All hair cells make a tiny bit of hydrogen peroxide, but as you age, the amount increases. Essentially, you bleach our hair pigment from within, and your hair turns gray and then white.
Researchers made this discovery by examining cell cultures of human hair follicles. They found that the build up of hydrogen peroxide was caused by a reduction of an enzyme that breaks up hydrogen peroxide into water and oxygen.
They also discovered that hair follicles could not repair the damage caused by the hydrogen peroxide because of low levels of the enzymes MSR A and B, which normally serve this function. The high levels of hydrogen peroxide and low levels of these enzymes also disrupt the formation of tyrosinase, another enzyme that leads to the production of melanin in hair follicles.
It is an accepted part of the ageing process, but experts say understanding how grey hair happens could help find a way to prevent it.
Experiments found it is caused by a massive build-up of hydrogen peroxide due to wear and tear of hair follicles, which blocks hair’s natural pigment.
The research has been hailed as a “major breakthrough”.
The scientists worked in collaboration with experts in Mainz and Luebeck in Germany and the discoveries have been published in the FASEBscientific journal, published by the Federation of the American Societies for Experimental Biology.
Lead researcher Karin Schallreuter said experts examined hair as well as cells from human hair follicles to uncover the findings.
He said: “This discovery is a major breakthrough in the understanding of hair greying and opens up some novel ideas to combat this scenario.
“These are being followed up at the current time in our laboratory.”
According to Gerald Weissmann, the Editor-in-Chief of the ‘FASEB Journal‘, which published the study, “All of our hair cells make a tiny bit of hydrogen peroxide, but as we get older, this little bit becomes a lot.
“We bleach our hair pigment from within, and our hair turns gray and then white. This research, however, is an important first step to get at the root of the problem, so to speak.”
In fact, the scientists made this discovery by examining cell cultures of human hair follicles. They found the build up of hydrogen peroxide was caused by a reduction of an enzyme that breaks up hydrogen peroxide into water and oxygen (catalase).
They also discovered that hair follicles could not repair the damage caused by the hydrogen peroxide because of low levels of enzymes that normally serve this function (MSR A and B).
Hair transplantation is a surgical technique that involves moving skin containing hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. However, it is also used to restore eye lashes, eye brows, beard hair, and to fill in scars caused by accidents and surgery such as face lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.
Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant these naturally occurring 1 – 4 hair “follicular units” in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This recent hair transplant procedure is called “Follicular Unit Transplantation.”..
The use of both scalp flaps, in which a band of tissue with its original blood supply is shifted to the bald area, and free grafts dates back to the 19th century. Modern transplant techniques began in Japan in the 1930s, where surgeons used small grafts, and even “follicular unit grafts” to replace damaged areas of eyebrows or lashes. They did not attempt to treat baldness per se. Their efforts did not receive worldwide attention at the time, and the traumas of World War II kept their advances isolated for another two decades.
The modern era of hair transplantation in the western world was ushered in the late 1950s, when New York dermatologist Norman Orentreich began to experiment with free donor grafts to balding areas in patients with male pattern baldness. Previously it had been thought that transplanted hair would thrive no more than the original hair at the “recipient” site. Dr. Orentreich demonstrated that such grafts were “donor dominant,” as the new hairs grew and lasted just as they would have at their original home. Today Dr. Orentreich’s practice still performs hair transplants.
For the next twenty years, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2-4 mm “plugs” leading to a doll’s head-like appearance. In the 1980s, Uebel in Brazil popularized using large numbers of small grafts, while in the United States Rassman began using thousands of “micrografts” in a single session.
In the late 1980s, Limmer introduced the use of the stereo-microscope to dissect a single donor strip into small micrografts. In 1995, Bernstein and Rassman published the first paper on “Follicular Unit Transplantation,” where hair is transplanted exclusively in naturally occurring groups of 1-4 hairs. With microscopic dissection of donor pieces from an excised portion of scalp, individual follicular units containing but 1-4 hairs could be prepared and individually relocated into needle punctures in the recipient areas. Since the transplanted hair mimics the way hair grows in nature, close to natural results were attainable.
The follicular unit hair transplant procedure has continued to evolve, becoming more refined and minimally invasive as the size of the graft incisions have become smaller. These smaller and less invasive incisions enable surgeons to place a larger number of follicular unit grafts into a given area. With the new “gold standard” of ultra refined follicular unit hair transplantation, over 50 grafts can be placed per square centimeter, when appropriate for the patient.
Surgeons have also devoted more attention to the angle and orientation of the transplanted grafts. The adoption of the “lateral slit” technique in the early 2000s, enabled hair transplant surgeons to orient 2 to 4 hair follicular unit grafts so that they splay out across the scalp’s surface. This enabled the transplanted hair to lie better on the scalp and provide better coverage to the bald areas. One disadvantage however, is that lateral incisions also tend to disrupt the scalp’s vascularity more than sagitals. Thus sagital incisions transect less hairs and blood vessels assuming the cutting instruments are of the same size. One of the big advantages of sagitals is that they do a much better job of sliding in and around existing hairs to avoid follicle transection. This certainly makes a strong case for physicians who do not require shaving of the recipient area. The lateral incisions bisect existing hairs perpendicular (horizontal) like a T while sagital incisions run parallel (vertical) along side and in between existing hairs. The use of perpendicular (lateral/coronal) slits verses parallel (sagital) slits however, has been heavily debated on patient based hair transplant communities. Many elite hair transplant surgeons typically adopt a combination of both methods depending on what is best for the patient.
At an initial consultation, the surgeon analyzes the patient’s scalp, discusses his preferences and expectations, and advises him/her on the best approach (e.g.,single vs. multiple sessions) and what results might reasonably be expected.
For several days prior to surgery the patient refrains from using any medicines, or alcohol, which might result in intraoperative bleeding and resultant poor “take” of the grafts. Pre-operative antibiotics are commonly prescribed to prevent wound or graft infections.
Hair transplantation is a surgical technique in which a physician redistributes hairs from an area of thick growth to bald areas.
This Procedure is Performed because:
In patients who are concerned about their balding, hair transplantation can significantly improve their appearance and self confidence. Realistic expectations are important, however. It is important to remember that hair still cannot be created; it can only be redistributed from the back of the scalp to the front.
Most patients undergoing hair transplantation have traditional male or female pattern baldness, with hair loss on the front or top of the scalp. Patients must still have thick hair on the back or sides of the scalp, or there may not be enough hair follicles to move. In some cases, patients with hair loss from lupus, injuries, or other medical problems may be treated with hair transplantation.
Patients undergoing hair transplantation should be otherwise relatively healthy, or surgery is less likely to be safe and successful. Always discuss your risks and options with your physician before undergoing any elective surgery.
Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected topical anesthesia, and typically last about four hours. The scalp is shampooed and then treated with an antibacterial chemical prior to the donor scalp being harvested.
In the usual follicular unit procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1-1.5 x 15-30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts from the strip. Working with binocular microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting.
The surgeon then uses a fine needle to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The assistants generally do the final part of the procedure, inserting the individual grafts in place.
Risk Factor:As with any surgical procedure, risks exist. The most common complications of hair transplantation are bleeding, infection, and scarring.
Though less dangerous, it is also possible that the transplanted hair won’t look as good as you had desired. Older techniques often resulted in unnatural appearing tufts of new hair growth. With modern techniques, this complication is infrequent.
Advances in wound care allow for semi-permeable dressings, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have you shampoo the day after surgery. Shampooing is important to prevent scabs from occurring around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.
During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out (“shock loss”). After two to three months new hair will begin to grow from the moved follicles. The patient’s hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.
There are two main ways in which donor grafts are extracted today. These are the Strip Harvesting Technique and the Follicular Unit Extraction (FUE) Technique.
The Strip Harvesting Technique involves removing a strip containing a large group of follicular units from the donor area – almost always from the back and sides of the scalp. The strip is then divided into grafts (or follicular units) containing 1 to 4 follicles.
The Follicular Unit Extraction (FUE) Technique involves removing one follicular unit at a time directly from the donor area – usually the back and sides, but also sometimes from the chest, legs or face (beard hair) – using a small punch usually of between 0.5mm and 1mm in diameter.
Hair thinning, known as “shock loss”, is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day.
Other side effects include swelling of areas such as the scalp and forehead. If this becomes uncomfortable, medication may ease the swelling. Additionally, the patient must be careful if his scalp starts itching, as scratching will make it worse and cause scabs to form. A moisturizer or massage shampoo may be used in order to relieve the itching.
The scalp is divided into 5 layers, which are easily remembered by the mnemonic SCALP, which represents, in order from outermost to innermost layer, the skin, connective subcutaneous tissue, galea aponeurosis, loose connective tissue, and periosteum over the cranium.
The skin contains all the epidermal appendages, including hair follicles, which extend into the connective subcutaneous layer. In areas that have undergone hair loss, thinning of the outer 2 layers usually occurs. This situation can be appreciated when one compares the thickness of the scalp in recipient areas to that in donor areas.
The subcutaneous layer is well vascularized and contains the main penetrating branches of the named main arteries that travel primarily along the external surface of the galea. The importance of staying superficial along the connective subcutaneous tissue layer (when one makes slit recipient sites to avoid compromising circulation) has only recently become apparent. The scalp has an excellent blood supply. The supraorbital, supratrochlear, superficial temporal, postauricular, and occipital arteries are the primary vessels, and they typically travel with the veins.
The galea aponeurotica is a nonelastic layer that connects the frontalis muscles anteriorly with the occipitalis muscle at its posterior aspect. The temporoparietal fascia, in which the superficial temporal artery travels, is also connected to the galea. The galea sliding over the loose connective tissue layer allows for most scalp mobility. This loose connective tissue layer and the periosteum below have minimal sensory innervation.
The sensory innervation of the scalp closely follows the vascular supply. At the anterior aspect, the supraorbital and supratrochlear nerves provide sensation to the anterior half of the scalp. On occasion, sensation to the frontal scalp can diminish for several weeks when a large number of graft recipient sites are made along the hairline. The occipital nerve serves the posterior half of the scalp, whereas the supraauricular and superficial temporal nerves contribute innervation from the sides.
Perhaps no anatomic feature of the scalp is more important with regard to hair transplantation than the microscopic distribution of hair. Scalp hairs usually do not grow individually; they most often grow in tiny follicular-unit bundles, which usually contain 2-3 hairs and occasionally 1 or 4 hairs. A follicular-unit contains these 1-4 terminal hairs, a sebaceous gland element, and insertions of the arrector pili muscles, all wrapped in an adventitial tissue sheath. These follicular units are dispersed throughout the scalp, where non–hair-bearing skin constitutes up to 50% of the total tissue. By transplanting only these follicular units and dissecting away the 50% of unnecessary non–hair-bearing tissue, the most natural-appearing results can be attained. Prognosis
Most modern hair transplants result in excellent hair growth within several months after the procedure. Often, however, more than one treatment session is needed to create the best-looking results. The replaced hairs are usually permanent, and no long-term care is necessary.
During the recovery period after surgery, the scalp is often very tender. Strong pain medications taken by mouth may be necessary for several days. A bulky surgical dressing, or sometimes a smaller dressing protected by a baseball cap, must be worn for at least a day or two. Some surgeons may also recommend several days of antibiotics or anti-inflammatory drugs following surgery. After this very brief recovery period, no special treatment is needed.
In recent years hair transplants have become less expensive. Prices typically range from $3.00 to $7.00 per graft, with $4 to $5 per graft being about average. Normally the price per graft also drops as the size of the surgical session increases. Depending on the needs of the patient a typical surgical session can range from 1,500 to over 4,000 grafts, resulting in a total cost of approximately $6000 to $15,000. A few clinics offer larger sessions of up to 6000 grafts in one sitting.
Perhaps the most difficult part of being a surgeon is knowing when not to operate. In elective cosmetic surgery, sound judgment must certainly be exercised.
Individuals must be motivated to undergo hair transplantation. Although the author does not conduct a formal psychological evaluation by means of lengthy questionnaires and examinations, some surgeons use this method. During the consultation, the present author generally reads to the individual to ensure that he or she is mature enough to decide to undergo the planned procedure. A prospective patient who has realistic motivations and expectations before the procedure is likely to be happy after the procedure. Honest and thorough preprocedural consultation is perhaps the most important part of the process.
Poor medical health is a potential contraindication for elective surgery of any kind. Individuals cannot be taking anticoagulants (eg, Coumadin, aspirin) before the procedure. Good surgical judgment must be exercised when one considers surgery in individuals with potentially complicating medical conditions. Age is not a medical contraindication. The author has performed procedures on men in their late 70s. Ensure that such patients provide medical clearance from their internist.
Perhaps no single hair-loss condition calls for more conservatism in judgment than premature MPB. Teenagers and men in their early 20s are particularly self-conscious about hair loss because most of their peers still have full heads of hair. These young men often hold unrealistic expectations, desiring a youthful hairline that will not be appropriate as they age. Worse, early surgical correction uses a large number of donor hairs, which will be sparse in the future, potentially resulting in an unnatural look and a disappointed patient.
In general, attempt to delay the procedure in individuals in their 20s or younger, though the author has performed procedures in select individuals as young as 20 years. When counseling young men about hair loss, the author advises a conservative approach to give patients time to consider hair transplantation. If the patient and surgeon agree on transplantation, restore a relatively high hairline and instruct the patient to use minoxidil for the crown region. Perhaps in the future, as effective medical therapies that end or substantially slow MPB progression become available, a less conservative approach can be taken.
For a number of medical conditions that are associated with or that can cause hair loss, treatment with hair transplantation is not appropriate. Examples are the active phases of alopecia areata, lupus, and infections. Scalp conditions, such as vitiligo and psoriasis, must be evaluated because hair transplantation can aggravate them.
Hidradenitis suppurativa is a chronic skin inflammation marked by the presence of blackheads and one or more red, tender bumps (lesions). The lesions often enlarge, break open and drain pus. Scarring may result after several occurrences.
The cause of hidradenitis suppurativa isn’t known. But it’s considered a severe form of acne (acne inversa) because it occurs deep in the skin around oil (sebaceous) glands and hair follicles. The parts of the body affected â€” the groin and armpits, for example â€” are also the main locations of apocrine sweat glands.
Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. There is no cure for hidradenitis suppurativa. But early diagnosis and treatment can help manage the symptoms and prevent new lesions from developing.
Other names for HS
Hidradenitis suppurativa has been referred to by multiple names in the literature, as well as in various cultures. Some of these are also used to describe different diseases, or specific instances of this disease.
*Acne conglobata – not really a synonym – this is a similar process but in classic acne areas of chest and back
*Acne Inversa (AI) – a new term which has not found favour.
*Apocrine Acne – a misnomer, out-dated, based on the disproven concept that apocrine glands are primarily involved
*Apocrinitis – another misnomer, out-dated, based on the disproven concept that apocrine glands are primarily involved
*Fox-den disease – a catchy term not used in medical literature, based on the deep fox den / burrow – like sinuses
*Hidradenitis Supportiva – a misspelling
*Pyodermia sinifica fistulans – an older term, considered archaic now, misspelled here
*Velpeau’s disease – commemorating the French surgeon who first described the disease in 1833
*Verneuil’s disease – recognizing the French surgeon whose name is most often associated with the disorder as a result of his 1854-1865 studies
Stages HS presents itself in three stages.
1.Solitary or multiple isolated abscess formation without scarring or sinus tracts. (A few minor sites with rare inflammation; may be mistaken for acne.)
2.Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent inflammations restrict movement and may require minor surgery such as incision and drainage.)
3.Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection – see fistula. Obviously, patients at this stage may be unable to function.) Sign and Symptoms:
Hidradenitis suppurativa commonly occurs around hair follicles where many oil and sweat glands are found, such as the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.
Click to SEE THE PICTURES Hidradenitis suppurativa usually appears as one or more red, tender bumps that fill with pus. It commonly occurs where oil (sebaceous) and apocrine sweat glands are found, such as the armpits, groin and anal area.
Signs and symptoms of hidradenitis suppurativa include:
*Small pitted areas of skin containing blackheads, often appearing in pairs or a “double-barrel” pattern.
*One or more red, tender bumps (lesions) that fill with pus. The bumps often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.
*Painful, pea-sized lumps that grow under the skin. These hard lumps, which may persist for years, can enlarge and become inflamed.
*Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.
For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.
Hidradenitis suppurativa develops when the oil glands and hair follicle openings become blocked. When oils and other skin products become trapped, they push into surrounding tissue. Bacteria can then trigger infection and inflammation. It’s not known why this occurs, but a number of factors â€” including hormones, genetics, cigarette smoking and excess weight â€” may all play a role.
As this disease is poorly studied, the causes are controversial and experts disagree. However, potential indicators include:
*females are more likely than males
*plugged apocrine (sweat) gland or hair follicle
*sometimes linked with other auto-immune conditions
*genetic disorders that alter cell structure
*stress can bring on outbreaks
*being overweight makes it worse, however this condition is not caused by obesity and weight loss will improve but not cure it.
*cigarette smoking tends to encourage outbreaks as well
The historical understanding of the disease is that there is a misfunction in either the apocrine glands or hair follicles, possibly triggered by a blocked gland, creating inflammation, pain, and a swollen lesion. More recent studies imply there is an autoimmune component.
HS is not caused by any bacterial infection — any infection is secondary. Most cultures done on HS lesions come back negative for bacteria, so antibiotics should be used only when a bacterial infection has been confirmed by a physician.
Hidradenitis suppurativa is not contagious.
Screening and Diagnosis:
To make a diagnosis, your doctor may ask about your symptoms and medical history, examine your skin, and order blood tests. If pus or drainage is present, your doctor may send a sample of the fluid to a laboratory for testing. This test is known as a culture. Such tests may be necessary to rule out other skin conditions, such as tuberculosis of the skin, a carbuncle or a pilonidal cyst. General Complications:
Hidradenitis suppurativa often causes complications when the disease is persistent and severe. These complications include:
*Sinus tracts or tunnels that connect and form a network under the skin. The tracts prevent the sores from healing and cause more sores to develop.
*Scars and skin changes. Severe hidradenitis suppurativa may leave thick, raised scars, pitted skin or patches of skin that are darker than normal (hyperpigmentation).
*Restricted movement. The disease may cause limited or painful movement, especially when it affects the armpits or thighs.
*Cellulitis.This potentially serious bacterial infection appears as an area of swollen, red skin that feels hot and tender and that may spread rapidly. Although the initial infection may be superficial, it eventually can affect the tissues underlying your skin or spread to your lymph nodes and bloodstream.
Severe complications: Left undiscovered, undiagnosed, or untreated, the fistulas from severe stage-3 HS can lead to the development of squamous cell carcinoma in the anus or other affected areas.
There is no cure for hidradenitis suppurativa. But early treatment can help manage the symptoms and prevent new lesions from developing.
Treatments may vary depending upon presentation and severity of the disease. Due to the poorly-studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet clear, and patients should discuss all options with their doctor or dermatologist. Nearly a quarter of patients state that nothing relieves their symptoms. A list of treatments that are possible treatments for some patients is as follows.
*oral antibiotics (to treat inflammation and bacterial infection)
*isotretinoin (Accutane), a prescription-only oral acne treatment (benefits for HS are very controversial, but it is generally considered to be ineffective)
*sub-cutaneous injection or IV infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade), etanercept (Enbrel), and adalimumab. This use of the drugs is not currently Food and Drug Administration (FDA) approved and is
*somewhat controversial, and therefore may not be covered by insurance.
*Zinc gluconate taken orally has been shown to induce remission
surgery (But Obesity, incomplete removal and ongoing skin infections can increase the chances that hidradenitis suppurativa returns, even after surgical treatment.)
*incision and drainage or lancing
*wide local excision (with or without skin grafting), or laser surgery
The following suggestions may help relieve discomfort, speed healing and prevent the infection from spreading:
*Apply a warm washcloth or compress to help reduce swelling.
*Gently wash the affected areas with antibacterial soap. After washing, apply an over-the-counter antibiotic.
*Wear loosefitting clothes and underwear to prevent skin irritation.
*Avoid shaving the affected areas to prevent skin irritation.
*Don’t smoke. Smoking can worsen symptoms and trigger new outbreaks.
Excess weight increases the number of areas where skin rubs together â€” for example, between skin folds â€” causing friction, increased perspiration and bacterial growth. Though weight loss won’t cure the disease, it may improve symptoms.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose