Hair today, gone tomorrow: Women and the fear of balding – not all is lost
Hair loss can happen at any time, even in one’s 20s. Identifying the underlying reasons is crucial. It is estimated that 40% of women will have some hair loss by the time they reach 40.
“One of the hardest things about losing one’s hair is that it makes one feel so incredibly ugly.” So says 50-something Samantha (not her real name), a lecturer who has been battling with hair loss for the past seven years.
“Coming to terms with it is one of the toughest challenges I have had to face. I was in the final stages of completing my PhD when I noticed that there were piles of hair on my pillow every morning. It happened completely out of the blue. Initially, I was not too worried about it because I thought that once the stress of the studies was over, my hair would grow back.
“Three months later, I realised I could no longer ignore it and went for help. The first few doctors I consulted made an incorrect diagnosis. After a few months with no improvement, I went to see a GP at a hair loss clinic. He diagnosed my hair loss as lichen planopilaris (LPP). It is an autoimmune disease that results in permanent hair loss.”
Samantha explains that to this day the causes are unknown, and although there is no treatment to cure it – once one’s hair has fallen out scar tissue forms and no new hair can grow – it can be slowed down.
“The initial treatment was really tough. It included weekly cortisone injections into my scalp. This was not only painful but caused major side effects such as sleeping problems, brittle teeth, aching joints and inflamed cheeks. To treat the side effects, I had to change doctors. Now I am under the care of a dermatologist who has a special interest in hair problems.
“The treatment is indefinite as long as the disease is active. At the moment there is no end in sight. It makes me feel very depressed to think that I may lose all my hair.”
In addition to the pain and the emotional toll, Samantha’s treatment wasn’t covered by her medical aid because, she says, “it doesn’t recognise lichen planopilaris as a chronic disease. Regular check-ups and injections are quite expensive for someone with my budget.
“My best advice for anyone who battles with hair loss is to seek help as soon as possible, and change doctors until you find someone you trust. Luckily I have a good support system. I don’t know how I would have coped without it because it is virtually impossible to find a support group in South Africa, and one’s hair is so closely connected with one’s identity and self-worth.”
For the time being, Samantha is able to disguise the hair loss by keeping her hair short and covering the affected areas.
Prof Rannakoe Lehloenya, a Cape Town-based dermatologist, says “everyone experiences hair loss to some degree as we age, because the body’s ability to regenerate new cells diminishes. Hair that falls out is replaced by thinner hair because the hair follicles shrink. When it eventually stops producing new hair, little can be done about it. It is comparable to our eyes growing weaker or our joints deteriorating.”
Dr Lushen Pillay, head of the department of dermatology at the Helen Joseph Hospital and who also works in a private practice in Sandton, explains that “hair loss can happen at any time, even in one’s twenties. Identifying the underlying reasons is crucial. It is estimated that 40% of women will have some hair loss by the time they reach 40”.
He adds that everyone loses hair as this is part of its natural growth cycle. But should one notice more hair than usual on one’s brush or piles of hair on one’s pillow, then you should get professional advice.
Hair growth goes through three stages, he explains. “It starts with the growing stage, also called the anagen stage; this could take six to eight months. The second stage is called the catagen stage when the hair is preparing to shed. The final stage is known as the telogen stage – during this period the hair is shed. The follicle remains dormant for about three months until new hair grows and the cycle is repeated.”
There are many causes of hair loss or Alopecia; some are permanent and called scarring Alopecia, while temporary hair loss is known as non-scarring Alopecia.
Pillay adds: “Common causes of non-scarring Alopecia include extreme emotional or physical shock or stress… an abnormal thyroid, an iron or Vitamin B12 deficiency and some immune depressants. The good news is that these conditions are treatable and hair will regrow once the underlying cause has been treated.”
Further, Lehloeya explains that another frequent cause of scarring Alopecia is Traction Alopecia. “It is set off by styling practices such as braids, weaves, tight ponytails or frequent rollers in the head. The tight pulling damages the hair follicle that will eventually die. This causes the hairline to recede.
“Chemical processes such as relaxers or Brazilian blow waves can also trigger hair loss. If a treatment is painful or irritates your scalp, it is probably damaging. Patients often wait until it is too late before they seek help.”
One of the most common causes of hair loss in women is Androgenetic Alopecia, or Female Pattern Hair Loss (FPHL). It is associated with a family history and can be accelerated by hormonal changes or during menopause. It starts with the thinning of hair along the top of the head. This process is irreversible, but early treatment with a topical solution can help the stimulation of the hair follicles and as a result, prolong their lifespan.
“Samantha’s hair condition, lichen planopilaris, is a rare inflammatory type of scarring hair loss,” says Pillay. “The hair follicle is destroyed. Patchy hair loss, mainly on the scalp, gets progressively worse. Symptoms could include itchiness, pain and burning; small areas may merge to form larger irregular areas. It usually affects young women and commonly develops in association with Lichen planus that affects the skin, nails and mucosa. Women are more likely to develop lichen planopilaris than men.”
He notes that although the cause of lichen planopilaris is unknown, it may be linked to the body’s immune system “that starts to attack the hair follicle”.
As pointed out earlier, the condition cannot be cured, but treatment helps “to preserve the remaining hair and symptoms. In many cases the condition does eventually become inactive. Hair transplants are not suitable for this condition because in the areas where scar tissue has formed, hair can’t regrow.
“The important thing to remember is to get professional advice as soon as possible. There are many over-the-counter lotions and shampoos that make claims which have not been definitively proven. The sooner one gets a diagnosis from a registered dermatologist, the greater the chances that the underlying causes can be identified and treated.
“Buying products based on anecdotal evidence is often a waste of money. One doesn’t have to spend a fortune. My best advice to prevent hair loss,” says Pillay, “is to follow a balanced antioxidant rich diet, with adequate Vitamin A, C, and D. This helps improve the blood supply to one’s hair follicles. In addition, one should get regular exercise and participate in meditation, yoga or a hobby that will help bring stress levels down.”
Various options to treat Alopecia
“Hair loss in women is often multifactorial,” says Dr Kashmal Kalan, medical director of the Alvi Armani hair clinic in Johannesburg. “Once the cause of Alopecia is established, there are various options to consider depending on how advanced the balding is.”
Kalan, who has completed internationally recognised hair transplant courses after graduating as a GP in South Africa, believes it is important that one does proper research before selecting a particular doctor or treatment.
“Hair loss is an extremely emotive issue and many clients are misguided by marketing gimmicks that make promises that have not been scientifically proven.” In his experience, there are two options that have “proven results”, he says.
“For those clients with hair thinning and who don’t have large areas of baldness, we recommend PRP (platelet rich plasma) therapy. It is minimally invasive and no downtime is necessary. It helps put the brakes on the hair loss process as well as strengthen the current follicles on the scalp. It involves re-invigorating the hair follicles with platelet-rich plasma that stimulates growth.
“To do this, blood is drawn from a patient and platelet rich plasma is extracted and injected into hair follicles. After a period of 4-6 weeks, new, stronger hair grows. The procedure is low on the pain scale and takes about an hour in totality. Over time it will be necessary to repeat the treatment to keep the follicles strong.”
The second option is hair transplants: “They are suitable for patients with genetic hair loss, burns, scar tissue or for those who have severe balding who have not responded to preventative care measures. The main aim of the procedure is to extract follicles from one area of the scalp and implant them into an area that needs it.
“Once it is established that a patient has suitable donor hair, hair roots or follicles are surgically removed from donor areas. They are then implanted into areas where the follicles have died. The procedure should only be performed by a medical doctor and could take up to ten hours depending on the number of follicles needed by the patient.”
Kalan explains that there are no mental or cognitive effects, which means that patients could be active from the day after the procedure. “The physical appearance of the procedure will be visible for about 7-10 days, and after a week, patients can use certain types of headgear to conceal it.” DM/ML
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