Lifestyle Choices

Most of the time we take little notice of our hair and nails. During adolescence there may be times we would wish to have different colored or textured hair or curse that our nails break too easily, but after that we pretty well accept our lot. That is until some change occurs. When hair starts to be lost there is not only an immediate cosmetic problem but the scalp may be damaged by sunlight or low doorways. Equally, when finger nails fail to develop properly this problem is both cosmetic and functional: it may become impossible to pick up small objects.

Too little Hair

Male-pattern baldness

This term is used because it is so much more marked in men than in women. The typical changes of receding hair and thinning on top are well known and often run in families: the process may even start before the age of thirty years. Women are much less severely affected and anyway tend to keep the front hair line. However, with increasing age many women notice some thinning on their scalp. The hair loss, in both sexes, is due to the effect of hormones but not an excess of them. The fault lies in the hair roots which become over-sensitive to existing hormone levels.

The first thing is to decide whether you want to try to hide or reverse the hair loss. Men are more used to the idea of balding and may accept it philosophically. It may be possible to alter the hair style, and shorter styles are often better. Dark-coloured dyes are counter-productive because the pale scalp shows through more clearly. Wigs or toupés find favor with some people.

A lotion containing minoxidil has been available for a couple of years. It is very expensive and not available through the National Health Service: it needs to be applied indefinitely. It may restore hair growth in some hair roots in a minority of balding people, but the benefits tend to be marginal.

Special forms of plastic surgery are also available in private clinics. Three techniques are used: the first is illustrated in the left hand column. The second approach is for people with a prominent bald patch in the middle of the scalp. A bald area roughly 15 cms (6 ins) long and 5 cms (2 ins) wide can be cut out and the edges sewn together. Finally, there is a difficult technique in which a flap of hair bearing skin is moved forward to cover a bald area but without interrupting its blood supply.

Alopecia areata

This is the medical term for loss of hair in round patches. It may occasionally lead to a more widespread hair loss and, rarely, every hair may be lost from the body. No cause has been identified but the condition sometimes runs in families and may be associated with other diseases e.g. vitiligo (see Birthmarks and pigment). It usually starts in childhood or early adult life. Most of the bald patches regrow within a month or two but new ones may develop at the same time. Sadly, in a few people, there is little regrowth. Occasionally it is only pigmented hairs that fall out, leaving gray ones untouched, and when this happens people seem to go gray overnight.

It is never easy to be philosophical about a disease. This is certainly true when your hair is falling out. However, there is a very good chance that your hair will regrow normally even if there are a few further small bouts of hair loss along the way. Steroid creams and steroid injections, into the bald area, may speed things up. Ultraviolet light can also be useful. Otherwise, hairpieces may be the only long-term solution.

Less common types of Hair Loss

Some hair styles may put a great pulling force on the hair root: these include some of the plaiting methods used by Africans. In Westerners the problem is usually seen in girls who twist their long hair around the fingers and pull on it. Scarring of the hair roots prevents any possible regrowth. It may occur in uncommon skin diseases such as lupus erythematosus, lichen planus, some infections and other rare diseases. Some of these may be treatable and should be diagnosed as early as possible in order to minimize the hair loss. Some serious diseases, such as cancer, may be treated with drugs which can also damage the hair roots. Complete baldness may develop within a few days but the hair starts to grow again quite quickly. After certain stresses to the body - e.g. pregnancy, illness, accident or operation - there can be a tendency for most scalp hairs to grow in unison. They are then shed at the same time, a couple of months later. The result is quite marked hair loss with a general thinning. Fortunately it is followed by regrowth.

Too much hair

Men have coarse hairs growing over a wider area than women. Hirsutism is the term for the growth of coarse hair on a woman, but in a male pattern. There is a wide variation of normal hairiness in women. For instance, some hairs on the upper lip, around the nipples, and on the lower legs are common enough to be normal. This is particularly true after the menopause. On the other hand, a heavy beard or growth on the chest is clearly abnormal but there is no easily identifiable point to distinguish between normal and abnormal. The problem is made more difficult by the considerable variation between different racial groups. Many Middle-Eastern and Mediterranean women have dark hair on the face and limbs. The first decision is whether to consult your doctor. If in doubt do so. The huge majority of excessively hairy women have no underlying disease. It is just part of their own development and may run in the family. Your doctor will be looking for some pointers which might indicate that there is an underlying problem. If the hirsutism has come on very suddenly, or your periods have stopped or you also appear to be infertile, your doctor might wish to do some blood tests. Otherwise, the decision whether to have treatment for excess hair is your own.

Local treatment

Shaving is a good treatment. Now that there are shavers marketed for women it has become a more acceptable practice. Waxing is used for large areas, as on the legs, but must be repeated every couple of months. The hair is removed by the root and possibly a few may be permanently damaged in this way. It is quite painful and may produce infection around the follicles. Bleaching hairs makes them less obvious and is a method used by many people. The chemist may have a proprietary preparation but it is practicable to make your own one up at home: 50 ml hydrogen peroxide to 6 drops of ammonia solution, made into a paste with soap flakes. It should be applied to the skin for ten minutes before being washed off. Creams that loosen hair, thus enabling it to be pulled out, can irritate the skin and tend to be foul smelling. They are not widely used. Electrical methods are very popular but expensive. A fine needle is pushed down the side of the shaft and a tiny electric current passed which is converted into heat and destroys the root. Very few hairs regrow. The treatment is painful and most people can only tolerate a fifteen minute session. In that time between fifty and a hundred hairs can be treated.

Medical treatment

Very rarely the doctor will discover an underlying cause for the hirsutism. Treatment of that condition will then reduce the excess hair. When no underlying cause is found medical treatment is rarely recommended. Treatment, once started, would need to be given indefinitely and there tend to be side effects.

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