Baldness: in a nutshell

Baldness is the complete loss of, or partial thinning of the hair. There are various forms of baldness, some of which only affect the hair on the head and others that also affect the hair on the body. Alopecia is the term used to describe significant baldness, and can similarly affect only the hair on the head and/or other areas of the body (e.g. body, beard etc.)
There are numerous causes for baldness. The main cause is a genetic predisposition that induces hypersensitivity to male hormones and, in such cases, baldness is referred to as androgenetic alopecia. Other triggers that can transiently induce baldness include: the use of certain drugs; chemotherapy; severe psychological shock or stress; very intense fever; autoimmune diseases that affect hair bulbs; during pregnancy, or after childbirth; nutritional and iron deficiencies.

Description

The average person has more than 100,000 hairs on their head and will lose up to fifty to 100 hairs per day. Baldness is a condition that can affect men, women and children. Androgenetic alopecia is more common in men and causes hair thinning on the temples, forehead or top of the skull. Over time, the balding line recedes further to push the so-called ‘hairline’ back. Alopecia areata, on the other hand, causes bald, round patches to form, eventually causing rapid yet transient hair loss across areas of the scalp. This form of baldness often develops in adulthood. Finally, traction alopecia is more common in women and can even appear in adolescence. This form of hair loss is caused by the use of hair irons and/or hairstyling that stresses the hair, and can impact future hair growth.

Causes of baldness

Androgenetic alopecia is the result of hereditary predisposition, with studies confirming that baldness is an inherited condition.
The factors that cause hair loss in such cases are both genetic and hormonal, as sex hormones, including testosterone, interfere with the functionality of hair bulbs.
Other causes of hair loss or thinning may be:

• thyroid diseases;
• scalp infections;
• systemic diseases, such as lupus or psoriasis;
• lichen planus;
• chemotherapy;
• medications to treat arthritis, depression, and heart disease;
• psychological shock or periods of intense psychophysical overexertion;
• use of hair irons;
• poor nutrition and/or extreme diets.

Symptoms

Symptoms of baldness may begin as early as adolescence or during the early phase of puberty, but most often appear during adulthood. Signs of hair loss may be particularly noticeable after washing, hair drying and combing. The thinning of the hair usually consists of the steady receding of the hairline. In men, this usually starts from the temples or as localized loss in certain parts of the scalp. Regardless of the extent of hair loss, remaining hair may appear weaker or thinner.

Diagnosis

Before commencing any treatment, it is important to conduct a thorough examination of the causes that may have led to hair loss or baldness. This can be done with a thorough dermatologic examination that allows familial and personal medical history to be assessed.
The next step is the exclusion of other diseases that may affect hair growth and regrowth, such as thyroid diseases, diabetes, lupus or psoriasis. At this stage, blood tests may be necessary.
A trichologist (from ‘tricos’ meaning hair) will be able to provide a specific diagnosis and will be able to ascertain other causes. During the examination, hair samples from the scalp are analyzed under a microscope to assess the condition of the hair bulbs, which are the structures responsible for producing new hair.

Treatment

In cases of baldness caused by systemic diseases, therapies to reduce inflammation or that boost the immune system can be applied directly to the scalp.
Treatments to limit the pathology that has caused the baldness should run concurrently.
In cases of androgenetic alopecia, the two most widely used drugs are minoxidil and finasteride, which are administered locally and orally, respectively. The effectiveness of these treatments varies from one person to another, and they come with some unpleasant side effects that must be weighed up against any potential benefits. Other interventions to tackle baldness include:

• antioxidant and vitamin supplements, to stimulate the resumption of hair bulb activity;
• surgery, whereby intact hair bulbs are taken and transplanted into bald areas

Prevention

It is practically impossible to completely prevent baldness. This is especially true for androgenetic alopecia, which will appear due to genetics and hormones regardless of an individual’s lifestyle. However, the hair will benefit from following a healthy, balanced diet and from avoiding smoking. Avoid damaging the hair by: not washing it too frequently; not using excessive heat on the hair; avoiding chemical substances, such as dyes; and not overly-brushing or aggressively brushing the hair.