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Interview of Dr Alexander for ‘Shape' Magazine – May 2011 article

Since hair loss is very often stress /trauma related, do you think the fact that South Africans live a very stressful life (politics, crime, economy)  make us more prone to hair loss?

•  The answer is yes. Stress and trauma are accelerating factors when it comes to hair loss. They create hormonal fluxes in the the body which result in an increased turnover of hair.

•  The problem for most people is the fact that the hairs that grow back to replace the ones that fall out, are generally thinner than the ones that fell out. This leads to permanent thinning of hair and the stress or trauma makes this happen at a younger age and at a faster rate than it would normally have occurred.

SHAPE's approach is a holistic one – we are looking at all aspects influencing hair health: diet, stress, exercise, proper relaxation, sleep, lifestyle etc 

So here are my questions:

•  It seems that hair loss is a problem that is dramatically increasing amongst women. Certainly I have noticed more and more women with little bald spots, even as young as their late twenties! Do you find the same, and what do you think are the main causes?

Yes, hair loss in women is on the increase, probably due to the increased risk of hormonal fluxes brought about by stress, emotional trauma, post pregnancy and menopause.

The most common underlying cause of hair loss in women is still the inherited condition which we refer to as alopecia androgenetica or female pattern baldness. Half the patients that I treat at my Hair Loss Clinic in Bedfordview are women and most of them have alopecia androgenetica.

Less commonly, I treat the condition of alopecia areata which is the condition that gives you "the little bald spots " that you mention.

•  I notice I am losing hair. When should I worry and where do I start looking for help?

Start to worry when you notice that your pony tail is thinner than it was and that you now see more visible scalp on top of your head under certain lights like downlights.

Also, be concerned if you notice that the shaft thickness of your hair has become thinner. If it is simply a matter of seeing more hair falling out, but there is no change in your pony tail or scalp visibility, then the hair loss condition is most likely temporary and should eventually "burn itself out".

To seek help, ideally one should try to locate a doctor such as myself who specializes in the medical treatment of hair problems.  Failing this, seek help from your dermatologist.

•  Can too frequent washing cause hair loss?

Not in my opinion. I generally recommend a daily wash for most of my patients because the cleaner the scalp, the better the absorption of the topical medicines.

If you are using good quality shampoos, conditioners etc., then washing daily should not be a problem.

•  What exactly happens during a consultation with you? Does one need more than one session?

The most important visit is the first visit which takes about one hour. I am very thorough when it comes to finding the cause of the hair loss problem. A medical history is taken, followed by a clinical examination of the hair and scalp.

If necessary, blood tests may be performed to exclude certain causes. Once a patient has been put onto a course of medical treatment, I see the patient for regular check-up visits to ensure that the hair loss problem stays away.

•  Can you briefly go into the roles respectively of: Diet; Exercise; Lack of sleep; Stress; Wrong products

Diet doesn't influence hair loss nearly as badly as most people believe. Unless you are overdosing on vitamin A or completely deficient in iron, your hair is unlikely to be effected by diet alone. The genetic factor is far more important when it comes to hair loss.

Exercise, lack of sleep and stress can all induce hormonal fluxes in the body which can cause the acceleration of an underlying genetic condition such as alopecia androgenetica or female pattern baldness.

During times of hormonal flux, one will see more hair falling out. These hairs will grow back, but they will grow back thinner and finer, leading to permanent thinning of hair.

Wrong products obviously can be detrimental to the hair at worst, or simply don't work at best. There are a host of unproven cosmetic hair growth products on the market that desperate sufferers of hair loss fork out huge sums for, only to be extremely disappointed at the results.

•  Will sleeping on a satin pillow case stop my hair from breaking and falling out?

The satin pillow cannot stop your hair from falling out, but because it is less likely to "catch the hair", it may be beneficial in terms of preventing breakage of hair.

7. What role does medication play in hair loss? (I've heard that prescription drugs like Roaccutane can cause hair loss)?  On the other hand, are there drugs that will induce hair growth?

Roaccutane, along with other high-dose vitamin A drugs, can cause temporary loss of hair. Virtually all hair loss caused as a side-effect of drug treatment istemporary.

There certainly are drugs that will induce hair growth. In fact, there has been a revolution recently in terms of prescription tablets and topical lotions thatdeliver an excellent regrowth result in a high percentage of men and women. These are the drugs that we use at my Hair Loss Clinic in Bedfordview. They are prescription medicines that have been through clinical trials worldwide where they have been found to work and to be safe to use.

8. Are there irreversible  cases of female hair loss? 

Yes , unfortunately there are some rare conditions which result in irreversible hair loss in women. One such condition is called Pseudopelade of Broq. It is an auto-immune condition in which the follicles are destroyed by rogue auto-antibodies. We can stop the progress of the condition if it is diagnosedearly, but unfortunately most patients that I see with this condition havebeen misdiagnosed for years and the condition has been allowed to progress to a late stage. Trauma, resulting in scar tissue and burns can also result in irreversible hair loss.

Thank you for you help.