Hair Loss
The normal male scalp contains between 100,000 and 150,000 hairs. On average, 80100 are naturally shed every day, to be replaced by new hairs growing through. If daily hair loss is any greater than 100 hairs per day, gradual thinning occurs.
Each hair follows its own life cycle. There is an initial growth phase lasting two to six years, followed by a resting period of around three months during which no further growth occurs. At the end of this time, the hair falls out. If a hair follicle dies, no more hair will grow and hair loss in that area will be permanent.
At any one time, 90 per cent of the hairs on your head are in the growth phase and 10 per cent are in the resting phase. Under certain conditions such as stress, thyroid disease, iron deficiency or while taking certain drugs, the life cycles of hundreds of hairs synchronize so that they all fall out at once. This causes a form of patchy baldness known as alopecia which can be difficult to treat. Left untreated, over 70 per cent of cases recover within five years. Steroid creams applied locally may help.
Other causes of localized alopecia include ringworm (a fungal infection), repeated plucking or twisting of hair and excessive traction especially at the hairline from pulling the hair back into a tight ponytail.
Androgenic Alopecia
Androgenic alopecia is the correct term for male pattern baldness. Hair loss occurs over the temples to cause a receding hairline, and/or from the crown (vertex) to form a circular bald patch. Androgenic alopecia affects 5 per cent of males by the age of 20 years. By the age of 70, 80 per cent of males are affected.
There is a strong hereditary component which determines at what age thinning starts and the pattern of baldness that follows. Most men inherit the same pattern of hair loss as their father had.
Male pattern baldness is androgen-dependent. Although body hair is increased by the action of testosterone, scalp hair is decreased. Blood levels of testosterone hormone are usually normal in men with a receding hairline, however, and the hair loss is probably due to the breakdown of testosterone into dihydro-testosterone (see what causes BHP) within the hair follicle, which somehow switches the follicle off.
This may in part be related to diet. Men in Japan and China are less likely to develop other diseases (such as benign prostatic hyperplasia and prostate cancer) related to dihydro-testosterone levels. They are also less likely to develop androgenic baldness. It is possible that following the prostate-friendly diet discussed may also help to reduce hair loss.
Certainly the hair is often the first part of the body to show evidence of vitamin and mineral deficiencies. For optimum hair health it is important to obtain adequate dietary supplies of vitamins C, E, and betacarotene, and the minerals manganese, zinc and copper.
Recent research suggests that male pattern baldness may be a risk factor for coronary heart disease (CHD see Chapter 11). In one study, 685 men aged under 55 who were admitted to hospital with a heart attack were matched with 772 men admitted for other, non-cardiac reasons. Their degree of baldness was assessed and it was found that men with mild to moderate crown (vertex) balding were 1.3 times more likely to have a heart attack than men without crown hair loss. For men with extreme crown baldness, the relative risk rose to 3.4 times more likely, and did not seem to be related to the age at which baldness started.
It is possible that baldness is an indicator of a pattern of testosterone metabolism that in some way increases the risk of CHD. While this is only a hypothesis, it might be sensible for younger men with thinning crown hair to keep other risk factors for CHD (e.g. obesity, raised blood cholesterol, smoking, lack of exercise, high blood pressure) to a minimum. Frontal balding alone does not seem to be associated with an increased risk of a heart attack.
Several treatments are available to overcome androgen alopecia. These have varying degrees of success and varying cosmetic results.
Scalp Massage
Improved blood circulation to the scalp can encourage new hair growth. Gentle fingertip massage, plus hanging upside down for a certain amount of time per day, demonstrate varying degrees of success.
Herbalists suggest rubbing arnica cream or ointment into the scalp. Aromatherapists suggest a daily scalp massage with two or three drops of clary sage, lavender, rosemary or ylang-ylang added to 60 ml of a wheatgerm or almond oil base.
Homoeopaths recommend combining massage with taking tablets of lycopodium for androgenic baldness and premature greying, and kali carbonicum for hair loss associated with a dry, flaking scalp.
Thickening Hair Sprays
The appearance of a thicker, fuller head of hair can be obtained by spraying on a coloured agent that dries on the hair shaft and thickens it. This gives the illusion of more hair.
Minoxidil
Minoxidil is a drug originally used in its oral form to treat high blood pressure. One of the side-effects of treatment was excess-ive hair growth.
Minoxidil is now available as a topical solution. One ml is applied to the scalp twice per day for a minimum of four months; this appears to reduce hair loss in around 70 per cent of patients. New hair growth occurs in a third of patients but only 10 per cent produce a good cosmetic result. In others, new hair remains thin, wispy and miniaturized. The regular massage effect may contribute to the treatment's benefit.
Minoxidil is thought to work by increasing the blood flow to tiny capillaries feeding blood to the hair follicles in the scalp, thus stimulating hair growth.
If minoxidil produces an acceptable result, treatment must be continued regularly. If it is stopped the new hair growth tends to fall out again, usually within four to six months. Minoxidil treatment seems safe, with only occasional side-effects of irritation or dandruff reported. If large amounts are absorbed, low blood pressure is another possible side-effect.
Hair Follicle Relocation
This technique involves relocating healthy hair follicles from thicker areas of hair to thinning or balding areas. This is used to treat receding hair lines, balding at the temples and crowns, and generally thinning hair.
Hair Transplants
Circular plugs or strips of skin are transferred from hair-bearing parts of the scalp onto bald or thinning areas. Grafts are described as micro, mini, quartered or full size depending on the size of the plugs transferred. These are inserted into a ready-made slit or hole in the bald or thinning part of the scalp.
Punch grafting can produce an artificial, dotted appearance. At best this offers only a visual illusion of more hair, as in fact existing hair is just redistributed. Results depend on the oper-ator's skill, the pattern of hair loss, the colour of the scalp, and the texture and colour of the hair and whether it is curly, wavy or straight. There is also the risk that grafts will not take. You are then left with an extra patch of baldness where the original plug was removed. Several operations are needed to fill in areas between previous punch grafts to produce a more natural appearance. This procedure is especially successful for frontal hair loss.
Scalp Reduction
With scalp reduction, a strip of bald skin is removed from the upper forehead before transplantation to reduce the area that needs to be grafted. This is usually done as a separate procedure, then followed by three or four sessions of hair transplantation at four-monthly intervals.
Implantation of artificial fibres
A polyethermid fibre that has the same strength, thickness and colour as human hair is available for an artificial hair transplant. Each false hair is individually inserted and anchored into the scalp under a local anaesthetic. Up to 1,500 hairs are implanted per hour.
Toupees
Excellent artificial hair pieces are now available which can disguise balding. Careful colour matching and skilful interweaving or fusion techniques with remaining hair will improve the cosmetic effect. Toupee tapes, elastic tapes and velcro can be used to keep the hairpiece in place.
DANDRUFF
Dandruff is a common form of seborrhoeic dermatitis that affects the scalp. White flakes of skin result, which are sloughed to produce an embarrassing fall-out. Some flakes are small, but sometimes large flakes form especially if there is an associated yeast infection (Pityrosporum ovale) in the hair. Treatment must usually be ongoing to prevent the condition recurring.
Mild dandruff is controlled by washing the hair regularly with a medicated antidandruff shampoo.
More severe dandruff often responds to a prescription-only anti-fungal shampoo containing an agent such as ketoconazole. If this does not work, a steroid lotion (betamethasone) sometimes helps.
Alternative remedies for dandruff include using live bio (natural) yoghurt as a hair conditioner. This is left on washed hair for 15 minutes and then rinsed out. Infusions of sage, thyme, rosemary or lavender are traditional remedies used to massage the scalp.
Aromatherapists also recommend using a few drops of cypress, juniper and cedarwood in a carrier oil to rub onto the scalp and leave there for one hour before rinsing off.
SYCOSIS BARBAE (Folliculitis)
Sycosis barbae is an inflammation of the beard area. It is also known as 'barber's itch'. It is caused by infection of hair fol-licles with the common skin bacterium Staphylococcus aureus. Reinfection is commonly transmitted via used razors and towels, so scrupulous hygiene is essential.
Folliculitis causes multiple small pus-filled blisters and occasional boils in any hair-bearing area of skin. It can even occur on the thighs, although the beard area is the commonest site. If not treated adequately, tiny white scars can result.
Sycosis barbae is quickly and easily improved with topical or oral antibiotics, depending on its severity. Some men have frequent recurrences which can be minimized by growing a beard instead of shaving.
Shaving Rash
If shaving causes soreness but there are not any obvious infected follicles or pustules, the cause may be an allergy to soap or shaving cream. Alternatively, some delicate skins are sensitive to a too-close shave and develop a so-called 'razor burn'. Soothing creams, lotions or ointments containing calendula, heartsease or Evening Primrose Oil often help.
