Alopecia is the medical name for hair loss. Androgenetic alopecia (AGA) or male pattern baldness is a common, genetically determined hair loss in men. It involves the male hormone dihydrotestosterone (DHT). In 50% of males above the age of fifty, the hair loss from the temples presents as a receding hairline and from the crown of the head as a thinning of the hair or as a bald patch. The hair pattern may become an M shape or hair loss may even result in total baldness.
In about 25% females, female pattern hair loss typically presents as a thinning of the hair all over the head and the cause is unclear.
Alopecia areata or spot baldness is an autoimmune disease in which one’s own immune system attacks one’s own hair follicles causing hair to fall off in small patches. It can be caused by drugs that affect the immune system. It requires clinical attention. Alopecia totalis is complete loss of hair from the scalp.
Many people are not concerned with hair loss and wear their new look proudly. Others keep the baldness with resignation. Others wear a wig or camouflage their baldness with hair spray. However a sizable portion of the affected population wants a solution to arrest or reverse the condition.
Scientists have been working hard to study the biology of hair loss and have been coming up with promising new solutions, some of which are revolutionary. We here take a look at both current treatment and new inventions.
Many Nigerian men would possibly not spend their hard economy earnings on baldness. Perhaps they don’t even notice they are getting bald while worrying about electricity supply, traffic jams, school fees, and rich men playing with their wives. In the USA, Finasteride (Propecia, also Proscar) and a similar drug dutasteride (Avodart) are approved by the United States Food and Drug Administration (FDA) for the treatment of hair loss in men. These tablets are taken orally once a day. Some doctors may try them for female pattern baldness, though this is not the approved usage.
Minoxidil (Rogaine) is approved by the FDA for the treatment of male and female pattern baldness. It is made in a liquid or foam preparation which are available over the counter for application on the scalp twice daily. It is not to be taken during pregnancy to avoid the risk of birth defects. Results of thicker hair are obvious by 6-12 months but hair growth may also appear on the cheeks or other unwanted areas. Side effects during the first year may include headaches, hot flashes, and a decreased sex drive.
A chemical messenger, FGF5, down regulates the hair growth cycle, causing hair thinning. Evolis is a product that blocks FGF5T and its use is supposed to help reverse hair loss.
Platelet-rich plasma is a product that has high levels of growth factors and when injected into balding patches of the scalp may rejuvenate hair growth. Platelets are collected from the patient’s own blood and then injected into the patients scalp to stimulate hair growth.
Spironolactone (Aldactone), a diuretic drug that also blocks male hormone androgen production may help regrow hair in women with androgen dependent alopecia. Because it is hormonal and acts on different parts of the body apart from the scalp, it has many side effects such as electrolyte imbalances, fatigue, blood spotting between periods, irregular menstruation, and tender breasts. Use of it requires blood pressure and electrolytes monitoring. It should be avoided in pregnancy and women planning to get pregnant as it may cause birth defects.
Dietary supplements that may help to promote hair thickening are iron, biotin, folic acid, omega-3 fatty acids, omega-6 fatty acids, and antioxidants.
Various procedures in use are hair transplant, laser combs and helmets which all FDA approved. In hair transplant, hair is removed from one part of the scalp and implanted into a bald area. Low-level laser therapy (LLLT) uses light and heat to activate epidermal stem cells in the hair follicle. This returns the follicle into the growth phase. The process is used for both men and women.
Sufficient studies exist to qualify some herbs and herbal products as reliable treatment for hair growth and for increasing hair thickness. Amongst these are coconut oil, sweet almond oil, walnut oil, olive oil, mineral oil, jojoba oil, wheat germ oil, Chinese hibiscus, and the Ayuverdic medicines: jatamansi, coat buttons, and brahmi. Some herbal ointments made with petroleum jelly or cocoa butter and water contain herbs such as holy basil, aloe vera, gooseberry and gotu kola and are sold for hair health. Herbal creams containing the Ayuverdic medicine giant dodder may be effective against hormone induced hair loss. Herbal gels containing fenugreek, medications with nanoparticles containing oriental arborvitae and Mexican espinosilla are thought to stimulate hair growth. In Nigeria, the Asian herbal formula “Gentle Care Hair Growth Treatment Serum” has been used by many men with apparent results within 4 weeks. Two bottles cost about N15,000.00 which is about half minimal wage. Local herbal medicines are not yet developed in this line. Next we shall discuss new inventions.
Dr. Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis. For any comments or questions on this column, please email [email protected] or call 08160944635