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Exeter Trichology Blog
9th March 2016

We all know the link between cigarette smoking and increased morbidity. There has also been much documented evidence about the effects of tobacco smoking and its effect on premature skin ageing, but is there a link between smoking and hair loss?

A cross-sectional study in 2007 conducted in Taiwan demonstrated a significant link between smoking status and hair loss that was independent of age and genetic history. Male pattern baldness runs in families but it is also subject to environmental factors.

Evidence supports that smoking increases oxidative stress and this is pivotal in the ageing process. Ageing hair results in a decrease in melanocyte function or greying, and a decrease in hair production or alopecia. The mechanism by which cigarette smoking leads to hair loss are not fully understood. It is thought to be multi-factorial perhaps through damage to the micro-vasculature of the dermal papilla and to the DNA of the hair follicle.

Studies also claim that there is a link between common baldness in men and an increased risk of cardiovascular disease. The British Heart Foundation (BHF) warns men not to be alarmed by these findings.

"More research is needed to confirm any link. In the meantime, it's more important to pay attention to your waist line than your hair line."

The link between heart disease and baldness is unclear but baldness may be a sign of pre-diabetes, chronic inflammation or an increased sensitivity to testosterone, all of which increase the incidence of cardiovascular disease. Early hair loss in a smoker may be a warning signal of more serious damage elsewhere in the body.

Whilst hair loss may be attributed to many other reasons, if the link between hair loss and smoking is in the public’s awareness then it may encourage more people to quit smoking.

21st January 2016

PRP is marketed as an effective safe alternative treatment for hair loss in both men and women, but does it really work and what exactly is it?

What is PRP?
Human blood contains specific plasma rich growth factors that assist in wound healing and tissue regeneration. For many years platelet rich plasma or PRP has been used to augment other medical therapies with its ability to promote wound healing and more recently with its aesthetic and skin-rejuvenating effects.

PRP therapy has attracted attention recently as a promising treatment for hair loss, although the method of treatment is still in the early stages of being researched and more extensive studies are required. The role of PRP in hair restoration is to prolong and stimulate inactive hair follicles, into an active growth phase.

How is it performed?
Approximately 10mls of blood is drawn from the patient. The blood is spun in a centrifuge which separates the plasma from the red blood cells. Through a process of micro-needling the highly concentrated platelet rich plasma is injected into the scalp.

Patients require at least two sessions, one month apart before any results are seen. Typically 3 sessions over a 3 month period are required with maintenance sessions every 3 - 4 months. It can be used concurrently with other non-surgical treatments, minoxidil and DHT blockers but it does not offer a permanent solution to hair loss unlike hair restoration

Does the treatment hurt?
Patients should only experience very mild discomfort without anaesthesia. This largely depends on the expertise of the practitioner, the method of injecting or micro-needling and skin sensitivity.

Does PRP really work?
Reportedly some patients respond well and perhaps this could be a method of treatment for carefully selected patients, particularly those that are not suitable for other hair loss treatments or surgery and the treatment is without side-effects. As with all hair loss treatments, one needs to have realistic expectations and results cannot be guaranteed.

22nd July 2015

There is much controversy and skepticism regarding hair loss treatments and many people spend hours trawling the internet for various hair loss cures without firstly establishing a diagnosis. While female pattern hair loss (FPHL) is the most common cause of hair loss in women, other causes are possible or there may be multiple causes.

Treatment needs to address every contributing factor and tailored to the individual, including the cause, age, life style and ultimately cost.

A number of people are lucky and may stumble on the correct treatment whilst others may stop because they get frustrated with the slow results or simply become disillusioned, or they have unrealistic expectations.

If you want to address your hair loss issues you firstly need a correct diagnosis, support from someone who you can trust and ultimately dedication and commitment to follow a long term treatment programme. Don’t procrastinate, seek advice and don’t put off starting treatments. Hair loss treatments are more effective if commenced within the first five years of onset. Give treatments long enough to work, usually six to twelve months. It can be hard to tell if a treatment is working or not; take photographs or go for follow -up appointments. If a treatment stops working, reassess: have there been any changes in your health or circumstances? Not all hair loss treatments work for everyone.

These are photos taken by the patient to address her hair loss. She was diagnosed with FPHL, they may not be the usual like for like photos, they are not enhanced and the final photo was taken in preparation for her wedding, she reports 3” of new hair growth. no extensions, no concealers or hair fibres, just a lightly back combed fringe.

For more advice or to book a consultation, which includes 6 months email support, follow the link on the contact page.


24th February 2015

Hair loss during chemotherapy is often perceived as one of the worst anticipated unwanted side effects by patients. Often both men and women do not realise how important their hair is to them until they face the prospect of losing it.

Chemotherapy drugs have been developed to attack rapidly dividing cancer cells, but they attack healthy cells that divide rapidly too. Hair follicle cells are some of the fastest-dividing cells in the body, which is why many chemotherapy patients lose their hair. Chemotherapy may cause hair loss all over the body, not just on the scalp.
Some chemotherapy drugs are more likely than others to cause hair loss, and different doses can cause anything from a mere thinning to complete baldness.

Chemotherapy and  hair loss. What to expect. 

Hair usually begins falling out one to three weeks after treatment is started. Hair loss may continue throughout the treatment and for a few weeks after completion. There may be an associated tenderness of the scalp.

Fortunately, hair loss secondary to chemotherapy is often temporary. The hair can be expected to regrow three to 10 months after completion of the treatment, although the hair may be a different shade or texture.

Unfortunately no treatment exists that can guarantee prevention of hair loss during or after chemotherapy.

Scalp Cooling

The cold cap or scalp cooling has been developed to prevent or reduce hair loss during chemotherapy.

During chemotherapy, scalp cooling devices are placed on the head to slow blood flow to the scalp. It is thought that by reducing blood flow to the hair follicles, the chemotherapy drugs are less likely to affect the hair follicles thus reducing hair loss. It is not effective in all cases and some people have problems tolerating the device.

Scalp cooling is not suitable for all chemotherapy patients. It’s use prolongs the administration of the chemotherapy. Additionally it is not available at all oncology centres.

Please email for advice on how to care for your hair during and after chemotherapy.

8th February 2015

How Many New Mothers Experience Hair Loss After Child Birth?

Post-partum effluvium can affect as many as 40% of women following childbirth. Hair can be shed at an alarming rate causing great distress and emotional upset. Even for women who are aware of post-partum effluvium, its arrival is often unexpected and there is the fear of when will it stop.

What happens during pregnancy that causes this effect?

From approximately the second trimester the mother’s hair is usually at its absolute best. It is fuller, shinier, and more manageable. The improvement in the hair is largely due to the effect of the increased levels of oestrogen. Normally 85% of the hair is in the growing phase (anagen) at any one time. Oestrogen prolongs anagen and increases the ratio of hairs in anagen. The number of hairs shed each day is also greatly reduced, thus giving the effect of thicker, fuller hair.

Approximately 4 months post-partum (longer if you are breast feeding) the oestrogen levels fall back to pre-pregnancy levels. This causes a large shift in the number of hairs entering the telogen phase, and basically the hair that would have normally been shed during pregnancy is shed over a 2-7 month period.There is much variation in this and some women notice no increase in shedding. Breast feeding can delay this process or slow it down as oestrogen levels fall at a slower rate.

In most cases hair will be replaced. Often women forget what their pre-pregnancy hair was like and they complain that their hair has never regained its former density. There are other factors that can also affect hair loss and regrowth following childbirth, these include iron deficiency anaemia, post-natal depression, a traumatic labour, blood loss, and dietary deficiencies.

Women are often anxious to get back to their pre-pregnancy weight and in particular if they are breast feeding they are failing to take sufficient nutrients to maintain healthy hair growth.

It’s perfectly normal to lose hair after child birth and this can occur with one pregnancy and not another but if you become concerned or feel that your hair loss may be due to another cause, please call for a consult or further advice.


26th January 2015


In order to understand the causes of hair loss we need to explore the hair growth cycle.

There are three main stages to the hair growth cycle:

The first phase is the growing stage. Hair grows at about 1.25 cm each month, and this phase can last between 2 and 7 years. Hair growth is very active during this period and division of the cells is rapid. Eighty-five percent of the hair on one’s head is in this state at any one time. Stress, disease and poor nutrition can potentially affect hair during this period and disrupt the growth cycle.

Also known as the transition phase. As this phase begins the hair bulb detaches from the dermal papilla. the follicle shrinks and the hair shaft is pushed up. This period lasts for about two to three weeks.

This is the resting stage, during which there is no hair growth. This phase lasts about 3 months. At the end of the resting phase, the hair is shed (exogen), and the follicle starts to grow a new one. At any one time, only about 10% -15% of hairs are in the resting phase. It is normal to shed 50 - 100 telogen hairs on a daily basis.

Any disruption of of the hair growth cycle can result in hair loss. If there is an imbalance between the anagen and telogen stages, when more hairs enter the telogen phase prematurely, there results diffuse hair loss (telogen effluvium).

Follicles may temporarily fail to enter anagen after the telogen phase, which causes hair thinning. Hair thinning may therefore not necessarily be due to an increase in hair shedding, as can occur in the context of iron deficiency anaemia.

The development of androgenetic hair loss is seen with shortening of the anagen phase of the hair cycle with an increase in the proportion of telogen hairs.


9th January 2015

How does dieting affect hair growth?
Healthy hair, amongst other things is dependent on a balanced diet. The cells of the hair follicle are some of the most active cells in the body. Extreme calorie restriction with subsequent inadequate energy supply of the hair matrix is thought to be a cause of hair loss.

In the context of weight loss, whether it is due to calorie restriction, nutritional restriction or excessive exercise, energy that is normally available for hair growth is redirected to more essential needs. Therefore any diet that restricts calories or certain food groups to the extent that you are missing out on certain nutrients may affect hair growth. Additionally, diet pills can cause a change in metabolism and consequently hair loss.

The physical stress exerted on your body by weight loss can trigger a condition called Telogen effluvium, which results in increased hair shedding and loss. Usually full hair growth will return once imbalances are corrected but it may take several months.

There are many recognised diets that will enable you to achieve safe weight loss whilst maintaining a healthy nutritional intake and healthy hair.

31st December 2014

Biotin deficiency is rare but low levels may result in brittle nails, dry skin and hair loss. Advocates claim that by taking biotin supplements or even washing your hair in biotin enriched shampoos can thicken the hair and stimulate hair growth. For this reason it usually features in many hair and nail supplements. Whilst the role of biotin in treating hair loss is unclear it is generally felt that there may be some improvement in the keratin infrastructure of the hair, particularly if the hair is dry or brittle. However, there is some evidence that biotin may benefit children with alopecia areata. In 1999 a study published found that taking supplements containing both zinc and biotin while topically applying clobetasol propionate (a synthetic steroid hormone) may help reduce the hair loss associated with childhood alopecia areata.

What is Biotin ?

Biotin, also known as vitamin B7 is a water soluble B vitamin and it is important in metabolism, helping your body to process energy and transport carbon dioxide from your body's cells. This vitamin is naturally present in many foods, including wholegrain cereals, dairy products, egg yolks, chicken, salmon and nuts. Our bodies can also synthesize significant quantities of biotin, by means of naturally-occurring intestinal bacteria and a significant fraction of the body's biotin is recycled. Those susceptible to deficiency include persons taking long term antibiotics, anticonvulsant therapy, or consuming excessive amounts of alcohol.

Recommended dose of Biotin.

The recommended daily intake for an adult is 30mcg which can easily be obtained from the diet. Many supplements contain in excess of 5000mcg / day and this dose is generally considered safe although a question has been raised about the safety of higher doses. Possible signs of biotin overdose include slower release of insulin, skin rashes, lower vitamin C and B6 levels and high blood sugar levels. There are also claims of acne particularly in those with a previous history of the condition.

Whilst biotin deficiency can cause hair loss, it is more likely that your hair loss may be due to another pathology. Biotin supplementation may help to increase elasticity particularly if your hair loss is due to breakage. Be cautious of taking high doses which could be potentially harmful and unnecessary.

Nicola Hemsley AIT
Advice and treatment for hair and scalp conditions
Female Hair loss
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Nicola Hemsley
Southernhay Clinic 
4 Barnfield Crescent
Tel: 01392 430115
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