By A.I. Irinoye
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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:

1. 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.

1. 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

1. Treatment with an­ticancer drugs. This drug reduces the growth and development of the body cells including the hair.
2. 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),
3. “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.
4. Withdrawal of oral, contraceptives after a prolonged duration of use. The effect of this on hair loss is temporary and re-

versible.

1. 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).
2. 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.
3. 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

1. 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.
2. 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.
3. 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.

1. Some wild herbs (names withheld) for ethical reasons) pro­mote hair growth and development..
2. Aloe vera gel is a good hair tonic for exist­ing hair. Its role in bald­ness is still being inves­tigated.
3. Treat any obvious disease like ringworm, bacterial or viral infec­tions of the affected area.
4. Avoid leaving de­pilatory creams for too long on the .skin as this may bum the entire skin and hair bed.
5. Eat good nutri­tious food always. Cor­rect iron deficiency if it occurs.