Apart from age, lack of proper nutrients, stress, pollution or genetic history can give you hair trouble. A look at problems, and possible solutions

As we age, it's perfectly normal for our hair to lose some of its glory. Few people over 50 have the same volume of hair as in their 20s, 30s or 40s. The problem of scanty hair usually begins after 40, and aggravates with time. Though other problems such as greying, hair fall and baldness cannot be ruled out in younger people, they are more common in the elderly.

HAIR ANATOMY

Composed of protein called keratin - the same protein in nails and skin - a strand of hair consists of three layers. The outer layer is called the cuticle and protects the inner layers, the cortex and medulla. While the bulk and strength of hair comes from the cortex, medulla is almost always present in coarse hair and absent from fine hair.

Each strand of hair sits in a skin cavity called the follicle. While the hair root is embedded in the follicle, what you see is the hair shaft. One or more sebaceous glands are associated with each hair follicle and secrete sebum (oil), which protects the hair. The base of the follicle is called dermal papilla. The bulb-shaped papilla is fed by tiny blood vessels. Highly sensitive to hormones and chemicals, the papilla decides whether the hair grows faster, slower, or not at all.

Over 1 lakh strands of hair are found on our scalp. About 90 per cent of a person's hair is in a continuous growth phase (anagen), which lasts between two and six years. And 10 per cent of hair is in a resting phase (telogen), which lasts two to three months - at the end of the resting phase, the hair falls out. Each new strand of hair grows for two to seven years and can reach to 1 m in length, growing approximately 1 cm per month. There is a short intervening stage (catagen), which lasts approximately 10 days. It is normal to shed 50 to 100 hair strands every day.

GREYING, WITH AGE OR OTHERWISE

Greying occurs due to damage to melanocytes (melanin producing cells found in the papilla) and development of small air pockets in the hair shaft. Apart from age, pollution and stress can also contribute to this damage.

Hair colour or dye is one way to deal with greying. If you are colouring your hair, it is better to use natural dyes like henna to prevent skin allergies. From synthetic dyes, you can choose between temporary dyes (rinsed off during shampooing), semi-permanent dyes (last for a few rinses) and permanent dyes (stay on for a long time). Dyes have active ingredient, paraphenylenediamine hydrochloride (PPDA). This may cause allergy, redness and swelling of the scalp and face. Test the product before use on a small area behind the ear to rule out any allergic reaction.

DANDRUFF

Dandruff - dry, flaky scalp - can occur at any age. While some experts say it tends to decrease as you grow older, external factors such as change of season, stress, unbalanced diet and hormonal problems can aggravate the problem at any age. Some dermatologists link oily scalp and some diseases (Parkinson's and other neurological disorders) to dandruff, while others are convinced that a fungus called pityrosporum ovale is responsible for dry and itchy scalp.

Dandruff is either dry (pityriasis sicca) or oily (pityriasis steatoides). Pityriasis sicca is grey-white and flakes off when the scalp is scratched, while pityriasis steatoides sticks to the nails on scratching. Dandruff is generally seen as white scales on the scalp. If the scales are yellow and greasier and your skin is red and itchy, you may have seborrhoeic dermatitis, a severe form of dandruff.

BANISHING THE ITCH

It is advisable to wash your hair twice a week. Using an anti-dandruff shampoo helps but remember to leave the shampoo in your hair for several minutes before rinsing it off.

BALD TRUTHS

Hair loss, also called alopecia, is of three types. Gradual thinning with age is called involutional alopecia while genetic hair fall is called androgenic alopecia. Men suffering from this can suffer hair fall as early as in their 20s, while women generally don't experience hair fall until 40s - male pattern baldness and female pattern baldness respectively. A condition called alopecia areata causes total baldness in children and young adults, while alopecia universalis causes loss of body hair. Although a person's level of androgen - male hormones produced by both men and women - is believed to contribute to hair fall, hair loss itself has nothing to do with virility. Genes, however, influence predisposition to baldness.

Male pattern baldness affects 70 per cent of men above 40 years, while female pattern baldness affects 50 per cent of women. Roughly half of all women experience some hair loss during their menopausal years and two-thirds of post-menopausal women deal with thinning hair or bald spots.

CONSULTATION & TESTS

A dermatologist will first perform the 'pull test' - gently pulling your hair. This is repeated six to eight times. If no hair comes out and if the hair on the scalp does not appear scanty on inspection, it means hair loss is minimal. The 'pulled' hair undergoes a procedure called a trichogram, a standardised light-microscopic investigation of the roots. This method enables the specialist to establish the ratio of growing (anagen) and resting (telogen) hair, as well as hair at the regression phase (catagen). In addition, toxically damaged hair (dystrophic hair) is identified. This disruption of the growth phase occurs due to an infection or from drugs.

Normally, a total of two to five strands of telogen hair will be obtained in the 'pull test', depending on when the hair was last washed - more telogen hair will be obtained if you haven't washed your hair for two to three days. In extreme cases, your doctor may advise you to undergo a biopsy, which involves the removal of a small piece of skin from the scalp to evaluate the mechanism of hair loss inside the hair follicle. Sometimes, a blood test may be needed to rule out anaemia, thyroid, and kidney, liver or other disorders.

TREATMENT OPTIONS

There are various ways to treat baldness. Common baldness can be checked with prescription medication like Finasteride (tablets for a month cost Rs 120) and over-the-counter Minoxidil solution, which costs Rs 150 (2 per cent) and Rs 300-Rs 375 (5 per cent). While Finasteride is taken once a day to treat male pattern baldness, Minoxidil is a liquid that has to be rubbed into the scalp twice a day. These medications almost certainly prevent further progression of baldness, and re-growth is seen in 30 to 60 per cent of cases. The catch: you have to continue the medication lifelong as the results are reversible on stoppage.

Follicular graft surgery is another option for those with stabilised partial baldness. During transplantation, a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several strands of hair, from the back or side of your scalp. The plugs are then implanted in the bald sections. Several transplant sessions may be needed as hereditary hair loss progresses with time. This procedure is expensive and can cost up to Rs 75,000 or more.

Scalp reduction involves decreasing the area of bald skin on your head - your scalp is actually flexible for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp. In a technique called 'flap', specialists can fold hair-bearing scalp over the bald area. Scalp reduction can be combined with a hair transplant to fashion a natural-looking hairline.

Surgical procedures for baldness are expensive and can be painful. Possible risks include infection and scarring. If you are still interested, consider only board-certified dermatologists, plastic surgeons or cosmetic surgeons, and check local and state medical boards for a record of patient complaints before choosing a doctor. Review all treatment options, including non-surgical ones, before opting for surgery. Alternatively, you can opt for wigs, hair weaving or bonding. Its cost: Rs 3,000 to Rs 8,000.

An adequate amount of protein in your diet is essential to maintain normal hair production. Chicken, fish, milk, cheese, meat, soy, grains and nuts are foods rich in protein. Eat healthy, avoid stress and seek proper medical advice to prevent hair loss.

With inputs by Dr Ram Malkani, Consultant Dermatologist, Jaslok Hospital and Research Centre, Mumbai; Associate Dermatologist Dr Vandana Punjabi; and Dr Sushil Tahiliani, MD, Mumbai

Featured in Harmony Magazine
October 2006