinised, i.e. horny cells. These cells are thus dying and their nuclei are dissolved. They become flatter, more firm and com- pact. 2. b) The outermost layer of the epidermis is called the stratum disjunctum and is only 3 to 4 cells thick. The cells at its surface are constantly removed by the daily exposure of the skin (shedding of cells) and replaced by new cells rising up from the underlying stratum con- junctum. In normal, healthy skin, the processes of cell production and cell loss at the surface are meticulously synchronised. This means that new cells are produced at the same rate at which dead cells are removed at the surface. Disruptions in this balanced system can lead to flaky skin, excessive keratinisation, etc. scalp What are the functions of the epidermis Epidermis Stratum Corneum disjunctum Structure Function s approx. 15 to 20 layers of cells s Protection against that are held together by a wax-like UVB-radiation substance s Thermal protection s the entire skin surface can shed up s Prevents moisture loss and to 6 to 4 g per day stops antigenic substances s the thickness of the horny layer from penetrating the body varies, depending on the part of the body and the actual stress horny layer Stratum Corneum conjunctum Structure Function s the cell nucleus decomposes s formation of keratonhyalin, s the cell becomes compact, hard which a base substance of and flat and it gradually keratinised keratin s natural permeability barrier of the basal cell layer Stratum Corneum Structure Function s young cells moving towards the s formation of horny cells due to surface; they are supplied with nu- gradual differentiation trients and show redcued cell growth and division. s the cells are gradually flattened basal cell layer Stratum Basale Structure Function s interdigitated with the papillae of s continuous renewal of the skin the dermis and constantly supplied by production of new cells with nutrients and oxygen s protection against ultraviolet s production of new cells by mitotic (UV) radiation by means of division; over a period of 28 to 30 pigment cells (melanocytes) days, the cells are gradually moved containing melanin upwards until they are shed as s resulting in the brown colour dead skin cells of the skin Dermis Subcutis scalp How does the acidic protective The skin constantly produces the protective film of the skin work? film. Acidic and alkaline substances that re- ach the skin from the outside are neutralised The horny layer of the skin protects our by the formation of salts, whereby the skin body against both mechanical impacts and also regains its specific pH value. These salts temperature influences. However, the skin (proteinates) are produced by the reaction actually also protects itself. The horny layer of proteins that are specific to the skin and is covered by a thin film of sweat, sebum the acid. The acidity of substances reaching and bacteria: this film is referred to as the the skin is also reduced by other reactions of hydro-lipid film (film made of water and the acids with sweat and salts at the skin fat), also known as protective acidic film. Its surface. Skin contact with weak acids can al- pH is 5 to 5.5, thus slightly acidic. It acts as so contribute to a more stable acidic film. the “buffer mantle” of the skin. Its capacity to neutralise weak alkaline or acidic substan- Alkaline substances on the skin are partly ces protects our skin from damage. With neutralised by evaporating carbonic acid and proper skin care, for example the use of so- other acidic substances found in the skin. A aps and shampoos with pH around 5 to 5.5, cream with pH 7 or 8 that is brought into does not destroy this natural protective layer contact with the skin can thus improve its of the skin. elasticity and texture, without altering the natural pH value at the surface. However, The skin and its pH the pH on its own does not determine the The skin consists mainly of proteins, which effectiveness of a skin care or hair care pro- again are composed of acidic and alkaline duct. Various other factors play a more deri- groups. The surface of intact epidermis is sive role. slightly acidic, with a pH value between 5 and 5.5. This slight acidity is primarily They are: responsible for the protection of the body s the specific effectiveness of a substance s the molecule size of the agents against microbes as well as acidic and alkali- s the substrate ne substances The cell layers deeper down s the non-allergenic nature of all substances in the epidermis have a pH of approx 7.2, ri- sing to 8 in areas where more moisture is in a product contained such as armpits. The pH at the surface of the skin is the re- sult of internal as well as external factors such as s reaction with water-soluble substances (amino acids) in the skin cells s production of sweat, sebum and residue from their decomposition (fatty acids) s presence of substances from the meta- bolism of microorganisms s effects of substances from the environ- ment (dust particles, cosmetics) Other pH relevant substances are urocanic acid, lactic acid and corbonic acid scalp Which organs are found in the skin? Blood vessels of the skin Supply system for the metabolism basal cell layer The heart pumps blood into the main arte- capillary ries From there, it flows through a vast net- arteriole + arteries work of larger and smaller vessels and even- lymphatic system tually reaches the top layer of the dermis venules + veins The blood, containing oxygen and nutrients, arector pili muscle passes thereby from the arteries to arterioles sweat gland channel and subsequently into the extremely fine blood vessel loops referred to as capillaries. Their diameter (approx ten times smaller Blood rich in oxygen and nutrients is pumped to the than that of a hair) is slightly greater than corium via arteries, arterioles and fine capillaries loca- that of the red blood cells transporting oxy- ted direct in the basal layer of the epidermis where the gen, which are just able to slip through substances needed to build cells is deposited. At the same time waste products are absorbed and transported these loops. away by venules and veins. Capillaries reach the base of the basal cell layer of the skin and thus nurture the epider- When it is cold the capillaries contract to re- mis with all the necessary substances for cell duce blood flow, thus minimising the heat production. Oxygen and nutrients are able loss of the body. Another effect brought ab- to penetrate the thin walls of the capillaries out by the cold is goose pimples, caused by (diffusion) and to reach the stem cells of the the contraction of the arrector pill muscles, epidermis. Waste substances of metabolism which make hair “stand on end” In the pro- are absorbed through the capillary walls into cess, the arrector pill muscles stimulate the the blood, which eventually returns to the sebaceous glands, which secrete more se- heart via venules and veins. bum to the skin surface. This reduces the Venous valves prevent the reflux of blood. evaporation rate of water from the skin, Damaged venous valves combined with pro- further protecting the body against heat longed standing and lack of exercise can re- loss. sult in varicose veins. Temperature regulation – sophisticated regulation system for the body temperature We numerous fine capillaries near the body surface serve also a second purpose: in con- junction with the sweat and sebaceous glands, they play a major role in the regula- tion of the body temperature. If the body is heated up, due to high outside temperatures or excess heat production wit- hin the system (as a result of fever or physi- cal exercise), more blood is pumped into the skin where the heat is released into the envi- ronment. When sweat evaporates, this pro- cess is accelerated by the cooling effect on the skin and thus the blood. scalp Glands of the skin hydro-lipid-film Sebum – protective fat of the horny layer Sebum consists of dying and decomposing sebaceous cells and contains glycerides and sweat gland channel fat-like substances. Through a duct, the sub- stances are transported to the base of a hair follicle and from there to the surface. Due sebaceous gland to the ability of the substances to spread themselves evenly over the skin, they keep it eccrine sweat gland soft and supple. Sweat promotes the sprea- apocrine sweat gland ding of sebum. Skin however sometimes be- comes too oily, due to overactive sebaceous glands producing excessive sebum. This condition is known as seborrhoea. The Sebaceous glands: scalp with its many hair follicles contains s Dead cells from gland tissue form sebum consi- sting of glycerides and other fatty components. more and larger sebaceous glands that any s The sebum is expelled through an opening below other part of the body. The scalps of people the exit of the follicle to the surface of the skin suffering from seborrhoea becomes therefo- where it spreads. re quickly greasy Eccrine sweat glands s Sweat consisting 99 % of water Eccrine glands – the temperature regulators s is expelled to the skin via individual pores of the skin s where it evaporates and protects the body from Whenever we sweat – be in the sauna or overheating. s Contributes to better spreading of sebum. through physical exercise – approximately two million eccrine glands or sweat glands Apocrine sweat glands are activated, secreting a special liquid onto s empty into the hair follicle canal the surface of the skin. Sweat consists of s Secretion contains components of the cells of the gland tissue water (99 %), in which salts, urea and other s The typical odour of sweat is caused by bacteria. organic substances are solved. Evaporation at the surface cools the skin and the blood flowing in its capillaries This effectively pro- Axillary sweat glands tects the body against overheating. (apocrine sweat glands) – glands producing However, psychological factors can result in the distinct personal odour. Axilliary sweat excess sweat secretion. Examples of stress-re- glands develop in association with hair folli- lated excessive sweating are wet hands and cles and are mainly found under the armpits armpits or cold sweat on one’s forehead. and the area of pubic hair. Sweat supports the formation of an effecti- Similar to sebaceous glands, they undergo ve protective film and, together with the se- enlargement and secrectory development bum and the fats from the horny layer of under the influence of hormones, i.e. during the skin, provide the hydro-lipid film of the puberty. The axillary sweat glands produce a skin. If this protective layer is constantly re- turgid yellow-whitish liquid containing cell moved by washing or not produced due to a components of the gland tissue that provide medical conditions, skin can become very and excellent medium for the growth of bac- dry and flaky. teria. The typical acrid odour is actually the result of the bacterial decomposition of the sweat. dandruff Flaky Skin and Dandruff Greasy dandruff Persons with a predisposition to both dand- ruff and greasy skin (seborrhoea) suffer How does flaky skin occur? from yellowish greasy flakes that normally remain attached to the base of the hair or Healthy skin is continuously regenerating it- the scalp. self. Over a period of approximately thirty days, skin cells produced in the basal cell layer gradually move to the surface, develop Excessive flaking of the scalp as a into horny cells and are shed as minute cell result of a skin disorder Psoriasis – a non-contagious conditions particles that are not visible to the naked Not to be compared with the above types of eye. In flaky skin, the synchronisation of the flaky skin and dandruff is the medical condi- processes of cell production and scaling is di- tion of psoriasis. It is an inherited condition, sturbed. Generally, the cell production rate whereby external and internal factors such in the basal cell layer is too high. This means as stress and poor diet can actually bring ab- that cells reach the surface of the epidermis out the symptoms. The disease is characteri- prematurely without being properly kerati- sed by distinct, rather large sections of the nised. They are shed in larger groups of skin covered in silver- scaled lesions. cells, i.e. dandruff. It has been scientifically Psoriasis must be treated by a dermatolo- proven that the skin of persons suffering gist. The use of anti-dandruff products has from dandruff renews itself within a period no effect whatsoever on the condition. of 20 days. This means that the skin renewal process is one third faster than m persons Hairdressers are urged to show special care with normal skin. and empathy towards people suffering from psoriasis, as the condition can place a lot of What types of flaky skin are emotional strain on the person. Affected there? skin must be treated with special care. Avoid any mechanical or chemical irritation and Dry flaky skin use combs and brushes with great care. Especially during the winter months, many Generally, only the mildest products should people with dry skin suffer from accelerated be used. drying of the scalp in conjunction with sensi- tive reactions This can be traced back to What are the causes for flaky reduced air humidity and modified lipid composition in the horny layer of the skin. skin? Affected persons suffer from dry and itchy Internal causes: scalp. Isolated red spots and a fine flaky lay- s The excessive activity of the basal cell er of light grey dead cells are visible on the layer can be caused by disorders of the scalp. In such cases, the use of care products hormone system. Customers suffering for sensitive scalp is recommended. from dandruff that cannot be successfully treated with special products should con- Dry dandruff sult a Dermatologist. The scalp of persons suffering from dry s There are a number of drugs that are scalp (sebostasis) with a predisposition to known to stimulate the cell division in the dandruff sheds dry, fine white or clear flakes basal cell layer. that tall from the hair with every movement. s Many people have a genetic predisposi- tion for dandruff (here, good results can be achieved with anti-dandruff products). dandruff External causes (for dry, flaky and sensitive The bacterial flora and its protective scalp): function s Irritation by certain chemicals, for example One of the main factors for a healthy scalp unsuitable hair care products with a high is an intact film at the surface of the epider- pH; such substances can stimulate exces- mis and a balanced flora of non-pathogenic sive scaling bacteria and yeast. There are approximately s Mechanical irritation such as fine lesions 1 million such organisms on every square in the scalp caused by damaged combs, centimetre of scalp. This physiological flora etc. can also lead to excessive cell produc- in the hydro-lipid film and in the ducts of tion in the basal cell layer. the sebaceous glands protect the skin s Biological causes include the spreading of against colonies of pathogenic microorga- microorganisms that cause scaling on the nisms. scalp. s Excessive washing can also cause flaky Persons who have a predisposition to dand- scalp, as the skin reacts with increased se- ruff also generally show an excess growth of cretion of sebum possibly combined with the Ùted species on the scalp, promoting dry dandruff. the formation of dandruff. Anti dandruff agents (climbazole, piroctone olamines and External and internal causes are known to zinc pyrithione) target the yeast to achieve a interact, worsening the problem. balanced flora of microorganisms, which in turn reduced the scaling of the skin to nor- How do external influences mal levels. Laboratory tests have shown that affect the skin? the different varieties of the species Pityrosporum ovale are not equally affected External factors often attack the horny layer by anti-dandruff substances. In order to suc- of the skin, leading to an irritation of the cessfully eliminate all causes far dandruff, a basal cell layer, which responds with exces- combination of different agents is therefore sive cell production. Where the outer layers the mast effective method. However, if the of the skin and the protective hydro-lipid anti-dandruff product is not used all the film are damaged, they are unable to fulfil time, the yeast again starts to take over and their function in keeping antigenic substan- dandruff returns. ces and organisms away from the deeper layers. This can also result in dry scalp. Dry scalp in turn shows a tendency to excessive scaling and formation of dandruff. Potentially allergenic substances can pene- trate the scalp. Specialists refer to this condi- tion as sensitive scalp. dandruff How can hairdressers assess cases of dandruff and what are the important questions to be asked? Generally dry dandruff Generally greasy dandruff Typical symptoms Typical symptoms s Dandruff falls from scalp and hair, even if only s Flat dandruff particles that remain attached to slightly moved scalp or hair s Small flat transparent flakes s When rubbed between the fingers: oily, greasy, s Dull complexion sheen s Distinct red spots after washing s Tendency of acne s Sensitive scalp s Large pores in seborrheic skin areas s Blood vessels visible on the scalp Questions to be asked s Do you have any problems regarding your scalp? s Do you sometimes suffer from itchy scalp? s How often do you wash your hair? s For now long do you rinse your hair after shampooing? s What shampoo do you use? s Are there times where there is more dandruff? sensitive scalp What are the influences to Certain people react to UV radiation with which skin reacts? sunburn, while others simply get a suntan. In a similar way, skin types can be classified Over the last decades, the number of peo- according to their sensitivety to chemical ple that require treatment for “dry and sensi- substances, heat/cold or mechanical stress. tive scalp” is increasing. This development is It is thereby important to note that for most likely due to various related factors: example skin that reacts sensibly to UV radi- ation might not show any increased sensiti- External factors vity to chemicals. Also, the same skin might s Air pollution react to certain chemicals with clear signs, s Sunlight (UV radiation) while it is not affected by other substances. s Excessive drying of skin (by dry air in hea- Therefore. skin that shows a strong reaction ted rooms, air conditioning, etc.) to detergents (shampoos) might not show s Insufficient care after colouring and perm any increased sensitively to alcohol. s Exposure to chemical substances (cleaning agents, solvents, pesticides, etc.) A person´s skin might not always show the same sensitivity Internal factors The sensitivity of skin often varies with the s Inherited predisposition seasons (e.g. increased sensitivity during the s Ageing processes winter months) or age (example: prior to 20 s Stress and after 60 years of age = not particularly s Metabolic disorders sensitive/between 20 and 60 years of age = s Disorders m connection with hormone highly sensitive). Such variations are most and vitamin levels prominent in people that are born with high- s Side-effects of drugs ly sensitive skin. However, also normal skin s Side-effects of certain skin diseases can react strongly to certain strains and sub- stances. As anywhere else, the wisdom of Dry scalp is particularly at risk Paracelsus, the great medieval physician ap- Dry scalp has a tendency to react very sensi- plies to the quantity that makes a sub- tively to both external and internal factors. stance a poison. One of the reasons is that water does not pearl off; it penetrates the horny layer of the skin and dissolves and adsorbs hydrophile substances from the permeability barrier of the horny layer. This effect is increased, if the hair is washed frequently. Pathogenic mi- croorganisms and harmful chemical substan- ces have also a better chance to penetrate the skin, where they can lead to irritations or even infections. The lack of moisture and skin grease results in a sensation of taunt skin and itchiness. Skin types that show a genetic predisposi- tion for hypersensitivity Often, the degree to which skin reacts to environmental influences is inherited. In this context, two skin types are most at risk. One criteria by which such skin types can be distinguished is their sensitivity to sunlight (UV radiation): sensitive scalp How does skin react to adverse How can a hairdresser assess factors and how does sensitive sensitive skin and what are the skin develop? important questions to be asked? Whenever skin shows a reaction, two con- ditions are fulfilled: s The substance with which the skin has sensitive skin been in contact contains a component Typical symptoms that has irritating properties s Visibly red skin (erythema) (example: sunburn) s This substance has penetrated the skin in The redness is caused by the presence of red blood cells from capillary vessels that penetrate a quantity that is sufficient to cause irrita- and disperse in the tissue tion. In people that show an inherited ten- s Locally increased skin temperature (by approx. dency to sensitive skin, very small quanti- 1 to 3° C) ties, that would lead to no reaction s Increased permeability of the permeability bar- rier (in both directions). It is possible to indi- whatsoever on normal skin, can result in rectly measure this permeability by means of great irritation. the water transfusion through the horny layer of the skin (transepideirmal water) s Rough skin surface (ranging from tiny flakes to The exact way in which skin irritations deve- large areas of pealing, e.g. after sunburn) lop is highly complex and not yet fully un- s Sensation of irritation, i.e. itchiness, burning, derstood. However, studies show that the taunt skin contact with the irritating agent results in Questions to be asked the release of biochemical substances within s How does your scalp react to shampoos? the skin, leading to a complicated chain s How does your scalp react to products contai- reaction of symptoms. ning alcohol? s Are there specific reactions to heat/cold? s Do you suffer from contact allergies or hey fever (indictors for sensitive skin)? Irritated skin shows the above symptoms. However, most symptoms become only obvious several hours after the contact with the irritating substance (redness within 6 to 24 hours, scaling after several days). The diagnosis and anamnesis of sensitive skin is thus not that simple! Even experienced der- matologists are not always in agreement regarding the significance of “sensitive skin”. The problem lies in the fact that skin often shows a clear reaction to one sub- stance, while it might completely ignore other irritants. greasy scalp What are the main adverse factors and how does the skin react? spreading of the What is greasy skin? sebum Seborrhoea describes an overactivty of the sebaceous glands and a predisposition to sebaceous this condition is generally inherited. Sebaceous glands are found everywhere in our skin (with the exception of the soles of the feet and the palms of the hands). The sebaceous gland total number of sebaceous glands is deter- mined by genetic factors. The quantity of sebum that is secreted on the surface of the The condition of seborrhoea is an increased secretion of skin depends however not only on the num- sebum. This leads to a greasy scalp. ber of glands but also on their size. The sebum found on the surface of the skin is Seborrhoea only describes the condition of thus directly proportional to the density and overactive sebum production. In addition the size of sebaceous glands. The largest to the above causes, pollutants in the envi- such glands, actually consisting of several ronment, stress or a poor diet are common sacs, are found in the scalp. Their function is contributing factors. mainly controlled by hormones. Up to the age of puberty, they produce very little For the spreading of the grease, the secre- sebum. During puberty, the sebaceous tion of sweat also plays and important role. glands begin to produce more sebum, main- In hot weather, we transpire. Sweat dilutes ly stimulated by the male hormones (adro- the sebum and distributes it across the genic hormones). scalp pores. However, there are different types of greasy hair. As regards its causes, specialists diffe- rentiate between greasy scalp, i.e. sebor- rhoea and greasy hair due to the spreading of the sebum. greasy scalp Mixed skin – overactive sebaceous glands Sebostasis – insufficient activity of the in seborrheic zones sebaceous glands Depending on the size of the sebaceous If skin generally feels very dry and taunt, it glands and the effect of the androgenic is very likely that the sebaceous cells do not hormones, the quantity of sedum produced secrete enough sedum. This condition is re- in the different areas of the skin varies. In ferred to as sebostasis and is due to genetic the face, there is a distinct area in which the factors. After washing, the protective hydro- sebaceous glands are most active: it is the lipid film of the skin is only very slowly re- zone of the forehead and across the nose stored. The epidermis therefore tends to dry and chin and is often referred to as out quickly, and the skin shows dry tiny sca- “T zone”. les. Most affected are elderly persons, as the activity of sebaceous glands is significantly If the sebum production in the T zone is reduced from the age of 50. considerably higher than in the other parts of the face, the facial skin is referred to as Dry skin is often chapped and shows tiny “mixed skin”. The T zone has a tendency to lesions through which antigenic substances appear greasy, even shortly after it has been and germs can penetrate the tissue, causing cleaned, while the dryer parts of the skin infections. remain dry and even irritating. If this condition is combined with an inher- When assessing hair and scalp condition, ited predisposition for allergic reactions to the facial skin should also be looked at in certain substances, it leads to a high risk of order to recommend a suitable system treat- contact allergies. Skin affected by sebostasis ment. is very delicate and requires special care. The hair tends to be rather dry and rough it is therefore recommended to use products with greasing and moisturising components. greasy scalp How does skin react to adverse factors and how does greasy skin develop? A greasy scalp is the result of a functional di- sorder of the skin, in particular of the seba- ceous glands. This condition can be trigge- red off by a variety of factors, e.g. hormonal disorders or influences in the environment. The presence of hair also often leads to excessive moisture, due to transpiration, whereby the epidermis is swelled and its burner function is impeded. Under the influence of heat, sedum and sweat form an emulsion that quickly spreads across the scalp and hair, leading to greasy hair. How can a hairdresser assess greasy hair and what are the important questions to be asked? Rather greasy scalp Typical symptoms s Oily, greasy sheen s Demarcation lines of sebum and sweat Possible causes s Hormonal disorder s Poor diet s Psychological and physical disharmony s Chemical and mechanical factors s Environment s Inappropriate treatment with unsuitable or harsh products Diagnosefragen s Do you have any problems regarding your scalp? s How often do you wash your hair? s Does your facial skin tend to be greasy? s What shampoo do you use? s How do you style your hair? Recommendations s Dry-blow at low temperature s Always thoroughly rinse out hair care product (shampoo, conditioner, etc.) s Consequent system care s Only light perms s Layered haircut is recommended s wash hair more often s Use styling products hair loss What are the causes for hair Hair growth is for example influenced by the seasons. In this context, a unit has been loss? established, called the A/T quotient: it is calculated from the number of hairs in the Normal hair growth growth phase (A = anagen) divided by the The average scalp is covered by approxi- number of hairs in the resting phase of the mately 200 hairs per square centimetre. hair cycle (T = telogen). For healthy scalps, the A/T quotient is approx. 80/100, while At the beginning of each growth phase (ana- facial hair has a ratio of 50/50. Generally, gen), the hair grown during the previous hair growing on the head has a much higher cycle is shed. Given the above hair density, A/T quotient than body hair. An A/T quo- this means that every day, between 80 and tient that is permanently shifting towards a 100 hairs are lost This rate can however higher telogen ratio indicates hair loss. fluctuate considerably, a fact that normally should not cause any reason for concern. hairloss per day normal changes to hair hair loss 140 130 120 110 100 80 60 40 Ø hairloss normal hair loss short-term hairloss long term hair loss 20 (80-100 hairs per day) (not problematic) 0 t = month Hair loss: Normal changes to hair: We would only talk of “hair loss” when there is a Short-term variations from the normal rate of hair loss longer-term increase in rate of hairs falling out. (possibly due to the season of year) are not a cause for s Reversible hair loss can be cured with supporting concern . s Irreversible hair loss cannot be reversed, or only with difficulty. Causes for hair losses/alopecia/effluvium There are other forms of congenital forms of alopecia, where the hair growth is normal at Hair loss (effluvium/alopecia) occurs if the birth and hair loss only occurs later in life. number of haws that is shed by the scalp is for a considerable period of time above On the other hand, there are numerous the average. There are rare cases of congeni- forms of acquired alopecia. Within this tal alopecia caused by anomalies during the group, specialists distinguish between reversi- gestation, whereby the number of hair folli- ble and irreversible hair loss. Reversible hair cles is reduced in general, or where only a loss naturally disappears after a certain peri- fraction (hypotrichosis) or none (atrichosis) od of time; the hair growth can be stimula- of the hair follicles are actually functioning. ted and accelerated by proper treatment. hair loss What are the causes for and Sequence of reversible Telogen hair loss symptoms of reversible hair loss? The development of reversible hair loss and its symptoms If a hair follicle is disturbed in its function during the anagen, its might respond by directly progressing to the telogen, resulting in gradual hair loss. During the telogen, hair follicles are considerably more resistant against adverse influences than during the healthy hair dysfunction hair loss healthy hair anagen. As soon as the disturbance is + germ formation removed, the hair follicle produces again a new healthy hair. Anagen hair loss is due to influences that have an immediate impact on the body. In density of hair this case, the follicle is unable to shift to the telogen and the hair is shed immediately. Hair that is lost in this phase of the hair cycle differs from telogen hair in that it lacks Causes for hairloss: the typical bulb at the end (club hair) found external factors in telogen hair. s infections s long-term stress s drastical dieting All reversible types of alopecia – with the s malnutrition exception of localised hair loss – show a dif- s side-effects of medication fuse shedding of hair (i. e. equally dispersed s external mechanical factors across the scalp) and a gradual develop- internal factors ment. The effects are in all cases fully rever- s hormonal fluctuation due to pregnancy sible, once the cause behind it is removed. s dysfunction of the immune system Reversible hair loss is a rather common though not yet fully researched phenome- non. There are no exact statistics regarding a) Loss of hair after serious infections this condition. A strong attack of influenza is sometimes sufficient to induce telogen alopecia. It seems though that hair can in some cases The general weak state of the body thus react very sensitively to apparently insignifi- affects also the hair follicles, although the cant influences, which is even the more sur- exact causes are not yet known. prising, as it is normally very robust and strong. While, in the course of evolution, b) Hair loss after periods of great stress or hair has adapted to many adverse influen- shock ces, today’s way of life exposes it to comple- Research suggests that prolonged stress and tely new conditions that can lead to hair shock can lead to reversible loss of hair. It is loss. Examples of such conditions are: however not yet fully clear whether hair loss can be directly related to specific stress levels or trauma. Also to be taken into consi- deration here is the role of a possible gene- tic predisposition. hair loss c) Hair loss as a consequence of f) Hair loss after giving birth malnutrition During pregnancy, special hormones (gesta- In the case of malnutrition, the body does gens) are produced. They also affect the not receive a sufficient level of energy and growth of hair, as more follicles than usual nutrients required for growth and regenera- remain in the anagen. After delivery, the tion of the organism. This lack of substances gestagen level is suddenly reduced, with a including vitamins and trace elements direct- reverse affect on the hair growth cycle. In ly affects the hair, leading to hair loss in the order words, hair in the anagen goes over to telogen. Depending on the extent of malnu- the telogen (rest phase) and is shed after a trition, the shafts of hairs also becomes thin- few months. The new hair is still short and ner. the impression is that of thinning hair, alt- hough the number of active follicles is not The following trace elements and vitamins reduced. As soon as the growing hair has are necessary for keratinisation, i.e. the pro- reached its normal length, the hair volume duction of keratinised cells: iron, zinc and vi- returns to normal. tamin H (biotin). A deficiency in these sub- stances can result in hair loss and reduced g) Hair loss due to trauma hair diameters. Hairstyles that produce a constant pull on the hair roots can promote hair loss. Such Similar symptoms are known in connection stress impairs the formation of the hair shaft with protein deficiency. in the anagen follicles. Telogen hair is gradu- ally pulled out, leading to bald patches. The d) Hair loss during dieting hair shafts can be broken by excessive me- The above effects of malnutrition on hair chanical stress for example by unsuitable growth imply that radical dieting can lead to combs, also giving the impression of thining telogen hair loss. hair. e) Hair loss caused by drugs h) Appearance of bald patches (alopecia Certain drugs can lead to hair loss. The best- areata) known example are anti-cancer drugs (carci- This type of hair loss is characterised by nostatics in chemotherapy), where patients round patches of baldness on the scalp. It is suffer from reversible anagen hair loss. Such believed to be caused by autoimmune disor- substances reduce the mitotic rate of all cells ders and is thus not directly related to other m the body that normally undergo mitosis, types of hair loss. The smaller the number including of course the targeted cancer cells. and size of the affected areas, the greater Particularly drastic is however the effect of the chance of full recovery. If the hairdresser such drugs on the hair-producing trichocy- spots such typical round bald patches, the tes, that normally have the highest mitotic customer should be informed and urged to rate of all body cells. This leads to a com- consult a dermatologist. plete hair loss within only a few days after the commencement of the chemotherapy, whereby the hair roots have not sufficient type to go over to the telogen (rest phase). After termination of the cancer treatment, the hair grows back within a few months. hair loss The development of Sequence of androgenetic hair loss irreversible hair loss Irreversible hair loss occurs: s if the hair follicles are considerably reduced in volume (as is the case in andro- genetic hair loss) s if the function of the hair follicles is per- manently impaired (as in serious cases of alopecia areata) Wirkung Androgene s as a result of certain skin diseases terminal hair vellus hair The following explanations are limited to androgenetic hair loss, alopecia areata and hair loss due to age: a) Androgenetic hair loss in men and density of terminal hair women Irreversible hair loss due to miniaturization of the hair This most common type of has loss is follicle currently considered irreversible. It is charac- terised by the gradual replacement of the However, it is interesting to note that these terminal hair on the head by downy thin androgens have the opposite effect on body hair (vellus hair). In many men, this process hair: there, vellus hair follicles are transfor- begins as early as 17 years of age and is ac- med to terminal hair follicles (as in beards). companied by a gradually receding hairline. Androgenetic hair loss is normally comple- Women can also suffer from androgenetic ted at the age of 50. hair loss, though such cases are much rarer. Up to the menopause, the condition leads Male pattern hair loss is caused by androge- to a diffuse thinning of the hair around the nic hormones (androgens). The role that centre parting. After the menopause, female these hormones play in the development of pattern hair loss can in certain cases resem- male pattern hair loss was already known to bled the pattern of hair loss in men. Aristotle, who observed that eunuchs never However, normally only a small portion of suffered from baldness. the terminal hair develops into vellus hair. Therefore, only very few women suffer from The two main androgens responsible for the total baldness, as female pattern hair loss is condition are testosterone and its derivative characterised by a more or less prominent dihydrotestosterone (DHT). thinning of the hair. An enzyme called 5 alpha reductase con- verts testosterone to DHT. Scientists agree that the hormone causing androgenetic alo- pecia is actually DHT. It is directly respon- sible for the replacement of normal follicles with vellus hair follicles. hair loss b) Age-related hair loss Both men and women of an advanced age often show a diffuse thinning of the scalp, caused by continuing or newly induced con- version of the strong terminal hair to thin intermediary hair and vellus hair. The causes for this type of hair loss are not fully under- stood yet but are believed to be part of the general ageing process of the body. c) Severe cases of alopecia areata If large circular areas become completely bald, the patient suffers from a severe form of alopecia areata. The following rule ap- plies here: the larger the bald patches, the greater the probability that the hair loss is ir- reversible. In such cases, hairdressers should urge their customers to immediately consult a dermatologist. I II IIa III IIIa III-vertax IV IVa V Va VI VII men Hamilton-Norwook Skala Hamilton-NorwoodScale, androgenetic hair Haarausfall androgenetischer loss 1 2 3 4 5 6 7 8 Ludwig Skala Ludwig Scale women hair loss How can a hairdresser assess How can hairdressers assess hair loss and what are the hair loss? important questions for such an assessment? Obviously, an assessment by a hairdresser can never replace a diagnosis by a dermato- Hair is the fastet growing part of our body. logist. However, due to the often confidenti- No other cells have a comparably high al relationship between hairdresser and cu- mitotic rate than hair cells. Two main pro- stomer and based on professorial cesses are responsible for the development experience, hairdressers can: s describe the type of hair loss with great of healthy hair: accuracy s initiate the appropriate treatment, if any 1. continued production of trichocytes in the s assess whether the customer should hair matrix. 2. the conversion of trichocytes to hollow urgently consult a dermatologist hair cells during the process of keratini- sation. The following questionnaire can be very use- ful m cases, where hairdressers are consulted Healthy hair has an even sheen and is by their clients in connection with hair loss. robust and elastic. It allows hairdressers to produce attractive hairstyles with lasting hold. Healthy hair can only grow on a healthy scalp. A fine and efficient network of blood vessel transport all the essential nutrients to the hair root. The hair follicles can also be supplied through the scalp (i.e. epicutaneously) with special substances preventing hair loss and improving hair condition through the scalp (i.e. epicutaneously). Objectives of such treatment: s prevention of hair loss and improvement of hair quality s stimulation of hair growth in cases of re- versible hair loss s in the case of irreversible androgenetic hair loss: slowing down of the transforma- tion of terminal hair follicles to vellus hair follicles, and reversion of the process, as far as possible hair loss Questionnaire: s after dieting s after a prolonged period of poor nutri- Age of customer: tion s less than 20 Hair loss possibly due to malnutrition (see 5.2 c/d). s between 20 and 50 s over 50 years of age s during puberty s after puberty Hair is washed: Possible first sign of andorgnetic hair loss (see 5.2. a). s daily Customer´s hair style puts individual hairs s 2-3 x per week under considerable strain: s 1x per week s yes Customer that wash their hair every day find less hair in the wash basin than persons that wash their hair only s no once per week; in the latter case, hair loss is more ob- Constant pull on hair can result in hair loss (see 5.2 g). vious. Subjective impression of hair loss is Family background: Have other members of increased when the hair is grown longer: your family suffered from hair loss? s yes s yes s no s no Possibility that there is no hair loss. In long hair, the na- tural hair cycle is often more visible than in short hair The hair loss began in: (due to the length of the individual hair). s spring Hair loss already continues for: s summer s week s autumn s months s winter s years Consider the option that the hair loss is due to seasonal The longer the perios of hair loss, the more serious the fluctuations in the hair growth cycle and thus harmless condition. If could be irreversible. Advice customer to and reversible (see 5.1.). immediately consult a dermatologist. s after illness The hair loss is: s disorder of the thyroid gland function s limited to certain areas s hormonal change (pregnancy, s diffuse (i.e. all over the scalp) menopause, etc) Diffuse hair loss is reversible (see 5.2. a) to g), a symp- s iron deficiency tom of female pattern androgenetic hair loss (see 5.2 a) or of hair loss due to age (see 2.4. b). s after major surgery Distinct bald patches often indicate androgenetic hair (The hair loss might have been caused by a serious in- loss, commonly in men (see 5.2. a), alopecia areata (see fection (see 5.2 a) or by a drug (see 5.2 e). Increased 5.2. c) / 5.2. h)) or a skin disorder in both genders. hair loss in in many cases directly related to thyroid in- sufficiency or iron deficiency. s after treatment with certain drugs The hair loss could be an adverse side-effect of the drug (see 5.2. e). s during or after prolonged period of stress s after a mental shock Such experiences are known to cause temporyty rever- sible hair loss (see 5.2. b). hair loss The hair loss: Based on the completed questionnaire, the s commenced in the forehead corners hairdresser is in many cases in a position to assess whether the hair loss is reversible or s the hair line is already receding across not. The hairdresser will also know whether the entire forehead the consultation of a dermatologist is neces- Most likely a case of androgenetic hair loss (see 5.2. a) sary or not. The typcial symptoms of andorgenetic hair lines have already developed: Maintaining healthy hair s yes growth s no As outlined above, it is possible to stimulate (see above) and improve hair growth by the application of agents that penetrate the scalp in order The bald patches are circular in shape: to support the function of the follicles. The s yes following three objective are crucial for a s no successful treatment: Possible case of alopecia areata (see 5.2. h / 5.2. c). s Unimpaired blood supply to the hair roots. Advice the customer to immediately consult a derma- s Optimised supply of substances that are tologist. of special importance for the keratinisa- tion of the trichocytes. The scalp is: s Protection of the hair root against s reddish Influences that promote inherited hair s infected loss. Obvious sign for irritation, damaged scalp or serious skin disorder. Advice customer to urgently consult a dermatologist. If the above questions are discussed in detail during the customer´s visit at the hairdres- ser´s, it is comparatively simple to assess the hair loss. If the customer does not requi- re the immediate attention of a dermatolo- gist the hairdresser should recommend that the further development of the hair loss should be closely monitored. Encourage the customer to report back at the next visit.