Scalp Health, Hair Growth, and the Future of Hair Care with Dr. Aamna Adel of Rhute

0:00Hey guys, welcome back to Skin Anarchy. This is an episode focused on hair care today. I'm so excited. It's been a while since we got to really dive very, very deep into the hair care world, understanding scalp care, understanding what the health of, you know, scalp and hair actually means in a multifactorial way. So without further ado, I'm very much honored to be interviewing our guest today, Dr. Amna Adele, who is really redefining the conversation around hair health. And she is also the founder of Root. So welcome, Dr. Adele. I'm so, so excited to host you. Thank you so much for having me and for such a warm welcome and intro.

0:37So excited to be talking to you today. Yeah, no, it's really wonderful to have this opportunity to chat because scalp care, I feel like has, and I don't know if you agree, but I feel like it's kind of reached an evolution, evolutionary milestone, I should say, because we started with like not knowing what's going on with the scalp to knowing we have to take care of it. Now we're like in such a wonderful place. So I'm really excited to get this opportunity to chat with you. I would love if you could kind of start us off, though. Like, what really got you into medicine? Because you're a consultant dermatologist and you have so much experience under your belt.

1:09What made you want to go into medicine? You know, that feels like a question from such a lifetime ago. But honestly, I think for me, I knew pretty early on that I wanted to be a doctor. I think like around 13 years of age. I think like my parents were kind of like, oh, these are the kind of careers that you should think about, like with medicine being one of them. So that kind of like set like a little bit of a tone in my mind where I was like, actually, this sounds really interesting. And it's such an amazing job where you actually get to give back and make a real difference. As cliche as it sounds, but it is honestly true.

1:44Like it's like a job where you get so much job satisfaction, you're able to do so much. So honestly, from a really young age, and I think from 13 onwards, I was kind of like tunnel vision towards getting into medicine and wanting to go to med school. and that's kind of how it already started for me. That's awesome. I love that. And I love that you, see, I love asking this question. Like I feel like I've said this a lot of times, but every time I interview a doctor, I have to ask, you know, because our reasons for going into medicine are so different and they really translate, you know, it comes together.

2:14Like as you progress in your career, you start to see it. So I'm ranting, but it's a question I really enjoy the answer to, But I want to get started. I know that you are truly, you've dug deep into scalp. And I know you really kind of specialize in that in your practice as well as understanding hair. And I have so many questions, you know, and I would love to kind of pick your brain a little bit, if you don't mind, because I know a lot of consumers, a lot of our listeners don't really understand the true fundamentals of scalp health. You know, I know there's a lot of like information out there and that's wonderful.

2:45But like when it comes to the fundamental meaning of taking care of our scalp as it is, you know, skin, what are some things that you think should always be at the top of the list? I mean, I think that's a really great question. And I think, you know, kind of like you mentioned earlier, I think scalp health has been overlooked for such a long time and people really focus on their mid-lengths and ends and actually maybe overlook the fact that, you know, all growth is happening at the level of the hair follicle, which starts at your scalp. Everything from mid-length to ends is actually dead. So when you're thinking about really wanting to have healthy hair and you're concerned about like hair thinning and growth where you need to start is really your scalp what i always describe as kind of being the soil for growing anything great like you know it's that flower bed for having great flowers and i think that when you're thinking about how to look after your scalp actually you probably want to simplify things because your scalp is skin it's an extension of the skin on the rest of your body but it has its differences as well you know you have more sort of oil producing glands you have more spacious glands you also have increased nerve fibers, which is why people can get more sort of sensitivities and tenderness kind of to their scalp.

3:52It also has its own microbiome. So you have like natural organisms, yeast and fungi that live on your scalp. And for me, when it comes to sort of scalp care and scalp health, I think really the scalp barrier is a great place to kind of start. And that's an area that is often really overlooked. And I think there's been a lot more conversation around, you know, skin barrier health and understanding the importance of when your skin barrier is not quite in check, that's when you're going to get sort of dryness, irritation, flaking. And honestly, it's the same when it comes to your scalp. So often a lot of people will experience issues like dryness, excess oil production, their scalp feeling quite uncomfortable.

4:28And that can really be a sign that your scalp barrier is impaired. And I would say really the fundamentals of looking after your scalp is having a good hair care routine. I feel like it's so overlooked in terms of what you can actually do for yourself at home by using the right products, but also having the right behaviors when it comes to looking after your scalp. And like a really simple example I would give of that is even blow drying your hair after you wash it and not going to bed with your hair wet. Like this is something that parents have spoken about. They're like, oh, never go to sleep with your hair wet.

4:56And you know, it's true because when you do go to sleep with your hair wet, you get like an overgrowth of yeast, you increase your risk of bungal infection. You also get increased breakage of your hair strands. So really it's a lot about focusing on good hair care products which are going to strengthen your scalp barrier. So things like niacinamide, panthenol, in the form of a serum. And I think scalp serums are often really overlooked, but it's the same way that you look after your skin on your face where you would use like a moisturizer or like a sunscreen. Actually, for your scalp, you should probably be using a serum.

5:24And SPF when it comes to your scalp is also really important. Like the number of people that I see in clinic that have had a sunburn of their scalp along their hair parting is crazy. And also like just thinking to men who are losing their hair, the number of sort of skin cancers and early sun damage that we see on the scalp is like fascinating. and actually things like squamous cell skin cancers without getting too medical, the most common places that they tend to occur is actually head and neck because that's where you're getting the most sort of sun exposure. So yeah, people are very much now really into understanding the importance of sunscreen and sort of the learnings that people have taken from skin on the rest of their body also needs to be applied to your scalp.

6:02Absolutely. No, thank you so much for going into that because the scalp care conversation from what I've noticed has been very much focused on put the hydration in, You know, put the things in that are really going to nourish, just like skin, you know, just like we're trying to take care of the hydration and, you know, reduce water loss, all that. But then that's very interesting what you just said, which is the SPF component and actually focusing on protection. Where do we start with that? Is it you wear a hat? I mean, is that where you kind of should be focusing? How does somebody incorporate this in their daily life?

6:34Yeah, I mean, absolutely. I would say a hat, you know, as far as sort of UV protection or sun protection goes, there's nothing better than barrier. in all honesty that that is above sunscreen and we always recommend doing both together so you know kind of covering up wearing a hat is a great idea because you actually end up blocking almost all of uv rays but if you're not wearing hats wearing sunscreen which you apply to areas where you have exposed skin but also where you may have for example like if people have got like sort of a widening parting that really becomes an area that can get sunburn or people can develop certain types of skin cancers.

7:10So making sure that you're applying a sunscreen directly to that area. And I know it's not easy because I think a lot of sunscreens are quite greasy and they can be challenging to apply when it comes to the hair. But you know, there's now sprays which are out there. There are better sunscreens which are more in a gel version that could be a bit more practical to kind of apply. But definitely I'd say the combination of the two. So sunscreen and wearing a hat, especially when you're out during periods of the day where UV is at an all time high, which I would say is between 11am until 3pm. That's when you want to be the most vigilant.

7:38That makes sense. It's interesting. I'm going to start doing that. I actually don't do it. And I should because that's very, very important. And, you know, I wish dermatologists would speak more about this, you know, the real importance of protecting all of our skin, you know, and I think we're getting there. You know, I'm sure you've seen it. There's like a surge in like body care now, which, you know, because that's most of our skin. So that's, that's very interesting. Now, I want to dive in because I know that your, you creating root is, I think, amazing because I have been watching your content and I've been watching the education you put out and it's very it's very unique like I'll give you my example I was started on GLP-1s on the journey for almost a year and I started you know literally losing globally hair like way more hair and it was even with a scientific background it just didn't make sense to me when I dug into the you know what I mean like the pathways and stuff like what is going on at large you know at the same time one of my biggest questions for you is that they always say things like hyperpigmentation, hair loss.

8:36These are multifactorial approaches, especially from the pathway side. So can you go into that for us? Like what are the things, like the big buckets we should be targeting when we're trying to grow our hair back, improve density? Yeah, I mean, I think that's a really great question because I so agree with you that when it comes to sort of scalp and hair, that multifactorial approach is everything. There's not one magic bullet when it comes to actually growing your hair. And you know, kind of there's things that you can be doing yourself behaviorally. But if we kind of like split it up in terms of what you should be looking at, I think diet is a good place to start.

9:09So we know that having high protein in your diet is really important for healthy hair and healthy hair growth, but also addressing things like nutritional deficiencies. It's a really common reason why a lot of people experience quite a lot of hair shedding. So in my practice, I tend to see a lot of low levels of iron and ferritin. And sometimes your iron level can be within normal range, but your ferritin can be on the lower side. And for us, like when we look at the context of sort of hair shedding, hair thinning, or wanting to have fuller hair, actually your ferritin level should be 60 to 80.

9:38So I would definitely say like focusing on nutrition is really important. And as a first step, if you are losing hair or your hair is thinning, getting your lab work done by your doctor for things like vitamin D, vitamin B12, folate and iron are really important places to start and really focusing on your diet and kind of increasing protein and you know sort of those green leafy vegetables where you're going to be getting a lot of that sort of iron and other sort of nutrients would be the first thing that I would kind of say and then also another bucket is really thinking about how in terms of like I mean this isn't really pathways but one pathway that I would definitely talk about is DHT and the impact of DHT on the hair follicle and for anyone who's listening to this that doesn't know what DHT is it's essentially a hormone that can it can be at increased levels in some people but what it tends to do is it tends to shrink the hair follicle so it means that the hair doesn't really mature in the way that it should do normally it essentially stays almost like a baby hair doesn't mature and get thicker and then eventually it kind of falls out and often we tend to see dht related hair loss with things like androgenetic alopecia which is extremely common it's probably one of the most common causes of hair loss and that's basically male and female pattern hair loss but you also tend to see dht related hair loss with things like pcos for example yes yes so it's it's an important one which affects a lot of people and that's where things like minoxidil come in but you also have more natural dht blockers that we're getting more and more evidence around now things like saw palmetto and pumpkin seed oil that naturally block dht and can be useful if you're looking for a non-medicated option and you're not keen to kind of go down the pathway of minoxidil and then i think other things i would kind of say is like another big one is really the impact of stress on scalp and hair is huge and that when i say stress that doesn't just mean like emotional stress, which of course we all go through.

11:21I think naturally people's stress levels have like skyrocketed over the last couple of years. I think especially like, especially after COVID, and I mean, COVID is a whole nother topic in itself. But when I'm talking about stress, you have like your kind of emotional stress, but then you also have your physical stresses. So that can be like after having a baby and being postpartum or having had surgery or having an infection, which is kind of like COVID, that kind of like moves more of your hair follicles from the growth phase of your hair growth cycle into the shedding phase. And that essentially presents like people finding that they're losing huge amounts of hair, like in the shower, in their hairbrush, on their pillow.

11:55So it's what we call telogen F luthien. But that again is another big one with the hormonal changes, that stress reaction, that cortisol that can kind of really affect the hair growth cycle and lead to like quite extreme shedding. That makes sense. You know, it's really interesting that you brought up the DHT pathway. And, you know, I know there's a lot of products on the market that are targeting 5-alpha reductase and, you know, somehow working on the DHT pathway. But it's really interesting for me because when I look at like Wnt signaling with beta catanin and stuff, that's also a pathway that never gets talked about for some reason, but that's the growth switch, you know, like Wnt signaling is what turns the genes on.

12:32So why do you think it is that we don't focus there? Because every serum I see on the market, it's DHT focused, It's androgenic hair loss focused. And it's like, why aren't we going to that, you know, on off switch as well and combining the two? Yeah, I think that's a really interesting question. I think one thing that I would definitely say about the scalp and the hair space is that and it was one of the reasons why I was so passionate about going into this field is because I feel there's so much more work and understanding and research that kind of needs to be done. And really understanding, like, how do you bring that into more of like a kind of like a consumer space?

13:06because I think formulation and development is very challenging in itself. And one thing that I would say is that when you are looking to different kind of pathways and introducing those to kind of like consumers, there's a lot of education which also needs to be done there for people to understand what products are actually doing for them. I would say like, you know, the landscape is changing really rapidly. I think there's a lot more emphasis being put into scalp and hair being taken more seriously because I think for a long time, it's kind of always the thing, even within dermatology, all of the focus goes towards things which are really considered as more serious medical problems like skin cancer, melanoma, even psoriasis and eczema.

13:46The kind of the changes that we've had there have been huge in terms of research and biologics and different treatments that are now available. But I feel scalp and hair health is still very much bottom of the list. And I think we kind of need a bit more research, a bit more understanding and a bit more kind of education around certain pathways and people really formulating to bring those things into consumer products. Yeah, no, I couldn't agree with you more. I think that's really, really great feedback. And for everyone listening, I think that's really important to understand what you just said, that we do need to have more focus here because from my standpoint, yeah, we've been so hyper-focused on skin, especially facial skin aesthetics, you know, but yeah, the hair just always, we never talk about it.

14:27On another note, I want to actually talk to you, You brought a really cool point up earlier, and that's more about the environment that our scalp is in. That made me think of inflammation and it made me think of like all of the, you know what I mean, factors that really kind of irritate and inflame the microenvironment. What do you think are some of the very key things that we can incorporate, you know, or that you incorporated in roots that were kind of focused on that inflammation component, that microenvironment component? Yeah, and I mean, I think, you know, scalp barrier and inflammation do quite strongly go hand in hand because your scalp barrier, like your skin barrier, is really responsible for keeping everything good in and keeping everything bad out.

15:04So, you know, environmental stresses, bacteria, viruses, etc. When you have an imbalance of that and you naturally get an increase in levels of things like fungus on the scalp or you get an increase of melesthesia, which we all have, that in itself can lead to inflammation. For me in Root, one of the key things alongside looking at actives that were really focusing on reducing shedding, increasing density, blocking DHT, was actually looking at scalp barrier support, which I think is very overlooked. So ingredients like panthenol and niacinamide have been put in there to not only hydrate the scalp, but really to help balance the scalp barrier, which I think is so important when it comes to thinking about inflammation and balancing your microbiome and the excess levels of yeast that a lot of people can experience.

15:47Yeah, no, that makes a lot of sense. And it's interesting, you have the pantalon niacinamide. You know, we always overlook them, I think, in skincare now because they become like almost dated ingredients. But it's interesting that you're now like, you know, we're bringing them back for the scalp. That's really cool. Yeah, for sure. And I mean, I think it's something like niacinamide. It's like it had like its moment where, you know, you were seeing it in a lot of skincare products, not really in the context of hair. But I think when I truly think about an ingredient like niacinamide, it's one that has got so much research and data behind it.

16:15that although I think this is one of the problems I would say in the consumer space is that there's this real focus on trending ingredients and moving on to like what is the next trending thing what is the next new thing that's going to get people excited but actually you know where does the data lie where is the science what are actually the ingredients that are going to really give you most bang for your buck when you're looking at formulating products so yes something like niacinamide is not as sexy anymore but it is a great ingredient and I think it's really about like re-educating the importance behind ingredients like that so that consumers know what it's actually doing for something like your scalp barrier and your scalp in general versus them seeing that product and kind of thinking like oh you know niacinamide was all the rage and it's not anymore medicine's not like that you know it's not really about like what is trendy in the same way in terms of like what's happening in the beauty space where you may have like you know it's the next hottest blush like that's not biologically affecting your skin right yeah it works works Like, yeah, science is science at the end of the day.

17:13Like, we can't, you know, pretend like it's not going to work. And I agree with you. I feel like there's a lot of ingredients that we're just like, guys, this works, you know? And we're so hyper-focused on like right now, I know biotech is like booming, you know? But it's like what works, works. And it's going to keep on working. And there's so much data. And I think that's where also I get a little bit lost, especially with scalp care, because I'm like, why are we not going back? Like I know I've watched some of your content where you talk about like tretinoin and like combining it with noxodil.

17:43Yes. That's like that's the kind of stuff that I wish we would talk about more. You know, can you talk to us about the science of that? Like why does that matter and why does that help? Yeah, I mean, one thing that I would say is like just as a general point when we're looking at kind of treating the scalp and the routine and how we tend to use things together. It's kind of what I mentioned before. There's like no one magic bullet when it comes to hair growth. I say this in clinic all of the time. it's often a combination of using the right treatments in the right sequence, which is going to get you the best results.

18:12When we look at something like tretinoin and minoxidil, tretinoin essentially, you know, it's an ingredient that has been around for ages. But in the context of minoxidil, it actually just helps to increase the absorption of minoxidil and therefore you get better efficacy. And it's kind of getting your products to work harder. And I think, again, it kind of comes back down to rather than looking for the next new thing, How can we take existing things that we know have so much science and evidence behind them and pair them in ways where you're going to get better results? There's lots of data which looks at using minoxidone and tretinone in combination, plus even using a dermastamp in combination and how much better absorption, but also an increase in the hair count and hair density you're going to get when you use that combination.

18:53Yeah, I mean, it's really fascinating because, you know, I like how you've built your brand to kind of incorporate all of these different, like really, really, I think nuanced components that we never thought about. You know, I remember when I saw the hair stamp first, I was like, that's brilliant. That's brilliant because I'm always scared of, you know, there's the rollers that you can buy. That's, I don't know, it doesn't feel controlled enough for me, you know, as a consumer. So that's really cool. But I would love for you to dive in actually to root if you don't mind. I want everybody to learn more about the brand and like what really inspired you for your hero SKU, which is the serum and the oil.

19:25Dive into that for us. Yeah, of course. I mean, you know, Root is a brand that I really started thinking about almost two and a half to three years ago. It's really my baby. It has been such a passion project, I think, for me. You know, I'm a solo founder. There's no investors. And for me, when I first really knew that I wanted to create a haircare brand, like I'm saying, all those years ago, part of that was actually triggered by my own kind of like experience with hair loss, which I've spoken about quite openly on my socials. But that really was like a massive trigger for me. And you're not to be like, again, for it to feel very cliche, but I think you will agree that as a doctor, you know, you kind of see and treat things every single day and you can, to some extent, understand what your patients are experiencing.

20:11But I think being the patient yourself is a very different feel. And for me, I had like a very sudden episode of hair loss that happened in like over the period of a couple of days. And it was really unexpected. And I remember at the time how I felt and like, I think I can only talk for myself, but I feel like doctors are not great patients. And I think for me, I was just like, I was panicking. And you know, I was really fortunate that I had like my colleagues who did scalp biopsy and I got my diagnosis, but it really like set off something in me that really got me very interested in scalp and hair health.

20:42I think when you've personally been affected by it, you're so invested in wanting to know where are we at with research, the conditions, the products that are available. And for me, over the last couple of years, I've really been on my own hair growth journey. And as part of that, it's kind of what I've said to you, you have the medicated options, but you also have regular things that you use in your routine. And when I was kind of searching for those things, I was really confused. I was like, I've got no idea where I start, what this product is meant to do how is this different from this like what should a good routine when we're going outside of medical treatment actually look like and I think for me as well I think there was just not enough science and evidence in what it was that I was seeing they'd maybe have like one ingredient but then they hadn't really considered other elements of like the hair growth cycle for example or it just wasn't like a whole considered approach which I think is so important when it comes to scalp and hair health and I think for me when I was really thinking about creating Root, I knew I wanted to put something in the space that was really backed by like science and evidence.

21:41And it really bridged that gap between what I see and treat in clinic and what is actually available on the shelf. Because I think that a lot of formulation and products that happen, they don't really have the insight into what patients and consumers are actually saying, the kind of issues that they are really experiencing. I think you'll agree that when it comes to sort of like patient care, really adhering to whatever it is that somebody should be using is really important to see any type of results. And people aren't going to use something if it is sticky, if it is greasy, if it's not practical to use.

22:12And so for me, like, you know, that texture side of things and ease of use and really getting multi benefit from one product was really important to me. And that's kind of where for me, the scalp serum was really the first hero launch that I wanted to do because I was really thinking about this large group of people, not only in my own practice, but also in my online community that were experiencing hair loss and hair thinning for all different types of reasons like you know post-covid so many people were experiencing it postpartum people were really like also leaning more towards really embracing their natural hair and wanting to understand how to look after their scalp and you know we were moving out of this phase of people using hair extensions wearing hair extensions over bleaching the hair and people really wanting to go back to the source of making their natural hair better and a lot of those people didn't want to be on minoxidil or on medicated treatments and i think like you know often as doctors in our practice like there's obviously the medicated route which obviously i still prescribe all of that all the time like the minoxidil the finasteride other treatments that we kind of have but what about the rest of the routine how do you incorporate other products that are going to support what medical treatments are doing and are also going to be an option for somebody that really really doesn't want to go down that route no consumer product is directly comparable to the medicated options that we have i'm always very transparent about that.

23:30Nothing's really going to like for like compare with minoxidil, but there are definitely things that we know from research and evidence in terms of ingredients that can give you a similar benefit without having minoxidil in them. Yeah, absolutely. No, that's so, so important what you're saying, because I feel like that has been actually the missing link because there's frankly not enough funding. There's not enough money going into this in a meaningful way, honestly speaking, from the allopathic medicine side. We have very limited drugs. We have a lot of data on those limited drugs, but there is a huge bridge that needs to be, you know what I mean?

24:04Like made and filled. And I completely agree with you. And this actually is a question I had for you because natural extracts really come in, like plant extracts, like all sorts of oils. People don't realize like there's a whole side of this like discovery, you know, for medicine that is still pending, you know? And a lot of people like, they'll say, go to Ayurveda, you know, go to Chinese medicine, like go to these ancient understandings of herbs because you're going to find certain molecules. I mean, what do you think it's going to take for medical practitioners to really kind of get on this in a meaningful way?

24:35Because I feel like when you talk about this stuff, everybody goes like, oh, hocus pocus. I don't want anything to do with it. It's the monoxynol and tretinoin. Like that's what I'm doing. What are your thoughts on that? No, I completely agree because I think there's this idea of like, well, it must be woo woo. Like, you know, let's like really focus on like the drugs and the medication, which again is important but i think it brings us back to this bigger conversation that we haven't even really got the fundamentals and basics of truly fully understanding scalp and hair biology so that's the first place that we need to start before we even get a chance to go down more of these natural botanical ingredients like you know in my practice and when we're kind of looking at research obviously the scarring alopecia is not the most important because they're the ones that have lifelong lasting consequences for people and for anyone that's listening when we say scarring alopecias that's a group of hair loss disorders where the hair follicle itself is destroyed so those people will never regrow their hair and when i look at the research i could tell you like i could probably name like five medications that are used for pretty much anyone regardless of what type of scarring alopecia they have so i think that there's so so much work to be done in terms of research and understanding that i hope that we get to a point of addressing those things fast and then really looking at botanicals but i think it i have to be honest and you know how it is with sort of research like the priorities are always based on what is considered to be or perceived to be the most impactful um so i i don't see that maybe happening for quite some time if i'm being like really totally honest about it even though i think it's important because you've got a huge group of people that want options which are considered like more natural you know i don't really like using the word natural because i don't think anything is truly natural everything is a chemical but at the same time like there's a big group of people that don't want to go down the route of medication and it's like well we have to serve those people as well because then what are their options?

26:17Or what can they be using in addition to the medical treatment that they're already using that we haven't even discovered yet, or we haven't really put in the funding to understand more? Yeah, I totally get that. And I agree with you. You know, it's like the funding is just not there. And the pipelines to that funding are not there either, you know, like, and I think consumers, this is an important conversation, honestly, for our listeners, because there's a lot of people who wonder this, right? Like, they're like, why haven't we poured more money into like serious research for things that are going to be almost preventative in the long run when it comes to this, especially dermatology.

26:50Like this is a field of medicine. And I just want to say this, you know, for everyone listening, this is the one field of medicine that intersects so heavily and so meaningfully with almost every other subdiscipline. And so for us to not see that funding come through, just like we never see it come through for women's health, it's like the most disheartening thing, you know, from the science. It is really wild. And I think that, you know, it comes kind of back down to like the perception of hair being more of an aesthetic issue and almost not considered as being a real medical problem but it absolutely is it's like it's really hard like to really champion um scalp and hair health which i do all of the time because i think for the higher power is like to understand the impact that actually having scalp and hair disorders and having hair loss what that does to people and but you know obviously the funding is more towards you know like cancer research of course, diabetes, cardiac disease, understandably.