alopecia areata

Understanding Alopecia Areata – What is Spot Baldness

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Coping with Alopecia Areata: Spot Baldness

alopecia areataAlopecia Areata is frequently referred to as “spot baldness”, a term that reflects its unique pattern of onset. Where Male Pattern Baldness primarily affects the hairline and crown, and Female hair loss and thinning hair primarily affects the part area, Alopecia Areata is characterized by sudden and somewhat random hair loss in varying and irregular patches on the scalp. The onset of the condition, which is seen in both males and females, often begins sometime between late childhood and early adulthood, though it is not abnormal for Alopecia Areata to exist in very young children or start later in life. Nearly 6.5 million people in the United States alone live with Alopecia Areata; that is 2% of the population!

The condition itself can be confusing though. Earlier this year, we discussed the many faces of alopecia, noting that the umbrella of alopecias includes a number of different types of hair loss. Alopecia Areata is unique in that this specific term refers to hair loss caused by an autoimmune disorder and as mentioned above, causes distinct patches or spots of baldness. In an autoimmune disorder, an individual’s immune system confuses some of its healthy body tissues for unhealthy and unwanted outside materials such as bacteria, viruses, or toxins. It then tries to protect the body by ridding it of what it understands to be intruders by attacking them. Unfortunately, in this scenario, the tissues being attacked are actually healthy hair follicles.

Research continues on autoimmune susceptibility as well as why an immune system suddenly views healthy tissues as external intruders, and while records are growing to aid in the understanding of the genetic underpinnings of Alopecia Areata and hopeful progress is being made towards prescription drug applications, definitive answers to the many questions surrounding the condition’s origins and potential cure do not yet exist.

What is known is that the majority of people living with Alopecia Areata are completely healthy aside from their autoimmune hair loss.  For some individuals, hair loss and regrowth on certain spots of their head will be a continuous cycle throughout their life. For others, what began as specific spots of baldness may develop into broader hair loss and more rare forms of Alopecia Areata. When all hair on the scalp is lost, the condition is then called Alopecia Totalis. If the hair loss encompasses the entire body, including follicles in the eyebrows and pubic hair, the condition is known as Alopecia Universalis, the rarest form of Alopecia Areata.

Treatment options vary in the same way that prognoses do. Stimulation and maintenance of hair growth is possible through ongoing treatments for some individuals while external replacement systems are more effective for others. The degree of hair loss, pattern of hair loss, age of patient, and needs and desires of the patient all play a role in defining which options might suit a specific individual.

To best understand the possibilities available, a one-on-one consultation with a professional hair restoration specialist is the best place to start.

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Ways to Help Kids Overcome Trichotillomania

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If you are the parent of a child suffering from trichotillomania, you might feel confused, embarrassed or even scared.  It seems like such a bizarre bodily disorder, but truthfully, this may not be the case.

A possible reaction to stressful circumstances, Trichotillomania (trick-o-til-o-MAY-nee-ah) is a disorder that causes people to want to pull out their own hair.  The following are a few tips that might help you manage your child’s Trichotillomania.

Be More Aware

First and foremost, it is important to understand as a parent that trichotillomania is not as uncommon as you might think.  Time magazine reports that trichotillomania currently affects about two million Americans.  The stressful adolescence phase is a common time for symptoms to start showing, where a majority start at age 12.  It is also important to understand that the act of pulling out hair can feel good to your child and bring them instant gratification.  Unconditional love and support is needed to help your child through this tough time.

Communicate Openly

If you find talking about the condition with your child or young adult difficult, you might want to try talking with support groups with kids near their age.  If you cannot find a support group in your area, be sure to check online for support forums.

Celebrity Role Models

If a child knows that successful celebrities such as Charlize Theron, Megan Fox and Olivia Munn also suffer from trichotillomania, it might help them not feel so alone.  Even the likes of Justin Timberlake and Leonardo di Caprio have stated that they have OCD, which can cause trichotillomania as a symptom.  The point is that this disorder can happen to even the best of us, but it is in no way unbeatable or life ending.

Keep Fidgety Fingers Occupied

Giving your child’s fingers something else to do might help them resist the urge to pull out their hair.  Some of these activities include, but are not limited to; typing, needle-work, playing piano, play dough or silly putty, cooking lessons or even watercolor painting.  Find any activity they enjoy that keeps their hands focused on something else.

Coordinate a De-Stress Time

Talk with your child to try and identify specific times throughout the day where they feel the urge to pull out hair.  Sometimes this can occur right before bedtime when they are alone and feel insecure.  Playing soothing music before bed or even relaxing activities such as kid-friendly yoga or a warm bath could seriously help.

Cover Up the Hands

Utilize the “out of sight, out of mind” idea to help prevent your child from pulling hair.  Let them dress up in cool gloves to keep their fingers from wandering to the scalp.

Makeup and Beauty Products

Since hair loss can affect self-esteem in a negative way, try to help your child focus on body image in a playful, fun way.  Let your child experiment with makeup a bit if they enjoy it.  The introduction of beauty products that enhance healthy hair may also be a step in the right direction.  Let your child see that you really do care that he or she has a healthy body image as well.

Hypnotherapy

Sometimes called trichnotherapy, this method has been proven to work on its patients due to the fact that the part of the brain that is affected by trichotillomania is also near the memory center.  A good therapist can help your child do brain exercises or work with certain memories that may help to heal the mind and the body.  Hypnotherapy works to aid in assessing you child’s life and specific circumstances to really get to the root of the problem.

It is possible to fully recover from trichotillomania, and with the right communication, help, and understanding, your child will be on their way to happiness, health, and a full head of hair.  If your child suffers from trichotillomania and needs a hair replacement option to help cover up hair pulling, we are here to help.  At Van Scoy Hair Clinics we offer many options to hair replacement. We invite you to a free consultation and you can make an appointment by calling (419) 289-6665 or clicking here!

Photo Credit: Sophie Via Flickr Creative Commons

Author Research Links
http://content.time.com/time/health/article/0,8599,1909704,00.html
http://www.healthofchildren.com/I-K/Impulse-Control-Disorders.html#ixzz41wFDfthx
http://www.ibtimes.com/olivia-munn-battles-trichotillomania-five-celebs-ocd-symptoms-734128
http://www.teenvogue.com/story/how-beauty-products-help-trichotillomania
http://www.trich.org/

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Savin Scale

The Savin Scale: What Is It and Why Does It Matter?

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Diagnosing the cause of hair loss and understanding the degree of it are related and often linked tasks. Their core questions, however, are different, and so too are the tools used to reach answers. Diagnosis asks ‘Why is there hair loss?’ and utilizes a number of methods to find the cause, while labeling the degree of loss asks ‘How bad is the hair loss?’ and uses an objective visual scale to appropriately gauge the current state of follicles on the scalp. The Savin Scale is one of these scales; it is a tool used specifically for measuring the degree of hair loss in women.

Though four main scales have been suggested by doctors for measuring the level of female hair loss, the Savin Scale is the most widely used. Very similar to the Ludwig Scale, it was developed, tested, and put forth by Dr. Ronald Savin in the mid 1990s as a way to better facilitate hair loss research. Where the Savin Scale differs from the Ludwig Scale is in its ability to measure overall thinning in addition to loss. As can be seen in the image below, female pattern hair loss occurs along the part, and the Savin Scale acknowledges 3 different stages (I, II, and III) detailed as 9 unique phases (I-1, I-2, I-3, I-4, II-1, II-2, III, advanced, and frontal). When a hair restoration specialist or doctor sees a female patient, they examine her head, hair, and scalp and compare it to the scale. By choosing the image that most closely resembles the patient’s patterns, the specialist can gain a more measurable and communicable understanding of the degree of the woman’s hair loss.

So why is a scale like this so important? For a number of reasons! First, it can be difficult for researchers to discuss and compare their findings when there is not a shared method for recording various degrees of hair loss. With widespread acceptance and use of the Savin Scale, these researchers are now able to operate with a higher level of assurance that their understanding of a specified degree of female hair loss is the same as that of their peers. An invented and over-simplified example is that rather than two researchers comparing notes in which one of their studies discusses “early stage” hair loss and another reviews “light” hair loss (terms that they each defined separately and perhaps differently), they can now label the degree in question using the Savin Scale, knowing that when a reference is made to stage I-3, it is done with confidence that they are in agreement about exactly what that means.

Second, getting on the same page about more clearly defined stages of hair loss also has implications for doctors and restoration specialists as they ask questions and learn new findings. Being able to discuss a specific case with a peer for insight or to elicit a professional opinion is an important part of accuracy and development in the medical field, and the Savin Scale promotes higher levels of understanding in these types of situations too.

Third, and most directly related to the patient, the Savin Scale can be applied to an individual female’s hair loss at various intervals to more accurately gauge the change in her unique hair loss over time. This insight can aid in the diagnostic process, inspire a sense of urgency when necessary, and provide guidance for the best restoration solutions available for each specific woman.

 

Savin Scale

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Hair Loss In Women

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It is a widely accepted misconception that hair thinning and balding are problems that are unique to the male gender. Though still not desirable, there is an expectation of sorts that hair loss comes with age for men, but not for women. In actuality, hair loss does not discriminate and a notably high percentage of women will experience some degree of thinning or balding during the course of their lifetime.

The single largest cause of hair loss in women has hereditary origins and is known as Female Pattern Hair Loss (FPHL). This type of loss is usually identified by thinning along the part rather than the thinning at the hairline that is frequent in its male counterpart, Male Pattern Hair Loss. The degree of a woman’s hair loss with FPHL is measured using the Savin Scale. According to a 2013 study conducted by the Department of Dermatology and Cutaneous Surgery at the University of Miami, some 21 million women in the United States alone are suffering from FPHL with 12% of women seeing signs by the time they are 30 and upwards of 30-40% of women dealing with FPHL in their 60s. These numbers are astounding when one considers how little female hair loss is discussed and acknowledged in today’s society!

In addition to FPHL, hair loss in women can also be attributed to a number of other causes including hormonal changes such as postpartum, birth control, or menopausal hair loss, extreme stress, regular overstyling, medications including, but not limited to, chemotherapy, underlying medical conditions such as hyperthyroidism or lupus, other known hair loss conditions, such as alopecia areata and trichotillomania, and the list goes on and on. It can seem a bit daunting to pinpoint a specific cause with so many possibilities, but a doctor or specialist can help individuals to understand their unique diagnoses and the potential solutions that are suited to their condition.

It is true that certain medications or procedures that are successful in men are not as broadly applicable in women. For example, some medications simply do not treat FPHL and others have female specific side effects that deter doctors from prescribing them. This is not to say that there aren’t a range of options for women dealing with hair thinning and loss, because there absolutely are. From hair transplantations and medications to laser therapies and high quality human hair wigs, opportunities for female hair restoration have never been so plentiful. Like diagnoses though, these prescribed treatments require the expertise of a specialist who understands how to accurately match the unique details of a woman’s hair loss with the dynamic impact and effectiveness of various solutions.

Last, but certainly not least, the social and emotional impact of hair loss in women is a fundamental piece of the challenge faced by females who are enduring ongoing thinning and baldness. For centuries, hair has played an enormous role in defining self-image, femininity, youthfulness, and beauty, and despite how one categorizes things like beauty and femininity, losing the opportunity to decide for oneself can be remarkably difficult to overcome. Frequently women seek to hide their thinning scalp with a new style or limited public exposure, and these temporary solutions leave them feeling vulnerable and isolated. By increasing awareness and initiating conversations about hair loss in women, there is potential to not only limit the loss and commence restoration, but also to minimize the negative social and emotional strains on females that are caused by unwanted hair-based changes. Women struggling with hair loss are not alone!

With more than 40 years experience, Van Scoy Hair Clinics has offered the latest advances in hair restoration for men and women in our state-of-the-art facilities in Cleveland, Columbus and Ashland, Ohio. Schedule a FREE hair loss and scalp analysis today.

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The Hair Growth Cycle and Telogen Effluvium

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Hair growth is cyclical. Throughout an individual’s life, the hairs all over their body are going through a long growth phase followed by a brief transition phase and then an intermediate resting phase before the specific hair is shed and a new one begins its long growth phase in the first one’s place. Growth, transition, rest, shed. Growth, transition, rest, shed. This pattern, which varies in exact duration from one person to the next and one body area to the next, is most frequently discussed in terms of its three main phases, the anagen phase, the catagen phase, and the telogen phase.

The anagen phase, or growth phase, can last anywhere from 2 to 6 years for scalp hairs. During this time, the follicle’s cells in the root are dividing, receiving nutrients that fuel growth from the bloodstream that are delivered via the papilla. Scalp hairs in the anagen phase grow on average about 6 inches per year. Hairs on other parts of the body, such as eyebrows or arm hairs, have a much shorter anagen phase, and thus, are shorter hairs than those on the scalp.

The catagen phase, or transition phase, is the shortest of the three, lasting only a few weeks for scalp hairs. During this time, the hair moves (or transitions) from active growth to a resting state. The mechanism through which this is achieved involves the root attaching to the shaft and detaching from the papilla, cutting the hair off from its source of nutrients.

The telogen phase, or resting phase, typically lasts about 2 to 3 months for scalp hairs. During this time, the non-growing, detached hair is referred to as a club hair. It is essentially dormant until it falls from the head. If it has not been shed by the time the next anagen phase begins, it is forced out by the newly growing hair. For those hairs on other parts of the body such as eyebrows or arm hairs, which, as discussed above, have a shorter anagen phase, the telogen phase is actually longer, leaving the short hairs at rest for more time than on they would be on the scalp.

Fortunately, not all hairs experience these phases at the same time. If they did, a person would experience years of growth followed by complete baldness. Instead, most hairs are in different stages than those surrounding them. At any given time, about 85-90% of hairs are in the anagen phase meaning only 10-15% are in the catagen and telogen phases, with more in the latter than the former. Some noticeable hair shedding occurs (up to 100 each day), but a healthy head of hair appears consistently full.

In less healthy manes, hair loss can sometimes be explained by a shift in the percentage of hair in the anagen and telogen phases. If follicles that would typically be in the growth phase enter the resting phase early, then the percentage of hairs in the anagen phase drops and that of those in the telogen phase increases, leading to a period of shedding a higher than typical amount of hair. This type of hair loss is referred to as telogen efflivium and can be caused by a number of things, including stress and subsequent changes in dietary habits, sleep, and health. As we wrote in our discussion on the impact of stress on hair loss in April:

“When external or emotional stressors lead to physiological stress, the body responds by essentially taking the attention it was giving the hairs in the anagen phase and reallocating it to other areas in need, thus pushing a larger number of follicles into the resting state. After a few months, these resting hairs begin to shed. While it is normal to lose telogen phase follicles, the abrupt loss of so many new resting hairs when stressors have caused telogen effluvium makes a regular cycle of loss and growth into an unbalanced and noticeable process of hair thinning.”

Gaining comprehension of how healthy hair growth works is an important part of understanding irregularities. With the knowledge of expected growth patterns and mechanisms, we can then identify specific points of abnormal development and explore their causes.

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Tinea Capitis: Ringworm of the Scalp

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Despite being primarily known by a single name, ringworm comes in a variety of different strains. In fact, there are at least 8 separate types that affect the human body alone, with different Latin names for each. Ringworm of the hand is a different kind of infection than ringworm of the foot, and a third strain exists that impacts the nails. Ringworm of the face, scalp, and beard are three separate strains as well. On the scalp, the Latin name for ringworm is tinea capitis, with tinea representing all ringworms and capitis signifying the unique strain that affects the scalp area. Even within a single type of ringworm there is variation though. Tinea capitis, for example, can be caused by a number of different fungi which each cause a unique manifestation of the infection.

In general, ringworm of the scalp is identifiable by splotchy and itchy bald areas with scaly skin and black spots where the hairs have broken off. Some individuals may experience a raised ring, inflammation, or crusting. Though the infection occurs in people of all ages, children are the most susceptible and most cases of tinea capitis in the United States arise on the heads of the young. Treatment is usually comprised of oral and topical medications. The oral medication (most typically, griseofulvin) is often considered a requirement to dispel the infection while the topical medications (such as special shampoos or steroid ointments) act as a tool to contain the infection and keep it from spreading to other parts of the individual’s scalp or other family members. When following the doctor’s instructions, ringworm can usually be healed in 6-8 weeks.

Unfortunately, severe cases of tinea capitis can cause permanent hair loss and scarring. The preferred course of action is to avoid transmission of ringworm altogether. This means keeping clean, avoiding physical contact with someone who is infected, monitoring pets (especially cats) for patches of hair loss, wearing sandals in locker rooms, refraining from sharing brushes or towels with others, and possibly using anti-fungal shampoo for all family members if someone in the household has ringworm. Wouldn’t it be fantastic if all hair loss could be prevented with just a bit of attentiveness to a few simple practices?

When ringworm of the scalp is past avoidance, there are many options for hiding or repairing areas of temporary baldness as well as restoring hair that was lost permanently due to scarring and impact of the infection. To explore the available possibilities, contact a hair restoration specialist for a complimentary consultation and analysis of your hair and scalp.

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VIDEO: Genetic Underpinnings of Alopecia Areata

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The below video shared by the National Institute of Health gives a brief introduction to Alopecia Areata, the autoimmune disease in which the immune system mistakenly attacks hair follicles leading to hair loss.  As the video mentions, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) supported the establishment of a national registry in which five academic research centers compiled information on those with Alopecia Areata and their families as one of many tools now being used to further research the causes and genetic underpinnings of the disease. Ongoing investigation has been and continues to be an important factor in understanding the causes of hair loss and expanding our potential for hair restoration solutions.

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scalp health dandruff disease

Scalp Related Hair Loss

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It doesn’t matter what the reason is, losing your hair is never easy. It’s common knowledge that drug treatments like chemotherapy and the normal aging process can bring on thinning hair and hair loss. But what happens when you lose your hair because of a skin condition? There are not many people that are aware that skin conditions like eczema and psoriasis can affect the scalp, and that they can also affect hair growth. There is very little talk about coping with scalp-related hair loss. For individuals of all ages that struggle with this problem, it’s a painful condition and is often stigmatized and covered up due to embarrassment.

Hair Loss and Self-Esteem

If you have a skin condition on your scalp, one of the first steps in learning to cope with your hair loss and being aware there are others than can understand your condition. Most people that struggle with hair loss often struggle with their self-image as well. If a skin condition is the cause of your hair loss, then there is often a greater loss of self-esteem and confidence. Often this type of condition affects not only the thickness your of your hair, but leaves unsightly marks on the skin and scalp. It’s also not uncommon for people with skin conditions to experience dandruff and itching. When it comes to conditions like psoriasis and eczema, they are often chronic and affect a person throughout their entire life.

Finding a Trichologist Practitioner

If you didn’t realize that a skin condition could have such an affect on your scalp, then you may not know who to turn to if you suffer from eczema or psoriasis on your scalp. In this case, you would look to a Trichologist. They are similar to dermatologists, only they specialize in scalp issues. A trichologist is best suited help you with scalp issues that is causing your hair loss.

Hair Restoration

When you have hair loss, and especially when related to skin issues, it can have a large impact on your life. Take into account your mind and your body wellness when you plan treatments. To cope with your condition, it takes both time and effort and most of all patience. Having support along with appropriate treatment is key to dealing with the emotional and physical condition and recovering from it.

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The Urge to Pull: Trichotillomania

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Most people agree that having hair pulled out is a very unpleasant feeling. For someone with trichotillomania, though, pulling hair out feels good — and may help the person deal with stress and anxiety. Trichotillomania is one of the more unusual hair loss diseases. What causes this hair loss disorder, and can it be cured?

What Is Trichotillomania?

Trichotillomania (TTM) is a disorder that causes a person to have an overwhelming urge to pull out their own hair. Symptoms of trichotillomania include:

  • noticeable hair loss
  • increased tension right before pulling out hair, or when trying to resist pulling
  • pleasure or relief when hair is pulled

As long as hair pulling is not caused by another health issue, and it causes the puller enough problems to interfere with daily life, it can be classified as trichotillomania.

TTM is closely related to obsessive-compulsive disorder. The International OCD Foundation sheds light on the difference between the two:

  • OCD sufferers have repetitive behaviors that distract from bad feelings but do not bring pleasure.
  • TTM sufferers get pleasure or relief from pulling hair.

Scientists do not know the cause of TTM. Symptoms of TTM increase when the body encounters stress. Interestingly, this stress can be either negative stress (e.g., money problems) or positive stress (e.g., planning a trip). The brain does not differentiate between the signals, so both types of stress can increase the desire to pull hair.

What Are Complications of TTM?

On an emotional level, the sufferer may experience tremendous stress and shame because of their behavior. This can prevent them from going to work, engaging in social activities or pursuing higher education. Physically speaking, one of the worst complications occurs when a person eats the hair they pull. Strands of hair can build up in the intestines and cause painful, even life-threatening blockages, which may require surgery.

Can Trichotillomania be Cured?

There are several treatments for TTM. Different methods may work for some and not for others.

Cognitive Behavior Therapy

Cognitive Behavior Therapy (CBT) interrupts and resets the mental processes that lead to hair pulling. Through CBT, the patient identifies the factors that lead to the desire to pull, then learns techniques that can redirect those urges. To be effective, CBT should be performed by a qualified psychologist.

Medication

There are several medications that have been helpful for TTM patients. Among the most effective are the antidepressant clomipramine and the amino acid N-acetyl cysteine. SSRIs like Prozac have had mixed results; a few patients have reported that they stopped pulling their hair completely, while others felt no effect whatsoever.

Support Groups

Because sufferers of trichotillomania deal with debilitating of shame, support groups can be very helpful. Hair pullers may find that being in a support group helps them to focus their energies on finding an effective strategy, rather than hiding their disorder and feeling embarrassed.

Alternative Therapies

Certain hair pullers have reported success with alternative therapies like biofeedback, hypnotism or a strict regimen of diet and exercise. These methods have not been studied by scientists, so their usefulness remains in question.
Who Suffers from Trichotillomania?

Trichotillomania often begins in childhood or adolescence, but TTM symptoms can onset at any time in life. Boys and girls seem to be equally affected in childhood, but among adults, TTM appears to be more common among women.

Actress Olivia Munn has been open about suffering from Trichotillomania. In an interview for Self magazine, she speaks of the stress that brought on hair pulling. “I had it growing up, having had a little bit of a tumultuous upbringing, moving around a lot with a mixed family with five kids.” She remarked that the stress of being an actress has, at times, brought that anxiety back. “I just didn’t want to let anybody down,” she said.

Trichotillomania can affect anyone at any age. VanScoy Hair Clinics specializes in hair replacement and hair loss solutions for those who suffer from Trichotillomania. We have many options to choose from. To learn more, call us at (419) 289-6665 or click here and make an appointment online.

Photo Credit: Martin Cathrae Via Flickr Creative Commons

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Hair Loss Myths: Fact or Fiction

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Many people facing hair loss are well informed on the ins and outs of their specific condition. They might have heard that at least half of all men will have experience some degree of hair loss by the age of 50, or that 40 percent of hair loss victims are women, or even that the leading cause of hair loss is hereditary patterns. Although those are all true statements, there are some fictitious statements that get passed around which help the hair loss industry along. The real trouble is trying to decipher between fact and fiction.

Is it really your mom’s side of the family to blame for your hair loss? Can wearing a baseball hat actually make you go bald? The following are a few of the most common myths about hair loss, fact or fiction:

Hair Loss comes from the mother’s side

Fiction! Contrary to what people say, it is not your mom’s side to blame for your hair loss. Although male pattern baldness is hereditary, it has been proven that the condition could just as easily come from the father’s side as well. Since this condition is genetic, it cannot be prevented, but it can be treated.

Baseball Caps Cause Baldness

This one is actually fiction to. Health experts have not found any sort of specific link between hair loss and wearing a cap. Only hats that are tight enough to cut off circulation to the follicles would cause hair loss.

Poor Treatment of Hair, Causes Hair Loss

Fact! Using too much styling product like dyes and perms can cause hair loss. It is also stated that tight buns and braids can cause hair loss through follicle damage, so be sure to avoid those as much as possible. Even women that are trying to bleach their hair with natural sunlight should be sure to put a hat on because overexposure to the sun’s UV rays have shown to cause hair loss as well.

Hair Loss from Stress

This is a fact, but not in every aspect. Scientists have found that extreme emotional or medical related trauma can cause sudden hair loss. However, it is noted that stress stemming from every day stress of work and family life will not cause hair loss.

Hair Loss Only Occurs When You’re Old

This is fiction. Just like some of the examples given above, male pattern baldness among other conditions can occur as early as the teen years, or the early 20’s for women. For these cases, VanScoy hair loss specialists can work to help rule out a typical causes such as hormonal issues.

Let us help

Everyone is different when it comes to the reasons for hair loss. We understand that your needs are different than other, which is why we off many different hair replacement options. Visit us today for a free consultation.

 

Photo Credit: Chun-Hung Eric Cheng via Flickr Creative Commons

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