The UK's leading expert Dr Sharon Wong on hair loss, hair shedding, and eczema

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0:59Plus you can be assured that all ingredients undergo rigorous third-party testing. Buy Primudine now at OxfordHealthSpam.com and use the discount code DrSophie, that's D-R-Sophie for 20 % off. Hi I'm Sophie and this is Age Well with Dr Sophie Schotter, a space devoted to all things health, wellness and longevity, because for me, aging well is about looking and feeling like the best possible version of ourselves inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts, tapping into their knowledge, along with bringing you conversations from a range of interesting women and men, finding out how they age well.

1:47So this is my show, welcome along and as always thank you so much for listening.

2:00Sharon you're one of the UK's most respected consultant dermatologists and you deal with both hair and scalp conditions and in fact you're one of the few dermatologists over here to specialise in both. I really like that you've developed an approach that integrates traditional trichology and dermatology with a more holistic mindset. You're also frequently asked to contribute to all kinds of TV shows on the BBC in particular. And rather excitingly, you're now the founder of Dose, a range of hair loss and scalp health products. So we do want to get into all things hair, but I'm also very keen to talk about skin with you and specifically eczema.

2:36Can you start by talking to us about your own personal journey with eczema?

2:39Dr Sharon Wong:Yes, of course. And first of all, thank you for having me on the podcast. I've never known myself without eczema and some of the earliest memories that I have is actually being hospitalized as a child with really badly infected eczema. Back then there was lots of wet wrapping, so medicated bandages on my arms and legs and that was my earliest memory. So I've always been personally very interested in skin and skin health and that's why in medical school there was never any doubt or question as to what I would become. So dermatology was definitely on the radar and everything that I'd seen when I came to do my clinical attachments was only sort of confirmatory of that.

3:18Dr Sharon Wong:So when I did my first clinical attachment in dermatology, the first patient I was asked to speak to had eczema. And I remember that conversation really clearly because everything that he was saying, I completely resonated with. Like getting bloodstains on the bedsheets in the morning because you've been scratching, sleep disturbance, the fatigue, all of that. and I think you know the subject really resonated with me and that's ultimately why I became a dermatologist. Sharon what do we know about the causes of eczema because it seems there are now strong links between gut health and eczema plus certain foods and eczema I'm guessing that sugar plays a role here apparently yeast overgrowth is a common cause and I've also heard eczema can be triggered by antibiotics or steroids or even the birth control pill so what can you tell us about the causes?

4:03Dr Sharon Wong:That's quite a list there, sorry. Yeah, so eczema is incredibly common and obviously presents with dry, itchy, inflamed patches on the skin and there are basically multiple factors that can cause eczema but fundamentally the most common type is atopic dermatitis and dermatitis and eczema are interchangeable terms. But atopic eczema is essentially the childhood onset eczema where you typically get it on the creases of the elbows and the knees associated with hay fever and asthma tendencies either with yourself or with your family members. And whilst there are many factors that can contribute to the onset of eczema, fundamentally there are genetic factors at play and really genetic factors that govern two main things.

4:48Dr Sharon Wong:The first thing is how our immune system is wired to behave and respond to stimuli. The second genetic factor is to do with the integrity of our skin as a structure, the skin barrier. and by nature people with a tendency for eczema have defects in their skin barrier which makes them lose moisture, lose lipids and that's why it becomes dry and that's why certain allergens and irritants can get in and that's why you tend to have more sensitive skin type. So fundamentally there will be a genetic risk and on top of that there may be aggravating factors. You mentioned a few for example. Foods in some people, particularly in the paediatric population, There is a reasonable percentage of children who have eczema, but on top of that have food allergies as well, which can exacerbate their eczema.

5:39Dr Sharon Wong:We know that stress is a very common trigger for eczema because it tends to make your skin more pro-inflammatory. And you also touched upon diet. Now, diet's an interesting one because a lot of people will automatically, even before they come into clinic, have tried to eliminate certain foods. And whilst there are a core group of people who do genuinely have food intolerances that aggravate their skin, for the majority of people, it probably isn't that relevant. However, the area that's really interesting is actually looking at the gut-skin axis. So this is a bi-directional communication between the gut and our skin through the immune system.

6:15Dr Sharon Wong:And we know that gut health can govern the health of our immune system more widely, including in the skin. And there are some really interesting studies looking at how people with eczema have actually got less diversity in their gut microbiome compared to people who don't have eczema. But also the use of probiotics in pregnant women can actually reduce the risk of their child developing atopic eczema. So there definitely is quite strong links between gut health and your skin and specifically with eczema. I think research isn't quite there yet to enable us to be more prescriptive about the type of probiotic and the dose that we would recommend to people for specific diseases but I don't think we're that far off and generally I tend to tell patients that you know if you're conscious about your gut health and how that might impact your skin and your wider immune system then maybe look at your diet initially incorporate probiotics whether it be live yogurts or probiotic supplements and maybe a little bit more of the sort of fermented foods into the diet on a regular basis.

7:17In terms of a treatment plan for eczema are we talking lifestyle changes or medical treatments or interventions or maybe a bit of both what can be done and I'll ask separately about skincare

7:28Dr Sharon Wong:sure so my approach has always been both but ultimately you need to get on top of the inflammation first and foremost because that's the thing that is causing so much distress the itching the sleep deprivation all of that and of course we do that through first-line treatment which are usually topical steroids and that sets the skin in a good place to start healing as well because if you never got get on top of the inflammation that process of healing won't start But it's also important to get from your consultation with the patient what are their potential trigger factors. And as we mentioned, it might be a modification of their diet.

8:01Dr Sharon Wong:Sometimes it's looking at their skincare. Maybe they're using the wrong things on their skin day to day or their makeup products aren't suitable for their skin type. But also, especially this time of year, I'm often talking to patients about the fabrics that they're wearing. So obviously, as the temperatures go down, we're wanting to sort of all huddle up in nice thick woolly jumpers. but actually direct contact of really thick, coarse wool material onto the skin is an irritant and it can really make your skin very itchy. And I'm speaking from personal experience here. So, you know, the finer, typically more expensive wools like the cashmere are less irritating, but better still is actually if you wear like cotton or linen, like long sleeve tops underneath your jumper.

8:40Dr Sharon Wong:So things like that also need to be borne in mind and discussed with the patient as relevant. something i get asked a lot is recommendations for skincare and eczema is something i'm very happy managing mild cases of but obviously it's not my area of specialism or expertise so what would you recommend for anyone with eczema either specialist prescription products or sometimes in those milder cases anything that can be bought over the counter and if you are happy to please feel free to name check any products at various price points as well Sure. So as you mentioned, mild to moderate, little flare-ups, localised patches can be managed with over-the-counter strength steroids, which you don't actually need to get a prescription for.

9:23Dr Sharon Wong:So the likes of hydrocortisone or Umavate, you can just purchase without prescription directly over the counter. Obviously, we tend to see in dermatology the more severe end of the spectrum. So we would need to prescribe potent or super potent topical steroids and oversee the patients using them to ensure they don't run into any trouble with using strong steroids. And as I said earlier, that this is really important to get on top of the inflammation and to allow the skin to heal. But actually, your day-to-day skincare, so what you wash with, what you moisturize with, are staples that you need to get right.

9:56Dr Sharon Wong:and that is important regardless of what stage of eczema you are in. You could be in remission with no active eczema or you could be having the worst flare-up ever. Your soap substitutes and moisturizers are really important. Now when I say soap substitutes, a lot of, or I say avoid soaps to patients, are you telling me not to wash at all? And that's not the case, it's about the formulation because any soaps or shower gels that foam or lather has a surfactant in it by nature. So what I say to patients is that imagine when you're washing your plates and you're using the fairy liquid or detergent.

10:29Dr Sharon Wong:It makes foam and that's there to degrease your plates. Well, you don't want to degrease a surface, i.e. your skin, which is already dry. So when we talk about soap substitutes as dermatologists, we're talking about products that you can cleanse the skin with, but it's formulated as a lotion or as a milk, but something that doesn't foam so that the surfactant level is minimal to none and it's less drying on the skin. When it comes to moisturizers, there are loads of different base formulas and that's really a personal preference. There are some which are really thick, almost like Vaseline, which some people prefer, particularly in really troublesome dry eczema areas or they prefer it during the winter months, but they might favour something lighter on the face, which is more lotion-based.

11:14Dr Sharon Wong:So there is going to be a little bit of trial and error. I currently use CeraVe hydrating moisturiser and a cleanser. The CeraVe range I find are you know brilliant they're obviously the entire range is based on ceramides and ceramides are natural lipids in our skin that form part of our skin barrier and by nature people with eczema have a reduced amount of ceramides so that contributes to the sort of breaks in the skin barrier and why it's much more prone to dryness and sensitivity so I really like the CeraVe range and price-wise I don't think it's you know unattainable at all in the sense that it's about, depending on the size of the bottle, about 10 to 20 pounds, 20 pounds I think, or under for about 100 mils bottle of the moisturiser.

11:58Dr Sharon Wong:There are some others, but I'm a big believer that it doesn't need to be expensive to be good. There is La Roche-Posay's Lipicar Balm, which is even also safe for babies to use. And again, we're looking at under 20 pounds for 100 mil bottle. There's a recent product by Aveeno, which is the oat gel moisturiser, which is a really nice sort of surface texture. And that's for the face. And I've really enjoyed using that more recently. So there are lots of very good over-the-counter brands that really don't need to be expensive to be effective at what they do. But ultimately, your moisturizers and cleansers are your staple day-to-day.

12:35Dr Sharon Wong:You layer on the medical treatment according to how severe the flare-up is, and that will determine how strong the steroids need to be to settle the inflammation. This is so useful. Thank you, Sharon. And it's all kind of tracks into my next question. Do you feel as though certain chemicals or ingredients in existing everyday skincare can create problems, whether that's on the face or on the body? And are there any ingredients that you'd avoid? I mean, I guess you've mentioned ingredients that you think are great, but what about the ingredients that perhaps you think will steer clear? The general sort of overarching advice for anyone who is eczema prone is try and maintain soap-free, fragrance-free skincare.

13:14Dr Sharon Wong:It is, however, a bit boring. People do like to, you know, use nice smelling products, etc. So I think, you know, exercising a bit of common sense that if you have never had an issue with your perfumed body cream or whatever, there's no reason to stop. But you're absolutely right. There are multiple things across beauty and personal care products that you can become allergic to. And this is something that a lot of patients sometimes struggle to understand. It's like, well, I've been using the same product for 15 years. Why am I getting a problem to it now? And that's because allergic contact dermatitis, so a form of eczema that is as a result of becoming allergic to something you've put onto the skin surface, is a delayed hypersensitivity.

13:54Dr Sharon Wong:You don't get it after the first exposure. You have to have multiple exposures over months or even years to build up that sensitivity. So it's not uncommon for us to see patients who've got face and neck eczema all out of control and we patch test them and they're allergic to the dye that they've been using for the last 15 years. So delayed hypersensitivity is something that we see quite often. And usually the giveaway signs are when the eczema's changed. So either in terms of the distribution or how it's behaving in terms of the flare-ups that you're getting them back to back. Like every time you get over one episode, you have a week's respite and that's back again.

14:32Dr Sharon Wong:Or it's just really stubborn. It's like even your stronger topical steroids aren't controlling the problem. We would then refer patients on for patch testing. And that is to look at individual allergens and see whether they are creating an eczema on the skin. And common things would be fragrances, preservatives, factants. So obviously, if you are patch tested and shown to be positive to any of these things, then you would need to avoid those in your personal care and beauty products moving forward. Shall we move into hair thinning and hair loss? I loved reading another interview with you where you said, and I quote, that the hair follicle is a mini organ and that there's no other real structure in our body that continuously renews itself throughout our life.

15:15As you also pointed out, as a source of stem cells, hair has become really interesting. We did an episode nearly two years ago now where we talked all things hair and hair loss. So rather than repeat too much on this episode, can we hone in on women and hormones? So any hair loss related to childbirth, menopause, PCOS, and perhaps even stress. I was also reading about a lesser known cause of hair loss and that's diet. So I'd love you to also talk to us about what a woman can do to help herself in terms of diet and lifestyle to either mitigate any hair loss or hopefully help turn things around.

15:50What of course we can get into products and treatments too.

15:53Dr Sharon Wong:I think you've really listed some of the most common causes of hair loss in women but before I sort of explain each of those conditions or causes I think the fundamental thing to remember is female hormones i.e. estergens and progesterones are good for the hair male hormones or what we collectively call androgens are bad for the hair so if we just sort of remember that first if we take pregnancy and childbirth as one initial sort of important hormonal cause of hair changes, hair follicle changes. During pregnancy, you have really high levels of estrogen and progesterone to support that pregnancy.

16:30Dr Sharon Wong:And estrogens in particular basically hold your hair follicles in the growth phase for longer. So this concept of pregnant women getting thicker, longer, fuller hair is not a myth. It's physiologically as a result of really high levels of female sex hormones to support that pregnancy. But of course, after pregnancy, so after childbirth, those hormone levels will start to settle back down towards pre-pregnant levels. So all of those hairs that should have been normally cycling towards shedding during that nine months that you were pregnant will then all start to cycle towards shedding at the same time, which is when you get this dramatic postpartum shedding or what we call telogen effluvium.

17:10Dr Sharon Wong:That is the medical term for excess hair shedding. And typically that would be three to six months after a pregnancy or after you stop breastfeeding because obviously breastfeeding does tend to mean that you have those higher levels of pregnancy hormones for a bit longer. So that's what happens in childbirth, super common, but we expect it to spontaneously get better over time. Now menopause physiologically is the opposite of pregnancy. So what we're doing is we're losing gradually our oestrgens and progesterones. So obviously we're withdrawing that sort of hair protective effect of the female sex hormones.

17:46Dr Sharon Wong:But not just that, it's the ratio, the shift in ratio between male and female hormones. So as you're declining the female hormones, proportionately you're getting more of the male hormones or what we call androgen dominance. It doesn't even matter what your absolute values are. So if I actually did a blood test on somebody who's peri or postmenopausal, their testosterone levels may actually objectively be normal or even low. It's not so important about the objective levels. It's about that relationship between male and female sex hormones and the ratio between the two. So what androgen dominance does, androgens as male hormones are the hormones that drive balding and this miniaturizing process.

18:25Dr Sharon Wong:So often, and I would say probably at least 70 % of my patients in my clinic are women who are going through the perimenopause and they are seeing more hair fall out, they're seeing their hair actually become thinner, they're seeing their parting get wider and it's typically on that hormone dependent area of the scalp around the crown and the frontal area and often they also find that the hairline starts to thin out as well. Now with polycystic ovarian syndrome which is incredibly common, it is a condition where women are producing too many male hormones. And for exactly the same reason, it will feed into the same pathway for female pattern hair loss as it does with perimenopause.

19:05Dr Sharon Wong:So this is one of the commonest reasons why I would see early onset hair loss in a woman. So sometimes even in their late teens or early 20s with polycystic ovarian syndrome. And it's because these excess male hormones are driving the thinning process at an earlier age. So hormones and hair are, you know, there's such an intricate and delicate balance between the two, but it is really one of the main reasons, especially as women, that we undergo periods of hair loss throughout our lifetime. Now, stress never helps anything. Stress basically can magnify all forms of hair loss. And if we only took stress, let's say a bereavement or a really difficult time at work or in a relationship, that in itself can cause excess shedding, let alone having an underlying primary problem like PCOS or perimenopause changes.

19:55Dr Sharon Wong:It just magnifies and worsens the entire sort of hair cycling process. You also mentioned diet, and this is a situation where diet is really important to get right if you're going to maintain healthy hair. Your hair follicle cells are some of the fastest dividing. And to keep up with that cell turnover, you need energy and you need the entire spectrum of nutrients, so macro and micronutrients. And it's often quoted that hair is a very sensitive barometer of your nutritional status. And I completely agree. So when keto, paleo diets, all of these things came in and out of trend and loads of people were adopting these diets very quickly and losing a lot of weight, we would often see people who would shed hair, but also the texture and the quality of the hair was also very poor.

20:46Dr Sharon Wong:So whilst a lot of people want to know, is there like a superfood or is there a specific diet for your hair? This isn't like media grabbing at all. It's actually very boring advice, but it's genuinely what works. It's that the diet that you have to maintain a healthy heart, to help with your sugar control, is also the same diet that's going to be helpful for your hair. So the same advice as in lean sources of protein, complex carbohydrates, eating the rainbow to make sure you get all your vitamins and minerals and trace elements, maintaining hydration two and a half to three litres of water a day, all of that is really important for hair health as well.

21:22Dr Sharon Wong:I guess you could argue that actually protein is even more important when it comes to maybe looking at a more, inverted commas, diet that's friendly for hair because the structure of your hair is 95 % keratin. It's all protein. And I think up until more recently, the awareness around protein intake hasn't been quite so mainstream. I think particularly in women, certainly on my algorithm anyway, I'm seeing like eat lots of protein just in terms of muscle mass, etc. But it's also true for hair. So I think certain people with exclusion diets or maybe they have gut issues that they don't absorb their nutrients so well, they might benefit from supplements but it's always really important to look at your diet first and foremost.

22:05Dr Sharon Wong:Gosh this is so useful and so much of it is ringing true for me. In fact you've mentioned supplements. In your experience do any specialist hair loss quote-unquote supplements work? I mean either nutritional supplements that people can buy for themselves or Sophie I know that in clinic you offer Viviscal which I think you previously said is a blend of marine proteins and other nutrients. But Sharon, where do you stand on supplements? Either you've mentioned gut health supplements in the diet, but maybe specialist supplements or something similar to this vivascale treatment that Sophie offers? I think with supplements, it's always been a slightly controversial area.

22:43Dr Sharon Wong:Personally, in my clinical practice, I would test. I would test patients for any of the main nutritional deficiencies, which are common, but also have been associated with hair loss like low iron, low vitamin D, and also depending on what their diet is. So if they are vegan or they've got quite restrictive diets or they've got gut health issues, then I'll probably test for some of the more trace elements as well and replace what's necessary because to this day, the data hasn't supported supplementing individual vitamins and minerals in the absence of a deficiency. And biotin is a very good example.

23:17Dr Sharon Wong:Biotin deficiency is incredibly rare. There are exceptional circumstances where you are genuinely biotin deficient and in those cases by all means supplement but you know biotin isn't every single hair and nail supplement that you can find on the market and yet the data is just really poor in terms of it actually contributing to any improvement in hair health when you haven't got a deficiency in the first place so my stance on it is that I'll supplement where necessary but as I mentioned earlier that there are some patient groups who perhaps can't hit their protein intake daily or they have inflammatory bowel disease, which means that they don't really absorb their nutrients and they are at risk of being deficient or repeatedly deficient and things.

23:57Dr Sharon Wong:So in those situations, it may be helpful for those patients to be on supplements like the vifiscal, which have the marine protein. So it's a bit like an amino acid boost for people. But specifically for those, I think it's beneficial where they can't get it through their diet because ultimately your body will most efficiently absorb nutrients through food. That is the best and the most efficient way of nutrient absorption. So wherever possible, looking at diet is important, maybe working with a nutritionist. But if it genuinely isn't something that you can optimise through diet, then by all means supplement.

24:31Okay, so products. And it seems that in terms of hair loss or hair shedding products, the hair industry, like the aesthetics industry, isn't particularly well regulated and a lot of what's out there also isn't cheap. Would you mind running through a list of options for both women and men across all budgets? And at this point, we'd also love you to tell us about DOSE.