By A.I. Irinoye
Baldness means loss of hair. It is mostly pronounced where the density of hair is greatest, that is on the head. Baldness is not particular to any sex but it is common in males than females. Baldness means alopecia in medicine.
Hair loss or alopecia can be divided into two:
- Alopecia with Scarring – These are conditions in which damage to the scalp (skin of the head) is caused by inflammation or trauma (injury) thereby destroying the hair follicles causing irreversible hair loss.
This trauma could be due to chemical, thermal (burns) or radiation burns. The infections that could cause this defect could be fungal, viral or bacterial e.g. tertiary syphilis, zoster infection, lichen planus, discoidlupus enthematosus etc.
- The Non-Scarring alopecia. This group can further be divided into two namely localized and diffuse alopecia.
The localized nonscarring alopecia is hair loss generally due to alopecia areata, trauma or tinea capitis (lapalapa or tomona in Yoruba). Secondary syphilis in the rare form can cause patchy “moth-eaten” alopecia. Physical and violent pulling or twisting out of hair by nervous children or psychotic adults may cause hair loss. Traction from combs or plaits is common in African women after straightening procedures tend to cause marginal alopecia. Constant and vigorous (nervous) rubbing of hair may fracture it producing areas of stubby hair loss.
Alopecia areata is the loss of hair in a segment o r a r e a of the body. This is an extremely common condition characterized by com- plete loss of hair from patches of the scalp. It has a rapid beginning but is reversible at the early stage.
The exact cause of this hair loss is unknown but there appears to be a ill- defined genetic factor. Due to transmission of baldness gene, a bald father may have a bald son – (bald family). Baldness has a risk factor for heart disease just like smoking. People believe that bald men are more sexy, witty and virile, some say they tend to be rich, this however remains a myth. The disease may appear at any age but seen more in the second and third decades of life. The bald patches are sharply defined and develop and progress rapidly. Little or no symptoms or slight itching and little pain may be felt from time to time. Weather conditions may worsen this. This disease does not involve the whole head usually, it either occupies the frontal, central or back area of the head. Sometimes it affects the eyebrows and the eyelashes. Usually the affected skin looks shiny and normal. Sometimes some tiny “whiskers” are seen at the margins of this lesions. These are very short broken hairs, tapering and lack color (depigmented) in the periphery of the bald area. Pitting or sporting of the finger nails may also be present.
In the localized forms of the disease, recovery is generally complete after many weeks or months. Where the disease is extensive in the centre, around the ears or posterior scalp (opheasic pattern), recovery is poor or never attained. The chances of recovery is worse when total or universal alopecia develops in early life.
Ladies who go for the modem hair do with caustic soda application to the head end up with severe patchy burns of the hair and scalp. This may lead to scalp infection and temporary hair loss. The effect is reversible on healing and stoppage of repeated assault to the scalp.
Diffuse Non-scarring Alopecias – this is the common baldness. This is the male pattern alopecia which needs no description. The, rate and extent of balding are controlled by genetic factors and the individual’s age. Adequate levels of circulating male hormones (androgens) are necessary for these factors to operate, No amount of therapy or drug can reverse this abnormality. The only thing that can arrest its progress is castration.
Other causes of baldness
- Treatment with anticancer drugs. This drug reduces the growth and development of the body cells including the hair.
- Certain extreme stressors (psychological) can prematurely switch off the hair production cycle. The effect of the stresses are noticed’ months later after the protracted stress, e.g. after child birth (Postpartum alopecia),
- “Crash” dieting in the obese subjects. A crash diet may even make an obese subject look like a terminal case of HIV- AIDS due to the sudden fall in nutritional balance.
- Withdrawal of oral, contraceptives after a prolonged duration of use. The effect of this on hair loss is temporary and re-
- Metabolic alopecia – severe iron deficiency at any age can cause diffuse hair loss. This has to do with poor functionality of the thyroid organ (that is the organ in the front of the neck).
- Post-Menopausal alopecia – This is the female equivalent of the male balding. This may be due to reduced production of he female hormones at this stage.
- Idopathic Premenopausal alopecia – This is a common condition in the premenopausal women. It may begin in the early thirties and very embarrassing. The cause remains largely unknown.
It must be stated however that an obsessive urge to straighten the hair or pull to enlongate the hair which is common in ladies may give rise to alopecia, especially at the border of the scalp. The unnatural colour of the skin may be due to skin- lightening creams.
It must also be stated that malnutrition causes brownish, brittle hairs which break and fall off easily. In children, this manifests as kwarshiokor.
The use of depilatory creams (Hair removing creams) on a prolonged basis can have receding effect on the hair margins.
Another rare form of alopecia is alopecia totalis – this is the complete absence of hair on the whole body. This is very uncommon in practise. Constant bare head carnage of heavy luggage may also cause hair loss.
Management of Alopecia
- Use of wigs – We now have both male and female wigs in the market to cater for the interest of both sexes. Hair attachment may overlap the bald areas.
- Castration has been observed to arrest the progress of balding. Castrated dogs are known to be hairy among other features. This further suggest the homional role in balding. This further suggest the hormonal role in balding.
- Transplantation of hair-bearing grafts from non-balding areas of the scalp to the affected areas. This is only an impressible cosmetic treatment and can only be handled by the highly skilled and experienced hands.
High oral oestrogen contraceptives intake sometimes arrest the process of hair loss but this has its attendance cardiac risks.
- Some wild herbs (names withheld) for ethical reasons) promote hair growth and development..
- Aloe vera gel is a good hair tonic for existing hair. Its role in baldness is still being investigated.
- Treat any obvious disease like ringworm, bacterial or viral infections of the affected area.
- Avoid leaving depilatory creams for too long on the .skin as this may bum the entire skin and hair bed.
- Eat good nutritious food always. Correct iron deficiency if it occurs.
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