When discussing baldness, the topic is generally
about a hereditary condition called androgenetic
alopecia. Ninety-five percent of hair loss is of
this variety.
Male-pattern baldness refers to the upward retreat
of the hairline from the forehead, as well as an
expanding area of fallout from the crown of the
head. In the end, all that might be left is a
horseshoe-shaped fringe around the sides and back
of the head. Female-pattern baldness, which
recently has received more attention since
Pharmacia& Upjohn began packaging and marketing
Rogaine separately for women, refers to a diffuse
pattern of hair loss throughout the scalp.
Research continues in search of ways to treat
androgenetic alopecia and allow hair to sprout in
barren scalps. But, at this time, all you can do,
if you're a man, is to look at your father's head
and your mother's father's head to see how they
fared, because chances are you'll wind up with a
similar fate. In addition, female-pattern baldness
can be passed down from mother to daughter.
"I think it's just the luck of the draw what your
genetics are," says Allan Kayne, M.D., a
dermatologist and assistant clinical professor of
medicine at the University of Washington Medical
Center in Seattle.
In male- and female-pattern baldness, the culprit
is something called dihydrotestosterone, or DHT,
which is derived from androgen, a male hormone.
Circulating through the bloodstream, androgen is
converted to DHT by the enzyme 5-alpha reductase.
Those with greater enzyme activity have more DHT
binding to hair-follicle receptors. If flooded by
DHT, the follicles sprout thinner and thinner
hairs until nothing regrows, and the follicles
eventually wither away.
Currently, if you want to regrow hair, topical
minoxidil is the only approved way to go. As
Washenik explains, no one is quite certain how
minoxidil, an oral medication originally approved
to treat high blood pressure, works to grow hair.
To be effective, minoxidil must be used twice a
day. It works better on those who are younger and
whose hair loss is recent, according to clinical
studies by Pharmacia& Upjohn.
Those studies show that 26 percent of men between
18 and 49 reported moderate to dense hair regrowth
after four months of Rogaine treatment. An
additional 33 percent had minimal hair regrowth.
Almost 20 percent of women between 18 and 45 had
moderate regrowth, while an additional 40 percent
showed minimal regrowth.
A company spokesman said the research accounted
for the fully pigmented hair fibers normally seen
on the scalp and not vellus hair, which is more
like peach fuzz. Many doctors, however, say the
number of their patients who have as much success
is much lower, and some find that only vellus hair
appears.
"I have not been that impressed that it helps
regrow hair," Kayne says. "I think that occurs in
a very small minority."
One plus that Denise Cook, M.D., medical officer
in FDA's division of dermatologic and dental drug
products, points out is that patients report a
decrease in shedding due to minoxidil use, though
whether that perception is the result of fewer
hairs being lost or more hairs being produced is
unknown. Normally, you should lose only about 100
hairs a day.
One possible side effect of minoxidil is an itchy
scalp. Another drawback is that it must be used
for life or any regrown hair will fall out. Also,
only those people losing hair on the crown, not in
front, are candidates for regrowth.
Researchers are optimistic that more products to
boost hair regrowth will be coming down the pike.
For example, Proscar (finasteride), now used to
treat enlarged prostate glands, has anti-androgen
properties that may make it marketable as a
hair-loss prescription, Washenik says.
Theoretically, he says, if a drug can be targeted
to halt the conversion of testosterone to DHT in
the scalp region only, it could stop hair from
falling out. He foresees combinations of
medications as the wave of the future.
Twenty years ago, many people felt they risked
looking like a Cabbage Patch doll if they chose
surgery to eliminate baldness. Now, says Carlos
Puig, D.O., director of Puig Medical Group, which
is headquartered in Houston, better surgical
techniques--used by increasingly skilled
surgeons--are getting more eye-pleasing results.
"When I started in 1973 ... it was like the Stone
Age," the cosmetic surgeon says, referring to the
equipment and techniques in use. Now, he says,
surgeons have learned to create a much more
natural-looking hair line, using scalpels to cut
either small slits or holes in the scalp to
receive transplanted hair.
While there are numerous types of surgery, they
can be sifted into two main categories:
transplantation and scalp reduction.
Transplantation involves moving hair from densely
covered sites on the sides or back of the head to
bald areas of the scalp.
The key to success, explains Anthony Santangelo,
president of the American Hair Loss Council, is to
have good sites on the sides or back of the head
from which to move hairs. Otherwise, patients
can't expect ample coverage. Because their hair
loss is diffuse, women generally lack good donor
sites, making transplantation impractical for
them.
The biggest improvement in transplants is with
"micro" or "mini" grafts. "You're looking at one
to two hairs shot into the head with a needle,"
Santangelo says. "It achieves a very, very fine,
natural-looking hair line. The significant
difference there is you need a lot of hair to do
that."
Surgeons also use larger round plugs of seven to
10 hairs. Line grafts, the shifting of strips of
nine to 12 hairs, are common, too.
One thing to keep in mind is that prosthetic hair
fibers for transplantation are banned by FDA.
Implanting them, according to Stephen Rhodes,
acting chief of FDA's plastic and reconstructive
surgery devices branch, caused a high incidence of
adverse reactions, including infection.
If male-pattern baldness has left you with too
much balding area to cover, you may benefit from
scalp reduction: the surgical removal of large
sections of a bald scalp. Extenders and expanders,
elastic devices placed under the skin to stretch
the hair-bearing scalp regions on the side of the
head, have been used as a complement to reduction
surgery.
Another surgical method is the flap technique,
which rotates hair-bearing scalp areas from the
sides or moves those areas from the back forward.
The flap technique has the highest complication
rate, though, Puig says. Bleeding, scarring and
infection can occur from surgery. But advances,
such as knowing what size flap to use and how to
enhance blood supply to the region, have cut down
on the visibility of scars.
Finally, if you prefer to dodge the pain, time and
cost of surgery, there's always the old, reliable
hairpiece.
Obviously, all toupees and wigs are not created
equal. Just as the transplant is only as good as
the surgeon, the hairpiece is only as good as the
person creating it and the materials used.
There are a variety of ways of affixing the
hairpiece, which consists of human or synthetic
hair implanted one hair at a time into a nylon
netting. No method is permanent. The hair weave
involves sewing a wig into existing hair.
Also there are more traditional methods: You can
use bonding (a type of glue), metal clips, or
simple tape to attach the hairpiece to the scalp.
Unlike the weaves, these give you the option to
take the hairpiece on or off with ease. Many
companies advertise "hair systems" or "hair
clubs," which, according to Santangelo, offer
check-ups to clean, color and tighten the
hairpiece.
Lark Lambert, consumer complaint coordinator for
FDA's Office of Cosmetics and Colors, notes that
in addition to maintaining the cleanliness of
hairpieces and wigs, it is important not to
neglect the scalp under the wig. Keeping it clean
and healthy avoids skin irritation and disease, he
says. Also, as a precautionary safety measure,
first-time users of hairpiece adhesives and
solvents should test a patch of skin for 48 hours
to determine possible skin sensitization to these
products.
While hair loss is more harmful to the psyche than
anything else, some of the causes of baldness may
represent serious health problems. That's why it's
important to talk about hair loss with a
physician. One problem, says FDA's Cook, could be
a condition called alopecia areata. It's an
autoimmune disease of unknown cause in which
inflammatory cells attack the bulbs of the
follicles under the scalp, leaving hairless
patches. In more serious cases, hair may fall out
from the entire head--eyebrows and beard
included--and the entire body. Many times, though,
the hair returns spontaneously. Childbirth, severe
malnutrition, chemotherapy, thyroid problems, and
a form of lupus can also cause hair loss.
Something as simple as pigtails or cornrows, if
worn too long, can cause hair loss, too, because
of the stress they cause to the hair shaft. The
medical opinion concerning the role of emotional
stress in balding is mixed. If stress does play a
role, however, it's only at times of extreme
emotional trauma, according to Kayne at the
University of Washington Medical Center.
The mythology of hair loss is a book unto itself.
Wearing hats won't cause it, doctors say. Nor will
standing on your head to increase blood flow cure
it. Massaging your scalp and brushing your hair
won't save you. Toweling off your head lightly
rather than vigorously will only postpone the
inevitable for a few days.
Perhaps the biggest myth is that cleaning your
scalp of sebum (the semifluid secretion of glands
attached to the follicle) will unclog those
follicles and allow hair to grow. Surgeons will
tell you that when they're performing transplants,
there's no trapped hair to be found.
In 1989, FDA banned all nonprescription hair
creams, lotions, or other external products
claiming to grow hair or prevent baldness. And it
has taken action against companies that continue
to sell such products. In 1996, the agency sent a
warning letter to Daniel Rogers Laboratories Inc.,
of Paramus, N.J., the manufacturer of "Natural
Hairs," for claiming its product could promote
hair growth and prevent hair loss. Two years
earlier, after an FDA investigation, a U.S.
district court judge enjoined the marketing of
"Solution 109 Herbal Shampoo" because of claims
that the product warded off hair loss.
Advertisements for "hair farming" products and
others that hint they can regrow hair are still
plentiful. But if you're desperate, keep one thing
in mind:
"There will be never be a secret [ingredient] that
works for hair loss," NYU's Washenik says. And, if
they were to find it, he says: "It will be on the
cover of the New York Times. It will be on the
nightly news. ... When this happens, it's going to
be wildness. You're not going to need an expert to
tell you the name of the drug." |
