The truth behind your mane
Hair loss is a source of much worry and tension. Not many know that it is normal to lose some hair every day. DR. MURALIDHAR RAJAGOPALAN looks at common causes of hair loss and its probable treatment.
EVERYONE, when asked to describe a face, invariably talks about hair. All of us know that hair has no practical use for humans. But the anxiety of seeing a few hairs fall everyday has bred many who promise a magical cure for hair loss. Some feel that no hair loss is treatable.
The truth is, as always, somewhere in between. Most types of hair loss are treatable but some are not. If humans still exist 2,000 years from now, most will be bald. Though startling, this is an evolutionary fact. Successive races seem to have less hair than previous ones. At this stage we know a lot more about hair loss and are getting ready to battle it.
What is hair?
Hair is an appendage of your skin. The shaft we see consists of dead cells containing keratin, a protein found in the skin. It is mixed with two pigments eumelanin and pheomelanin the ratio of which gives hair its colour.
How does it grow?
Hair grows from its root, which is situated deep in the skin in a layer called the dermis. The roots may be as deep, as 5 mm in some places. The follicle rests on a living unit called the hair matrix inside the skin. This has cells, which divide and grow the hair above.
Does hair always grow?
No. Everyone has a separate genetic programme. The duration of an individual's hair growth is variable. While for some it may grow for three years, for others' it may grow for 10 years. It then falls off and is replaced by a new hair shaft.
What is the hair cycle?
Hair grows in a cyclical manner. The initial phase of growth is called anagen, then a resting phase called catagen and the stage when it falls or telogen. Each hair root enters into a different phase of hair cycle. So at a point of time, some 85 per cent of hair is in the anagen phase. The telogen stage lasts for three or four months. The hairs do not all grow synchronously. Some fall while others grow. Anagen hairs may grow for two or six years; they grow for longer in women than in men.
So does that mean some hair loss is normal?
Yes. Some hair loss occurs everyday and is normal. For a woman, even losing 50 to100 hairs a day is normal and does not lead to baldness because it is replaced by fresh anagen hair. If this replacement does not occur, then we have balding.
How is hair growth controlled?
At the molecular level, several substances in the body are responsible for this growth. Androgens male hormones have a direct influence on hair growth; they affect hairs differently based on the location. Hence, men have beards while women do not. Other hormones like insulin like growth factor 1, fibroblast growth factors and platelet-derived factors also control growth some positively and some negatively. The hormonal control of hair growth brings the whole system into perspective as any systemic illness may influence hair growth. Some drugs that we take can also affect hair growth as can the nutrient content of our diet. Our sleep-wake cycles and stress are other factors.
What are commonest types of hair loss?
Hair loss or balding can be conveniently divided into scarring and non-scarring types. The scarring types produce scars, which affect the hair root and destroy the papilla or matrix. There is no recovery for this, even with therapy. Fortunately, most hair loss is non-scarring. Male pattern balding or androgenic alopecia is probably the commonest cause for balding. Telogen effluvium is another one.
What is temporary hair loss?
Also called telogen effluvium, it happens frequently after an illness or pregnancy. Even a stressful event, an accident or an exam can trigger this hair loss. In such cases, the body shifts a large number of hairs prematurely from the anagen to the telogen stage. These fall after two or three months. Unless the patient has other underlying problems, he recovers with or without the doctor's help.
Is male pattern balding treatable?
Yes. Early forms of male pattern balding do well with treatment. The Food and Drug Authority (FDA) in the United States has licensed two drugs as safe minoxidil and finasteride. Minoxidil allows new hairs to grow faster, while finasteride blocks the male hormone from attacking the hair root. The drugs are quite safe in men and adults.
Do women also have male pattern balding?
Some women do have male pattern or androgenic balding that can be treated at an early stage with the same drugs. However, these can affect the foetus so women in the childbearing age should be careful. These drugs can be taken only under strict medical supervision.
What are the other diseases that produce hair loss?
Hypothyroidism, hyperandrogenism, anaemia, hepatitis and connective tissue diseases.
Do drugs cause hair loss?
A large number of drugs can cause hair loss. Anticancer drugs are notorious for this. Others include betablockers, lithium, anti-inflammatories, anti-tubercular drugs and heparin to name a few only. The exact mechanism for these is not known in many cases.
Does dandruff cause hair loss?
Dandruff is a disease of the scalp caused by a fungus. The overgrowth of this fungus stimulates scaling called dandruff.
It does not directly cause hair loss. However, it may aggravate hair loss due to other factors like in male pattern hair loss.
Does oil protect us from hair loss?
Oil has no role in hair growth. Nor does any other hair cosmetic for that matter. It may be a good conditioner and impart gloss to the hair but also makes it sticky and attracts dirt.
Do split ends heal?
Nothing can heal split ends. In fact, if the hair ends are splitting, they should be cut above the level of split or else the entire shaft can split into two.
Is shampooing bad for the hair?
In general, shampoos do not cause hair loss. Shampoos do not produce hair growth either. They are mere cleaning agents and can be used even every day, if required.
Some medicated shampoos may produce hair loss by causing brittleness of hair.
Are there any drugs that actually help hair growth?
Minoxidil and finasteride are routinely used to promote hair growth in male pattern hair loss. Vitamins, zinc and minerals are other examples. Some drugs used for other illnesses like cyclosporine and phenytoin may produce overgrowth of body hair.
Is alternative medicine better for hair growth?
There is no proven scientific data that can be universally accepted to say that alternative medicines are any better or worse than guesswork. Anecdotal reports of hair growth need to be verified scientifically. There are only two types of medicine tested and untested.
What is alopecia areata?
It is a common and treatable cause of patchy hair loss. The patches are well circumscribed and smooth. Most cases are resolved without any treatment, some require medication. Advanced cases in which all hair roots and papillae are destroyed may not recover.
What tests are done to evaluate hair loss?
Your doctor will usually do a complete medical examination. You will be screened for any internal illness. A basic screen will involve tests like blood counts, thyroid function tests and, sometimes, other hormonal and organ assays depending on the examination.
What are hair root studies?
Sometimes the doctor may want to examine the hair root to look for fungus or see what is the predominant type of hair falling whether it is anagen hair or telogen hair. Advanced computerised hair scanning and trichograms may be done in research centres and have more academic value at present.
Is premature greying treatable?
Premature greying is a genetic condition and there is no known treatment for it.
This article will not serve the needs of all patients. But an understanding of the biology of hair growth and some common ailments that affect hair can relieve a lot of worry and also help in better treatment. Above all, remember that there are no magical cures for anything.
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