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Baldness is a complex topic that can be the result of many conditions. Last week, this column was about normal hair growth and several temporary kinds of hair loss (alopecia). Now it is time to present some of the information about permanent hair loss, specifically male- and female-pattern baldness that we inherit from our ancestors. Heredity affects the age at which you begin to lose hair and the developmental speed, pattern and extent of baldness.
For men, alopecia generally causes a receding hairline at the temples and balding at the top of the head. However, female-pattern baldness usually involves hair loss limited to thinning at the front, sides, or top of the scalp. Women rarely experience complete baldness, but are often distressed by hair thinning for cosmetic reasons.
In pattern baldness, the time of hair growth shortens, and the hairs are not as thick or sturdy. With each growth cycle, the hairs become rooted more superficially and more easily fall out. No cure is available for permanent hair loss. However, you can talk to your doctor about treatments to hide or slow the rate of hair loss.
After a complete history and physical, your doctor may perform tests to determine if you have a medical condition that causes hair loss, such as thyroid disease, diabetes or lupus. Your doctor may also ask questions about the types of medications you are taking. Sometimes hair loss is a side effect of certain drugs, such as those that treat gout, arthritis, depression, heart problems and high blood pressure.
Hair loss treatments are available to help promote hair growth or hide hair loss. The effectiveness of medications used to treat hair loss depends on the cause, extent of the loss, and individual response. Generally, treatment is less effective for more extensive cases.
Drugs for treatment of baldness include:
•Minoxidil (Rogaine). This nonprescription drug is a liquid that you rub into your scalp twice daily to grow hair and to prevent further loss. Minoxidil is available in two or five percent solutions. New hair resulting from minoxidil use may be thinner and shorter than previous hair. But there can be enough hair growth for some people to hide their bald spots and have them blend with existing hair. New hair stops growing soon after you discontinue the use of minoxidil. It may take 12 weeks for new hair to start growing. If it does not help much within six months, your doctor may recommend stopping. Minoxidil can also cause irritation of the scalp as a side effect.
•Finasteride (Propecia). This prescription medication for male-pattern baldness is taken daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. It may take several months. Since this drug has its action on the male hormone, testosterone, some men experience diminished sex drive and sexual function. As with minoxidil, the benefits of finasteride stop if you stop using it. It is not approved for use by women. In fact, it poses significant danger to women of childbearing age and pregnant women should not even handle crushed or broken finasteride tablets because it may cause serious birth defects in male fetuses.
•In fertile women with female-pattern baldness who request birth control pills, it is important to select a pill containing the least amount of testosterone-like hormone, such as Ortho-Cyclen, Ortho Tri-Cyclen, Ovcon 35, Mircette, Demulen, Zovia, and others.
•Spironolactone (Aldactone). This drug decreases the ability of male hormone to bind to its receptors. It also decreases the production of testosterone. For these reasons, spironolactone has been tried for baldness, although questions remain about its usefulness. The Food and Drug Administration (FDA) has not approved this drug for the treatment of baldness.
•Tretinoin (Retin-A). Applying this drug to the scalp along with minoxidil has also shown some promise.
Hair transplants and scalp reduction surgeries are available to treat baldness when more conservative measures have failed. During transplantation, a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of the scalp. The plugs are then implanted into the bald sections. Several transplant sessions may be needed as hair loss progresses with time.
Scalp reduction involves decreasing the area of bald skin on your head. Your scalp and the top part of your head may seem to have a snug fit. But the skin can become flexible and stretched enough for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap. Scalp reduction can be combined with hair transplantation to fashion a natural-looking hairline in those with more extensive hair loss.
Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. It will take six to eight months before the quality of the new hair can be properly evaluated.
Hair weaving, hairpieces, or change of hairstyle may disguise hair loss and cosmetically improve appearance. This is often the least expensive and safest method of treating female-pattern baldness.
Stitching of hairpieces to the scalp is not recommended as it can result in scars, infections and abscesses of the scalp. The FDA has banned the use of hair implants made of artificial fibers because of the high rate of infection.
No matter what you might see on TV about miracle cures for baldness, there are none. The worst one I have seen so far involves spray painting the scalp, thinking that it will fool anyone closer than ten feet away.
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