No hair, don’t care… or should you?

Posted on 30 June 2016

Our hair is such a big part of who we are that when it starts falling out, for some it can be a catastrophe. Dr Willie Visser, a dermatologist at Mediclinic Milnerton and head of dermatology at the University of Stellenbosch says there’s hope for treating baldness if you start early enough.

Who is likely to go bald?
We use the term alopecia, meaning hair loss, to describe the phenomenon in men and women. Hair loss is extremely common in both sexes and most races – we all lose a few hairs during the course of every day and balding is a natural, gradual process. It’s when 10 or 12 hairs in your brush suddenly become enough to block the shower plug that you should worry. Women usually start experiencing hair loss around the same time as menopause, and by the age of 50, 50% of women have hair loss. By the age of 80, baldness is very common. Men can start losing their hair from their early 20s, and by the age of 50, 50% of men are balding.

What’s the cause of balding?
The main cause of male and female pattern baldness is a genetic predisposition, but not all hair loss is genetic. With male and female pattern baldness, women start losing their hair in the central part of the scalp, while men’s hair tends to thin in a bi-temporal pattern – at the temples and the crown, eventually meeting in the middle. The hair becomes finer and curlier, creating a downy look before falling out completely. This genetic predisposition has a tendency to be transferred along family lines from both sides.

What are the other causes of hair loss?
If you know your family is not genetically prone to baldness, any hair loss you think is sudden and excessive should be checked out by your GP or dermatologist to rule out other causes. Rapid hair loss is a danger sign and causes include:
• Telogen effluvium. Hair falls out rapidly after extreme physical or emotional stress. It usually starts to happen three months after the stressful event.
• Diseases including lupus, thyroid problems or an iron deficiency.
• Sudden onset. If you wake up with a sudden round bald patch, it usually has an autoimmune cause. It is called alopecia areata, or spot baldness.
• Inflamed hair follicles. This is characterised by small pimples on the scalp that destroy the hair shaft, and is called scarring alopecia.
• Harsh hair care practices Braids or hair extensions that are too tight; harsh chemicals used to straighten or curl the hair; accessories (like beads) that are too heavy; and extreme heat can not only irritate the scalp, but also result in baldness.
• Medical treatments such as chemotherapy can cause hair to fall out.

How is male or female pattern baldness diagnosed?
Your doctor will spot it immediately by the pattern of hair loss. If pattern baldness doesn’t run in your family, the doctor will use other diagnostic methods to determine an underlying cause for your hair loss, such as blood tests, a hair pull test and, in extreme cases, a scalp skin biopsy.

Can my type of baldness be treated?
Yes, but only if you seek out medical advice early – for example, in pattern baldness, before you go completely smooth and shiny. The first line of treatment is with a medication called minoxidil, which slows hair loss and promotes regrowth. Applied twice a day, it’s a lifelong treatment – if you stop, you’ll go back to where you started. The second line of treatment – mainly for men – is finasteride, a hormonal treatment that suppresses testosterone. It’s very rarely used to treat female pattern baldness, but we’ve found that used in combination with minoxidil, it has positive results. Again, it’s a lifelong treatment.

What if I don’t want to take medication for the rest of my life?
Becoming completely bald is a personal decision, but there are cosmetic interventions – wigs, creative styling or hair implantation. Low-light laser treatments are available, but science is still determining their value in reversing hair loss. When it comes to buying special shampoos, don’t believe everything you see on TV. If your baldness is due to a medical or genetic condition, the use of these special shampoos will have no benefit. Some shampoos can improve the quality of your hair, but can’t reverse hair loss.

Published in Dermatology

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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