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2017 HCHB_digital

Hair Loss Alopecia is

Hair Loss Alopecia is the medical term for hair loss. Hair loss is common, with almost 60% of men and up to 40% of women experiencing it at some point in their lives. While genetic inheritence plays a major role in most cases, many other factors contribute to hair loss, some of which are only temporary. Stages of hair growth We are born with all the hair follicles we are ever going to have, and these follicles usually continue to produce hair for the rest of our lives. However, as we age, some follicles start replacing longer hairs with finer, almost invisible hairs – this may look like we are losing hair, but in fact the hair has just become smaller. Human hair has three different growth phases: anagen, catagen and telogen. At any given time, hairs will be in various stages of growth or shedding. Anagen (growing) phase The anagen phase is the active or growing stage of hair growth. On average, hair grows 0.3–0.4mm/day or around 12–15cm per year. During this phase the hair root is long, white and tapered. How long hair stays in this growing stage is genetically predetermined and explains why some people’s hair grows longer than others. Around 85% of hair follicles are in this phase at any given time, although hair on different parts of the body varies as to how long it stays in this phase. On the scalp, the anagen phase can last for two to seven years, whereas on the arms, legs, eyelashes, and eyebrows this anagen growth phase only lasts around 30–45 days. At some point in the anagen phase, an unknown signal causes hair to go into the catagen phase. Catagen (transition) phase Hair growth stops in the catagen phase as the hair root sheath begins to shrink and becomes rounded as the follicle prepares to enter the telogen phase. This phase lasts for about two to three weeks, but can be as short as two days. Telogen (resting and new hair growth) phase This is the final stage of hair growth, also called the resting stage. The hair is fully grown and the root of the hair is now completely rounded. Pulling out a hair in this phase will reveal a solid, hard, dry, white material at the root. This phase lasts about three to four months for scalp hair but much longer for hairs on other parts of the body – around nine months for eyebrow hair. Hair is shed when a new anagen hair begins to grow under the resting telogen hair. Fifty to 100 telogen hairs are shed daily from a normal scalp. Common types of hair loss Hair loss can affect localised areas of the scalp or occur evenly over the whole area. Other hairy parts of the body may also be affected. Male-pattern hair loss Male-pattern hair loss (androgenetic alopecia) is an inherited condition, caused by a genetically determined sensitivity to the effects of dihydrotestosterone (DHT). DHT is thought to shorten the anagen phase of the hair cycle, causing progressively finer hairs to be produced. The disorder is characterised by a receding hairline and/or hair loss on the top of the head, and male Caucasians are more likely to be affected. Female-pattern hair loss The hereditary female-pattern of balding is characterised by a diffuse thinning of the hair on the scalp due to an increase in hair shedding or a reduction in hair volume. It is more common during or after menopause with around 40% of women by age 50 showing signs of hair loss. The hair loss process is not usually constant and there are often accelerated phases of hair loss for three to six months, followed by periods of stability lasting six to 18 months. Telogen effluvium Excessive shedding of telogen hairs occurs. This may be acute and temporary or chronic and persistent. Although the thickness and length of the hair may be reduced, because new hair continues to grow, it does not result in baldness. Acute telogen effluvium usually follows some major shock to the body and as many as 70% of the anagen hairs can be precipitated into the telogen phase. The telogen hairs remain firmly attached to the scalp at first. It is only about two months after the initial shock that the new anagen hairs growing up through the scalp push out the dead telogen hairs and increased hair shedding is noticed. Causes are numerous, including accidents, childbirth, surgery, certain medicines (eg, discontinuing the oral contraceptive pill), excessive sun exposure, TREATMENT OPTIONS Category Examples Comments Products for hair regrowth Natural / herbal products / supplements [PHARMACY ONLY MEDICINE] eg, minoxidil 5% topical solution/foam (Regaine Extra Strength Foam/Solution, Regro Hair Growth Spray) Gingko biloba (Sebamed Anti-Hairloss Shampoo), lavender oil, thyme, rosemary, cedarwood, saw palmetto, zinc Minoxidil is recommended for men who have a general thinning of hair on the top of the scalp (vertex pattern only). Not intended for frontal baldness or a receding hairline. Hair shedding may temporarily increase during the first few weeks of use. Some men may see regrowth after two months; in others it may take up to four months. Continued use is required to maintain hair regrowth. Some oils and herbs may help maintain a healthy scalp, encouraging hair growth. Page 82 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION excessive weight loss or major dietary changes, illness (especially with fever), and jet lag. In most cases the condition is self-correcting and complete recovery occurs within six to nine months, although it may be incomplete in some cases. Chronic telogen effluvium is characterised by a persistent or cyclical diffuse hair loss and inability to grow the hair long. There may be fluctuations in severity of the shedding (eg, cyclical variations) similar to moulting that occurs in other mammals. Although chronic telogen effluvium does not cause baldness, bitemporal recession of hair is common (high forehead). In some cases of telogen effluvium, tests may be done to exclude thyroid disease and to check levels of iron, vitamin B12 and folic acid, as any deficiency in these can slow hair growth. Anogen effluvium Hair shedding occurs due to interruption of the anagen phase of growth, and can result in baldness. Most common causes are chemotherapy, toxins or inflammation. Alopecia areata Round bald patches appear suddenly, most often on the scalp, although any hair-bearing areas can be affected (eg, eyebrows, eyelashes, beard). May occur at any age, including childhood. It is thought to be due to an autoimmune disorder, and commonly affects more than one member of the family, or in people with chromosomal disorders eg, Down’s syndrome. Alopecia areata is often first noticed by hairdressers, as the initial bald patch may be small. This enlarges over time before new growth occurs. Complete regrowth may take months, or sometimes years to occur; one patch can be falling out while another is regrowing. Various forms of the condition can exist including alopecia totalis when all scalp hair is lost, and alopecia universalis where the entire body hair is shed. Initial assessment Take an empathic approach when talking with a customer about their hair loss, as they may be distressed by it. Take a look at their hair and listen to their history to determine if they have any of the more common conditions listed above. Reassurrance that the hair should grow back may be all that is needed in customers with a temporary cause for their hair loss (such as illness, jet lag, childbirth). Before selling minoxidil to men, make sure the product is appropriate for their pattern of hair loss and they are aware of the pros and cons. Refer any customers with "yes" answers to the Refer to Pharmacist questions to a pharmacist; also refer if you are unsure what treatment would be best. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Has the person been diagnosed with another health disorder (eg, iron deficiency, thyroid disease, systemic lupus erythematosus)? • Has the person had chemotherapy or take any medication (including herbal/complementary medications) that may be contributing to the hair loss? • Does the scalp look flaky, scaly or does it itch? • Is the person younger than 18 years? • Does the person compulsively twist or pull out his own hair? • Has minoxidil been used for 12 months without success? • Does the person have any allergies to topical medicines? [PRESCRIPTION MEDICINE], hair replacement or transplantation, laser therapy, keratin treatment, hairpieces, or hormonal treatments. Advice for customers • Handle hair gently and avoid over-vigorous combing, brushing, tying up and any type of scalp massage. • Treat dandruff or psoriasis if present. • If using a hairdryer, use on a low setting to avoid damaging the hair shaft. • Relaxation techniques may help with hair loss caused by stress. • Eat a well-balanced diet and consider supplements with deficiencies. Treatment for hair loss Better results are achieved by people who seek help as soon as they notice their hair starting to thin out, fall out or becoming thinner or shorter than normal. Early treatment is the key to successful regrowth. Treatment options vary according to the type of hair loss but may include minoxidil solution, finasteride tablets Now you can complete your ENHANCE modules on your phone or tablet Page 83

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