The bald truth about hair loss

FROM the shaved heads of hip-hop artistes to the wavy long-haired tresses of Bollywood stars, hair has always made a personal statement in our society. Hair, as our crowning glory, is one of the main ways that people use to establish their individuality and express their style, and has had sociological significance throughout history.

Because of its perceived importance, anything that happens to our hair that we can’t control – falling out or turning grey, for instance – can be the source of much anxiety and in severe cases, can lead to depression.

If you are one of the many men and women who feel you are losing hair, look around you and you will notice that hair loss is not uncommon. In Malaysia, one in two men over the age of 50 are losing or have lost their hair from a condition called male-pattern hair loss (MPHL), according to the Malaysian Society for Hair Sciences. A similar proportion of women also experience some degree of hair loss (from female-pattern hair loss) by the time they reach the age of 60 years and a smaller proportion will lose their hair due to other causes.

Like it or not, hair loss is more than a cosmetic problem. While it does not present any vital structural problems, it has deep psychological effects on one’s social life, perception of self and confidence. This classifies hair loss as a medical health issue which should, for effective results, be diagnosed and treated by a doctor.

So, what causes hair loss? And more importantly, what has science got to do with it? Quite a lot it turns out. Read on to learn more.

The basics

Hair is produced by hair follicle-indentations of the epidermis (outer skin layer) that contain the hair root, the muscle attached to it, and sebaceous glands. Hair is made up of dead cells filled with proteins, most of which are known as keratins. The cells are woven together like a rope to form the hair fibre.

The hair fibre, in turn, has three layers: the outer cuticle with its fish-scale like structure; the cortex, which contains the bulk of the fibre; and the centre, or medulla. Hair colour is determined by melanocytes, cells that produce pigment. When these cells stop producing pigment, hair turns gray.

Although it seems as if the hair on your head is always growing, hair actually has active and rest phases. The growth phase, known as anagen, lasts for two to six years. At any given time, about 90% of scalp hair is in the growth stage. The remainder is in the rest phase, known as telogen; this lasts from two to three months.

Once the rest phase is over, the hair strand falls out and a new one begins to grow. As a result, it’s considered normal to lose from 20 to 100 hairs a day. Only a change in your regular pattern of loss is considered abnormal – but many things, including genetic factors, diet, stress, and medications, can change that pattern.

Baldness: Manifest destiny

The most common cause of hair loss in both men and women is rooted in genetic factors. Called androgenic alopecia, it is known as male-pattern baldness (MPHL) in men and female-pattern hair loss in women. (Alopecia is the scientific term for baldness.) In fact, genetics accounts for 95% of all cases of hair loss in this country.

Baldness results from a combination of genetic factors and levels of testosterone (a hormone produced by the adrenal gland in both sexes and also by the testes in men).

If hormone levels are right, then the hair follicles will express their genetic destiny by growing for shorter periods and producing finer hairs. In men, who have higher levels of testosterone than women, this eventually results in a bald scalp at the crown of the head and a horseshoe-shaped fringe of hair remaining on the sides.

In women, the hair thins all over the scalp; the hairline does not recede. This type of hair loss doesn’t usually show up in women until menopause; until then, oestrogen tends to counteract the effects of testosterone.

Other causes of hair loss
In addition, hair loss can also be caused by:

Situations of stress – many women lose hair after giving birth while both genders can experience hair loss after surgery or after a particularly stressful situation. In medical terms, this cause of hair loss is called telogen effluvium and is temporary. While patients can lose up to 30% of their hair, it would usually also grow back once the body and its systems recover.

Condition of the scalp – fungal infections of the scalp or hair root can lead to hair loss. So can psoriasis of the scalp.

Autoimmune suppression – known as alopecia areata, hair loss here is due to a reaction of the immune system which suppresses the growth stage of the hair follicle. Alopecia areata causes hair to fall in patches and can sometimes affect the whole body including facial hair like eyebrows and even pubic hair.

Existing medical conditions – people who suffer from thyroid disease or iron deficiency can also experience hair loss as a result of the effect the diseases have on the body. Internal fungal infections such as syphilis can also cause hair loss.

What your doctor has to do with it

Medical science has made significant strides in recent years to get to the root of the problem and there are now a number of effective treatment options available to help those suffering from hair loss.

A common misconception in hair loss is that there is no cure. This myth is particularly misguided because the fact is that there are approved, medically proven ways to treat the condition, depending on what causes hair to fall out in the first place.

For instance, if you discover that your hair loss is due to a fungal infection of the scalp, then appropriate medication can be prescribed to kill the invading fungi and restore the health and function of the scalp.

If, in a similar vein, your hair loss is caused by thyroid disease or anaemia, then treating the disease will also treat the hair loss.

If you find that it is telogen effluvium that is causing your hair loss, then you can only be patient because the hair will grow back once the stress period is over.

Where hair loss is caused by MPHL, which is most likely the case (it being the commonest cause for loss of hair), drugs such as the oral treatment finasteride have been an effective treatment for the condition. This drug has been scientifically proven in studies to tackle the very root of MPHL and inhibit the disruptive action of DHT in the hair follicle.

The conclusion is obvious. The key to effectively treating hair loss lies in a proper and accurate diagnosis of the cause of the problem which should only be carried out by a trained medical professional like your family doctor or a dermatologist (physicians who specialise in treating diseases of the skin, nails and hair). A misdiagnosis can, at worse, exacerbate the problem, or, at the very least, take you on a frustrating goose chase.

A doctor will evaluate a patient’s hair problem by asking questions about diet, medications including vitamins and health food taken in the last six months, family history of hair loss, recent illness, and hair care habits. Hormonal effects may be evaluated in women by asking about menstrual cycles, pregnancies, and menopause.

After examining the scalp and hair, your doctor may check a few hairs under the microscope. Sometimes blood tests or a scalp biopsy may be required for an accurate diagnosis. It’s important to find the cause and whether or not the problem will respond to medical treatment.

Excerpt from The Star

By Dr STEVEN KW CHOW