Hair Care and Hair Care Products

JOHN GRAY, MBBS, MRCGP, MIT

P
atients presenting with hair and scalp disorders
are more frequently encountered in medical prac-
tice than the average medical student might
imagine. Such encounters encompass a number of con-
ditions that, while they are not life threatening, never-
theless may be of significant concern to the patient or
the patient’s parent. The management of these condi-
tions is frequently an intellectual challenge, not neces-
sarily in diagnosis, but in patient management. A range
of near-physiological to pathological problems—neona-
tal “cradle cap”—to severe and dysmorphic hair loss
are well treated in the literature. Allied to these and as
a separate area for consideration are cosmetic hair is-
sues. In this arena, it is perhaps inappropriate to imply
triviality. Physicians will be required to manage com-
plex and difficult cases of hair disorder wherein patient
expectations of daily hair-care regimen advice is as high
as hopes of a cure (Fig 1).
To advise patients on the “proper” frequency of hair
washing, appropriate use of the myriad of conditioners
now available, and the suitability of styling and fixing
products, the physician might perhaps be familiar with
the cosmetic technology and product trends. Figure 1. Home coloring and cut by “desperate” patient with
chronic telogen effluvium after chemotherapy.
It should be remembered that the normal daily hair
care regimen of an individual may be influenced by
age, sex, culture, and economic circumstance as well as Coloring and bleaching
fundamental hair type. In the care of patients with Perming or relaxing
disorders of hair growth, the daily routines of hair care
and the types of products used at home or in the salon Increasing consumer demands have led industry to
should at least be recognizable. This section reviews the developing ranges of hair care products to meet specific
range of retail and professional hair care products that cosmetic needs—“damage,” “dryness,” “body,” “vol-
are now widely available and offers suggestions on hair ume”—to achieve maximum overall “end benefit” for
care regimens that may be part of patient management. the individual.
Expert help in this area may improve compliance to To develop “global” products to meet these needs is
less acceptable therapies or create a more optimistic no easy task. Fine “Nordic” hair and African hair, for
attitude to the probable outcome. example, have very specific grooming needs and cos-
metic problems. The frequency of washing and variabil-
Hair Care Products ity of water hardness (and supply) even before succinct
usage information in multiple languages are all chal-
The general categories of hair care products are: lenges to be met (Fig 2a and 2b).
Cleansing
Conditioning and “treatment”
Cleansing Products
Fixing—Style control Human hair may be left totally unwashed, as it proba-
bly was for many generations of Homo sapiens. Even-
tually, a static or stable state of sebum distribution
From the Procter & Gamble Technical Centres, Twickenham, England, appears to be reached: the interim is not necessarily
United Kingdom.
Address correspondence to John Gray, Lovett House, Procter & Gamble conducive to modern living.
Technical Centres, Lovett Road, Staines, Middlesex TW 18 3A2, England, UK. The frequency of hair washing may be influenced by

© 2001 by Elsevier Science Inc. All rights reserved. 0738-081X/01/$–see front matter
655 Avenue of the Americas, New York, NY 10010 PII S0738-081X(00)00133-4
228 GRAY Clinics in Dermatology Y 2001;19:227–236

Figure 2. Fine “nordic” hair (a) and tightly coiled “African” hair (b) have very different grooming needs.

length of hair, culture, sex, social pressures, and eco- that confer properties of increased mildness, condition-
nomics, as well as individual preference. Modern, well- ing benefits, anti-dandruff activity, volume enhance-
formulated shampoos effectively remove detritus, se- ment, and even improved moisturization (Fig 4).
bum, and such deposited cosmetics as hair spray. The Shampoo ingredients include the following:
surfactant systems are now sufficiently mild to allow at
Cleansing agents—surfactants;
least daily washing without evidence of accumulating
cuticular damage. Lather boosters;
Conditioning agents;
ADVICE POINT: Q. How frequently can hair be safely
washed? A. There is no upper limit of frequency; how- Functional additives—adjust pH and viscosity;
ever, regular conditioning is important Preservatives—from the point of view of microbial con-
tamination, a shampoo is a particularly promising
Shampoos
environment, having a water content of, on average,
For many years, shampoos were nothing less than 80%, a pH range of 5–7, and no antagonistic ingre-
soaps. Although potent cleansers, they had poor lath- dients; and
ering capabilities in hard water and led to dulling dep- Aesthetic agents—fragrance, colorants, and pearlescing
osition of insoluble calcium-magnesium salts (sterarate) agents.
on the hair. In some cultures, bar soaps are curiously
still preferred. Soaps are, strictly speaking, surfactants, but the term
In dermatological practice 30 years ago, shampoos is usually reserved for synthetic ingredients. Surfac-
with harsh surfactants were used to remove messy tants used in shampoos are syndets (synthetic deter-
treatments applied to the scalp. Retail shampoos were gents) and usually contain fatty acid chains with
originally simple products comprising aqueous solu-
tions of surfactants designed to clean the hair by emul-
sifying oils and dispersing solid material. Lemon juice
was, where available, used to remove the resultant hard
deposits.
Such was the irritation potential of these products
that bath night and, specifically, hair-washing night
could be a torment for both child and parent. Fortu-
nately, the introduction of modern mild synthetic sur-
factant systems allow hair washing to be, not infre-
quently, a pleasure (Fig 3).
ADVICE POINT: Shampoos are formulated for normal,
greasy, dry, permed, and damaged hair.
In the twenty-first century, the consumer (and the
physician) are now faced with a plethora of sophisti-
cated shampoo products (Fig. 4) designed for a range of Figure 3. Modern shampoos for children include very mild
hair types and conditions with additional ingredients synthetic surfactant systems to reduce eye irritation.
Clinics in Dermatology Y 2001;19:227–236 HAIR CARE 229

Figure 4. Montage of hair care products.

around 12 carbon atoms. They lather copiously with all

water hardness and rinse freely without leaving a dull-
ing film. They are effective to a greater or lesser degree
in dispersing greasy materials in water, having a water-
soluble component (negatively charged for anionic sur-
factants) and a fat-soluble neutral component. The latter
binds to and surrounds dirt and sebum. The water
soluble (negative) end faces outwards, and the hair, also
negatively charged, repels the dirt/surfactant aggregate
and is water-soluble (Fig. 5).
Modern shampoos contain a mixture of surfactants
(usually between 2 and 4) to provide different cleaning
levels according to hair type and requirement—normal,
permed, or damaged hair.
Improved mildness is important, especially for chil-
dren or frequent users. Shampoos are based on anionic
surfactants (ammonium or sodium lauryl and ammo-
nium or sodium laureth sulphate with amphoteric and
non-ionic surfactants). Natural soaps and cationic sur-
factants are rarely used because of their high irritancy
and heavy deposition potential.
Frequent and regular cleaning will not damage the
hair provided that the products used are well formu-
lated.1
Special Ingredients
Many shampoos contain additional ingredients that
confer physiological benefit to the hair shaft. It is now
routine that conditioning agents such as silicone (dime-
thicone), alcohol derivatives, and quaternary polymers
are included in “regular” shampoos, albeit at very low
concentration to improve hair separation and shine.
Regular shampoo users who do not employ separate
conditioners will unknowingly benefit from these con-
ditioning ingredients.
In addition the twenty-first-century cosmetic formu-
lator can create matrices that can include a variety of
ingredients that improve hair quality (or prevent dete-
rioration) to a degree undreamed of a decade ago.
Figure 5. Surfactant moiety
Panthenol in low concentration has been demon-
strated to penetrate the hair shaft and enhance moisture
content of the cortex. Amino acids can similarly pene-
trate into the cortex and assist in reducing protein deg-
radation during repeated washing.
Anti-dandruff Shampoos
A number of prescription, over-the-counter (OTC), and
retail shampoo products are available for the control of
Pityriasis Simplex. This near-physiological condition af-
fects some 50% of persons of Indo-European extraction
by the age of 20. In severe cases, radical and unpleasant
tar treatments may still have their place. Selenium and
imidazole (ketoconazole) shampoos are helpful.
Zinc pyrithione (“Head & Shoulders”) is available as
a retail shampoo and is as clinically effective as pre-
scription or OTC products but at a lower cost. Deposi-
tion of micro-fine crystals of zinc pyrithione on the
scalp can dramatically reduce the condition while pro-
viding a high quality, conditioning shampoo (Fig. 6).1
Preservation of Shampoos
Preservation of shampoos is required because, as essen-
tially aqueous-based products, they are easily contam-
inated in the home or salon setting where multiple use
230 GRAY Clinics in Dermatology Y 2001;19:227–236

Figure 7. Characteristic hair luster associated with silicone

conditioning ingredients
Figure 6. Micro-fine crystals of zinc pyrithione deposited on the
scalp.
When long hair became more popular in the 1960s,
there was an upsurge in demand for shampoos that
by many individuals is the norm. In an age where
could be used frequently. The anionic surfactants of the
manufacturers strive for “global” products, preserva-
time, at often alkaline pH levels, tended to strip sebum
tion has been hampered by regulation and/or local or
and damage the cuticle, and the early conditioning
regional bias. In parts of Asia, certain preservatives that
agents were not “consumer friendly,” being oil based
are accepted in North America and Europe are banned.
and often applied with heat.
Contrarily, preservatives that are acceptable in Asia and
A new generation of “leave on” conditioners was
approved in Europe may be restricted in use, based
developed from technology derived from experience
solely on very local professional concern or misunder-
with clothing softeners using quaternary cationic sur-
standing of their contact sensitization potential. Recent
factants and cetearyl alcohol. Although a distinct im-
work has reviewed the safety of a number of ingredi-
provement, they tended to suffer from build up, leaving
ents including methylchloroisothiazolinone/methyli-
the hair looking limp or even lank.
sothiazolinone (MCI/MI) and methyldibromoglut-
The introduction of such silicones as dimethicone in
aronitrile and indicated that exposure to these
the 1980s offered even further conditioning benefits
ingredients in shampoos formulations is many times
without build up or limpness. They have tended to
less than in patch testing. Consequently the risk of
supplement or replace the quaternary compounds as
inducing or eliciting contact allergic dermatitis is of an
formulation skills overcame solubility issues. Silicones
extremely low order.2
add a characteristic luster, reduce grooming force, and
Patients with hair disorders may seek advice on hair
are now a major component of conditioning products
washing regimens. Patients with reduced density, frag-
(Fig 7).
ile hair syndromes, and acute telogen loss may be con-
In contrast to shampoos, conditioners are essentially
cerned first that their hair care product(s) are damaging
cationic systems that, for best effect, are presented as
or even contributory, and, second, may need didactic
dispersions rather than solutions. Conditioners are usu-
advice on washing. There is a wealth of evidence to
ally oil/wax in water emulsions, with a cationic charge
show that modern, well-formulated, mild shampoos do
to encourage deposition with the net negative charge of
not interfere with mitosis in the growing matrix of hair
the hair at areas of increased weathering.
and may indeed help fragile hair by decreasing groom-
Conditioning agents may comprise, or be suspended
ing force. Regular cleansing (and conditioning) is not to
by, a liquid crystal phase, and improve detangling and
be discouraged.3
ease the combing of wet or dry hair. This is of particular
value in severely weathered or permed hair to reduce
Conditioners
further cuticular damage.
“Conditioning” the hair is a relatively new concept in Additional benefits include enhanced shine as de-
comparison to cleansing or even styling. Conditioners posited ingredients change the refractive index of the
are designed to deposit material onto the hair shaft, hair fiber. The viscosity control of conditioners is more
particularly at the cuticular edges, to reduce grooming difficult than shampoos, as it often varies with produc-
force, reduce negative charge (hence “fly-away”), in- tion parameters and time, and can be affected by the
crease fullness, and add shine. addition of electrolytes and solvents.
Clinics in Dermatology Y 2001;19:227–236 HAIR CARE 231

A conditioner may be a less promising environment

for micro-organisms than a shampoo. Although the
water content could be as high as 95%, the pH might be
in the range 3–5 with the possibility of antagonistic
cationic surfactants being present.

Conditioner Use
Regular conditioners are applied immediately after
each shampoo and are rinsed out immediately. Ver-
sions may include “frequent” or “dry/damaged.” In-
tensive conditioners are often cream formulations that
are applied once or twice weekly and left in for several
hours. These are useful for dry or weathered hair. Se-
rum or spray conditioners are portable and may be
used as “quick fix” for weathered hair. Conditioners
may include UV filters for color protection.

Combined Shampoos/Conditioners
As stated, conditioning ingredients are nowadays often
included in shampoos. Procter & Gamble introduced “2
in 1” shampoos/conditioners in 1987 using silicone
(dimethicone) droplets suspended in a surfactant mix- Figure 8. Severely weathered hair after repeated bleaching with
ture. It had been previously argued (and occasionally hydrogen peroxide. The patient was unaware of the cause of her
still is) that this is not feasible. The technology has been appalling hair condition. She declined to cut it, but prolonged
reviewed and approved by a panel of eminent derma- conditioning treatment eventually bore fruit.
tologists.1
Stage 2: Shampoo with appropriate variant “dry/dam-
aged/permed.”
Weathered Hair Stage 3: Regularly condition with appropriate formu-
The causes of weathered hair are legion—many self lation (see above).
inflicted.3 Today a plethora of conditioning and “treat- Stage 4: Use intensive conditioning (cream) once or
ment products” confront the consumer to deal with this twice weekly.
issue. Aqueous sprays to temporarily improve the ap- Stage 5: Minimize further damage from blow drying/
pearance of “split ends;” deep conditioning “masks” bleaching.
weathered hair; and the inclusion of UV filters prevents
photo-degradation, particularly for those with colored Fixing-Styling Products
hair. Women, and to a lesser extent men, use fixing or styling
“Deep conditioners” in cream formulations can be products to create temporary changes to their hair to
left on for prolonged periods, and some are now avail-
able that do not need to be rinsed out.
Advice offered to those with hair shaft and hair
growth disorders on maintaining the hair shafts in op-
timum condition depends on avoidance of excessive
physical and chemical treatments, and regular condi-
tioning. The basic morphology of the hair shaft and the
type and degree of damage must be assessed before
advice is considered. Over-conditioning may alarm and
discourage the patient as it may result in heavy and
unmanageable style.

Weathered Hair—Advice
Weathered hair is most frequently self-induced by pro-
longed physical and chemical damage. Consider under-
lying hair shaft abnormality (Fig 8).
EMG-1—conditioners tend to deposit at areas of increased
Stage 1: Recommend a good cut from an expert. weathering.
232 GRAY
EMG-2—spot welds that maintain a more flexible hold and
minimize grooming force and damage.
achieve changes in volume and hair shaft characteristics
(style). It has to be said that style is essentially created
by the hair cut, and a first-class stylist is a boon.
Stylists often use a significant amount of styling
product, such as gels, for maximum effect and may
recommend these to their clients for continued use. The
role of the stylist is not to be understated nor their
counsel to be denigrated or ignored. The popularity of
mousses, gel, and sprays have waxed and waned as the
styling product— each has their place, particularly for
modern the woman (and man) who has often little time
to spend in setting and styling with rollers. Reliable,
effective, and safe products were the challenge for the
cosmetic industry.
Fixatives: Settings, Mousses, Gels, and Styling Spray
These essentially oil-based preparations are used dur-
ing or after shampooing and often prior to hair drying
to hold the hair in place and add luster. They also help
to maintain volume, which is of major concern to those
with fine or low-density hair.
The traditional styling products were based on oils,
fats, or gums. These were later superseded by emul-
sions of water and mineral oil. The introduction of
synthetic polymers and dimethicones in recent years
has improved quality, reliability, and aesthetics consid-
erably.
There is now a huge choice of products, often assem-
bled in “ranges,” giving the consumer almost unlimited
but occasionally confusing choice. Mousses assist styl-
ing but are soft to the touch and easily removed. Cat-
ionic water soluble polymers are included in condition-
ing mousses; anionic fixative polymers provide hold.
Polymers used include polyquaternium 10, potassium
methylacryate, and carboxy functional silicone with a
cationic polymer. They are applied to wet or dry hair to
Clinics in Dermatology Y 2001;19:227–236
assist styling with hair dryer, rollers, or even tongs.
Some mousses now contain temporary colors.
Styling lotion applied to wet hair assists during blow
drying to subsequently hold the style.
Gels were originally aqueous solutions of substituted
methylcellulose ethers and left an unpleasant gum on
the hair. PVP/VA and vinylcaprolactam/PVP/dim-
ethyaminoethylmethacrylate copolymer are aestheti-
cally more pleasing. Styling gels and waxes are current
favorites for younger age groups, mousses for more
established styles. Stylist recommendation seems
highly significant.
Two generations ago, hair fixatives used aqueous or
hydro-alcoholic dispersions of vegetable based poly-
mers such as arabic gums. Combs would be dipped in
these solutions and applied to the damp hair. The next
generation packaged shellac solutions in atomizers or
squeeze bottles. Eventually, aerosols were developed,
which delivered soap-removable resins and revolution-
ized the hairstyle market. A review of the styles of the
early 1960s shows the maintenance of volume predom-
inating culminating in the beehive.
The dried film of hair sprays of the day had to resist
gravitational force; be tough, clear, easy to plasticize; and
have low water absorption. Shellac was not easily re-
moved, tended to flake, and could be highly inflammable.
Ultimately, these powerful ingredients were re-
placed by long-chain synthetic polymers, which deliv-
ered as droplets to maximize the number of bonds
between hair shafts. The first commercial polymer was
N-vinyl-2-pyrrolidine (PVP) and was an enormous ad-
vance in hair sprays because it was soluble in organic
solvents, gave good hold, was easily removed, and was
safe. It is still widely used in fixing products. This
followed the trends of the later 1960s and 1970s with
shorter bob or pageboy styles.
The second generation of polymers with improved
characteristics lead to copolymers—the addition of
film-modifying agents to soften or plasticize the resin
film reduced brittleness and flaking.
In the 1980s, octylacryamide/acrylates/butylamin-
oethyl methacrylate polymers were introduced. This
provided a tough, three-dimensional resin matrix with
good holding power and easy removability. Another
innovation was the use of silicones, which confer sheen,
lubricate, and increase the resins resistance to humidity.
The bonds formed by conventional hair sprays are
characteristically longitudinal. They tend to give a rigid
hold that is difficult to subsequently groom and that
breaks the style.
In the early 1990s, polymer styling products were
introduced which incorporated organic acrylate cross
polymers with grafted side chains. These tend to pro-
duce spot welds, which maintain a more flexible hold
and minimize grooming force and damage.
Clinics in Dermatology Y 2001;19:227–236
Figure 9. A well constructed perm.
Styling Advice
Patients with hair loss, low hair density, or fine hair
may wish to increase volume to create the effect of
improved density. Alternative strategies are setting or
perming.
Setting
Mousse plus rollers and/or hair drying,
Use low heat—never the highest setting on dryer,
Use flexible hold hair spray for easily groomed
“soft” style, and
Use “extra hold” hair spray for greater rigidity.
Perming or Permanent Wave
In 1906, Charles Nessler invented the Permanent Wave,
using ammonia and borax to soften keratin and wind-
ing the hair around electrically heated rods. In 1932,
Zotos introduced chemical heating pads. Although less
cumbersome this electrical process was replaced by the
phenomenally successful Cold Wave, using thioglycolic
acid.
Mercaptans, of which thioglycolic acid is the best
known, rapidly break the disulphide bridges at rela-
tively low pHs. The hair wrapped around rollers,
treated with a Cold Wave, which is then neutralized,
proved a gold mine to the hairdressing industry. In the
1950s, approximately half of all U.S. teenagers had per-
manent waves. Problems with perms included “perm
shock” because of grossly increased porosity in the
immediate post application period. Often (wrongly)
blamed on shampoos, this is invariably the result of
HAIR CARE 233
poor advice—avoidance of washing is imperative for
several days as the perm “cures.” Irritation reactions
and odor are problematic, and gloves are mandatory for
the technician.
Permanent waves have improved in sophistication
over the past few years. Originally, the creation of
volume seemed the driving factor associated with ease
of care. Once permed, little or no further styling was
necessary; however, as hair grew, it needed further
attention. Perms could be crude and unflattering in the
hands of the uninitiated; however, in the hands of an
experienced technician, a carefully considered perm can
add style and volume (Fig 9).
Careful attention after perming includes regular con-
ditioning and the selection of a shampoo for “permed/
damaged” hair.
“Ethnic” Hair Care Products
The problems associated with the physical and chemi-
cal treatment of African hair are well recorded—“hot
combing,” traction alopecia, and oil dermatitis. In the
United States in particular and increasingly in the de-
veloping world, individuals with characteristically
tightly curled African hair have sought methods to
straighten the hair shafts. This creates the ability for
subsequent diverse styling and easier grooming.
Straightening hair may be achieved temporarily by
pressing, which tends to be damaging, or by chemical
means (relaxing). Pressing involves the use of oils that
protect the hair and adds sheen and softness. Dimethi-
cone products are now available.
Chemical Relaxers
Addressing the needs of the ethnic hair-care market
requires an understanding of the unique nature of the
morphology of the hair typical of people of sub-Saharan
African origin. Hair relaxers are among the most pop-
ular hair-treatment products for people with such hair.
Relaxer Function and Chemistry
The first relaxers were crude solutions of sodium hy-
droxide. Highly irritating, they were gradually replaced
in the 1950s by the addition of petrolatum, fatty alco-
hols, and emulsifiers. The application of a petrolatum
pomade allowed extremely curly hair to be styled and
prevented the hair returning to its natural state in hu-
mid weather.
Relaxers consist of three principal components: an
alkaline agent, an oil phase, and a water phase. Relaxers
need a strong alkaline component; this may be sodium
or lithium hydroxide, or guanidine hydroxide formed
by the in situ reaction of guanidine carbonate and cal-
cium hydroxide. The oil phase contains a high concen-
tration of oils as well as a surfactant. Because these lipid
materials add sheen to the hair, ease combing, and lend
234 GRAY Clinics in Dermatology Y 2001;19:227–236

some barrier protection to the scalp, the oil phase can be

considered a conditioning and protecting vehicle. The
water phase carries the active and, in doing so, serves as
a vehicle for the alkaline component. The delivery of
these three components controls the relaxer’s efficiency
and effectiveness. Formulators aim to achieve quick
relaxation as well as minimal hair damage and scalp
irritation. The extreme alkalinity of relaxers requires a
highly viscous emulsion. Most relaxers use thick,
heavy, cream vehicles, consisting of very high oil-in-
water emulsions.
There are two common types of relaxers: the lye
relaxer and the no-lye relaxer. Lye relaxers use sodium
or potassium hydroxide as the alkaline agent. Sub-
categories within this group include no-base relaxers
and base relaxers. Base relaxers use a low oil content Figure 10. Modern permanent dyes are synthetic organic dyes
and a relatively high percentage of lye. Such systems consisting of solutions of paraphenylenediamine (PPD).
work quickly but are irritating to the scalp and can
damage hair. The no-base products, originally devel- balance allows effective bond breakage to straighten
oped in the 1960s, use high-oil-content emulsions and hair with the minimum damage.
do not require application of a protective base to reduce Washing the alkaline agent out of the hair or using a
scalp irritation. neutralizing (slightly acid) shampoo then initiates the
The no-lye relaxers use other alkaline ingredients; formation of cross-links. These new bonds lock in the
two common sub-categories are the mix and the no-mix new shape of the hair fibers. The neutralizing shampoo
relaxers. Mix no-lye relaxers consist of a cream base also closes down the cuticle. Relaxed hair can be re-
containing calcium hydroxide and an activator contain- permed with careful attention to condition.
ing guanidine carbonate. When the two parts are
HAIR TYPES The best relaxer for each individual de-
mixed, the resultant guanidine hydroxide activates the
pends on that person’s hair. Various hair types respond
relaxation. A two-part, guanidine-carbonate no-lye re-
significantly differently to relaxer treatments. This is
laxer uses the cetearyl alcohol/cetearyl phosphate
why salon application of relaxers predominates, as pro-
emulsifier system to reduce hair damage and scalp
fessional guidance in the selection and application of
irritation. No-mix products usually use lithium hydrox-
relaxers helps produce the most satisfactory results.
ide. By definition, “lye” is sodium or potassium hy-
Fine hair has less bulk, so saturation progresses
droxide; in fact, most consumers only recognize sodium
quickly. Such hair needs a shorter processing time un-
hydroxide as lye.
less the cuticle layer is very resistant. Damaged (po-
Relaxers and Hair Chemistry rous) hair also needs less processing time.
The breaking and reforming of bonds permanently re-
Hair Coloring
arranges the internal protein structure of curly hair.
Relaxers work in two stages: relaxing the hair’s curl, Women, and to a lesser extent men, color their hair for
and locking in the new hair fiber configuration. Apply- a number of reasons. As part of a fashion or tribal
ing the relaxer initiates the process. The emulsion’s high statement (i.e., “punk,” change of “image,” or most
pH (12–14) swells the hair, opening the cuticle. This commonly to cover grey hair). There is a myriad of hair
allows the alkaline agent to penetrate the hair fiber and color products available as retail or professional prod-
diffuse into the cortex. The relaxer reacts with the ker- ucts. Results may often be disappointing because of
atin protein, breaking the structural bonds in the hair.
Poor selection against base color,
This action softens and straightens the hair. The pres-
ence of the hydroxyl ion (OH⬘) disrupts the structured Weathered hair, or
ordering of bonds in the hair’s keratin protein. The salt Failure to adhere to instructions.
bridges and other ionic bonds are easily broken by Coloring the hair may be temporary, semi-permanent,
increased alkalinity. or permanent.
The breakage of disulfide bonds denatures the hair
so the fiber can then be extended to a straight configu- Permanent Hair Coloring
ration. The optimum hair-fiber extension can be found
There are three main types of permanent dyes:
by measuring the force needed to deform the fiber by
25% in the selected yield region. Manipulating this 1. Natural vegetable dyes,
Clinics in Dermatology Y 2001;19:227–236
2. Metallic dyes, and
3. Para dyes.
NATURAL VEGETABLE DYES Originally, coloring materials
for the hair were obtained from plants, henna being the
best known. Henna, also known as Lawsone, is produced
from the crushed, dried leaves of the Egyptian privet
plant, which grows in Iran, Egypt, and along the Medi-
terranean coast. It imparts red pigment to the hair, and the
shades vary slightly according to existing levels of pig-
mentation and hair condition. The depth of red depends
on the length of time that it is left in contact with the hair.
METALLIC DYES These deposit metal salts both in the
cortex and on the cuticle, which may dull the hair, can
color the skin, and potentially react with hydrogen
peroxide. They are not now widely used.
PARA DYES (OXIDATION DYES) Modern permanent dyes
are synthetic organic dyes consisting of solutions of para-
phenylenediamine (PPD), or similar “para” compounds,
together with other substances, such as conditioners and
antioxidants to prolong shelf-life. PPDs are derivatives of
coal tar and are synthetic aniline dyes. Para dyes are
known sensitizers and may induce and elicit contact
allergic dermatitis. Skin testing for a reaction before
each application of a para dye is recommended.
These dyes are widely used in retail a professional
hair color products. They are able to cover white, gray,
or most natural hair colors, and have a vast color range. It
is possible to obtain almost any shade, from natural right
through to exotic greens, reds, blues or purples (Fig 10).
Para dyes are manufactured in three forms: cream,
liquid and gel. All forms must be mixed with hydrogen
peroxide before application, without which they are
ineffective. These dyes are water soluble and have com-
paratively small molecules (at this point it is often
colorless), which will penetrate the cuticle and enter the
cortex. When mixed with hydrogen peroxide, the oxy-
gen released enables colorless molecules to join to form
larger, colored, insoluble molecules, which are then
trapped in the cortex. They are too large to pass through
the cuticle and therefore do not wash out easily. For an
efficient tint, 20 vol. (6%) hydrogen peroxide is used,
unless tints lighter than the natural shade are required,
in which case, 30 vol. (9%) is used.
Lightening dyes consist of tinting the base shade of
the hair lighter than the original color. Covering dyes
consist of tinting the hair darker or a similar shade to
the natural base color, or matching white hair to the
natural base color.
The base color of the hair determines the volume
strength of the hydrogen peroxide to be used. The
lighter the color required, the stronger the strength (or
higher the volume) of hydrogen peroxide. The darker
HAIR CARE 235
the color required, the weaker the strength (or lower the
volume) of hydrogen peroxide.
As a general rule, 30 vol. (9%) hydrogen peroxide is
the highest strength that can be safely used on the scalp,
and 40 vol. (12%) hydrogen peroxide is the highest
strength that can be safely used on the hair. Sixty vol.
(18%) hydrogen peroxide should only be used with spe-
cially designed tints, and the manufacturer’s instructions
should be strictly followed. Repeated applications at
high concentrations can lead to gross weathering.
Bleaching
Bleaching lightens the shade of the hair by oxidation of
pigments in the hair shaft, eumelanin and pheomelanin
in the hair cortex. Bleaching is permanent, and serial
bleaching of black hair will result in the following:
Black ⬃ Brown—Red ⬃ Orange—Yellow—Pale yellow—
White
The main oxidizing agent used in bleaches is hydro-
gen peroxide (H2O2), which can release oxygen. It is a
highly effective bleaching agent, which releases oxygen
and can then bind to the hair pigments and lighten their
color. This ability to act as an oxidizing agent is also
used in ‘fixing’ perms and developing oxidation tints.
Hydrogen peroxide is colorless and odorless.
Uses of bleaching:
1. To lighten previously unbleached hair.
2. To pre-lighten prior to tinting.
3. To lighten or remove tint from hair.
4. To lift the cuticle scales slightly and make the hair
more porous; therefore, resistant hair becomes more
susceptible to tinting as it can penetrate into the
cortex more easily.
5. To break down any resistant patches before a tint is
applied.
6. To give highlights and streaks to the hair.
7. In conjunction with tint, to produce extra hair color-
ing techniques.
RESULTS OF FREQUENT OR EXCESSIVE BLEACHING One of the
commonest cosmetic conditions seen by physicians is
the result of excessive bleaching (occasionally com-
bined with perming): increased porosity and reduced
tensile strength result in weathering, occasionally
grossly so. Bleached hair is less elastic and more porous
than untreated hair; therefore, it will require far more
attention when conditioning, perming, or tinting.
Conclusions
The care of the hair is almost certainly part of the
physician’s own personal and professional life. It is
important to keep abreast of the enormous increase in
sophisticated products available in retail and profes-
236 GRAY
sional ranges. Care of the hair in pathological condi-
tions is part of the physicians remit: one should never
underestimate the fundamental importance and signif-
icance that is attached to this, albeit “dead,” material.
Loss of self-esteem and even employment opportunities
may occur if this social device is significantly flawed.
The combination of the physician’s skill and counsel
allied to the formulation skills of industry are there for
the patients benefit.
Clinics in Dermatology Y 2001;19:227–236
References
1. Dawber RPR. Shampoos—Scientific basis and clinical as-
pects. London: Royal Society of Medicine ISCD, 1996.
2. Gray J, MacNamee P. Preservatives—Their role in cosmetic
products. Scientific review series, volume 1. Munksgaard:
Copenhagen, Denmark, 2000;xi:40 – 42.
3. Gray J, Dawber RPR, Whiting D. The hair shaft—Aesthet-
ics, disease and disorder. London: Royal Society of Medi-
cine ISCD, 1997.