Everyone would like a full head of hair, and, when it begins to fall at an alarming rate, anxiety and consternation set in. Hair loss appears to be a common problem, and its treatment a lucrative business, if the number of advertisements for oils, shampoos and revitalising products are to be believed.
Hair growth and loss has its own natural cycle. Scalp hair grows about half an inch a month during a long growing phase that lasts from two to six years. This is followed by a resting phase that lasts two to three months. At the end of the resting stage, the hair is shed. Losing 75-100 hairs a day is normal. At any given time, 10 per cent of hair is in the resting and 80-90 per cent in the growing phase. After hair is shed, a new hair grows from the same follicle, starting the cycle once more.
As people age, their rate of hair growth slows. Some of the hair follicles die and the number of follicles shows a gradual decline.
If the loss is greater than 150 hairs per day, there is a pathological process affecting the normal hair renewal process. This needs medical evaluation. The affected person alone may be sensitive to his or her hair loss. It may be within the normal spectrum and may not be taken seriously by the doctor. Also, 50 per cent of hair needs to fall before it becomes obvious to the doctor.
Hair loss may be due to dietary factors with sub-clinical malnutrition. This may be the result of fad or crash diets, with an accompanying deficiency of proteins, vitamins and minerals, particularly iron and zinc.
Hormonal imbalances cause increased hair loss, with the hair also becoming thin, brittle and lacklustre. The hormonal balance can go awry because of malfunction of any of the endocrine glands. Thyroid hormones are notorious for this. Androgens (male hormones) cause male pattern baldness. If a women has excess androgens for any reason, she tends to become bald. The female to male hormone ratio can be altered as part of the natural changes at menarche, pregnancy, lactation and menopause.
The predisposition to lose hair after a certain age is genetically transmitted in families. It usually affects males, but females can also start going bald.
Hair loss can occur in well-defined, circular patches. Expert evaluation is required to rule out conditions like alopecia areata. Local treatment can initially reverse the process. One it progresses to alopecia totalis (loss of all hair) treatment is not very successful. Hair loss may be may be due to “hair pulling” or trichotillomania where people, particularly children, twist and pull out their own hair, eyebrows, or lashes. It is a habit precipitated by psychological and social stress. There is spontaneous improvement with psychiatric help if the stress factors are removed.
Chemotherapy causes reversible hair loss. Radiation injury and surgical scars cause permanent hair loss.
Medical treatments are available to reverse hair loss. Applications of minoxidil solution (two per cent in women and 5 per cent in men) to the scalp twice a day results in improvement in about six months. Once the application is discontinued, the new hair falls out within a few weeks. Finasteride, when taken regularly, blocks the formation of the active male hormones in the hair follicle and causes hair growth in men. It cannot be used in women.
Hair transplantation is a plastic surgery procedure which can be used in men and women and provides permanent hair replacement. It involves moving hair from donor sites to recipient sites with simultaneous removal of the bald skin.
For proper care and maintenance of normal hair a few tips need to be followed.
• Mix half kg coconut oil, half kg sesame oil and 100ml castor oil. Boil the mixture after adding a bunch of curry leaves, a clove and 20 peppercorns. If you need to darken the hair, mix in henna leaves or powder and petals of red hibiscus. Massage this oil into the hair twice a week using the tips of fingers (not nails). Vigorous massage may break the hair at the roots
• Use only half a teaspoon shampoo to wash hair. Apply shampoo on the hair shaft and not the scalp.
• Blow-drying damages hair. If a dryer has to be used, cover the head with a towel and allow the air to heat the towel instead of applying it directly to the hair
• Heat and chemical treatments for curling or straightening hair eventually damage it. Crinkling and curling can be safely done at home by plaiting wet hair tightly and leaving it overnight
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org