Is my regrowth a positive sign?

My hair is regrowing. There are tufts. It's more than a centimetre. Is this a positive sign? These are all questions that I've seen before, and ones that gain so many responses on forums or social media feeds. Understandably, any regrowth can be exciting and exhilarating and maybe, just maybe a sign that your immune system is back under control and leaving your hair alone! Or maybe not...

Hair regrowth will vary from person to person; I've met people who have lost all their hair, then almost immediately received full regrowth which has lasted for months or years or to this day. Others who are in a perpetual cycle of shedding, growth, shedding, growth, shedding again. Then of course there are people just like me who have seen no more than a millimetre of growth or the odd longer hair, but never for very long!

As well as being unpredictable, it also means it is impossible to determine a pattern and even more difficult to determine what the hair regrowth may mean. To understand it even a little bit, we have to look to the causes and process of alopecia...

Each individual hair naturally goes through a three phase cycle, and it does so over a number of months, at a different rate / time to the hair next to it. The cycle is:

• Anagen Phase: In simple terms, this is the 'growth' phase of the hair. Each individual hair grows for somewhere between three and five years, reaching lengths of up to 30 inches in most people. With good care, diet and a bit of luck, this phase can last up to seven years, reaching lengths of up to a metre! That's if you let it grow out of course!
• Catagen Phase: Occurring immediately at the end of the Anagen Phase, the Catagen phase is a transitional period for the hair, when the hair follicle begins to collapse. This indicates the start of the shedding period and can last up to 10 days.
• Telogen Phase: An immediate follow-on from the Catagen phase, Telogen is a period of 'rest' for the hair follicle, lasting around three to four months for each individual follicle. The hair follicle releases the hair shaft (the individual strand of hair), which is shed from the head and falls out. The hair follicle remains in this period of statis, before returning to the Anagen Phase to start growing again.  

At any one time, 90% of the hair on your head is in the Anagen Phase and you will lose approximately 80 hairs per day from the head. As each individual hair is at a different point in the cycle, it means that in normal cases, you won't see any thinning or baldness. When this cycle becomes interrupted however, it will cause baldness or patches of baldness, which may have many triggers.

What this means is that any hair regrowth is in itself positive because it means the hair follicles are still able to enter the Anagen phase and able to produce new hair shafts, which could signify a return to a full head of hair in the future. Unfortunately, the longer hair follicles go without growing new shafts, the less likely they will restart or be able to restart BUT again, this is not a certain outcome either! To explain, we need to revert to the examples included previously, which show that hairloss and regrowth is unique to the individual...

• Some people will be a permanent state of flux, growing hair, losing it, growing it again, and it is likely will be like this forever
• Some people will have no regrowth at all for years, only to regain it again out of the blue
• Some people will have almost instant regrowth, which may or may not stay forever

Looking at the hairloss cycle, it is clear that any regrowth is positive in as much as the hair is growing, but that is about all you can draw from it! Those experiencing hair regrowth should be happy, but also wary and honest with themselves that it may change just as quickly, taking each day as it comes, and those with no regrowth ever should not be disheartened that it will be this way forever, as it may change on a coin flip too (not literally).

So yes, it's positive, but no it might not mean anything either!

Victoria x

www.prettybald.co.uk Twitter: @PrettyBald

Sarah Vine and a BBC Radio Five Live interview...

You may or may not know that famous British journalist Sarah Vine (also married to Michael Gove), suffers from thinning hair and has had since she was 14. Well yesterday, she shared an in-depth insight into her own experiences, in her Daily Mail column; from covering it up, to destroyed self-esteem and even a few treatments she tried along the way!

Whilst she and I have differing hairloss conditions - for Sarah it's female pattern baldness AND telogen, for me it's Alopecia Universalis - it seems our own experiences have seen many similarities along the way.

For example, Sarah says "I stopped exercising, not just because I was embarrassed about the way the thinning strands would separate and cling unflatteringly to my scalp when I sweated, but also because there didn't seem much point when my ugliness was on the top of my head for all to see." Whilst my hairloss was slow and wasn't an all-over shedding, when my alopecia was in the initial stages, I remember tipping myself upside down in a yoga class, giving myself a head rush as I straightened suddenly, realising that the patches would be on show for all to see if they opted to look through the window. In a crowded gym, where many attend to 'show off', I remember feeling like a fraud for being there when I was somehow less than perfect! Needless to say I cancelled my gym membership and have failed to rejoin since!

Reading on in her column, this also made me nod vigorously to myself "It fundamentally damaged my sense of self as a female, too. So much of the culture of beauty revolves around having long, thick, glossy locks that I felt I could never match up. I was so pathetically grateful for any male attention I made some seriously unwise choices in that department." Whilst I can't concur in the men department, I do remember struggling with the social 'ideal' that is oft foisted upon us. As my friends posted facebook pics of their new cuts, colours and styles, I was carefully scraping and securing strands of hair over ever-enlarging patches in a hope I'd get away with it a little longer and cringing at the sight of my odd head shape in a bad wig. In fact, sentences like these simply serve to remind me of the survey results from Dove US which highlighted 44% of women stated they were 'defined' by their hair - not just that they liked it, but that it was intrinsic to who they are as people! Sad but true!

One final point that I really related to was this: "...at the end of the day, it’s true: hair loss may be demoralising, undermining, upsetting and even embarrassing. But it is not fatal." Whilst the phrase "Its just hair" was one of the ones I frequently heard AND hated, at the end of the day it is just hair and I am grateful I'm not sick! Don't forget, search #100HairFreeDays above to check out all the positives of hairloss I've identified.

I'm seriously impressed with how open and honest Sarah Vine's column is on this subject and how brave she is to share the pictures, and I think she makes some very true and valid points! I only hope it serves to help those that read it, hairloss sufferer or not, and at the end of it all will somehow improve and diminish the stigma that many of us feel within society. The only difference (well actually there are many) between mine and Sarah's experience is that she's found comfort in a weave to cover it up, and I've embraced regular wig wearing, and more often than not you'll find me bald-headed too!

Following her fabulous column, which you can read here, BBC Radio Five Live interviewed Denise Hayes on the challenges she faced getting a job with a similar hairloss condition, highlighting just how appearance can contribute. Following the two, I am very proud to announce that in just over an hour, at approximately 10.35pm, I will be talking live on BBC Radio Five Live and you'll be free to listen in here. I'll be part of a much larger feature on hairloss in general and will follow an interview with Sarah Vine! Wish me luck! If I can, I'll share a link tomorrow and don't forget if you miss it you'll be able to listen again on BBC iPlayer!

Victoria x

www.prettybald.co.uk Twitter: @PrettyBald

Interview with a Trichologist - talking everything Alopecia with @Mark_Blake

Mark Blake is a celebrity Trichologist, drawing on years of experience as a hairstylist, to support men and women with hair thinning and hairloss issues. A comment I often hear from Alopecians and an experience I once shared was that "Trichologists can't help and just rip you off". Mark has restored my faith in their profession after my own first disastrous experience elsewhere and whilst he can't help cure my alopecia, he has huge success with other types of hair conditions and hairloss. Here at Pretty Bald, we put him through his paces answering all things Alopecia and here's what he had to say...

Q1: What is Alopecia? 
Alopecia is a generic term for any type of hair loss, including male pattern baldness, but it is commonly used to specifically refer to the Universalis, Totalis and Areata forms of the condition where the immune system attacks hair follicles.

Q2: What is the difference between these three types of Alopecia? 
The main difference between these three types of Alopecia is the amount and pattern of the hairloss, (although there are numerous other types of Alopecia that can affect someone). Alopecia Areata is a patchy hairloss, mostly from the head and usually in circular patches. Alopecia Totalis refers to total loss of scalp hair, and may appear initially as Areata before progressing to total hairloss. Alopecia Universalis refers to total loss of hair, including all scalp and body hair.

People can progress through these different stages quickly over just a few days, or slowly over several years, and not everyone will progress to Universalis either.

Q3: What causes it? 
Alopecia is a disease of the autoimmune system where the immune system becomes overstimulated and attacks healthy cells. The causes are still a bit of a scientific mystery, however more work has been done to solve alopecia in the last few years than ever before. Research shows that this process does not just affect hair follicles, but also attacks cells in the skin and nails too.

Q4: What happens to the hair? Is it dead? 
The body attacks its own hair follicles by mistake thinking they are a foreign body; despite attacking the follicles, they don't die, the hair simply stops growing. Hair growth goes through several phases including the Anagen (growing phase) and a stage called the Telogen phase where the follicle rests before growing again. Each hair enters the various phases at a different stage and because the head has so many hairs on it, despite many being in the Telogen phase the individual will still have a full head of hair. With alopecia, all the hair follicles enter and remain in the Telogen semi-permanently or permanently, waiting for the signal to start growing again which doesn't come. Over time, the likelihood of the hair regrowing is diminished, but in the right circumstances it is always possible that the hair will start growing again.

Q5: What can be done to prevent it happening? 
Unfortunately, not enough is known about alopecia, so nothing can prevent alopecia from happening. Hopefully in the future this will become a fully preventable and treatable disease, however for now you only know about it when you've got it.

Q6: Is there anything that can be done to treat it?
Some treatments are available, all with varying degrees of success. The effect of the treatment will vary from person to person, meaning some will be effective and sometimes they simply won’t work, at the same time leaving you with uncomfortable or difficult side effects. If you do start suffering from alopecia, the best thing to do is ask your Doctor for a referral to a dermatologist, or opt to visit a Trichologist if you would prefer. Some of the treatments available include:

• Scalp irritants - strange as this may sound, irritants like DCP or Dithranol are painted onto the scalp creating a burning sensation and redness. The logic is that through either an irritant or allergic reaction, they will provide a 'distraction' for the immune system, hopefully improving the long-term balance of the body, and enabling the hair to regrow. The expected side-effect is raw, irritated skin that can be quite painful, but which will heal; the physical response of the body is usually mixed, and whilst it can be really effective for some, and totally non-effective for others. 
• Corticosteroids - either applied topically as a cream, or injected direct into the scalp, corticosteroids can help suppress the immuno-effects, enabling the hair to regrow. For some people, a single course of treatment will be enough for permanent regrowth, whereas in others the effects will be temporary or even non-existent. Short-term used, particularly when topically applied will have limited side-effects, but if taken orally or used over long periods, side-effects can become more pronounced. It's worth noting that the scalp injections can be pretty sore too!
• Minoxodil - Minoxodil is a topical scalp treatment; it is a synthetic drug used in the treatment of hairloss, and is most effective for patchy hairloss. It helps to suppress the immuno-effects, enabling the hair to regrow and fill back in. It is not normally effective for long-term use or for widespread hairloss, and can cause skin irritation. 
• High-dose zinc - zinc is required for healthy growth of the skin, hair and nails and in some cases, has proved effective for alopecia patients. It is however required in very high doses and side effects include vomiting and diarrhoea. 
• Immuno-suppressant drugs - used to 'switch off' the immune system, providing time for the hair to regrow, immuno-suppressant drugs are almost universally effective; BUT before you get over-excited, use can only be short-term due to the increased risk of contracting infections, and the negative effects on organs such as the liver. This means that although in many cases the drugs will be effective whilst you are taking them, many will lose their hair again when the treatment is stopped.
• Light treatments - including UVB exposure which has been effective in a few limited cases, but which is more likely to simply increase the potential for skin cancer, and exposure to UVA light when combined with oral light-sensitive drugs. The idea is that the skin will be partially damaged and the body will focus on skin repair rather than attacking itself. 

As well as pharmaceutical solutions which have varying degrees of effectiveness, some people have had success with changes in diet or addition of specific minerals or vitamins if they are found lacking. Realistically however, it is entirely possible that your alopecia will be untreatable and that's why support from organisations like Alopecia UK may be a viable, more long-term solution.

The above list is by no means a definitive list of treatments, but is an overview of some of the most common ones you could be offered. More information can be found on the Alopecia UK website here, 

Q7: How long will alopecia last?

The time someone will have alopecia will vary from person to person and in some will be weeks or months, whereas in others it will be permanent. Generally the rule of thumb for hairloss is that "the quicker the hair grows back the better the long term stability of the hair is"; the important thing to remember though is that the follicle is not dead and hair could start to regrow at any moment if something in the body’s immune system flicks the relevant switch on!

Q8: What does the latest research into the condition show? 

There has been a lot of different types of research going on, but most recently, the focus has been on JAK inhibitors in a new study by Dr Angela Christiano. JAK inhibitors are already being successfully used for other conditions, and recently reversed hairloss in people with alopecia areata. There were only three participants in the study, but all of them saw their hair grow back after five months of treatment. This theory is now being put to the test on a larger scale in partnership with the Department of Dermatology at Columbia University Medical Centre with a clinical trial in humans.

Q9: Can Trichology help with alopecia? 

Given the unpredictable nature of alopecia and the limited effect of treatments, it is difficult for many professionals to help and support with the condition. Trichologists can help with the early diagnosis of alopecia, identifying the condition, monitoring its progression, at the same time providing reassurance and passing on information about support groups and social networks for alopecia. Some topical treatments (irritant sensitisers) are also available from trichologists.

Q10: Is there anything else about alopecia that our readers might find interesting? 

Yes. All of the world's leading scientists are meeting in Miami USA from November 18th –21st to share the latest research on Alopecia and hairloss. I am one of the delegates attending the ninth World Congress for Hair Research and will be reporting for Pretty Bald as one of only a few British delegates attending.

One final piece of advice, the most important thing is to ask yourself what your ultimate objective is and whether the treatment is really worth it? This is a very personal question, but alopecia sufferers should take care to be true to themselves and to ensure they focus on realistic outcomes rather than risk compromising their health through long-term treatments that aren't working. 

Thanks very much Mark! We'll put you through your paces with another interview again soon! 

In the meantime, anyone interested in talking to Mark, he can be reached through his website, or you can follow him on Twitter @Mark_Blake.

Victoria x

www.prettybald.co.uk Twitter: @PrettyBald