Scientific collaboration between Professor Marco Toscani and Dr. Pasquale Fino, Chair of Plastic, Reconstructive and Aesthetic Surgery, Umberto I Health Center – “Sapienza” University of Rome.
The scalp is an ultra-specialized area of the skin, where hair is anchored. Like other hair, also the hair on the scalp originates from a hair follicle, called a bulb.
Since it is skin (like all other areas of the body), the scalp is susceptible to problems such as imbalances, anomalies, disorders or actual illnesses. The scalp is responsible for protecting the brain, not just through the presence of hair, but also through thermoregulation of the entire head, filtering the sun’s rays and blocking excessive heat dispersion in cold environments.
The scalp is tightly bound to the galea aponeurotica, the aponeurosis that directly covers the skull, with the interposition of weak connective tissue.
The scalp is composed of: a superficial epidermis, with little pigment and well-protected from light by the hair, and a deeper area, the dermis, in which hair bulbs are densely packed.
Capillaries cross the scalp and bring nourishment to the hair through the blood. Other important functions are carried out by sebaceous glands and sweat glands that, with sebum and sweat, ensure protection and lubrification of both the scalp and hair.
Each bulb corresponds to the outlet of a sebaceous gland. A particular characteristic of the hair derives from the extent of sebaceous gland activity, and related hair problems may depend on this factor too. If the sebaceous glands are very active and secrete a lot of sebum, the hair will appear greasy, covering itself easily in the greasy secretion. If, on the other hand, the activity is reduced and produces a small quantity of sebum, the hair will be dry.
The skin or dermis is composed of two layers, a superficial layer, called the epidermis, and a deeper layer, called the dermis, under which the hypodermis or subcutaneous adipose tissue is located.
The epidermis is separate from the dermis of the basement membrane.
The epidermis or epithelial tissue is composed of 4 different types of cells, the most important of which, composed of keratinocytes, is distributed across many overlapping rows of cells divided into 5 layers: the basal layer, the spinous layer, the granular layer, the translucent layer (present only on the palm of the hand and the sole of the foot) and lastly the cornified layer. Keratinocytes are formed and reproduced in the deepest part (the basal layer), and from here, following the aging process, slowly climb towards the surface (in about 28 days), producing within them a protein called keratin, which has a particular resistance to external aggression (soap, oils, solvents, heat and cold, visible and ultraviolet radiation, germs, mold and pathogens, etc…).
The detachment of the now-dead cells from the surface is usually invisible. If, instead, for some reason, due to particular scalp problems, cellular masses form (hundreds or thousands of elements), the detachment becomes visible in the form of flakes (dandruff).
The basal layer is the only one that needs nourishment, which it receives from the underlying dermis. The epidermis is devoid of arterial or venous circulation. The basement membrane is a complex structure with an undulated shape that is responsible for both anchoring the epidermis to the dermis and for allowing and regulating the exchange of substances (nutrients and waste) between the epidermis and the dermis. In the dermis (connective tissue) the cells are scarcer and divided into various types: among these we can note the fibroblasts, mastocytes and macrophages. The most important are fibroblasts, that produce both the “fundamental” gelatinous substance, composed mostly of water, salt, sugar and protein, and various types of fibers (reticular, collagen and elastic), which take on the role of providing support, consistency and elasticity to the tissue itself. The dermis is full of blood vessels, lymphatic vessels, fibers and nerve endings. Finally, the hypodermis (subcutaneous adipose tissue) is composed mainly of interwoven fibrous bands (a direct continuation of those found in the dermis) that outline a series of spaces, called adipocytes, occupied by adipose cells. In the hypodermis there are fewer cells and nerve endings, while blood supply is more abundant. Under the hypodermis are bands of muscular tissue with the correspondent muscles.
A shedding of hair is considered physiologically normal when hair loss is limited to around one hundred hairs per day. During an individual’s life hair grows, falls out and regrows around twenty times. Each cycle, especially for females, may last up to six years and if hair loss is found within this time frame, it is considered absolutely physiological.
Psychogenic alopecia is a type of hair loss related to stress. Though not yet scientifically explained, this connection is well-known in the experience of those working with the problem. In addition to stress, other causes are personality disorders, states of anxiety and depression, all of which are conditions of acute or chronic stress.
Hyperseborrhea or hypersecretion of sebum is simply a scalp problem due to an excessive production of sebum caused by hyperactivity of the sebaceous glands. Immediate symptoms of hyperseborrhea are scalp itchiness and pain. However, a later symptom is hair loss.
The acronym PRPHT stands for “Platelet Rich Plasma Hair Therapy”. It is a therapeutic medical technique that falls within the field of “regenerative medicine”; it is based on the principle that stem cells, which have been demonstrated to be present in the hair bulb, are equipped with growth factor receptors.
A hair follicle is a formation of epidermal origin, anchored in the dermis and consisting of a hair and its sheath.
The formation of hair follicles occurs early. They begin to appear as early as the second month of gestation. These follicles will continue to form for the entire duration of the pregnancy. At birth, the baby will indeed have the entire supply of follicles with which it was genetically equipped and from this moment on, no others will form.
The term Telogen Effluvium was introduced for the first time by Kligman (*) in 1961 to introduce an acute hair loss of benign origin that follows an intense and short period of stress of different types. Subsequently, Rebora (**) introduced the concept of chronic Telogen Effluvium.
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