Baldness

From Freepedia

Alopecia
ICD-10 code:	L63-L64
ICD-9 code:	704.0

See also baldness treatments.

Image:Yul brynner.jpg Image:PatrickStewart2004-08-03.jpg

Alopecia, commonly known as baldness, is a set of disorders which involves the state of lacking hair where it would normally grow, especially on the head. The most common form of baldness is a progressive hair-thinning condition that occurs in adult humans and other primate species. Nonetheless, the severity and nature of condition can vary greatly; it ranges from male and female pattern alopecia (alopecia androgenetica), to alopecia areata, which involves the loss of some of the hair from the head, alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body. Treatment for alopecia has limited success. The more hair lost, the less successful the treatment will be. The psychological implications of alopecia include stress, anxiety and depression, and can in many cases involve issues relating to identity change, particularly when the eyebrows and eyelashes are also lost. Hair loss is sometimes the result of chemotherapy treatment for cancer sufferers.

Male pattern baldness is thought to occur in varying forms in about 66% of adult males at some point in their lives.[1] It is characterized by hair receding from the lateral sides of the forehead, known as "receding hairline" or "receding brow." An additional bald patch may develop on top (vertex). The trigger for this type of baldness, which is also known as androgenic alopecia, is currently believed to be 5-alpha reductase, an enzyme that converts the hormone testosterone into dihydrotestosterone (DHT), which, in genetically-prone hairs on the scalp, inhibits hair growth. Onset of hair loss sometimes begins as early as end of puberty, and is mostly genetically determined. Male pattern baldness is classified on the Hamilton-Norwood scale I-VIII.

Female pattern baldness, in which the midline parting of the hair appears broadened, is less common. It is believed to result from a decrease in estrogen, a hormone that normally counteracts the balding effect of testosterone, which normally occurs in women's blood. Female pattern baldness is being classified on the Ludwig scale I-III.

There are several other kinds of baldness. Traction alopecia is most commonly found in people with ponytails or cornrows that pull on their hair with excessive force. Wearing a hat shouldn't generally cause this, though it is a good idea to let your scalp breathe for 7 hours a day.[2] Traumas such as chemotherapy, childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium. Some mycotic infections can cause massive hair loss. Alopecia areata is an autoimmune disorder also known as "spot baldness" that can result in hair loss ranging from just one location (Alopecia areata monolocularis) to every hair on the entire body (Alopecia areata universalis).

1 Evolutionary theories of baldness
2 Approaches to baldness
- 2.1 Psychological implications
- 2.2 Preventing and reversing hair loss
3 Concealing hair loss
4 Embracing baldness
5 Common baldness myths
6 Trivia
7 Reference
8 See also
9 External links
- 9.1 Consumer information pages
- 9.2 Hair loss specialist directories

Evolutionary theories of baldness

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There is no consensus regarding the details of the evolution of baldness. Most theories regard it as resulting from sexual selection. A number of other primate species also experience hair loss following puberty, and some primate species clearly use an enlarged forehead, created both anatomically and through strategies such as frontal balding, to convey increased status and maturity.

One theory, advanced by Muscarella and Cunningham, suggests baldness evolved in males through sexual selection as an enhanced signal of aging and social maturity, whereby aggression and risk-taking decrease and nurturing behaviours increase.(1) This may have conveyed a male with enhanced social status but reduced physical threat, which could enhance ability to secure reproductive partners and raise offspring to adulthood.

In a study by Muscarella & Cunnhingham, males and females viewed 6 male models with different levels of facial hair (beard and moustache or clean) and cranial hair (full head of hair, receding and bald). Participants rated each combination on 32 adjectives related to social perceptions. Males with facial hair and those with bald or receding hair were rated as being older than those who were clean-shaven or had a full head of hair. Beards and a full head of hair were seen as being more aggressive and less socially mature, and baldness was associated with more social maturity.

Approaches to baldness

Psychological implications

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The psychological implications for individuals experiencing hair loss vary widely. There can be a general societal anxiety surrounding the process of hair loss, but some individuals view it as nature taking its course.

Some balding men may feel proud of their baldness, feeling a kindred relationship with famous charismatic bald film actors such as Yul Brynner, Telly Savalas, Ben Kingsley and Patrick Stewart, who have been considered masculine and handsome in part because of their most obvious distinguishing feature.

Preventing and reversing hair loss

For more information, see the main article on Baldness treatments

It is easier to prevent the aging and falling out of healthy hairs than to regrow hair in follicles that are already dormant. However, there are products that have good success rates with maintenance and regrowth, including the scientifically proven Propecia, Rogaine. The prospective treatment of hair multiplication/hair cloning, which extracts self-replenishing follicle stem cells, multiplies them many times over in the lab, and microinjects them into the scalp, has been shown to work in mice, and is currently under development, expected by some scientists to be available to the public in 2009-2015. Subsequent versions of the treatment are expected by some scientists to be able to cause these follicle stem cells to simply signal the surrounding hair follicles to rejuvenate.*

Interestingly, placebo treatments in studies often have reasonable success rates, though not as high as the products being tested, and even similar side-effects as the products. For example, in Finasteride (propecia) studies, the percent of patients with any drug-related sexual adverse experience was 3.8% compared with 2.0% in the placebo group.[3] Proponents of alternative therapies believe that the majority of cases of hair loss that progress despite treatments do so because the people believe no such cure can occur. In this view, this belief, which is prevailing in the modern civilised world and continuously reinforced by medical science, is the main obstacle for effectively finding and applying a cure.

There are many misconceptions about what can help prevent hairloss, one of these being that frequent ejaculation may have an influence on MPB. There is absolutely no proof of this; another false reason is "blood-flow" theory which led men to stand on their heads in the 1980's, and can be found in the advertising for many of the fake hair-loss treatments for sale on the internet.

Concealing hair loss

One method of hiding hair loss is the comb over, which involves restyling the remaining hair to cover the balding area. It is usually a temporary solution, useful only while the area of hair loss is small. As the hair loss increases, a comb over becomes less effective.

Another method is to wear a hairpiece - a wig or toupee. The wig is a layer of artificial or natural hair made to resemble a typical hair style. In most cases the hair is artificial. Wigs vary widely in quality and cost. The best wigs - those that look like real hair - cost up to tens of thousands of dollars. Organizations such as Locks of Love and Wigs for Kids collect individuals' donations of their own natural hair to be made into wigs for young cancer patients who have lost their hair due to chemotherapy or other cancer treatment.

Embracing baldness

Of course, instead of concealing hair loss, one may embrace it. A shaved head will grow stubble in the same manner and at the same rate as a shaved face. Many celebrities and athletes shave their heads. The St. Baldrick's Foundation spreads the message of baldness by shaving the heads of adults to raise money for curing childhood cancer, which often causes children to lose their hair. See Head shaving.

Common baldness myths

There are many myths regarding the possible causes of baldness and its relationship with one's virility, intelligence, ethnicity, job, social class, wealth etc. Most of them can be dismissed by the existence of many counterexamples or by a lack of sufficient scientific research.

"Intellectual activity or psychological problems can cause baldness."

This myth probably was inspired by the fact that the human brain is located inside the skull, very close and just below where hair grows, and so it was thought that the use and abuse as well as mental diseases could have negative effect on hair growth and number.

This is sometimes used as a stereotype in films, where the more intellectual or rather frustrated characters are most usually portrayed as bald and generally unattractive, as opposed to the main characters which are usually portrayed as attractive, fit, mentally stable and generally with no apparent hair problems.

This same myth normally extends to considering people having intellectual jobs more prone to baldness problems compared to manual laborers, sometimes further extending the myth to male college or university students when compared to workers of the same age. The myth is suspect because counterexamples can be found in any case.

"Baldness can be caused by emotional stress, sexual frustration etc."

While emotional stress can have a part in causing baldness, again it is easy to find counterexamples like non-frustrated and non-stressed people with hair loss problems as well as stressed and/or frustrated people with no hair loss problem at all.

This myth also suggests that a vicious circle between hair loss and emotional stress/sexual frustration can take place, although only one part of it can be scientifically explained (hair loss causing low esteem and then frustration, but not vice versa).

"Bald men are more "virile" or sexually active than others."

This myth probably stems from the fact that some forms of baldness in some predisposed individuals are caused by androgens, and removal of androgens (by castration) prevents baldness or stops it from progressing further. Yet counterexamples can be found, like men with perfect hairlines and similar levels of androgens or men with sensitivity to androgens causing hair loss but which are not very sexually active.

"Shaving hair makes it grow back stronger"

Proposed as a popular remedy against baldness, it's very probably just an illusion similar to the one perceived after shaving one's beard or mustache. Shaving one's head doesn't increase the number of healthy hair present on the scalp, and, when the remaining hair has grown a few millimeters, no enhancement in thickness or overall quality can be observed.

Similar observations can be done regarding the people living in most Western countries when compared to people living in "underdeveloped" or Third World countries, but lacking any official anthropological, medical and scientific research to back them up, such observations degenerate into a racial/social stereotype.

A very similar stereotype exists even between the various European ethnic groups, when comparing people of Southern European descent with those of Northern European, Germanic or Slavic origins, with the stereotype summarily describing the "Southern Europeans" as darker-skinned, with more body hair, with the women more prone to cellulite problems and the men more prone to baldness, a stereotype probably developed under times of war or diplomatic tensions between European countries.

"Baldness is inherited from the mother's side of the family"

One of the identified genes involved in male pattern baldness is located on the X chromosome, which is inherited only from the maternal side, but this one gene does not explain all the cases of male pattern baldness. Baldness in a child cannot be predicted only from the mother's lineage. There are probably other unidentified autosomal genes that are also involved. In other words, genetics does play a role in male pattern baldness, but the genes can come from either parent, not just the mother.

Trivia

John D. Rockefeller had an extreme case of alopecia that caused him to lose all of the hair on his face, including his eyebrows and eyelashes. Another famous person who suffers from similarly severe alopecia is Italian football referee Pierluigi Collina. Actor Patrick Stewart lost most of his hair to alopecia by age 19.
Eunuchs do not go bald. [4]
Baldness is not only a human trait. Some other primates, such as Chimpanzees, stump-tailed macaques, and South American nakari show progressive thinning of the hair on the scalp after adolescence. [5]

Reference

Muscarella, F., & Cunningham, M.R. (1996). The evolutionary significance and social perception of male pattern baldness and facial hair. "Ethology and Sociobiology" journal (volume 17: 99-117 (1996).
Rossi S (Ed.) (2004). Australian Medicines Handbook 2004. Adelaide: Australian Medicines Handbook. ISBN 0-9578521-4-2