Alopecia - what causes it, and how can we treat it?

Alopecia affects half of men over the age of 50 and half of woman over 65, and also affects younger people. It can have devastating repercussions on the psyche. What causes the hair loss and what treatments are out there? Rita deBrún finds out.

Alopecia - what causes it, and how can we treat it?

Imagine having no hair. Not by choice, and not just on your head. No eyebrows, no eyelashes, no body hair. And you can’t do anything about it. In our fixation with flawless perfection, a lack of a crowning glory can be a follicular fiasco; a confidence-zapping twilight zone nobody wants to be in.

Yet hair loss, or alopecia to give it its medical term, is so common it’s normal, affecting — as one strain of it does — 50% of men over 50 and the same percentage of women aged 65 and over. For them, genes or hormones result in progressive hair loss of the androgenetic alopecia type, which manifests as hair-thinning, or baldness of varying degrees.

Of course the impact of hair loss experienced by a man at any age — let alone one who has lived for more than half a century — cannot be compared with the same loss endured by a child or a woman. But that’s not to minimise the fact that regardless of sex or age, the experience can be deeply negative in an emotionally crippling way.

While it may sound like something you’d read on a music score of an Italian operetta, alopecia areata, another strain of the hair-erasing disorder, affects about 2% of the population. It happens when the body’s immune system attacks hair follicles and usually manifests in the form of bald patches on the scalp. It’s a mean disorder; one that can impact not only on eyelashes, brows, and beards, but on the entire body.

“Most people believe hair loss is a genetic condition, but it can be hormonal as well,” explains Dr Gillian Gibson, a hair-loss expert at Cork’s Lee Clinic Dermatology.

“Sometimes it follows a shock to the system, surgery, crash dieting, giving birth, or enduring a stressful time,” she says. “As for alopecia ariata, most often I see it in kids as young as three or four, and in adults in their 20s.

“For most, regrowth occurs within months or years, but the loss/growth cycle can be repeated, and there’s no guarantee that all of the lost hair will grow back, or that when it does it won’t be white for at least a period of time. If the hair loss is of the non-scarring type brought about by bad infections and radiation, the prognosis for regrowth is good.

“With the scarring type — which can be brought on by inflammatory skin conditions, shingles, or bad bacterial and fungal infections — we never say never. Sometimes it depends on how scarred the hair follicle is. Generally though, it’s hard to reassure anyone that their hair will regrow when the follicles are scarred. Our goal then is to stop further scarring and hair loss.”

Dr Gibson is right of course, because how we look is important. But it’s not as important as how we feel we look. For those for whom bald or thinning hair is not something that feels good, there are treatments ranging from steroid creams and injections, to leech therapy and hair transplantation.

Having had ten — yes ten — hair transplants to date, UK-based Spencer Stevenson knows more about the topic than most. An online hair loss guru better known as Spex, he’s also the author of an ebook: The Hair Raising Truth.

Describing how hair restoration stopped him fixating on hair loss, Spencer says it “transformed and empowered” him. For sure, he now sports a great head of hair, but in achieving that, he learned a lot along the way, and, as a result, recommends the IAHRS hair restoration surgeons as a group with expertise in the area.

As for why Spencer endured so many surgeries, the answer lies in his frank admission: “Hair loss is a cancer of the spirit. It traumatised me and stripped me of my self-esteem and confidence.”

In her work, Dr Gibson has seen many who have felt the same way: “Lots of men aren’t bothered by it, probably because it’s more acceptable in males, but others — particularly women — feel devastated by it.”

Given the distress it causes to so many, it’s worrying that hair loss is on the increase. In Dr Gibson’s experience there has been an epidemic over the last five to eight years of women presenting with frontal hairline scarring alopecia. “Most are post-menopausal but some are in their 30s,” she says. Spencer Stevenson agrees: “Hair loss is a hidden epidemic of biblical proportion,” he says.

In her work with the Rapunzel Foundation, Deborah O’Neill says demand for their freedom wigs from people with alopecia is increasing year on year. “It’s scary how many kids in Ireland are bald because of the condition,” she says.

“Research is going on all the time but not a huge amount,” according to Dr Gibson. There is progress, however. Describing a therapy which has not yet come onto the market, Dr Gibson says: “There are trials going on at the moment with a medication that removes the stimulus which causes the immune system to attack hair follicles.”

Until a cure is found, hair loss remains with us. But it should never — unless we choose to wear it like a badge — define us. Nor should it be something that anybody has to endure beneath the radar. In an ideal world, wigs, hair-pieces, hats, and bandanas would only ever be worn by choice; not because of a belief that without them, there would be exposure of an embarrassing kind.

Spencer Stevenson: ‘Hair loss is a hidden epidemic of biblical proportion
Spencer Stevenson: ‘Hair loss is a hidden epidemic of biblical proportion

The fact that so many feel the need to cover up is indicative of an underlying shame-inducing stigma that will only be rooted out when more and more of those affected dare to bare or at least dare to be open about their hair loss.

Two who have done just that are a couple of ladies, Bernadette and Karen, who have had alopecia and together give up their time to run the Alopecia Ireland support group.

Another is Dublin beauty Amber Jean Rowan. Currently signed with Morgan The Agency, the model and actor says about her experience of alopecia: “With the work that I do, I guess you’d always fear it would have a negative impact; but it doesn’t and I don’t see why it should. It never stopped me from doing what I love — acting. It should never stop anyone from doing exactly what they love.”

Recalling Amber Rose as a 10-year-old child model, Rebecca Morgan, boss of Morgan The Agency, says: “When Amber Rose started modelling she didn’t have alopecia. I well remember her as a 10-year-old model and there was no sign of hair loss. That arose when she hit puberty. At first it became apparent in the form of bald patches on her scalp. Then the hair loss became more abundant and she lost her eyelashes and her eyebrows as well.”

Confirming that the stunning Amber Rose has been bald for at least five years now, Rebecca says: “Amber wears very high-quality wigs and when she does, most wouldn’t know that it isn’t her natural hair.

“When modelling and acting, she works around the fact that she does not have eyelashes or eyebrows. This is not a problem for her as there is a lot that can be done with makeup, and as for false eyelashes, they can look great and they’re fashionable as well.”

Expressing her hope that further research into the condition will bring a cure in the near future, Amber says: “For now, we just have to continue to love ourselves and our differences.”

Julia’s story

Naas schoolgirl, Julia Kolter, 10, was aged 3 years and 3 months of age when she got alopecia. First came patches of baldness, then the loss of most of her hair. Upset on the tiny beauty’s behalf, her father Rajmund did his best to help. “I talked with her about it and we agreed that to make it look nicer, I would shave her head,” he says.

Julia Kolter and her family in Naas. Julia first got alopecia when she was 3 years of age
Julia Kolter and her family in Naas. Julia first got alopecia when she was 3 years of age

Julia’s hair grew back again, but a year later she lost it all and her eyelashes and eyebrows with it. Because she had just started school, her parents thought the hair-loss was stress-related; that even though she was getting on great, being separated from her sister was causing upset.

Meeting the cost of medical testing and treatments for Julia has been difficult for the family but they persevere. So severe have Julia’s symptoms been over the years, that she has been wearing wigs. “Every year we buy a new one,” says Rajmund. “She chooses them herself.”

Concerned by the fact that steroids are so often recommended as a therapy for alopecia and by the fact the conventional remedies they tried were “fairly useless”for the treatment of his daughter’s hair loss, Rajmund decided to try leech therapy, which he describes as “a more natural” option. “Because that treatment is expensive, we could only try it once,” he says.

"But we then learned that to have a good chance of success the process must be repeated a few times.”

For all the difficulties, Julia, with the help of her parents is coping really well. A meeting with another youngster with the condition at a support group run by Alopecia Ireland also helped.

It was the catalyst that led to her recently telling her classmates about her condition. “I don’t think any of them had ever asked her about it, but she recently decided to tell them all the same,” says her father.The braveness of this young girl became particularly apparent to her parents on a sunny day at the beach,

One sunny day, Julia was out swimming when she lost her bandana. Concerned that she would be distressed, her parents approached to comfort her.

“It took less than five minutes for her to accept that the waves had carried it away; that it was gone for good,” says Rajmund. “Once that reality sank in, she looked us in the eye and announced: ‘It’s okay. I don’t need it anymore.’”

Connor’s story

It was a bald patch on the side of his head that signalled alopecia for Nenagh schoolboy Connor Quinn, 12. At the time the family had just moved from England to Ireland. He was four years of age.

Celtic supporter Connor Quinn from Co Tipperary with his parents Teresa and Damian.
Celtic supporter Connor Quinn from Co Tipperary with his parents Teresa and Damian.

“I thought the barber had made a bad job of his haircut,” says his mother, Theresa.

“But when the hair didn’t grow back and the patch got bigger we went to see a specialist. It was then that we were told that when Connor becomes ill his antibodies attack his hair follicles instead of whatever virus needed fighting.”

When Connor’s alopecia became “much worse in the last year than ever before”, Theresa took him to see a medical consultant who helped her to weigh up the pros and cons of steroid treatment.

“I was told that because steroid cream can thin the skin, Connor might be more vulnerable should he get a bang on the head while playing sport or whatever.

"For that reason this product could only be used over a four-week period.”

The family opted for the treatment and were delighted they did, as it stimulated hair growth that covered all but one bald patch. Since then, Connor’s hair growth has continued to improve and six weeks ago he had his first haircut “in years”, followed by another a few weeks later.

Connor has attended a support group run by Alopecia Ireland, where doubtless he found comfort in meeting other kids with hair loss. As for the response of his schoolmates to his alopecia, his mother says: “ I don’t think he has had problems at school. But it’s adults rather than other kids who cause the most hardship in my view, especially the insensitive types who do a cruel double-take when they see a youngster with a bald patch.”

She has seen that happen and it upsets her greatly.

“If I could take Connor’s alopecia from him I would. I wish it were me not him who has to deal with it,” she says.

Theresa can’t do that but she must be proud and heartened by her son’s strength of character.

Aware that his condition is not something that either defines or limits him, he has told her on more than one occasion: “I don’t need hair to be the wee boy I am.”

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