Age-related trichology: aging processes of scalp and hair

Anna Khaldeeva , dermatovenereologist, trichologist, cosmetologist, injectionist, hair transplantologist, founder of the " Derm Space " clinic, president of the All-Ukrainian Association of Children with Alopecia " At the Same Time in Harmony ", member of EADV, EHRS, UADV, ATU.

Trichology... Popular in recent times, but at the same time remains incomprehensible to many. Why is it unclear? I think this is due to the different perception of hair loss between the patient and the trichologist. For a doctor, “My hair is falling out” is a much broader concept and includes more than 15 diagnoses, with different clinical and trichoscopic manifestations.

Recently, there has been a trend of preventive visits to a trichologist. This makes me very happy: it means that awareness and self-care is becoming a priority for Ukrainians. But are trichologists ready for preventive visits? What do you think, colleagues?

The awareness of patients is directly proportional to the attitude of the doctors themselves. The latter are accustomed to a tough problem.

It’s just that before, people didn’t come to doctors with the complaint: “I just want to check my scalp and hair and know that everything is fine,” or “I had Covid 19 a month ago, and I want to play it safe,” or “I’m 45 years old. and I would like to slow down the aging of not only my skin, but also my hair.” As a clinician, I was at a loss at the first such requests. It’s good that only recently my colleagues and I raised the issue of trichoscopic criteria for a healthy scalp, which we will discuss below.

I think that the reason for such increasing preventive visits with a request to look, comment, recommend care, give recommendations is Covid-19. There are many post-Covid and post-vaccination requests. People are frightened, many come with a serious baggage of concomitant diagnoses, many take psychotropic, cardiological drugs, antiplatelet agents, vitamins, non-steroidal anti-inflammatory drugs, antibiotics with antiviral agents.

In order to distinguish an emerging problem in its preclinical manifestations, you need to clearly know the criteria for healthy scalp and hair, as well as the features of aging of the scalp and hair.

It takes time for preventive visits to a trichologist to become the basis. At the moment, there are no fewer complex trichological diagnoses and advanced conditions.

What should the scalp look like during natural aging?

Skin aging is an irreversible complex process associated with genetic, hormonal and environmental mechanisms. Unlike skin, hair aging is a relatively recent topic of interest in the dermatological community.

Hair, like skin, is affected by biological (internal) and external (environmental) aging processes.

Both processes occur in conjunction with each other and influence each other . Let's remember the key factors:

External:

• UV radiation;
• free radicals;
• unfavorable environmental conditions;
• allergens;
• mechanical damage to the skin;
• smoking;
• unbalanced diet.

Internal:

• genetic;
• nervous (mental stress);
• immune (immune status disorders);
• hormonal.

What is an indicator of aging scalp and hair?

1. Progressive decrease in the number of follicles in the anagen phase
2. Hair reduction in one follicular unit
3. Reducing the diameter of the rod
4. Increasing the interval between hair loss in telogen and the appearance of new hair in anagen - the “waiting phase”

What is the purpose of the aging process?

The scientific community believes that the main mechanism is associated with the stem cells of the hair follicle and includes a complex system of multicellular interaction, which, in turn, contains epithelium, mesenchyme, and neuroectoderm.

The hair follicle is an accessible model for studying the biology of hair growth and age-related changes. Particular attention is paid to the study of the Bulge - the zone included in the “unchanged” part of the follicle. This is a small cluster of cells, in the basal layer of the follicle, under the sebaceous gland, first discovered in mice. In humans, krt 15+ cells have the ability to self-renew and differentiate into several cell types (multipotency), stimulate the growth of all cell lines of the lower layer in the hair follicle, including the root sheath, the matrix of the outer root sheath, the auxiliary layer, the three layers of the inner root vagina, hair cuticle, cells of the cortex and medulla.

Causes of loss of pigment in the hair fiber

The main factors are considered:

• decreased melanin synthesis (decreased melanogenesis function - tyrosinase);
• disruption of the interaction between melanocytes and hair cells;
• slowing down the migration of melanocytes into the hair follicle;
• deterioration of hair follicle microcirculation;
• damage to melanocyte DNA by reactive oxygen species;
• genetically determined depletion of the melanocyte reservoir.

The main areas of hair aging research include the aesthetic problem of hair aging and the management of age-related features such as hair color, quantity and quality. And the main goals and objectives that the anti-aging program is aimed at are slowing down the aging process and reducing or reversing the effect of hair aging.