Spartak Kayumov talked with the head physician of the Hair Health centers Silyuk Tatyana Valentinovna.

After the last congress in Scotland, Tatyana Silyuk spoke about how the career of a trichologist began, about what they talk about at medical congresses, about modern trends in trichology.

Kayumov Spartak (K.S.) Tatyana Valentinovna, please tell us about your activities. How many years have you been working as a trichologist? Why Trichology?

Silyuk Tatiana (S.T) My parents are doctors and I have been accustomed to medical conversations in the family since childhood. Therefore, when the question of a profession arose, there was only one option - only a doctor.

The choice of trichology was, most likely, accidental. However, as Steve Jobs said: You cannot connect the dots of your destiny if you look ahead, you can only connect them retrospectively. So you have to believe that these dots will somehow connect in the future.” . When I was a student, I would never have thought that my professional activity would be connected specifically with hair, although I remember my histology exam. I got a question about the structure of the hair follicle. I had a cheat sheet with which I successfully copied. And when in the last grades of school I went to additional courses in chemistry to enter the university, the classes were held on the street where the trichological center where I work is now located.

I had my first consultation in 2000 and have been working in this field ever since. To be honest, I don't remember who my first visitor was, but I remember my third patient well. This patient, or rather a young lady, continues to visit me to this day.

K.S. Did you attend the regular (EHRS) congress of trichologists in Barcelona this year? Are you satisfied with the trip? Did you get what you expected? Who represented Russia among the speakers and participants?

S.T. This year I attended the 16th Congress of the European Society for the Study of Hair, which was held in Spain. I am satisfied with the trip, because, in addition to new knowledge, it brought a lot of positive human emotions. Barcelona offers a variety of excursions and activities, ranging from the unusual, mesmerizing creations of Gaudi to shopping for world famous brands.

Russia was represented by a whole group of doctors. There were even more of them than at the last congress in Israel. It is worth noting that Aida Guseikhanovna Gadzhigoroeva read a report on alopecia areata, which, in my opinion, was of very high quality. The report, in good English, adequately presented trichology from Russia.

Within the framework of the congress there is a specialized exhibition and for the first time the Russian company "Trilogic" presented its development to European colleagues - the latest version of the program for professional use and for research work in the field of trichology - TrichoSciencePro.

K.S. Did the congress (its organization, composition of participants and speakers, topics of reports) in Barcelona differ from the previous congress in Israel, except for the venue? If so, could you (detail on this) answer in more detail?

S.T.In contrast to the previous congress in Israel, it can be noted that the congress in Barcelona was more interesting for practical doctors. There have been many reports on the standards of trichological care for various types of hair loss, as well as trichoscopic findings that we previously did not take into account in the diagnosis and choice of therapy. That is, something that can be useful to the doctor in everyday activities. In Israel, reports with a biological and genetic bias prevailed, and this makes it difficult to understand the material, even with good knowledge of the English language.

The organization of the congress, in my opinion, was less convenient than the previous one in Israel. For example, it was surprising to me that a number of the most interesting reports could not be photographed or filmed. This was the wish of the speakers themselves. Of course, with such a busy congress program, when reports are read from 8 in the morning for several days, and they are read in different halls, you do not always have time to fully understand its value at the moment, then I would like to have some materials at hand in order, in the future, in a calm atmosphere, to analyze what was heard.

K.S. What general trends in trichology are being monitored (What general trends in trichology could you note by analyzing all the reports presented) based on the reports of trichologists at the congress? Can this be useful in the practical part of the work of an ordinary trichologist in Russia. (What, in your opinion, could ordinary Russian trichologists use in their daily activities?)

S.T.I would recommend domestic trichologists to pay special attention to the reports concerning the standards of trichological care for patients with androgenetic alopecia, as well as with alopecia areata.

It's no secret that AGA patients make up the lion's share of our visitors. And, of course, it would be correct to work according to the standard, from the point of view of providing a service and from the point of view of obtaining an effect. I would like our doctors to be more bold in using oral anti-androgen drugs like finasteride and dutasteride. Unfortunately, in our country there is a fear of prescribing such drugs on the part of doctors, and this “willy-nilly” is passed on to patients, as a result, a whole correction mechanism is skipped.

As for nested hair loss, this is perhaps the leader in terms of the number of unnecessary examinations ordered and absolutely fantastic recommendations.

K.S. We are aware of your plans to make a presentation at the next event. Could you tell about it?

S.T. If I manage to collect enough material, then at the next similar event I plan to make a report on prostaglandins. This class of substances has recently come to trichology and has already established itself as a promising option. To date, many drugs for stimulating eyelash growth contain prostaglandin analogues and give obvious results. However, there are already preparations adapted for use on the scalp.

The main drug that we use for androgenetic alopecia is minoxidil, and it does not always bring the expected effect. There is a percentage of patients who are not sensitive to it. I hope that the use of prostaglandins opens up great prospects in the treatment of just such cases. Also, in my opinion, the combination of minoxidil and prostaglandins is interesting.

K.S.Many thanks to Tatyana Valentinovna. Looking forward to the same interview with you after your trip to Scotland.

Trichologist is a doctor of narrow specialization who is engaged in the identification ( diagnostics) and treatment of diseases hair and scalp in both adults and children ( children's trichologist). This specialist develops prevention methods aimed at preventing early destruction of the hair structure, gives recommendations on proper care of the scalp and hair, and conducts some medical procedures himself. A trichologist can prescribe a wide variety of treatments, from drugs to surgery ( hair transplantation). It can also be physiotherapy procedures ( darsonvalization, cryomassage, laser therapy) and the use of various masks, herbal tinctures. In some cases, hair diseases can be treated by dermatologists or cosmetologists, but it is best to contact a trichologist when problems of this kind appear.

In order to become a trichologist, you first need to get a higher medical education after graduating from the medical faculty. Trichology is considered to be a subsection of dermatology ( dermatocosmetology), so you should complete a residency as a dermatologist. After that, you need to get the so-called additional education, that is, improvement in trichology.

Trichology ( trichos - hair and logos - science; "hair science") is a branch of medicine that studies the structure of hair ( morphology) and their physiology. Science began its development in the second half of the 20th century and continues its active development. To date, there are a large number of educational and research centers for trichology. Every day, new methods of preventive measures, diagnostic procedures and treatment regimens are being researched and developed. In some countries, there have recently been trichological centers and clinics where highly specialized professionals treat.

History contains many cultures and peoples who attached different meanings to hair. For example, in ancient Egypt it was fashionable to shave their heads and wear wigs. After that, hairdressing began its development, various hair products were made. In other nations, men were forbidden to have long hair. If a girl in Russia left her hair loose, this indicated that she was a witch.

What does a trichologist do?

A trichologist deals with the diagnosis and treatment of diseases that affect the hair and scalp. Also, a trichologist develops methods of prevention and gives recommendations on proper hair care, which are selected individually in each case.

Usually when there are any problems with the hair ( hair loss, brittle hair, dandruff) many people begin to self-medicate, which is unacceptable. Another part seeks advice from friends or their hairdresser. Some hair problems may indicate the presence of serious pathologies. And a trichologist can help deal with this.

Trichologist treats the following diseases and pathological conditions of the hair:

• alopecia ( baldness);
• seborrhea ( seborrheic dermatitis);
• psoriasis ( psoriasis);
• ringworm ( trichophytosis, microsporia);
• favus ( scab);
• folliculitis;
• trichoclasia;
• trichoptilosis;
• trichonodiasis;
• trichotortosis ( trichokinesis);
• allotrichia symmetrical limited;
• leukotrichia;
• moniletrix ( spindle hair);
• hypertrichosis;
• dandruff;
• early gray hair;
• allergic reactions.

Alopecia ( baldness)

Alopecia ( baldness) is a disease that is characterized by complete or partial hair loss on any part of the body ( more often on the head) and disruption of the new hair growth process. The causes of alopecia are hormonal disorders in the body, genetic predisposition, exposure to external factors, and taking certain medications.

There are the following types of alopecia:

• diffuse alopecia- characterized by uniform hair thinning;
• alopecia areata- absence ( dropping out) hair on some parts of the head or torso;
• total alopecia- characterized by a complete absence of hair;
• androgenetic alopecia hair loss occurs as a result of an increase in the level of male sex hormones ( androgens).

Seborrhea ( seborrheic dermatitis)

There are the following types of seborrhea:

• Oily seborrhea- a pathology that is characterized by increased work of the sebaceous glands ( excess sebum production) and is accompanied by flaking of the scalp, itching. Hair acquires an unhealthy shine, dandruff appears. If untreated, it can be complicated by the development of pustular skin diseases ( furunculosis, abscess).
• Dry seborrhea- pathology, which is characterized by a violation of the consistency ( density) sebum ( becomes viscous), which makes it difficult to separate it normally. Clinically manifested by dryness, thinning and brittle hair. It also causes itching and dandruff.
• Mixed seborrhea- this pathology combines the manifestation of oily seborrhea in some areas and dry seborrhea in others.

Psoriasis ( psoriasis)

Psoriasis is a non-infectious skin disease that is characterized by the formation of scales ( red scaly patches) or blisters ( bubbles) with clear liquid, itching. As a rule, it has a chronic course. The most common form is scalp psoriasis. The disease begins with itching. Then red spots appear, which are usually located in the forehead and back of the head. These foci of psoriasis ( scales or blisters) merge with each other and can cover the entire head. The causes of this pathology may be disorders in the functioning of the immune system, exposure to environmental factors or genetic predisposition.

Ringworm ( trichophytosis, microsporia)

Ringworm is a contagious fungal infection that affects the skin, hair, and nails. The foci of the disease are most often formed on the crown, in the region of the temple and the back of the head.

There are the following types of ringworm:

• Trichophytosis is a disease caused by fungi of the genus Trichophyton. With this pathology, clearly demarcated rounded foci of inflammation with scales, vesicles, which quickly dry out and turn into crusts, form on the scalp. Hair with trichophytosis is usually broken off at a level of 2 - 3 millimeters from the skin and looks like black dots ( so-called stumps).
• microsporia is a disease caused by fungi of the genus Microsporum. With this disease, peeling appears at the site of infection. A week later, the hair begins to break off, as with trichophytosis. If you run your hand over the hearth ( pat) where the hair is broken, they will not restore their original position. The skin in the affected area turns red, swells and becomes covered with scales.

Favus ( scab)

Favus is a fungal disease that can damage the skin, scalp, nails, and internal organs. More often women and children get sick. Favus of the scalp is characterized by the appearance of red spots with the formation of a yellow-gray crust along the edge. These foci are saucer-shaped with a depression in the center. The hair in the affected area becomes thinned, thinned ( easily pulled out), dry, dull ( as if dusty). Can acquire a specific mouse ( granary) smell.

Pediculosis ( lice)

Folliculitis

Folliculitis is an infectious disease that is most often caused by staphylococcus bacteria and is characterized by purulent inflammation of the hair follicle ( hair root). Minor damage and contamination of the skin, changes in environmental temperature, malnutrition, and the presence of chronic diseases can contribute to its occurrence. Folliculitis begins with the formation of inflammation ( redness and swelling) around the hair follicle. After a few days, a bubble forms ( abscess), filled with purulent fluid ( yellow green). After a few more days, this abscess may burst ( open up) and a dry crust will appear in its place, which will peel off. The hair that is involved in the infection is easily shed or removed. Folliculitis is usually accompanied by itching and soreness.

Trichoclasia

Trichoclasia is a pathological condition of the hair, which is characterized by their fragility. Outwardly, the hair is usually not changed, but breaks off at a distance of up to 10 centimeters from the scalp. Typically, lesions with damaged hair are round in shape. Trichoclasia can be accompanied by itching, dry scalp and flaking. The development of this pathology may be due to a genetic predisposition to increased hair fragility, exposure to external factors ( curling irons, hair dyes), improper hair care or a lack of vitamins in the body.

Trichoptylosis

Trichoptylosis is a pathological condition of the hair, which is characterized by their longitudinal section. The ends of the hair are split into several parts. Over time, this can lead to thinning, weakening, brittleness and hair loss. More often, women with long hair who do not cut their hair for a long time are prone to trichoptylosis. From gravity, the structure of the hair begins to deteriorate, and they begin to split. Split ends are caused by many factors. Some of them are the wrong hair care ( blow-drying, frequent dyeing, curling), temperature fluctuations, malnutrition and, as a result, a lack of vitamins.

Trichonodiasis

Trichonodiasis is a pathological condition in which the hair is pulled into small knots ( loops). The formation of nodules leads to tangled hair and the accumulation of dust and bacteria in these areas. Over time, the hair is injured, split ( delaminate) and break. The occurrence of trichonodiasis can contribute to existing diseases of the scalp ( accompanied by itching), inaccurate combing. Also, nodules can form due to the use of combs with sharp teeth, improper hair care.

Trichotortosis ( trichokinesis)

Trichotortosis is a pathological condition of the hair, in which their shape is disturbed and they are twisted around the longitudinal axis ( by lenght). This pathology is congenital and is quite rare, mainly in owners of blond hair. Hair with trichotortosis is dry, thin, prone to breaking off. Foci with twisted hair, as a rule, are located in the temporal and occipital regions. Gradually, if left untreated, trichotortosis can lead to baldness.

Allotrichia symmetrical limited

Allotrichia symmetrical limited is an anomaly in the development of hair, which is inherited and is characterized by the presence of symmetrical foci with impaired hair growth. Unlike other hereditary diseases, allotrichia begins to appear in adolescence. This pathology can be accompanied by the growth of thin, coarse, discolored and spirally twisted hair. Hair begins to tangle and gradually fall out. Slight peeling can be observed on the scalp.

Leukotrichia

Leukotrichia is a genetic disease that is characterized by congenital graying of the hair. This pathology is due to the absence of pigment ( coloring agent) or insufficient production. Clinically manifested by graying of hair, eyelashes, eyebrows. Also, in people with leukotrichia, the skin becomes white and sensitive to external factors.

Moniletrix

Moniletrix is ​​a pathological hair condition that is inherited and begins to manifest itself in early childhood ( in the first year of life). At the same time, on the scalp ( at the site of hair growth) form small dense nodules resembling beads. The skin becomes dry and begins to peel off. Hair takes the form of a spindle and is called spindle-shaped. Areas of hair thickening alternate with areas of thinning. Also, the hair becomes dry, brittle, split ends. Alopecia may form.

Hypertrichosis

Hypertrichosis is a disease characterized by excessive hair growth anywhere on the body ( even where it is not typical). It can develop in both men and women and does not depend on age. Excessive hair growth can occur as a result of genetic mutations, disorders in the hormonal system. Also, certain diseases can contribute to the development of hypertrichosis ( fungal skin lesions, anorexia nervosa) and taking medications ( antibiotics, corticosteroids).

hirsutism

Hirsutism is a disease that is characterized by excessive growth of hair on the body and face in women in a male pattern. Hair appears on the chin, above the upper lip, in the upper chest, back and abdomen. In this case, the hair becomes dark in color and becomes stiff. This pathology is associated with an increase in the level of male sex hormones ( androgens) in a woman's blood. Hirsutism often leads to menstrual irregularities, uterine bleeding, and infertility.

Dandruff

Dandruff is a syndrome that is characterized by prolonged detachment of white scales from the scalp. Often this syndrome develops in people with oily hair. The causes of dandruff are considered improper care of the scalp and hair, lack of vitamins in the body, reduced immunity, constant stress.

early gray hair

Early gray hair is a pathological process characterized by the appearance of gray hair ( bleached) hair under the age of 25 years. The causes of early gray hair are thyroid disease, iron deficiency anemia, gastritis, genetic predisposition, nervous stress, frequent chemical exposure to hair ( dyeing, curling). All these reasons can lead to disruption of melanin production ( coloring hair pigment).

allergic reactions

If allergic reactions occur that affect the scalp, it is also necessary to contact a trichologist. Allergies can result from hypersensitivity ( individual intolerance) to certain substances or tissues. An example would be the use of hair dye, shampoos, gels, wearing hats. Allergies may not develop immediately, but after several such procedures. Initially manifests as redness of the skin, the formation of a rash or blisters ( bubbles with liquid). Then itching and burning join, peeling appears. Gradually, the hair begins to thin and fall out.

How is a trichologist appointment?

To visit a trichologist, it is recommended to follow some simple rules. The day before the consultation of this specialist, it is necessary to wash your hair with a shampoo that the patient uses constantly. Directly on the day of the examination, it is recommended to exclude tight tightening ( weaving) hair, the use of any cosmetic products on the hair ( gels, varnishes), the use of curling irons, ironing.

The appointment with a trichologist begins with a detailed survey ( history taking) of the patient. The doctor asks about complaints, finds out when they started and what the patient associates with it ( followed by symptoms). It is necessary to clarify if any symptoms increase or decrease after certain exposures or circumstances. You also need to find out if any self-treatment was undertaken ( creams, masks, therapeutic hair lotions, vitamins), how the body reacted to it and clarify the features of hair and scalp care. When questioning, the presence of chronic diseases, family history ( with hereditary pathologies), the patient's lifestyle, bad habits and diet.

After collecting an anamnesis, the doctor proceeds directly to the examination. At the same time, the condition of the scalp and hair is examined and assessed. After examination, the doctor can suggest what causes could cause a particular disease. Depending on the alleged pathology, additional tests or examinations are prescribed to confirm or exclude it. After receiving them, the doctor compares all the received data about the patient ( complaints, results of inspection and research) and prescribes a course of treatment that improves the condition. These can be medicines or homeopathic remedies, herbal tinctures, physiotherapy or surgical treatments. In some cases, the trichologist may appoint consultations of other specialists. Also, the doctor may recommend the use of certain scalp and hair care products that are suitable for this patient. The result of treatment will depend on the right scheme and on the patient's attitude to the doctor's prescriptions. In order to achieve the most positive result ( effect) it is necessary to follow all the recommendations of the doctor and in case of any questions, do not postpone and do not hesitate to ask them.

What are the symptoms of a trichologist?

In case of symptoms that affect the scalp or when hair damage occurs, it is necessary to consult a specialist such as a trichologist. If the hair begins to fall out, becomes dry or greasy, thin and split, loses its luster, you can not self-medicate. With the appearance of some peeling on the scalp, dandruff and itching, it is necessary to seek help from a trichologist. Only this specialist will help determine whether the symptoms that have arisen are associated with cosmetic products for the care of the scalp and hair, or whether their appearance is caused by the presence of any disease. It is very important to contact a trichologist in time, so as not to miss the time when you can still save your hair and get rid of pathological conditions.

Symptoms that should be referred to a trichologist

Symptom	Origin mechanism	What studies are performed to diagnose the causes of this symptom?	What disease can this symptom indicate?
Hair loss and thinning	mechanical damage; exposure to low or high temperatures; hormonal disbalance; malnutrition of hair follicles; long-term use of certain medications; outcome of radiation therapy and chemotherapy.	survey; inspection ( visual); inspection under a Wood's lamp; scalp scraping; hormone analysis; spectral analysis of hair for trace elements; densitometry; Savin scale; trichogram; phototrichogram; hair tension test.	alopecia; seborrhea; psoriasis; ringworm; favus; pediculosis; folliculitis; trichoclasia; trichoptilosis; trichonodiasis; allotrichia; moniletrix.
Thin and brittle hair	violation of normal metabolic processes; violation of the structure of the hair; the result of frequent chemical procedures ( curling, dyeing); heat treatment ( hair dryer, iron); hormonal disbalance; heredity; climate zone change.	survey; inspection; trichogram; phototrichogram;	alopecia; seborrhea; psoriasis; ringworm; favus; trichoclasia; trichoptilosis; trichonodiasis; trichotortosis; allotrichia; moniletrix; early gray hair.
split ends	lack of protective lubrication of hair; heat treatment and destruction of the hair structure; mechanical damage ( combing, rubbing with a towel); improper care; chlorinated water.	survey; inspection; trichogram; spectral analysis of hair for trace elements.	seborrhea; ringworm; favus; trichoclasia; trichoptilosis; trichonodiasis; moniletrix; early gray hair.
Dry hair	insufficient secretion of sebum; hair dehydration; violation of the microcirculation of the scalp; follicle malnutrition; insufficient intake of vitamins and microelements; improper hair care.	survey; inspection; general blood analysis; trichogram.	alopecia; seborrhea; favus; trichoclasia; trichoptilosis; trichonodiasis; trichotortosis; moniletrix; early gray hair.
Greasy hair	excessive production of sebum; hormonal imbalance; taking contraceptives; the use of oils, fatty masks for hair care; improper nutrition.	survey; inspection; general blood analysis; hormone analysis; trichogram.	seborrhea; trichoptilosis; hirsutism; dandruff.
Loss of shine (dull hair)	improper hair care; thermal and chemical procedures; lack of vitamins and minerals; insufficient consumption of drinking water; hormonal imbalance.	survey; inspection; hormone analysis; trichogram.	seborrhea; psoriasis; ringworm; favus; folliculitis; trichoclasia; trichoptilosis; moniletrix; early gray hair.
Grey hair	lack or insufficient production of coloring pigment ( melanin) in the hair; cell aging ( melanocytes), which produce melanin; insufficient intake of proteins from food; genetic predisposition; hormonal disbalance; the result of temperature and chemical effects on the hair.	survey; inspection; general blood analysis; blood chemistry; hormone analysis.	allotrichia; leukotrichia; early gray hair.
Dandruff (peeling)	violation of the microflora of the scalp; the fungus is activated; the cycle of development of the cells of the upper layer of the skin is disrupted ( epidermis); lack of vitamins; the result of improper hair and scalp care.	survey; inspection; inspection under a Wood's lamp; general blood analysis; blood chemistry; hormone analysis; spectral analysis of hair for trace elements; trichogram; phototrichogram; scraping from the scalp.	alopecia; seborrhea; psoriasis; trichophytosis; favus; folliculitis; trichoclasia; allotrichia; moniletrix; hirsutism; allergic reactions.
Itching and burning of the scalp	skin irritation; dry skin; improper care; unbalanced diet ( lack of vitamins and minerals); inadequate hygiene.	survey; inspection; inspection under a Wood's lamp; spectral analysis of hair for trace elements; trichogram; scraping from the scalp.	alopecia; seborrhea; psoriasis; ringworm; favus; pediculosis; folliculitis; trichoclasia; trichonodiasis; moniletrix; dandruff; allergic reactions.
Red spots on the scalp	development of the inflammatory process; response to a stimulus paint, shampoo).	survey; inspection; inspection under a Wood's lamp; general blood analysis; blood chemistry; scraping from the scalp.	psoriasis; ringworm; favus; folliculitis; allergic reactions.

What research does a trichologist do?

Hair is a reflection of the state of health of the body. If there are any changes in the hair ( breakout, dryness, dandruff) it is necessary to immediately look for the cause of their occurrence. That is, it is necessary to engage in timely diagnosis in order to identify the presence of a problem and begin effective treatment.

Research in trichology is based on the study of the condition of the skin and scalp. Using these methods, you can determine the causes of baldness, dandruff, and evaluate the structure of the hair.

The easiest way is to visually inspect the scalp and hair. In this case, the doctor pays attention to the amount of hair, their color, shine, the presence of foci of baldness. The color of the scalp, the presence of any spots, rashes, peeling, dandruff is determined.

There are standard laboratory research methods that are assigned to all patients, without exception, to determine the general condition of the body. There are also special diagnostic methods that are typical only for this specialization. Additional studies are carried out in almost all pathological conditions, since a simple examination is not enough to establish a diagnosis.

General blood analysis

A complete blood count is the very first and simplest test that is prescribed to almost all patients. The analysis provides general information about the state of the body.

The analysis is recommended to take on an empty stomach ( on empty stomach). Blood sampling for research is carried out from a finger or from a vein. The puncture site is wiped with a swab dipped in alcohol. The health worker makes a small puncture with a scarifier ( blade with sharp teeth) and collects blood in a special sterile tube.

In the general blood test, indicators such as hemoglobin, hematocrit, erythrocytes, leukocytes, platelets, ESR are determined ( erythrocyte sedimentation rate) . Any changes in the results of the analysis are deciphered by a specialist and give a more detailed picture of the disease.

Blood chemistry

A biochemical blood test is prescribed to evaluate and identify abnormalities in the functioning of internal organs. It is also important for a trichologist to assess the amount of trace elements that have a great influence on the formation and growth of healthy hair.

In a biochemical blood test, determine:

• squirrels ( albumen);
• enzymes ( ALAT, ASAT, amylase, alkaline phosphatase);
• carbohydrates ( glucose);
• fats ( cholesterol, glycerides);
• pigments ( bilirubin);
• nitrogenous substances ( creatinine, urea, uric acid);
• trace elements ( iron, calcium, magnesium).

The day before the date, preparations for the analysis begin. The night before, fatty, spicy foods are excluded from the diet. From liquids, you can drink only plain non-carbonated water. The analysis is taken on an empty stomach, that is, after the last meal, at least 8 to 12 hours should pass. Also, one hour before the analysis, smoking and physical activity are excluded.

A biochemical blood test is taken from a vein. A tourniquet is placed on the shoulder. In the injection area, they are treated with an alcohol swab, then a needle is inserted, and the tourniquet is removed. After making sure that the needle has entered the vein, blood is taken into a special sterile tube.

Hormone analysis

Hormone analysis is a laboratory diagnostic method that provides information about the functioning of the endocrine system. To prepare for analysis, it is necessary to abandon emotional and physical stress. A few days before the study, they exclude the intake of alcoholic beverages, do not visit the sauna. Before taking the test, it is imperative to warn the doctor if any treatment has been taken at the moment or in the last two weeks. Smoking is not allowed at least one hour before blood donation. An analysis for hormones, as a rule, is taken before 12 noon on an empty stomach. Some hormones change their values ​​depending on the day of the menstrual cycle, so women should check with their doctor before taking the test on which day it is better to take this analysis.

The main hormones for research are:

• thyroid hormones- thyroid-stimulating hormone ( TSH), thyroxine ( T4), triiodothyronine ( T3);
• sex hormones- testosterone, dehydroepiandrosterone ( DGEAS), prolactin, progesterone, follicle-stimulating hormone ( FSH), luteinizing hormone ( LG).

This analysis is taken from a vein in the same way as in a biochemical blood test. The medical worker treats the surface of the elbow with an alcohol swab, inserts a sterile needle into the vein, and draws a few milliliters of blood into a disposable plastic tube. The blood is then sent for testing. The norms of analyzes in different laboratories may vary, which is usually indicated on the sheet with the results.

Research carried out by a trichologist

Study	What diseases does it reveal?	How is it carried out?
Inspection under the Woods lamp	alopecia; seborrhea; psoriasis; ringworm; favus; pediculosis; folliculitis; trichoclasia; trichonodiasis; moniletrix; dandruff; allergic reactions.	This research method is safe and painless. Helps to identify certain diseases using ultraviolet rays. To prepare for the examination, exclude any hair products ( may distort the result.). It is recommended to wash and dry the scalp. Inspection under the Wood's lamp is carried out in a dark room. At a distance of about 10 - 20 centimeters from the skin, the doctor brings a Wood's lamp and assesses the condition of the skin. Normally, the scalp does not glow. If any luminous spots appear, the result is considered positive.
Scalp scraping	alopecia; seborrhea; psoriasis; ringworm; favus; folliculitis; dandruff; allergic reactions.	This research method is prescribed for suspected fungal nature ( reason) diseases. Three days before the test, it is not allowed to wash your hair. It is also forbidden to use any cosmetics during this period of time. Some medications may interfere with test results and may require temporary discontinuation. With a special tool ( scalpel) peeling skin flakes are collected at the hair roots ( top layer of the epidermis) for research. The resulting material is placed in a sterile disposable test tube and sent to the laboratory for further research.
Spectral analysis of hair for trace elements (hair mineralogram)	alopecia; seborrhea; psoriasis; ringworm; favus; pediculosis; folliculitis; trichoclasia; trichoptilosis; trichonodiasis; allotrichia; leukotrichia; moniletrix; hypertrichosis; hirsutism; early gray hair.	This study is a non-invasive ( without skin damage) a diagnostic method that helps determine the amount of trace elements ( mineral composition) in your hair over the past few weeks. A complete spectral analysis includes the study of forty trace elements. But it is possible to determine the content of only one trace element of interest. To prepare for the analysis, it is recommended to stop taking medications 2 weeks before the test. Immediately before delivery, you must wash and dry your head. Gels, varnishes, styling products should not be used. If you have had any chemical treatment on your hair in the last 30 days ( curling, bleaching, dyeing) must be reported to your physician or laboratory worker. For analysis, several strands about 5 centimeters long are cut off from the back of the head at the hair root and sent for analysis. Under laboratory conditions, the hair is degreased, washed and dried. Then they are placed in a container, to which a special solution is added to help dissolve the hair. The resulting mixture is loaded into the so-called spectrometer, where it burns under the influence of gas. Special sensors process data about the study and transfer it to a computer.
Densitometry	alopecia; seborrhea; psoriasis; ringworm; favus; pediculosis; folliculitis; trichoclasia; trichoptilosis; trichonodiasis; allotrichia; moniletrix.	A diagnostic research method that can be used to determine the density ( count the number) hair per square centimeter. Counting the number of hairs is carried out in problem areas ( hair loss areas) using a special densitometer device. The results obtained are compared with normal values. This diagnostic method helps to identify the risk of excessive hair loss or assess the degree of baldness.
Trichogramma (computer trichogram)	alopecia; seborrhea; psoriasis; ringworm; favus; trichoclasia; trichoptilosis; trichonodiasis; trichotortosis; allotrichia; moniletrix; dandruff.	A method of research with which you can determine what stage of growth the hair is in ( active growth, transitional stage, cessation of growth). Information is given as a percentage. To prepare for the study, at least two weeks in advance, any chemical or cosmetic ( colouring, curling, styling products) procedures with hair. It is recommended not to wash your hair five days before the procedure. The essence of the method is to extract about 60 hairs from different parts of the head and examine them under a microscope. Trichogram allows you to identify hair loss and monitor the prescribed treatment.
Phototrichogram		A more detailed and more sensitive diagnostic method than a trichogram. With this method, you can take pictures of problem areas of the hair, which enable the doctor to make certain calculations. In addition, you can determine the density, diameter, structure of the hair, assess the condition of the scalp. The difference from a trichogram is that for a phototrichogram, a small area of ​​​​hair is shaved off and the scalp is examined after a few days. The regrown hair on this part of the head is dyed with a special dye. Then, using a special device ( trichoscope) data is transferred to a computer where calculations are made to establish the correct diagnosis.
Savin scale	alopecia; seborrhea; ringworm.	This diagnostic method helps to determine the degree of hair loss in women. For this, a scale is used, which shows nine illustrations that differ in the intensity of hair loss. The illustrations begin with a depiction of minor hair loss and end with increased loss up to baldness.
Hair tension test	alopecia; favus.	This test allows you to identify pathological hair loss. To prepare for this test, you must not wash your hair for five days. The hair pull test involves the doctor grabbing a small tuft of hair between thumb and forefinger and pulling it up. This procedure is checked at several points - in the frontal, occipital and parietal regions. Pathological hair loss is said to be when more than 10 percent of the hair remains in the hands of a doctor. If there is less hair left, then this is considered the norm ( physiological hair loss).

What methods does a trichologist treat?

Hair diseases lead, as a rule, to noticeable external changes. A person begins to feel discomfort and is embarrassed to appear in society. If you experience any symptoms affecting the scalp and hair, you should immediately consult a trichologist. In some cases, when the disease is hereditary, the doctor may prescribe only supportive therapy, which will alleviate the symptoms of the disease. In other cases, the trichologist prescribes a comprehensive treatment, which is based on the use of ointments, masks, and medications. Sometimes physical therapy is prescribed. The trichologist also gives recommendations on the proper care of hair and scalp, depending on the individual characteristics of the patient. Recommends funds ( shampoo, balm, mask) with a specific composition that suits a particular type of hair. Of great importance in the treatment of diseases of the hair and scalp is lifestyle and bad habits, which must be abandoned.

The main methods by which the trichologist treats

Disease	Basic Treatments	Mechanism of therapeutic action	Approximate duration of treatment
Alopecia	depends on the type of alopecia; normalization of the regime of work and rest; good sleep and healthy eating; drug treatment- drugs that improve blood microcirculation ( chimes), sedatives ( sedatives); hair growth stimulants minoxidil); local treatment- glucocorticoids ( prednisolone), irritants; non-drug treatment– physiotherapy, laser therapy, massage; surgery- hair transplantation.	the main mechanism of therapeutic action is based on the stimulation of new hair growth; some drugs dilate blood vessels, resulting in hair follicles ( roots) receives more blood and nutrients; hair becomes stronger, thicker, the intensity of their loss decreases.	The duration depends on the type of alopecia, the severity of the disease and the correct treatment regimen; The recovery course of treatment can take from one month to several years.
seborrhea	healthy lifestyle ( good sleep and rest, normalized work schedule); it is recommended to avoid stressful situations; dieting - avoiding sweet, salty, spicy, fatty foods; local treatment- salicylic acid, sulfur, selenium, creams with vitamin F; proper and regular care of the scalp and hair ( herbal shampoos, masks); drug treatment- antifungal drugs ketoconazole); vitamins ( A, B, D, E) and minerals ( zinc, sulfur, copper); non-drug treatment– physiotherapy, cryomassage of the scalp ( under the influence of cold), magnetotherapy, electroporation, darsonvalization ( improves blood and lymph circulation), laser puncture, mesotherapy; adherence to a diet - the rejection of sweet, salty, spicy, fatty foods.	the production of sebum is normalized; improves the condition of the scalp and hair; the hormonal background is restored; fungicidal action ( inhibition of fungal activity).	The duration of treatment depends on the type of seborrhea; It is usually carried out in courses and lasts about two months.
Psoriasis (psoriasis)	stress must be avoided; follow a diet; local treatment- hormonal drugs, antibiotics; sulfuric, salicylic sulfur-tar ointment; systemic treatment griseofulvin), immunomodulators; vitamin therapy ( A, B, C, folic acid); phototherapy, plasmapheresis, cryotherapy ( exposure to cold), phytotherapy ( herbal treatment).	treatment is aimed at achieving remission ( absence of clinical manifestations of the disease); therapeutic action is based on reducing inflammation and restoring the maturation of scalp cells.	The duration of treatment is approximately 1 - 2 months.
Ringworm (trichophytosis, microsporia)	in uncomplicated forms, the disease is treated at home; drug treatment- antifungal drugs griseofulvin, fluconazole), corticosteroids; sulfuric, salicylic, sulfur-tar ointment.	the treatment mechanism is based on drying the lichen, stopping the growth of the fungus and preventing the transition of the disease into a chronic form.	Depends on the form of the lesion; The duration of treatment is about 6 weeks; With complications, it can take up to several months.
favus (scab)	shaving hair; drug treatment- antifungal drugs ciclopirox, griseofulvin), immunomodulators, vitamin therapy; lotions from vaseline oil; preventive treatment- Compliance with the rules of personal hygiene.	the therapeutic effect is aimed at stopping the growth of the fungus.	Treatment is long; It depends on how the body reacts to the treatment.
Pediculosis (lice)	isolation from healthy people for the period of treatment; shaving hair off more often in males); drug treatment- benzyl benzoate, parasidosis, permethrin, para-plus; you need to comb your hair with a comb ( crest) with frequent teeth; All items must be washed and ironed underwear and bed linen, towels); preventive treatment- hygiene, regular head examination.	the treatment mechanism is based on the destruction of lice and nits; dissolves a substance that promotes the attachment of nits to the hair ( facilitates the process of brushing them).	The period of complete disposal of lice usually takes up to two weeks.
Folliculitis	dieting ( limit your intake of fats and carbohydrates); hygiene; drug treatment- antibiotics ( cephalexin, erythromycin), antiviral, antifungal, immunomodulators, vitamin therapy ( A, C); antiseptics ( green, methylene blue); compresses with ichthyol ointment non-drug treatment- ultraviolet irradiation, laser therapy, polarized light, darsonvalization; opening of the abscess with subsequent removal of pus.	treatment is aimed at destroying the microorganisms that caused the disease; disinfection of problem areas; boosting immunity.
Trichoclasia	a diet rich in fruits, vegetables, seafood; drug treatment - vitamin therapy ( A, B, E); non-drug treatment– cryomassage, mesotherapy, darsonvalization, keratin procedures; fortified masks based on oils.	the therapeutic effect consists in the careful restoration of the hair structure, their hydration and nutrition.	The course of treatment to restore the hair structure can take about 6 months.
Trichoptylosis	it is necessary to cut the ends of the hair every 2-3 months; exclude the use of a hair dryer, ironing; exclude hair coloring; provide proper hair care; shampoo with lecithin, vitamin B5, chamomile, wheat; the use of fortified masks, creams or balms for split ends; Lamination of hair; drug treatment- vitamin therapy A, B, E).	special products for the care of split ends cover them with a protective film and restore the hair structure from the inside; vitamins help strengthen hair.	Hair restoration usually takes several months; Constant prevention is needed.
Trichonodiasis	cutting off affected hair; the use of combs made of natural materials with rare rounded teeth; dyeing, curling); cosmetic procedures– plasmolifting; masks based on tea tree and sea buckthorn oils; drug treatment- vitamin therapy A, B, E), antiallergic drugs; non-drug treatment– mesotherapy, ozone therapy, electroporation.	treatment is based on preventing the formation of nodules and alleviating the symptoms of the disease; all procedures contribute to the nutrition of the hair and the restoration of its structure; antiallergic drugs help get rid of itching; non-drug treatment is aimed at eliminating dry hair.	The duration of treatment depends on the severity of the disease and is selected individually.
Trichotortosis	prevent hair damage use combs with rounded sparse teeth; exclude chemical procedures ( dyeing, curling) and heat treatment of hair ( hair dryer, iron, curling iron); provide proper hair care moisturizing shampoo, nourishing masks and tonics); medicinal herbal serums.	the mechanism of therapeutic action is based on stopping the progression of the symptoms of the disease and stimulating hair growth.	The duration of treatment is several months; Conducted courses 2 - 3 times a year.
Allotrichia symmetrical limited	proper hair care masks with oils, mild shampoo); use of a comb with rare teeth; exclude chemical treatments for hair ( perm); drug treatment- vitamin therapy A, B, E), hormonal preparations; wearing wigs.	the therapeutic effect is aimed at alleviating the symptoms of the disease and masking the foci with impaired hair growth.	The disease is not treatable; Maintenance therapy is prescribed in courses several times a year.
Leukotrichia	It is necessary to protect the scalp and hair from ultraviolet rays ( cream, headdress); avoid stressful situations; drug treatment- vitamin therapy A, B, C, D, E, riboflavin); hair coloring.	treatment is based on maintaining the patient's condition.	It is not amenable to treatment, as it is hereditary; Symptomatic treatment is carried out several times a year.
Moniletrix	it is necessary to avoid injury and overdrying of the hair; drug treatment- vitamin therapy A, B, F, E); preparations containing phytin, iron, zinc; local treatment- sulfur-containing ointments ( sulfur-salicylic, sulfur-tar); non-drug treatment- cryomassage, electrophoresis, darsonvalization.	the therapeutic effect is aimed at improving the patient's condition and reducing the intensity of symptoms; topical use of ointments helps soften and exfoliate dead skin particles.	Not amenable to treatment; Requires ongoing support symptomatic) therapy courses.
Hypertrichosis	it is recommended to avoid mechanical and chemical skin irritation; cosmetic procedures– electric epilation, depilation, diathermocoagulation of hair follicles; drug treatment- hormonal drugs; non-drug treatment– phytotherapy ( raspberry, walnut).	restoration of hormonal levels; cessation of hair growth.	The duration of treatment varies in each individual case; Electric hair removal procedures are carried out for one year.
hirsutism	elimination of the cause; treatment of the underlying disease; dieting; drug treatment- antiandrogenic drugs, oral contraceptives ( Janine, Diane-35), glucocorticosteroids ( dexamethasone, prednisolone); non-drug treatment– phytotherapy ( walnut, dope, chestnut); cosmetic procedures- hair bleaching, shaving.	therapeutic effect is based on a decrease in testosterone levels ( male sex hormone); a positive result is characterized by a stop in the growth of new hair.	Treatment may take up to one year to achieve a marked reduction in clinical manifestations.
Dandruff	proper care, hygiene; drug treatment- antifungal drugs ketoconazole), selenium disulfide, zinc pyrithione; tar, ichthyol; burdock, olive, castor oils; non-drug treatment– physiotherapy, cryomassage, darsonvalization.	the therapeutic effect is based on the cessation of growth and the destruction of the fungus; complex treatment helps to relieve inflammation; cell division is normalized, due to which a smaller number of scales is formed.	Treatment can last up to two months depending on the severity.
early gray hair	compliance with the regime of work and rest; it is necessary to avoid stress, ultraviolet rays, temperature changes; eliminate bad habits; vitamin therapy ( A, C, E, folic acid); non-drug treatment– head massage, mesotherapy, plasmolifting, laser therapy, iontophoresis; castor, burdock oil; hair coloring.	the early appearance of gray hair is an irreversible process; the therapeutic effect is aimed at slowing down the process of early graying; hair coloring gives the hair a uniform tone, healthy shine, provides easy combing.	Supportive treatment is carried out 1-2 times a week in courses of 2-3 months.
allergic reactions	eliminate the allergy-causing factor ( care product, headwear); drug treatment- antiallergic drugs tavegil, claritin), anti-inflammatory ( advantan), antibacterial ointments ( levomekol), sedatives, enterosorbents ( activated carbon, enterosgel); non-drug treatment– phytotherapy ( chamomile, calendula, sage).	antiallergic drugs relieve itching and prevent the further development of allergies; antibacterial ointments prevent the spread of infection; anti-inflammatory drugs relieve redness, disinfect, anesthetize, promote wound healing ( when combing); herbal medicine helps to soothe the scalp and relieve redness.	The duration of treatment is 2 - 3 weeks.

A trichologist is a highly specialized dermatocosmetologist who studies the structure of the hair and scalp, the causes and mechanism of the development of pathologies, and also treats diseases of the hair and scalp.

The main problem that the trichologist deals with is children's, male and female pattern baldness of various origins and related diseases. The trichologist performs preventive procedures that keep the hair and scalp in good condition, gives advice on care, treats hair loss after radiation or chemotherapy together with oncologists, participates in doctors' consultations on the advisability of hair transplantation.

A trichologist does not treat internal organs, but can refer you for a consultation and examination to doctors of related specialties to make an accurate diagnosis. The profession of a trichologist is most closely associated with endocrinologists, gastroenterologists, therapists, pediatricians, dermatovenereologists, mycologists, epidemiologists, cosmetologists, infectious disease specialists, and oncologists. Within trichology there is a specialty of a pediatric trichologist.

Trichologist treats:

• Total alopecia and local alopecia of various origins, including genetically determined.
• Trichophytosis or ringworm.
• Early gray hair.
• Hair loss of various etiologies.
• Pityriasis - pityriasis versicolor, dandruff.
• Lichen: pink, asbestos, red flat.
• Psoriasis of the scalp.
• Microsporia and other mycoses.
• Seborrhea dry and eczema-like.
• Lice (pediculosis).
• Mentagru - lichen, localized on the chin.
• Spontaneous change in color, structure of hair.
• Manifestations of tertiary syphilis.
• Hyperkeratosis.
• Sclerderma, lupus erythematosus - autoimmune skin pathologies.
• Folliculitis.
• Excessive growth of hair on the body - hirsutism.
• Favus or scab.
• Allergic reactions.
• Excessive hairiness of the skin - hypertrichosis.

It should be emphasized that officially the specialty of a trichologist does not exist. Patients in this area are usually treated by a dermatologist, less often by a dermatocosmetologist. According to the international classifier of diseases (ICD-10), trichology is a branch of dermatocosmetology and a trichologist, as a rule, owns the methods of laser correction, cryomassage, plasmolifting, ozone, mesotherapy, electroporation, darsonvalization, electrophoresis.

In Russia, the first trichologists appeared only a few years ago.

Places of work

The trichologist works in dermatovenerological dispensaries and cosmetology clinics, research institutes, beauty parlors, conducts appointments in special polyclinics, regional hospitals.

History of the profession

Trichology is one of the youngest sciences. She was born at the beginning of the last century, in the West. In fairness, it should be noted that academician D. Wheeler was the first to show interest in hair, who, after another visit to the hairdresser, thought about the reasons for thinning his hair (1860). He wrote many scientific articles on this subject, introduced the term "trichology". However, until 1902, until the Institute of Trichology was created in London, the science of hair was not recognized as official medicine.

F. Low is considered the founder of the new direction. After 16 years of scientific and practical activity, he managed to open the world's first Scalp and Hair Hospital, which quickly gained popularity among patients and well-deserved authority. The hospital worked until the outbreak of World War II and was reopened only in 1959. On the basis of this medical institution, the training of trichologists began, first for England, and then for the whole of Europe. Today, special attention is paid to trichology in the EU countries. It has become a whole branch of aesthetic medicine.

In the Russian Federation, trichology began to develop from the end of the twentieth century, the first trichologists appeared only a few years ago. All of them have been trained in the West. Today, this branch of dermatology is rapidly developing, using modern methods of microvideo diagnostics. Trichologists use innovative pharmaceuticals, physiotherapy, the latest techniques, including laser, plasmolifting and mesotherapy. The newest trend is the gradation of science into trichotherapy and trichosurgery.

Mesotherapy is one of the treatments for baldness that a doctor uses.

Duties of a trichologist

The main responsibilities of a trichologist are:

• Outpatient consultations and inpatient treatment of patients.
• Hardware treatment: photorejuvenation, laser hair removal, non-injection mesotherapy, electrocoagulation.
• Injection therapy: mesotherapy, biorevitalization, plasmolifting.
• Drawing up individual programs for hair restoration.
• Learn how to take care of your hair and scalp. Selection of individual cosmetics, shampoos.
• Organizing and conducting phytotherapy sessions.
• Direction for hair transplantation.
• Registration of sick leave and primary documentation.

Requirements for a trichologist

Basic requirements for a trichologist include:

• Higher medical education, valid accreditation sheet in dermatovenereology or cosmetology.
• Training in trichology is welcome.
• Working with botulinum toxin.
• Ability to carry out biorevitalization with fillers.
• Compliance with the rules of asepsis and antisepsis.
• Confident PC skills, work in a single clinic information system.

Hair loss can indicate serious pathologies.

How to become a trichologist

To become a trichologist, you must:

1. Graduate from a university or medical school with a degree in General Medicine or Pediatrics.
2. Get an accreditation sheet. To do this, you need to pass the exam and successfully pass an interview with an expert commission.
3. After that, you can work with patients on an outpatient basis (for example, a general practitioner or pediatrician).
4. To obtain a narrow specialization, you can enroll in residency (2 years of study) in the specialty "Dermatovenereology", "Cosmetology", "Dermatocosmetology" (there is no specialization in trichology in the Russian Federation). Paid easier, because the competition is small and for admission you need to have only 50 attestation points. Is free You can get into residency in two ways: by competition on a general basis or by the target referral of the head physician of a medical organization in which the specialist is already working.

Each year, doctors are required to score 50 certification points. To do this, you can take advanced training courses (36 points), attend scientific and practical conferences (the number of points depends on the event, but usually about 10 points), publish scientific papers, write books, defend dissertations. If enough points are scored, then you can work further. If points are not scored, then you will either have to stop medical practice, or solve this problem in “non-standard” ways.

The experience, skill and quality of the doctor's work is usually assessed qualification categories which can be obtained by defending a research paper. During the defense, the commission evaluates the doctor's skills in the field of diagnosis, treatment, prevention, as well as the relevance of his knowledge.

What are the qualification categories?

• the second - over 3 years of experience;
• the first - more than 7 years of experience;
• higher - more than 10 years of experience.

The qualification category allows you to hold high positions in medical institutions, entitles you to a salary increase, gives you status in a professional environment and high confidence on the part of patients. Even more respect can be achieved by speaking at conferences, symposiums and creating scientific articles and papers.

The doctor has the right not to qualify, but this will hinder his career and professional growth.

Salary of trichologists

The general income range is as follows: trichologists earn from 20,000 to 250,000 rubles per month. Trichologists are most in demand in the Moscow and Leningrad regions. We found the minimum salary from a doctor in one of the Moscow medical centers - 20,000 rubles a month, the maximum - also in Moscow in a modern trichology clinic - 250,000 rubles a month.

The average salary of a trichologist is 60,000 rubles per month.

The Village rips off the covers from the head and finds out why we cannot grow hair to the buttocks, how many times a week a healthy person should wash their hair and what is the deceit of burdock oil

• Sasha Sheveleva , March 13, 2015
• 289613
• 75

In various fields of knowledge, everything is changing so quickly now that even specialists do not keep up with the changes, let alone ordinary citizens. Therefore, under the heading "What's new?" every week we hear from scientists, doctors and other professionals about how their fields of activity are changing and what these changes mean for mere mortals. In this issue of our medical detective, The Village correspondent Alexandra Sheveleva finds out from a trichologist what hair care products men can save on, but women can't, why we can't always grow our hair to the length we want, and whether we are really bald men are the sexiest.

About the short life of hair

- As it turned out, few people know what trichologists do and what kind of doctors they are.

This is a narrow specialization of a dermatovenereologist. Trichology has been actively developing in the world for a long time, and since the mid-90s, when the first trichologists appeared in our country, it has been actively developing in Russia too. In the USSR, there was no trichology as a specialty, and all hair treatment was limited to burdock oil, castor oil, pepper, burdock root and the advice not to wash your hair often.

- When a patient comes to you, what do you do with him?

The first is an examination. We must exclude internal factors that can cause hair loss, such as general diseases. For this purpose, tests are recommended (blood test for sex hormones, thyroid hormones, trace elements). Computer diagnostics are carried out to determine the type of hair loss. Under high magnification, we check the condition of the skin and hair: we evaluate the amount of hair, the percentage of vellus and thinning hair, the presence of “empty” hair follicles, inflammation of the scalp. The examination also includes a special analysis - a phototrichogram: two sections of hair of small diameter are cut to stumps of the same length. Two days later, the patient comes to the appointment and we take pictures of the prepared areas, on which the hair growth indicators are determined - the percentage of growing and falling out, hair density, growth rate. Based on the totality of analyzes, the cause of the loss, aggravating factors are determined, and a forecast is made. There is also a spectral analysis of hair for trace elements. This analysis is recommended for pathology of the hair shaft, and can also be used in combination with blood tests to diagnose deficient conditions in the body.

- In general, what do people come to you with? When everything is already completely bad (early baldness, gray hair, hair fell out)?

The attitude to hair is changing in both women and men. People already understand that a presentable appearance is not only a well-groomed face and figure, but also healthy hair. Quite young people come to us - 20-40 years old. At a later age, patients, unfortunately, are not yet accustomed to taking care of themselves, so there are not so many older patients, although according to statistics, most women and men over 50 years old have hair problems. Increasingly, men with incipient thinning, or androgenetic alopecia, seek help. This is a typical form of hair loss - the fronto-temporal angles are aggravated, the amount of hair in the crown region decreases, and a horseshoe-type thinning is formed.

Why does this happen to men?

This happens not only to men, but to women too. This is our hereditary predisposition. By and large, in modern man, hair has lost its biological significance. Now the hair has only an aesthetic function. From a physiological point of view, the body ages, and hair aging is one of the manifestations of the aging of the body as a whole. It is believed that the peak of our hair development is 16-18 years. In children, the hair is still immature (lighter and thinner), then during puberty, under the influence of hormones, the hair matures: it thickens and becomes pigmented, but it becomes smaller. In general, throughout our life there is a progressive decrease in the number of hair follicles - for example, in a newborn, the density of hair is about 1100 per square centimeter, by the age of 16 there are about 400. New ones are no longer formed.

Woman endured stress, calmed down, had already forgotten about him, and after two or three months she delayed hair reaction for stress

- From the age of 18, the death of follicles begins?

It can be more pronounced, and then such patients come to us. Now the thinning processes are getting earlier. Children of 12 years old with developing androgenetic alopecia are already brought to us. Children mature earlier and hair loss becomes more youthful.

- Is there any way to stop this?

Can. Now there are both systemic and external therapy, as well as physiotherapy.

- It turns out that from the age of 18 the hair begins to die off?

This is normal, because our skin also ages. If we are talking about women, then before the menopause, only those who are genetically determined to lose hair will feel hair loss. With the advent of menopause, hair deteriorates in all women. In women, hair loss is a combination of various factors: we are more emotional, more prone to stress, often experience depression, diets, we lose monthly iron, plus a genetic predisposition can be added.

- Does hair color affect their vitality?

Hair loss is the same for blondes and brunettes. To a lesser extent, those who have grayed early are susceptible to this: gray hair becomes less sensitive to harmful factors. If a man turns gray before he begins to thin, he will have a lion's gray mane until old age.

About how not to be left without hair

- What to do? Can you somehow slow down the death of follicles?

Yes, various lotions have been created for this, which affect the metabolism of the hair follicle. These are chemically synthesized growth stimulants that regulate the division of hair bulb cells. Recently, the use of preparations based on peptides in trichology has been rapidly developing. These are artificially synthesized active substances, which, according to the mechanism of action, resemble natural hair growth factors. In addition, there are drugs that reduce the negative effect of male hormones on the hair.

- What are the new technologies of treatment?

Probably, the use of peptides and growth factors in trichology, which can be either synthetic or isolated from the patient's blood. This is a procedure (plasma therapy), which is becoming more and more popular - plasma is obtained from one's own blood with a high content of platelets, which are the source of the main growth factors.

- Surely, lifestyle, as usual, also affects growth and thinning.

Yes, a study was conducted - the development of androgenetic alopecia was observed in twins with the same set of genes. The degree of thinning with age was different for them: those who did not smoke, ate right and led a healthy lifestyle, the safety of hair was higher.

- Serious difference?

Serious enough, noticeable to the eye.

- When do you need to drop everything and run to the trichologist? Or, if tufts of hair are already falling out, is it too late to talk to the doctor?

No, it's not too late. You need to see a doctor for a fallout that lasts more than three months. If the hair falls out for less than three months, this may be a reaction of the hair to the transferred anesthesia, surgery, trauma, illness with high fever, medication, stress. Hair follicle cells are the most rapidly dividing cells in the body, so they are very sensitive to all negative factors.

- That is, today I was nervous, and tomorrow my hair may fall out?

No. There are different stages of hair growth, the shedding stage lasts two to three months. This means that we were nervous, the hair immediately entered the stage of hair loss, stopped growing, but it will leave the head only after two to three months. It turns out that the woman suffered stress, calmed down, already forgot about him, and after two or three months she has a belated hair reaction to stress. However, if the triggering factor is eliminated, such a loss will be favorable and, with a high probability, will stop on its own. If the loss lasts more than three months, this is a reason to see a doctor. Prolonged hair loss suggests that either recurring provoking factors are at work, or there is a permanent cause that has not been eliminated.

Is it true that bald men are the sexiest?

You can see for yourself that with age, there are more balding men, while the amount of testosterone does not increase with age, but decreases. Therefore, it is important not only how much testosterone is in the blood, but also its metabolism in tissues. Low testosterone exacerbates hair loss, but what baldness says about high testosterone levels is not true.

About fighting dandruff

- Can a person himself understand that he has inflammation?

Yes. This is itching, dandruff, soreness of the skin.

- Oh, that is, dandruff is inflammation?

Of course, this is the peeling of inflamed skin.

- Why is it happening?

The most common cause is seborrheic dermatitis, a problem that most people experience during their lifetime. The kind of dandruff that we often have is inflammation of the skin against the background of excessive secretion of fat. The fact is that the scalp actively secretes a sebaceous secret, and this lard is a breeding ground for fungi - our normal microflora. The problem is more common in those who do not properly care for the scalp.

- And I remember, on the contrary, they said that if you wash your hair often, dandruff may appear.

If you wash your hair often, there may be overdrying of the skin and its dehydration, but do we wash our face every day? And there is more fat on the head than on the face.

- But doesn't this fat protect our hair?

Yes, but at the same time it is a breeding ground for microbes and fungi. They actively multiply, releasing fatty acids, and this inflammatory reaction is an allergy to their metabolic products. Hence the anti-dandruff shampoo industry based on antifungal ingredients.

- Do these shampoos help? Or do I need to go to the doctor so that he picks up the drug?

If this dandruff first appeared and is not accompanied by severe inflammation, rash, itching, soreness of the skin, then you can go to the pharmacy and buy a dandruff shampoo based on ketoconazole or climbazole. It should include salicylic acid or other fruit acids, as well as antipruritic and anti-inflammatory components. The right shampoo - which contains several active ingredients. One of the reasons dandruff shampoos don't work is because they're used once a week, which isn't enough. Within two weeks, dandruff treatment should help.

average man must wash your hair every day

- Many from childhood remember that you need to wash your hair once a week.

The average man should wash his hair every day.

- Is it normal to wash your hair every day? Are there people with dry scalp?

They don't. Only during menopause or a pronounced decrease in testosterone, serious skin diseases. Grease is a hormone-dependent process, it is stimulated by androgens, male hormones.

- But I have, for example, curly and porous hair. If I wash my hair every day, I will have a washcloth on my head.

It is enough for the average woman to wash her hair every other day, three times a week, because we have less testosterone and less greasiness than men.

- And what about the curly-haired?

Externally, curly hair is less polluted, but the activity of the sebaceous glands does not depend on the structure of the hair. Porous curly hair absorbs sebum well - if you do not have scalp problems and no hair loss, we recommend washing your hair on demand. If you suffer from dandruff, then you would have to wash your hair more often.

How to properly wash your hair

- How do trichologists recommend hair care? What is proper care in the understanding of a specialist?

The head should be washed as the skin gets dirty. A simple test: touch your scalp with your fingers, and then a paper napkin. If greasy prints remain on it, it's time to wash it. The need for washing is also indicated by the appearance of itching. It is better to wash your hair with a shampoo selected according to the type of scalp.

Yes, questions immediately arise. The person thinks: "I have dry hair, I will wash it with shampoo for dry hair." But at the same time, the scalp itself can be oily.

If a person has dry hair and oily scalp, and he takes a mild shampoo that does not wash off the sebaceous secret, there is a constant under-cleaning of the scalp, and the sebaceous secret accumulates on the skin and is a constant factor for the imbalance of the microbial flora. Hence chronic dandruff and inflammation, which can cause hair loss. Therefore, shampoo should be chosen according to the type of scalp.

- Clear. Shampoo once or twice?

Correct twice. Remember when your mother washed your hair as a child, they creaked. Are you washing like this now? The head should be clean, washed, so it is advisable to wash it twice: the first time we wash off the dirt and fat, the second time we fix the medicinal components on the head. After washing, we always apply either a conditioner, or a mask, or a balm to neutralize the alkaline environment that remains after the shampoo. Shampoo is an alkali that saponifies fat and has a negative charge. It must be neutralized with a positive charge of a mask, balm or conditioner. In this case, our hair will not be electrified, we close the scales of the hair cuticle and make combing easier.

Remember when you Mom washed her hair as a child, they creaked. Are you washing like this now?

Do men need air conditioning too?

Conditioners are applied along the length of the hair. If a man has medium length hair, then he also needs to use conditioners, otherwise they will be confused and electrified. Men with short hair do not need to use conditioner.

- And how do you feel about co-washing when a person washes his hair with silicone-free conditioner and does not use shampoo?

Healthy skin and hair will withstand anything, but air conditioners do not contain detergents - surfactants (surfactants). Its purpose is different - to neutralize the effect of the shampoo, so co-washing is not a cleansing of the scalp, but its additional "fatting". Now some girls still wash the head itself with shampoo according to the type of scalp, and the length of the hair is washed with shampoo according to the type of rod. This is better than washing your hair with conditioner. We also recommend washing the hair roots and skin, and rinsing the hair with flowing foam. If the head is washed often (for girls with thin hair who want to artificially create volume of hair), then you can take more neutral shampoos for frequent use. They have milder detergent components that will damage the hair less, but wash away the sebaceous secret.

- What's next?

After shampoo and conditioner, it is advisable to use leave-in products for the hair shaft (oils, gels, serums, fluids), which cover the hair with a film, protect it and restore it. This is especially necessary for women with long, curly (porous), dyed hair and those who lighten their hair.

- Do you need to comb your hair every day in the morning and in the evening, or once a day is enough?

Paradoxical as it may seem, even with hair loss, we recommend brushing frequently, because dead hair must be removed. This also applies to healthy hair - you need to comb it in the morning and in the evening.

- Grandmothers say that you need to comb to distribute fat through your hair. This is true?

Salo is essentially the lipid mantle of the hair. When we distribute natural fat through the hair, we partially restore it. But our sebaceous secret is thick, it does not independently distribute along the entire length. Long hair is recommended to be combed with a wide massage brush made of natural bristles, which should be done in 100 strokes.

About hair coloring

- I just wanted to ask about coloring. In general, how often can you dye your hair? Or is it so harmful that it is better not to even start?

There are different paints: there are tinting paints that do not contain ammonia and peroxide. These paints only cover the hair cuticle, and are as gentle as possible for the shaft. There is lamination (phytolamination, elumination) - not chemical, but physical staining. The dye in this case remains on the hair due to the difference in the electrical charge of the hair shaft and the pigment itself. This is covering the hair with an additional film, which, on the contrary, can be a protection of the structure. Of course, paints of this level are not able to change color significantly, they give tone to the hair and are quickly washed off. Next in terms of exposure are chemical paints that do not contain ammonia, with a low percentage of oxide. They change hair color by 1-2 levels. Such paints slightly harm the hair, they can be used once a month. Next come persistent paints containing ammonia, which penetrate into the cortical part of the hair, where they are fixed quite firmly - only they are able to paint over gray hair. And the most harmful for the rod is clarification, for which both ammonia and high concentrations of oxide are used. When re-lightening, it is recommended to apply such paints only to the roots, and tint the length.

If there is a repeated aggressive effect of a chemical dye on the hair shaft, then this can lead to cross-section, brittleness, dryness, loss of shine. The part of the hair that is above the surface of the scalp is dead, and whatever you do with it will leave a mark on it until you cut it off. Therefore, the farther the hair is from the scalp along the length, the more it is damaged. If the hair shaft is constantly dyed with ammonia paint, this will even lead to its fragility along the length.

- Is that why the ends of the hair split?

Split ends are damaged chains of keratin, the cortical layer of the hair. They are recommended to be cut monthly, because they cling to each other, get confused, and look unaesthetic.

How to grow hair

- Hairdressers say that you need to cut your hair regularly so that it grows better. It's true?

It is not true. We cut off the already dead part of the hair.

- If a person wants to grow hair, should he go to a hairdresser or not?

Even if you grow your hair, you still need to take care of it and cut it. Untidy long hair looks unaesthetic, and long hair is needed precisely for the sake of aesthetics.

- Is there any magical way to quickly grow long hair? Some promising products are constantly appearing: either shampoo for horses, or whey. What helps?

It is not always possible to grow hair to the desired length. There are three reasons for this: firstly, the maximum length of hair is genetically programmed and determined by the duration of the growth stage. For example, the stage of hair growth in a woman is on average 3–5 years. The average hair growth rate per month is 1–1.5 centimeters, it grows 12–15 centimeters per year, and 45 centimeters in three years. After the hair has reached its maximum length, it will enter the stage of loss and leave the head. If a woman has a growth stage duration of 10 years, then she can grow a braid to the floor, but this is rather rare.

The second reason is the section of the tips, the fragility of the hair along the length due to their damage. If you stretch your hair, for example, every day with an iron, dye it, dry it with a hairdryer and do not take care of it, then it will not grow long. The third reason is pathological loss, when the hair does not grow to its maximum length, because it prematurely enters the stage of loss. This may be due to depression (it reduces the growth rate), low estrogen, deficient conditions (low hemoglobin, low iron, low vitamin D levels). If a woman wants to have longer hair, it is necessary to minimize damage to the structure (dye hair with gentle colors, do not use irons and curling irons, use a hair dryer less often, drying with cold air) and actively care for the structure. There are also lotions to stimulate hair growth.

After hair has reached its maximum length, he will enter into the fallout stage

- What are these drugs?

These are medicinal or cosmetic preparations for the correction of hair loss. Lotions affect both hair loss, thickness, growth rate, and sometimes an increase in the amount of hair on the head.

- So there are still some magic pills?

Each plus has its minus: the stronger the drug, the more dependent on it. If you have a non-functioning follicle and we stimulate its work, then after stopping the use of the drug, these follicles will again enter the resting stage, which is manifested by increased loss.

- That is, these drugs must be constantly used.

If we are talking about genetic forms of hair loss, then yes, drugs are used constantly or in courses. If we are talking, for example, about some kind of deficient condition, then after its elimination, normal hair growth is preserved.

About gray hair and the miracles of pregnancy

- What to do for people who have gray hair at the age of 25-30? Why is this happening?

The mechanism of pigment loss is not fully understood. It is very complex, includes many factors: in general, it is a failure in the synthesis of melanin pigment. But this is not the problem that people come to us with - hair coloring easily solves it. Gray hair is genetically programmed, aggravated by a number of factors (including stress), and there are no effective methods of struggle.

- Can I stop her?

Not yet. But this is not necessary, the hair can be dyed.

There was also a recent scandal around Kate Middleton, who is now expecting a baby. Tabloid journalists like the Daily Mail found gray hair in her photo, and the public was divided: some said that she was great, that she didn’t dye her hair during pregnancy, while others said: “Well, she’s completely launched herself.” Do pregnant women really change their hair so much, up to gray hair?

In pregnant women, on the contrary, they improve. During pregnancy, the placenta is formed and estrogens rise many times. Starting from the 20th week, the hair improves and becomes what it was in adolescence. When childbirth occurs, the level of estrogen drops, prolactin rises, and after two or three months, the retribution for the period of good hair condition begins: postpartum hair loss begins.

- This is fine?

It is physiological and normal if there are no factors that aggravate it: for example, a poor mother does not sleep, she has postpartum depression, iron deficiency, and a malfunction in the thyroid gland. In this case, the prolapse is pathological. At the same time, the structure of the hair may change - the hair may become more wavy or, conversely, straight.

- Then everything comes back?

Not always.

- For me and my curly girlfriends, curls returned a year and a half after giving birth, but everyone was very worried. But tell me, please, why does someone have curly hair, and someone does not. Is it just genetics?

The structure of the hair is determined by the structure of the keratin protein, namely the number of disulfide bonds in this protein. Keratin is a chain of amino acids, and the more disulfide bonds, the more helical the keratin molecule is. The number of these connections is genetically programmed. It is on working with them that straightening and perm are based: with the help of a special composition (for example, thioglycolic acid), disulfide bonds are first broken, a new form is created, and then new bonds are formed. To a greater extent, curls are genetics, so Tsvetaeva's attempts to shave her head to become curly were unsuccessful.

About burdock oil and a hat

- Indeed, if you do not wear a hat in winter, the condition of the hair will deteriorate and they may even fall out?

No, because there is even such an ancient hair treatment procedure as cryomassage: this is a head massage with liquid nitrogen at low temperatures. It was once noticed that workers who wore ice on their backs began to grow wool in this area. Therefore, the cold just stimulates hair growth.

- What about the blood vessels? Because the blood flow is reduced.

On the contrary, cold training occurs: spasm, and then expansion. In addition, the vessels of the scalp are not able to subside, so there can be no persistent disturbances in blood flow in the scalp.

- What about smokers? It is said that smoking affects vasoconstriction and the amount of oxygen.

Smoking damages hair in a different way - through toxins and cell exposure to free radicals.

- Do burdock oil and castor oil really help, as our grandmothers think?

They help in cases where the loss will soon pass by itself. We recommend applying oils to the skin extremely rarely, because burdock and castor oil have a comedogenic effect: they increase the viscosity of fat, which accumulates at the mouth of the follicle and forms plugs. This leads to inflammatory diseases of already oily skin, so it is better not to use burdock oil.

Workers who wore ice on their backs in this area hair starts to grow

- And if they are applied not to the scalp, but to the hair?

Oils are applied to the hair because they stick together the hair scales and make up for the lipid deficiency. But our hair loves exotic oils: orchid, macadamia, shea, argan, jojoba.

- Do they need to be bought in their pure form and applied warm?

The easiest way is to heat the oil and apply it along the length of the hair after washing, then wrap the head with a film and a hot towel for half an hour. If the oil is greasy, it is better to wash it off with water. Now there are ready-made preparations based on oils that are not washed off.

- What do you think about the quality of our water? In any country in the world, hair after washing is completely different than in Moscow.

Yes, we have hard water, there are a lot of salts, including iron. Such water is unpleasant for the hair, leads to a loss of shine. But this is not such a serious problem: water can be softened, for example, with citric acid, or filtered.

- Do children really need to be shaved bald a year?

No. In any case, we cut only the dead shaft, and hair cutting cannot affect hair growth. In a year, the natural first change of hair occurs, when the vellus is replaced by thicker ones. Often a mother sees that the child's hair is starting to fall out, shaves it, does not see the hair falling out anymore and thinks that the haircut helped. In fact, this is just a transitional moment of hair maturation, which will pass by itself, regardless of whether we shave the child or not.

Until now, the specialty "trichologist" has not been introduced in the classifier of professions. What are the features of his work, what education he should receive, what are the requirements for this specialist - we tell in the article.

In our country, trichology is considered a branch of dermatology and aesthetic medicine, and there is still no specialty “trichologist” in the classifier of professions of the Ministry of Health.

The peculiarity of the work of a specialist in Russia lies also in the fact that the doctor not only prescribes treatment, but also conducts all physiotherapy and injection procedures, and also selects care.

Trichologist education

The future trichologist must first get an education at the Department of Dermatovenereology or cosmetology, and then attend a certification course in trichology, or enroll in a clinical residency in cosmetology, which includes the Trichology cycle.

INTERESTING

The education received at the First Moscow State Medical University named after I.M. Sechenov. Here at the Department of Skin and Venereal Diseases. V.A. Rakhmanov, you can choose the discipline "Trichology", or listen to the course of the same name at the Department of Cosmetology. There are a large number of training centers where they teach, including practicing doctors.

The duration of trichologist training varies from one to five days. Very important:

There are a large number of sites on the Internet that offer to learn the profession of a trichologist, posing as branches of the departments of popular universities. However, often words like “at RUDN University” mean only geographical proximity to the university. When choosing courses, I advise you to avoid the training that cosmetic companies offer. Most often they have nothing to do with medical trichology, and the document that you receive at the end of the training program will only be a reminder of wasted money.

I received the specialty "General Medicine" at the Kuban State Medical University, and I completed an internship in dermatovenereology at the St. Petersburg Medical Academy of Postgraduate Education (MAPO), where I also underwent a retraining cycle in cosmetology. Interestingly, as part of their qualifications, cosmetologists and plastic surgeons can accept patients with trichological problems (in particular, hair transplantation is a surgical operation). However, in these cases, the diagnoses may be inaccurate and the treatment plan incorrect. In addition, of course, not every cosmetologist who has found the opportunity to purchase a trichoscope has the right to make a diagnosis and prescribe treatment. Yes, certain knowledge will help to see the problem, but only trichologists can provide high-quality history taking, research and treatment, and even better if paired with fellow endocrinologists.

What knowledge should a trichologist have?

A specialist trichologist must, first of all, understand the anatomy and physiology of the hair and skin of the scalp, understand the nature of diseases that affect the condition of the hair. It is very important to collect the most complete history, conduct a qualified diagnosis, competently develop a treatment plan and ensure a stable positive result.

A specialist trichologist needs knowledge in dermatology, immunology, endocrinology and even nutrition. It is very important to attend scientific and practical conferences, communicate with colleagues and constantly invest in your development. If possible, you should become a guest of international congresses, because this is a great chance to stay in touch with world trichology, start exchanging experience with trichologists from other countries.

If we talk about me, then I combine all of the above with the knowledge gained at the Department of Endocrinology of the FPC MR RUDN University. Here, doctors are taught the modern concept of medicine "5P", help to become the so-called D-doctors, that is, specialists who can work with vitamin D and hormones, and also answer the question of what happens in the body during a particular disease at the cellular level .

A simple example: among the causes of diffuse hair loss is a lack of vitamins, and a trichologist, if vitamin D deficiency is detected, may recommend taking medications so that the level of the substance becomes optimal - 50-80 ng / ml. Alopecia areata is an autoimmune disease, and vitamin D activates the human immune system.

In other words, along with the competition, the need to know and be able to have many more colleagues is growing. Modern patients demonstrate the consequences of environmental degradation, malnutrition and a decrease in the quality of food taken. I often say that hair loss is a consequence of negative changes occurring in the body.

Demand for the profession of trichologist

There are always vacancies for trichologists, there are many of them, and this is largely due to the growing popularity of the profession. Perhaps in the near future, Russians will begin to visit a personal trichologist, by analogy with a dentist and a general practitioner or a family doctor. In the West, this approach is already practiced.

A novice trichologist receives a salary in the region of 15,000-20,000 rubles, an experienced specialist can earn up to 60,000 rubles a month. At the same time, in Moscow this figure can reach up to 150,000.

The average price of a trichologist appointment ranges from 1,100 to 4,000 rubles per consultation. Often, trichologists combine two jobs: a trichologist directly, as well as a cosmetologist, performing procedures in the field of aesthetic cosmetology.