tag:theconversation.com,2011:/global/topics/hair-loss-14378/articlesHair loss – The Conversation2024-03-18T17:12:01Ztag:theconversation.com,2011:article/2220942024-03-18T17:12:01Z2024-03-18T17:12:01ZThe hidden racist history of hair loss<figure><img src="https://images.theconversation.com/files/581618/original/file-20240313-24-vfq5r9.jpg?ixlib=rb-1.1.0&rect=0%2C28%2C4810%2C3168&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/image-bald-man-looking-half-head-1632693475">Chris Tefme/Shutterstock</a></span></figcaption></figure><p>Hair loss is common in men and women, particularly with age – for example, androgenetic alopecia (or pattern baldness) affects <a href="https://doi.org/10.1007/s40265-016-0629-5">80% of men and 40% of women</a>. For the most part, it can be physically inconsequential. </p>
<p>Yet, modern society has a distaste for hair loss. Look at how news stories have speculated about whether ten-year-old Prince George and his younger brother, Louis, will inherit their father’s <a href="https://london-post.co.uk/princes-louis-and-george-will-probably-go-bald-like-their-dad-says-hair-expert/#:%7E:text=expert%20%2D%20London%20Post-,Princes%20Louis%20and%20George%20will%20probably%20go,their%20Dad%2C%20says%20hair%20expert&text=Royal%20Princes%20George%20and%20Louis,hair%2C%20an%20expert%20has%20claimed.">“baldness genes”</a>. </p>
<p>The market in hair restoration procedures is projected to be worth <a href="https://www.researchandmarkets.com/reports/4844574/hair-restoration-services-market-by-service-type">£10 billion</a> by 2026. You can even purchase wigs for babies that proclaim to make children up to three years old <a href="https://www.amazon.com/colorvay-Hairband-headband-Children-Accessories/dp/B0B7L5VRLF/ref=sr_1_2?dib=eyJ2IjoiMSJ9.2NMdjCSLMFiYV1bKK8VQ7UPVtimQ6dBnry119SE6YhVlke3oxZdNd5-rjnptPXm23JOsa_ih9-1CIBgktuzPM6BX7GNp6iY6o8U6n-rla4l1FJKGQvCRLBIqTZH6wHwNpwmqRkl5PLdftMjZ6_W1gdLWb9FFyDcjSwf5AbY48jQlIO-cYtOsMCX61pUyEUTHe8xB0X_6yo4PDi17omp29aeBGq44dfl5cxhZS2w4-mbDLFf9-fyBCJ4-wx_2UaHPBJRGnZdA2VIA9YBEFG2uwcMvHNAEBmTK9JeVwH9GQWk.3I-M2F8KvztAuSAV6b2O49GNG_m6yl6uBI8RTQGRY9Y&dib_tag=se&keywords=baby+wig&qid=1708942972&sr=8-2">“more attractive”</a>. </p>
<p>It wasn’t always this way. In many cultures and periods of history, baldness has been revered, from ancient Egypt to the 18th century people of Issini (modern-day Ghana). Shaved and bald heads could represent purity, a rejection of superficiality, and be ritualised through daily shaving. </p>
<figure class="align-center ">
<img alt="Fresco painting of a balding Jesus with a halo." src="https://images.theconversation.com/files/581644/original/file-20240313-22-eoaj97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581644/original/file-20240313-22-eoaj97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=319&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581644/original/file-20240313-22-eoaj97.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=319&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581644/original/file-20240313-22-eoaj97.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=319&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581644/original/file-20240313-22-eoaj97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=401&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581644/original/file-20240313-22-eoaj97.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=401&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581644/original/file-20240313-22-eoaj97.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=401&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The fresco of a young, bald-headed Jesus in Cave Church of Sts. Peter and Paul, Serbia.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Celavi_isus.jpg">непознати/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Bald heads have also been positively associated with divinity. Medieval and Christian art includes <a href="https://commons.wikimedia.org/wiki/File:Celavi_isus.jpg">balding depictions of Jesus</a> and <a href="https://commons.wikimedia.org/wiki/File:Jean_Fouquet_-_Virgin_and_Child_Surrounded_by_Angels_-_WGA8039.jpg">Madonna</a>. Today, Buddhist monks, nuns and <a href="https://linkinghub.elsevier.com/retrieve/pii/S0738081X11002082">other political and religious groups</a> routinely shave their heads. </p>
<p>In the west in the 19th century, baldness also came to be celebrated. But rather than for religious reasons, it was for pseudoscientific ones that were tied in with harmful ideas about intelligence and race. It set a precedent for a Eurocentric bias in hair-loss research that continues to this day.</p>
<h2>Eugenicists and hair loss</h2>
<p>Ten years after Charles Darwin published his famous evolutionary thesis “On The Origin of Species” in 1859, his cousin Francis Galton extended it to suggest that some groups of humans were <a href="https://galton.org/books/hereditary-genius/text/pdf/galton-1869-genius-v5.pdf">more evolved than others</a>. Galton and others used any observable differences in humans, including variation in skin colour and hair, as “proof” of distinct human races, some of which were supposedly superior to others. </p>
<p>Black people in particular were pseudoscientifically classified as being differently haired and evolutionarily inferior to white people. Victorian <a href="http://archive.org/de.tails/9604111.nlm.nih.gov">eugenicists</a> regarded black people’s hair as animal fur, arguing they had been the same “blackskinned, woolly-headed animal[s] for the last 2,000 years”.</p>
<p>Related to eugenics was the pseudoscience of phrenology, which attempted to predict traits like personality and morality from physical characteristics. These included a person’s head shape, complexion and head hair amount. Phrenology, which has been thoroughly discredited, was used to uphold <a href="https://www.medicalnewstoday.com/articles/phrenology-the-pseudoscience-of-skull-shapes">scientific racism</a>, the idea that race is biological and that some races are superior to others.</p>
<p>The Victorian writer Henry Frith wrote in his 1891 book, <a href="https://www.google.co.uk/books/edition/How_to_Read_Character_in_Features_Forms/bHkAAAAAMAAJ?hl=en&gbpv=1&dq=physiognomy+and+baldness&pg=PA1&printsec=frontcover">How to Read Character in Features, Forms and Faces</a>: “The hairless men are the intellectual ones: their mental and bodily strength are both considerable … brain dominates matter in the bald”.</p>
<p>Such ideas were combined with the false belief in white men’s superiority and intelligence compared to other “hairier” races. Frith wrote: “White and, comparatively, hairless races hav[e] dominion in the world [over the] strong, wild, hairy races.” </p>
<p>American medical students <a href="https://www.abebooks.co.uk/9781582343945/Bald-Hairless-Heroes-Comic-Combovers-1582343942/plp">were taught</a> “that slaves, Indians, women and donkeys never go bald because of their small and undeveloped brains”. In 1902, medical doctor David Walsh <a href="https://archive.org/details/willan-72129">wrote</a> a book on hair diseases in which he stated: “Baldness is practically unknown among savages.”</p>
<p>Shockingly, such eugenicist logic remained unchallenged until the late 20th century. In 1966, the dermatologist <a href="https://cdn.bad.org.uk/uploads/2022/01/29200050/Dr-I-Martin-Scott.pdf">Ian Martin-Scott</a> concluded: “In coloured races baldness is a rarity and virtually unknown in many semi-civilised communities”.</p>
<figure class="align-center ">
<img alt="Illustration of Franz Joseph Gall, the founder of phrenology, measuring the head of a bald, elegantly dressed old lady; her pet poodle is entwined in her wig on a chair." src="https://images.theconversation.com/files/581629/original/file-20240313-28-xbar5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581629/original/file-20240313-28-xbar5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=533&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581629/original/file-20240313-28-xbar5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=533&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581629/original/file-20240313-28-xbar5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=533&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581629/original/file-20240313-28-xbar5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=670&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581629/original/file-20240313-28-xbar5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=670&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581629/original/file-20240313-28-xbar5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=670&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Phrenologists thought your skull shape determined your personality.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/vjrra36z/images?id=egmjuj96">Wellcome Collection</a></span>
</figcaption>
</figure>
<h2>Diversity in hair loss matters</h2>
<p>Today, such false beliefs are thankfully rare in science. However, as in many areas of medical research, <a href="https://doi.org/10.1177/12034754221099667">studies and clinical trials into hair loss</a> predominantly focus on white people, ignoring or excluding other racial groups.</p>
<p>Social psychologist Hannah Frith (no relation) and I <a href="http://dx.doi.org/10.1080/13548506.2023.2242049">recently reviewed psychology studies</a> that collectively researched more than 10,000 balding men. We found almost all of the research participants were European or Asian, with just 1% from South America or Africa. </p>
<p>Meanwhile, dermatologists and other hair-loss practitioners continue to routinely study medical textbooks that only include images of <a href="http://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.13028">white scalps and straight-textured hair</a>. </p>
<p>This is a problem because, as recent (and limited) research shows, hair loss is common in all racial and ethnic groups. A 2022 <a href="https://doi.org/10.1016/j.jaad.2022.03.016">study</a> reviewed data from almost 200,000 UK men (aged 38-73). The researchers found 68% of white men reported hair loss compared to 64% of South Asian men and 59% of black men. (The relatively small differences are partially explained by the fact the white men in the study were older).</p>
<p>There are also forms of hair loss that are known to be more common in people of colour. For example, Asian women are more likely to have <a href="https://www.niams.nih.gov/health-topics/alopecia-areata">alopecia areata</a>, an autoimmune condition that causes hair loss. </p>
<p>Black people are more likely to develop <a href="https://knowyourskin.britishskinfoundation.org.uk/condition/traction-alopecia/">traction alopecia</a>, a hair loss type related to constant pulling of the hair follicles including through tight hairstyles. This condition highlights the impact of a racist society on hair. </p>
<p>Specifically, black people may feel compelled to conceal their afro-textured hair (stereotyped as uncivilised) through weaves, braids and chemical relaxers. All of these practices can be physically damaging, including to the hair follicles. </p>
<p>Alopecia resources that are racially inclusive (by the <a href="https://www.nottingham.ac.uk/research/groups/cebd/resources/skin-of-colour/hair-scalp-disorders.aspx">Centre of Evidenced-based Dermatology</a>) help dermatologists make more realistic recommendations that situate people’s hair concerns within their societal and cultural contexts.</p>
<p>A better understanding of the racism of hair loss research is important. It reminds us that neither the texture, colour nor amount of hair a person has conveys anything meaningful about them, evolutionarily or otherwise.</p><img src="https://counter.theconversation.com/content/222094/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glen Jankowski does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Victorian eugenicists perpetuated the idea that only white men went bald because of their intelligence.Glen Jankowski, Senior Lecturer in the School of Social Sciences, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2237362024-03-14T22:29:22Z2024-03-14T22:29:22ZWhat is minoxidil, the anti-balding hair growth treatment? Here’s what the science says<figure><img src="https://images.theconversation.com/files/579728/original/file-20240304-24-fy5cnb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4256%2C2822&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hiker-man-backpack-walking-looking-mountain-2024434988">Lia Kos/Shutterstock</a></span></figcaption></figure><p>Hair loss (also known as alopecia) often affects the scalp but can occur anywhere on the body. It’s very common and usually nothing to worry about; about <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15525840">half of Australian men</a> show signs of visible baldness at age 50 and <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15525840">over a quarter of Australian women</a> report hair thinning by the same age. It’s often genetic.</p>
<p>But if you’ve noticed hair loss and are worried by it, see a GP or dermatologist for a diagnosis before trying any treatments. Products claiming to reverse hair loss are everywhere, but few have been scientifically tested for how well they work.</p>
<p>One group of products that have actually been scientifically tested, however, are known as topical minoxidil products. These include products such as Regaine®.</p>
<p>So, do they work? Here’s what the research evidence says, what you can realistically expect and what you need to know if you’re considering this treatment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A happy and handsome man with receding hairline relaxes in a park while listening to headphones." src="https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579711/original/file-20240304-24-7l5aya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hair loss is very common, and often has a genetic cause.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-man-red-basecap-sunglasses-white-2414090295">TunedIn by Westend61/Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-art-of-balding-a-brief-history-of-hairless-men-199531">The art of balding: a brief history of hairless men</a>
</strong>
</em>
</p>
<hr>
<h2>What is minoxidil – and does it work?</h2>
<p>Topical minoxidil usually comes as a kind of foam or serum you apply to your scalp.</p>
<p>It’s been approved by the <a href="https://www.tga.gov.au/">Therapeutic Goods Administration</a>, Australia’s regulatory authority for therapeutic goods, for the treatment of hereditary hair loss in males and females. Minoxidil is also available in tablet form, but this isn’t currently approved for hair loss (more on that later).</p>
<p>So, is topical minoxidil effective? In short – yes, but the results vary widely from person to person, and it needs to be used consistently over several months to see results.</p>
<p>Scientists don’t know exactly how minoxidil works. It may affect the different phases of the hair life cycle, thereby encouraging growth. It also <a href="https://www.tandfonline.com/doi/full/10.1080/09546634.2021.1945527?casa_token=KhIM_u0u8nwAAAAA:5njp_XE5cHhip454ycvU1p9p_t0VVzpjRu0ozDZ9YqNb04fmhmngWzYeiowZcG5UugLQkTVIzCcj7A">opens up blood vessels</a> near hair follicles. </p>
<p>This increases blood flow, which in turn delivers more oxygen and nutrients to the hair. </p>
<p>While minoxidil is unlikely to restore a full head of thick, lush, hair, it can slow down hair loss and can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007628.pub4/full?highlightAbstract=minoxidil">stimulate regrowth</a>. </p>
<p>It is the over-the-counter option with the most evidence. Two strengths are available: 5% and 2%.</p>
<p>An analysis of randomised controlled trials found minoxidil applied to the scalp twice a day increased the number of hairs per square centimetre by <a href="https://pubmed.ncbi.nlm.nih.gov/28396101/">eight to 15 hairs</a>, with the higher strength treatment having a slightly greater effect. </p>
<h2>Can I use it for non-genetic balding?</h2>
<p>There are many causes of hair loss. The main cause in both males and females is a hereditary condition called androgenic alopecia.</p>
<p>Although topical minoxidil is only approved for use in Australia for androgenic alopecia, there is some evidence it can also help in other conditions that cause hair loss. </p>
<p>For example, it may hasten hair regrowth in patients who have lost hair due to <a href="https://www.jaad.org/article/S0190-9622(96)90500-9/abstract">chemotherapy</a>. </p>
<p>Unfortunately, minoxidil is not effective when the hair follicle is gone, like after a burn injury.</p>
<p>Although small studies have found promising results using minoxidil to promote hair growth on the face (for <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.13312">beard</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/24471459/">eyebrow</a> enhancement), topical minoxidil products are not currently approved for this use. More research is required.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man who is balding is admiring a sunset." src="https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579723/original/file-20240304-30-fan36r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The main cause of hair loss is a hereditary condition called androgenic alopecia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/silhouette-bald-vacationer-sunglasses-backpack-on-2333317813">tativophotos/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What else do I need to know?</h2>
<p>Minoxidil won’t work well for everyone. Early in treatment you might notice a temporary increase in <a href="https://pubmed.ncbi.nlm.nih.gov/22409453/">hair shedding</a>, as it alters the hair cycle to make way for new growth. Minoxidil needs to be trialled for three to six months to determine if it’s effective.</p>
<p>And as it doesn’t cure hair loss, you must <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.14624?casa_token=P-zW7kDNRs8AAAAA%3AaUgUzxU7lbwBpg1BYPajOfXFhpb_mU5g_ounZ6GtjsLLkHO_AdVQ2Kf-8zZkW80ykBj3N_sOsyn392uc">continue</a> to use it each day to maintain the effect. If you stop, you will start losing the new hair growth <a href="https://www.nps.org.au/assets/medicines/1f8127a5-2a98-4013-a7c3-a53300feb0e5-reduced.pdf">within three to four months</a>.</p>
<p>Minoxidil products may not be suitable for everyone. If you have any medical conditions or take any medications, you should speak with your doctor or pharmacist before using minoxidil products. </p>
<p>It has not been tested for safety in <a href="https://www.nps.org.au/assets/medicines/1f8127a5-2a98-4013-a7c3-a53300feb0e5-reduced.pdf">people under 18, over 65, or those who are pregnant</a>.</p>
<p>You can read the <a href="https://www.nps.org.au/medicine-finder/regaine-for-men-regular-strength-application">consumer medicines information sheet</a> for more information about using over-the-counter minoxidil products. </p>
<p>Many people do not like to use minoxidil solution or foams long-term because they need to be applied everyday day, which can be inconvenient. Or they may notice side effects, such as scalp irritation and changes to hair texture. </p>
<p>Some people <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.14624?casa_token=P-zW7kDNRs8AAAAA%3AaUgUzxU7lbwBpg1BYPajOfXFhpb_mU5g_ounZ6GtjsLLkHO_AdVQ2Kf-8zZkW80ykBj3N_sOsyn392uc">tolerate the foam products better</a> than the solution, as the solution contains more of a compound called propylene glycol (which can irritate the skin).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman noticed hair in her hairbrush." src="https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579725/original/file-20240304-20-fan36r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hair loss affects women, too.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-comb-brush-long-loss-hair-684900076">zentradyi3ell/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What about the oral tablet form of minoxidil?</h2>
<p>Minoxidil is also available on prescription as an oral tablet. While traditionally used for high blood pressure, it has also been used as a treatment for hair loss.</p>
<p>In 2020, a <a href="https://www.jaad.org/article/S0190-9622(20)32109-5/abstract">systematic review</a> identified 17 studies involving 634 patients using oral minoxidil for various hair loss conditions. </p>
<p>The authors found oral minoxidil was effective and generally well tolerated in healthy people who were having trouble using the topical products.</p>
<p>The review noted oral minoxidil may increase hair growth over the whole body and may cause heart-related side effects in some patients. More research is required.</p>
<p>In Australia, oral minoxidil is available under the trade name <a href="https://www.nps.org.au/assets/medicines/df29e16f-6464-4652-ba1f-a53300fed275.pdf">Loniten</a>®. However, it is currently only approved for use in high blood pressure. </p>
<p>When people seek a prescription treatment for a non-approved purpose, this is called “off-label” prescribing. Off-label prescribing of oral minoxidil, potentially for use in alopecia, may have contributed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10170338/">shortages</a> of Loniten® tablets in recent years. This can reduce availability of this medicine for people who need it for high blood pressure.</p>
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Read more:
<a href="https://theconversation.com/big-hair-bald-how-much-difference-your-hair-really-makes-to-keep-you-cool-or-warm-201380">Big hair? Bald? How much difference your hair really makes to keep you cool or warm</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/223736/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacinta Johnson is Senior Pharmacist for Research within SA Pharmacy and Board Director for the Society of Hospital Pharmacists of Australia. In the last five years, she has received research funding or consultancy funds (for development and delivery of educational materials) from SA Health, the Medical Research Future Fund, the Hospital Research Foundation – Parkinson's, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Society of Hospital Pharmacists of Australia, Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Viatris Pty Ltd. and Reckitt Benckiser (Australia) Pty Ltd. No funding has been received relating to minoxidil.
</span></em></p><p class="fine-print"><em><span>Kirsten Staff does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s what you can realistically expect and what you need to know if you’re considering this treatment.Jacinta L. Johnson, Senior Lecturer in Pharmacy Practice, University of South AustraliaKirsten Staff, Senior Lecturer in Pharmacy, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2221892024-03-01T17:24:55Z2024-03-01T17:24:55ZAlopecia in art history: the many ways women’s hair loss has been interpreted<figure><img src="https://images.theconversation.com/files/575695/original/file-20240214-28-28jr2t.jpg?ixlib=rb-1.1.0&rect=10%2C20%2C3344%2C1866&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Met Museum/National Portrait Gallery</span></span></figcaption></figure><p>At least 40% of women experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684510/">hair loss or alopecia over their lifetimes</a>. This could be alopecia areata (patchy hair loss), traction alopecia (strained hair loss) or another form. The different ways that women’s hair loss has been depicted across art history demonstrates the many different ways it has been interpreted over the years. </p>
<p>In 16th and 17th century Britain, for example, women’s alopecia was sometimes interpreted as <a href="https://doi.org/10.1086/SCJ27867791">retribution for sins</a>, including adultery. </p>
<p>Some historical art, however, depicts a more neutral, or even positive, attitude towards women’s alopecia. In religious or mythical art, it was sometimes idealised as divine. </p>
<figure class="align-center ">
<img alt="Two paintings of Madonna and baby Jesus, in which Madonna has a receding hairline" src="https://images.theconversation.com/files/574083/original/file-20240207-33-ro1k4j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574083/original/file-20240207-33-ro1k4j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574083/original/file-20240207-33-ro1k4j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574083/original/file-20240207-33-ro1k4j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574083/original/file-20240207-33-ro1k4j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=518&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574083/original/file-20240207-33-ro1k4j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=518&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574083/original/file-20240207-33-ro1k4j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=518&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Left: Madonna and Child by Carlo Crivelli (circa 1490). Right: Madonna and Child with St. Mary Magdelene and St. Jerome by Cosmè Tura (circa 1455).</span>
<span class="attribution"><a class="source" href="https://www.nga.gov/collection/art-object-page.407.html">National Gallery of Art/Musée Fesch</a></span>
</figcaption>
</figure>
<p>Madonna and Child, painted in the 15th century by Italian Rennaisance artist Carlo Crivelli, shows Jesus and Mary embracing in a gold, stylised setting. The pair sit behind a religious altar surrounded by ripe fruit and adorned with halos. Madonna has a high forehead and her blonde hair recedes, particularly on her right temple. </p>
<p>This association between alopecia and divinity is echoed in a work by another Renaissance Italian artist, Cosmè Tura. His <a href="https://commons.wikimedia.org/wiki/File:Cosm%C3%A8_Tura_-_The_Madonna_of_the_Zodiac_-_WGA23139.jpg">Madonna and Mary Magdalene</a> (circa 1490) depicts both mother and child with prominent foreheads. </p>
<figure class="align-center ">
<img alt="Prudence depicted in stone as two headed, with balding woman one side." src="https://images.theconversation.com/files/571879/original/file-20240129-29-981pd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571879/original/file-20240129-29-981pd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571879/original/file-20240129-29-981pd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571879/original/file-20240129-29-981pd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571879/original/file-20240129-29-981pd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571879/original/file-20240129-29-981pd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571879/original/file-20240129-29-981pd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Prudence by Andrea della Robbia (circa 1475).</span>
<span class="attribution"><a class="source" href="https://www.metmuseum.org/art/collection/search/194838">Met Museum</a></span>
</figcaption>
</figure>
<p>A glazed terracotta piece created by the Italian sculptor Andrea della Robbia in 1475 features Prudence, a human embodiment of Christian morality, as a balding two-headed person. </p>
<p>Baldness in women has been connected to the divine for various reasons. It took the emphasis off of personal appearance in favour of deeper, more spiritual, priorities. But intentional hair removal played a role too. For some religious people, such as Buddhist nuns and Haredi Jewish wives, a bald head is thought to be <a href="https://doi.org/10.1007/s12147-007-9043-3">purer</a> and shaving can represent a <a href="https://doi.org/10.30674/scripta.67392">regular, sacrificial ritual</a>. </p>
<h2>Ancient depictions</h2>
<figure class="align-center ">
<img alt="Egyptian painting of two princesses" src="https://images.theconversation.com/files/575688/original/file-20240214-30-dgx556.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575688/original/file-20240214-30-dgx556.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575688/original/file-20240214-30-dgx556.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575688/original/file-20240214-30-dgx556.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575688/original/file-20240214-30-dgx556.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575688/original/file-20240214-30-dgx556.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575688/original/file-20240214-30-dgx556.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Two Princesses (circa 1353 to 1336BC).</span>
<span class="attribution"><a class="source" href="https://www.metmuseum.org/art/collection/search/557782">Met Museum</a></span>
</figcaption>
</figure>
<p>Artwork on the walls of the tomb of the ancient Egyptian pharaoh, Akhenaten who ruled from 1351 to 1334BC, depicts two of his daughters, naked, with bald heads. Head shaving as well as natural baldness was common among the ancient Egyptians, including women.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/575689/original/file-20240214-28-1bs0gz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="statue of a bald headed princess" src="https://images.theconversation.com/files/575689/original/file-20240214-28-1bs0gz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/575689/original/file-20240214-28-1bs0gz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575689/original/file-20240214-28-1bs0gz.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575689/original/file-20240214-28-1bs0gz.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575689/original/file-20240214-28-1bs0gz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575689/original/file-20240214-28-1bs0gz.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575689/original/file-20240214-28-1bs0gz.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The bald head of an ancient Egyptian princess (circa BC 1352–1336).</span>
<span class="attribution"><a class="source" href="https://www.metmuseum.org/art/collection/search/547692">Met Museum</a></span>
</figcaption>
</figure>
<p>In fact, ancient Egyptians had <a href="https://doi.org/10.21608/ijthm.2019.77625">distinct terms</a> for female and male alopecia. This attests to just how common baldness, head shaving and wig wearing were for both sexes in ancient Egypt.</p>
<p>And it isn’t just Egypt. Partial and full head shaving has historically been common among women across sub-Saharan Africa. As <a href="https://doi.org/10.2307/3337689">one traveller observed</a> among the inhabitants of the 18th century Kingdom of Issini (modern-day Ghana): “Some only shave one half of the head … Others leave broad patches here and there unshaved.”</p>
<h2>Medieval and Renaissance alopecia</h2>
<p>The 15th century painting, Portrait Of A Woman With A Man At A Casement, by the Italian artist, Fra Filippo Lippi, features an aristocratic profile of a woman facing a man. She has a prominent forehead and high hairline.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/575686/original/file-20240214-22-cy04ht.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Portrait of a balding woman in profile." src="https://images.theconversation.com/files/575686/original/file-20240214-22-cy04ht.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/575686/original/file-20240214-22-cy04ht.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=906&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575686/original/file-20240214-22-cy04ht.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=906&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575686/original/file-20240214-22-cy04ht.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=906&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575686/original/file-20240214-22-cy04ht.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1138&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575686/original/file-20240214-22-cy04ht.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1138&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575686/original/file-20240214-22-cy04ht.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1138&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Portrait Of A Woman With A Man At A Casement by Fra Filippo Lippi (circa 1440).</span>
<span class="attribution"><a class="source" href="https://www.metmuseum.org/art/collection/search/436896">Met Museum</a></span>
</figcaption>
</figure>
<p>The appearance of recessed frontal hairlines in Medieval and Renaissance Europe <a href="https://www.jstor.org/stable/3679214">may have been fashionable</a> and even considered a sign of intelligence, encouraging customs of forehead shaving and eyebrow plucking.</p>
<p>The 16th century queen of England, Elizabeth I, was often painted in this way. <a href="https://www.npg.org.uk/collections/search/portraitConservation/mw02076/Queen-Elizabeth-I">One undated oil portrait</a> of the British monarch depicts her in bejewelled robes, with a pearl emblazoned veil and a prominent forehead. </p>
<p>The removal of female bodily hair at this time, including on the forehead, wasn’t just a matter of fashion. It also arguably arose due to patriarchal ideas that women’s body hair was <a href="https://doi.org/10.1017/9781787442443.005">dirty and even dangerous to men</a>. </p>
<h2>Modern alopecia</h2>
<p><a href="https://doi.org/10.1080/10350330.2013.777596">Adverts</a> and <a href="https://doi.org/10.1177/13591053211024724">research</a> today tend to discuss hair loss exclusively through medical terms, as a kind of detrimental disease. A recent <a href="https://www.bbc.co.uk/news/health-68367795">BBC article</a> refers to people with alopecia areata as “patients” and their experience of it as “profoundly challenging”. This certainly reflects some experiences, but not those who interpret their hair loss more neutrally, or even with <a href="https://www.instagram.com/p/CxJLSUtvf_j/?next=%2Femmina97%2F&hl=cs&img_index=1">pride</a>. </p>
<p>Pharmaceutical and cosmetic products are promoted as “necessary” treatments. A newly licensed drug, litfulo or ritlecitinib, has been <a href="https://www.bbc.co.uk/news/health-68367795">hailed this week</a> as the “first treatment” and “medicine” for alopecia. But as many forms of alopecia are not delimiting and as the “treatments” on offer have limited efficacy and potential safety issues, this should <a href="https://www.youtube.com/watch?v=YxwPZY3_sR4">not be the default response</a>. For example, the <a href="https://www.ema.europa.eu/en/documents/overview/litfulo-epar-medicine-overview_en.pdf">European Medicine Agency</a> notes that ritlecitinib results in 80% hair regrowth but only for 36% of people taking it. About 10% are at risk of diarrhoea, acne and throat infections. </p>
<p>Another study <a href="https://doi.org/10.3389/fphar.2022.950450">noted that</a> similar alopecia drugs, that operate through immunosuppression, only seem to work if they are taken continuously, yet their long-term safety has not been established. </p>
<p>Depictions of alopecia throughout art history are a reminder of the many complicated ways women’s hair loss has been viewed. Sometimes weaponised as a way to shame women, sometimes venerated as a sign of the divine, the truth is that hair loss really indicates nothing about a woman’s worth, morality or status. </p>
<p>But historical depictions of women’s alopecia and baldness provide hope. They show that alopecia has been conceptualised differently at different times. This means the current framing of alopecia as an inevitably disadvantaging disease in need of certain “treatments” might be biased too. They suggest if our societal interpretation of alopecia improves (as something that shouldn’t be stigmatised), then so too may the individual experience (as something that shouldn’t be dreaded). </p>
<hr>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
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<p class="fine-print"><em><span>Glen Jankowski does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What changing artistic depictions of women’s alopecia tells us about hair loss today.Glen Jankowski, Senior Lecturer in the School of Social Sciences, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2193292024-01-12T00:16:53Z2024-01-12T00:16:53ZFrom straight to curly, thick to thin: here’s how hormones and chemotherapy can change your hair<figure><img src="https://images.theconversation.com/files/567011/original/file-20231221-27-ytfbxc.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C6000%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-young-beautiful-woman-white-1489934231">Orawan Pattarawimonchai/Shutterstock</a></span></figcaption></figure><p>Head hair comes in many colours, shapes and sizes, and hairstyles are often an expression of personal style or cultural identity. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36631178/">Many different genes</a> determine our hair texture, thickness and colour. But some people’s hair changes around the time of puberty, pregnancy or after chemotherapy.</p>
<p>So, what can cause hair to become curlier, thicker, thinner or grey?</p>
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<strong>
Read more:
<a href="https://theconversation.com/big-hair-bald-how-much-difference-your-hair-really-makes-to-keep-you-cool-or-warm-201380">Big hair? Bald? How much difference your hair really makes to keep you cool or warm</a>
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<h2>Curly or straight? How hair follicle shape plays a role</h2>
<p>Hair is made of <a href="https://my.clevelandclinic.org/health/body/23204-keratin">keratin</a>, a strong and insoluble protein. Each hair strand grows from its own <a href="https://www.ncbi.nlm.nih.gov/books/NBK470321/">hair follicle</a> that extends deep into the skin. </p>
<p>Curly hair forms due to asymmetry of both the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894537/">hair follicle and the keratin</a> in the hair.</p>
<p>Follicles that produce <a href="https://www.medicalnewstoday.com/articles/318524">curly hair</a> are asymmetrical and curved and lie at an angle to the surface of the skin. This kinks the hair as it first grows.</p>
<p>The asymmetry of the hair follicle also causes the keratin to bunch up on one side of the hair strand. This pulls parts of the hair strand closer together into a curl, which maintains the curl as the hair continues to grow. </p>
<p>Follicles that are symmetrical, round and perpendicular to the skin surface produce straight hair. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram shows the hair follicle shape of straight, curly and coiled hair." src="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Each hair strand grows from its own hair follicle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/diagram-hair-follicle-shape-vector-illustration-2248429145">Mosterpiece/Shutterstock</a></span>
</figcaption>
</figure>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-dandruff-how-do-i-get-rid-of-it-why-does-it-keep-coming-back-201082">What is dandruff? How do I get rid of it? Why does it keep coming back?</a>
</strong>
</em>
</p>
<hr>
<h2>Life changes, hair changes</h2>
<p>Our hair undergoes repeated cycles throughout life, with different stages of growth and loss.</p>
<p>Each hair follicle contains stem cells, which multiply and <a href="https://www.frontiersin.org/articles/10.3389/fcell.2022.899095/full">grow into a hair strand</a>.</p>
<p>Head hairs spend most of their time in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905671/">the growth phase</a>, which can last for several years. This is why head hair can grow so long. </p>
<p>Let’s look at the life of a single hair strand. After the growth phase is a transitional phase of about two weeks, where the hair strand stops growing. This is followed by a resting phase where the hair remains in the follicle for a few months before it <a href="https://www.healthline.com/health/stages-of-hair-growth">naturally falls out</a>.</p>
<p>The hair follicle <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/exd.13347">remains in the skin</a> and the stems cells grow a new hair to repeat the cycle.</p>
<p>Each hair on the scalp is replaced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/#b3">every three to five years</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with curly hair works on her computer." src="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Each hair on the scalp is replaced every three to five years.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-businesswoman-office-beautiful-woman-listening-1702284601">Just Life/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Hormone changes during and after pregnancy alter the usual hair cycle</h2>
<p>Many women notice their hair is <a href="https://www.medicalnewstoday.com/articles/pregnancy-hair">thicker during pregnancy</a>.</p>
<p>During pregnancy, high levels of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908443/">oestrogen, progesterone and prolactin</a> prolong the resting phase of the hair cycle. This means the hair <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/">stays in the hair follicle for longer</a>, with less hair loss. </p>
<p>A drop in hormones a few months after delivery causes increased hair loss. This is due to all the hairs that remained in the resting phase during pregnancy falling out in a fairly synchronised way. </p>
<h2>Hair can change around puberty, pregnancy or after chemotherapy</h2>
<p>This is related to the genetics of hair shape, which is an example of <a href="https://www.biologyonline.com/dictionary/incomplete-dominance">incomplete dominance</a>. </p>
<p>Incomplete dominance is when there is a middle version of a trait. For hair, we have curly hair and straight hair genes. But when someone has one curly hair gene and one straight hair gene, they can have wavy hair. </p>
<p>Hormonal changes that occur around <a href="https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-019-0780-4">puberty</a> and <a href="https://www.mdpi.com/1422-0067/23/20/12698">pregnancy</a> can affect the function of genes. This can cause the curly hair gene of someone with wavy hair to become more active. This can change their hair from wavy to curly.</p>
<p>Researchers have identified that activating specific genes can change hair in pigs <a href="https://www.frontiersin.org/articles/10.3389/fgene.2023.1184015/full">from straight to curly</a>.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759815/">Chemotherapy</a> has very visible effects on hair. Chemotherapy kills rapidly dividing cells, <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2628766">including hair follicles</a>, which causes hair loss. Chemotherapy can also have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1988866/">genetic effects</a> that influence hair follicle shape. This can cause hair to <a href="https://www.medicalnewstoday.com/articles/chemo-curls">regrow with a different shape</a> for the first few cycles of hair regrowth.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with wavy hair looks in a mirror" src="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your hair can change at different stages of your life.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-redhaired-girl-bathroom-looks-mirror-2139652407">Igor Ivakhno/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Hormonal changes as we age also affect our hair</h2>
<p>Throughout life, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/">thyroid hormones</a> are essential for production of keratin. Low levels of thyroid hormones can cause dry and brittle hair.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36578854/">Oestrogen and androgens</a> also regulate hair growth and loss, particularly as we age. </p>
<p>Balding in males is due to <a href="https://theconversation.com/starting-to-thin-out-hair-loss-doesnt-have-to-lead-to-baldness-34984">higher levels of androgens</a>. In particular, high dihydrotestosterone (sometimes shortened to DHT), which is produced in the body from testosterone, has a role in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269836/">male pattern baldness</a>. </p>
<p>Some women experience <a href="https://theconversation.com/health-check-why-does-womens-hair-thin-out-39126">female pattern hair loss</a>. This is caused by a combination of genetic factors plus lower levels of <a href="https://www.mdpi.com/2077-0383/12/3/893">oestrogen and higher androgens</a> after menopause. The hair follicles become smaller and smaller until they no longer produce hairs. </p>
<p>Reduced function of the cells that produce <a href="https://www.health.com/mind-body/what-going-gray-early-can-tell-you-about-your-health">melanin</a> (the pigment that gives our hair colour) is what causes greying.</p>
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<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-dont-burns-bleed-130792">Curious Kids: why don't burns bleed?</a>
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<img src="https://counter.theconversation.com/content/219329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Theresa Larkin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Changes around puberty and pregnancy can affect the function of genes influencing hair shape. And chemotherapy can cause hair to regrow in a different shape for the first few cycles of hair regrowth.Theresa Larkin, Associate professor of Medical Sciences, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1995312023-02-24T17:19:47Z2023-02-24T17:19:47ZThe art of balding: a brief history of hairless men<figure><img src="https://images.theconversation.com/files/509817/original/file-20230213-16-23xyos.jpg?ixlib=rb-1.1.0&rect=42%2C19%2C737%2C724&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Man With a Tankard, by Frans van Mieris the Younger (1739).</span> <span class="attribution"><a class="source" href="https://collection.beta.fitz.ms/id/object/1674">The Fitzwilliam Museum</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Balding is really common, affecting more than <a href="https://www.alopecia.org.uk/androgenetic-alopecia-pattern-hair-loss">50% of men</a>. It’s also physically inconsequential (bald men live just as long as haired men). So why, in his memoir <a href="https://theconversation.com/prince-harry-early-leaks-came-from-a-spanish-translation-causing-confusion-about-what-was-really-said-198556">Spare</a>, does Prince Harry refer to his brother’s baldness as <a href="https://www.newsweek.com/prince-harry-william-alarming-baldness-diana-resemblance-spare-memoir-1771856">“alarming”</a>?</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/509504/original/file-20230210-22-74qj84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A balding man working at a loom." src="https://images.theconversation.com/files/509504/original/file-20230210-22-74qj84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/509504/original/file-20230210-22-74qj84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=879&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509504/original/file-20230210-22-74qj84.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=879&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509504/original/file-20230210-22-74qj84.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=879&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509504/original/file-20230210-22-74qj84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1105&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509504/original/file-20230210-22-74qj84.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1105&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509504/original/file-20230210-22-74qj84.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1105&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An Ancient Egyptian depiction of a balding man.</span>
<span class="attribution"><a class="source" href="https://access.bl.uk/item/viewer/ark:/81055/vdc_00000000DCF8#?cv=1152&c=0&m=0&s=0&xywh=-1869%2C-705%2C5031%2C3639">John Gardner Wilkinson / British Library</a></span>
</figcaption>
</figure>
<p>As a social psychologist with a special interest in balding (and author of an upcoming book entitled Branding Baldness), I know this didn’t used to be the case – as the presence of balding men in art history demonstrates.</p>
<p>Historically, baldness was treated with neutrality, as a regular part of daily life. In 2019, <a href="https://journals.ekb.eg/article_77625.html">Egyptology professor Samar Kamal</a> found evidence of 122 bald men painted in private Ancient Egyptian tombs, circa 2613 to 525 BC.</p>
<p>Most of these men were visibly aged (their remaining hair was white). They were depicted in varied spheres of Egyptian society, from farming and fishing to sculpting and scribing. </p>
<p>The art suggests that the Ancient Egyptians didn’t treat bald men any differently from their haired peers.</p>
<p>Kamal also observed that the Ancient Egyptians had <a href="https://hairanddeathinancientegypt.com/2013/07/17/hathor-and-baldness-in-ancient-egypt-symbolism/">specific terms for male baldness</a>, included a “baldness line” during mummification, and had different balding hairstyles (e.g. short all over or long at the back).</p>
<h2>Balding men in European paintings</h2>
<p>European art also showcases baldness’s historical ordinariness. Vincent van Gogh’s painting On the Threshold of Eternity (1890) features the balding Dutch pensioner <a href="https://en.wikipedia.org/wiki/Adrianus_Jacobus_Zuyderland">Adrianus Zuyderland</a>.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/509506/original/file-20230210-28-cn8tff.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A painting of an old man in a blue suit sat in a wooden chat. His head is in his hands which reveals his bald head to the viewer." src="https://images.theconversation.com/files/509506/original/file-20230210-28-cn8tff.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/509506/original/file-20230210-28-cn8tff.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=790&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509506/original/file-20230210-28-cn8tff.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=790&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509506/original/file-20230210-28-cn8tff.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=790&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509506/original/file-20230210-28-cn8tff.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=993&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509506/original/file-20230210-28-cn8tff.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=993&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509506/original/file-20230210-28-cn8tff.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=993&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vincent van Gogh’s On The Threshold Of Eternity.</span>
<span class="attribution"><a class="source" href="https://krollermuller.nl/en/vincent-van-gogh-sorrowing-old-man-at-eternity-s-gate">Kröller-Müller Museum</a></span>
</figcaption>
</figure>
<p>While the painting evokes a sense of existential despair, Zuyderland’s baldness is an incidental – even attractive – feature of the artwork. Van Gogh <a href="https://vangoghletters.org/vg/letters/let286/letter.html">described the painting</a> in his letters, writing: “What a fine sight an old working man makes, in his patched bombazine suit with his bald head.”</p>
<p>Zuyderland is not an exception – there are many other bald men featured neutrally in historical art. For example, Dutch Golden Age painter <a href="https://artuk.org/discover/artworks/man-with-a-tankard-5245">Frans van Mieris the Younger’s Man With A Tankard</a> (1793) depicts a bald man contentedly enjoying a pub lunch.</p>
<p>Balding men have also historically been idealised in art. For example, Italian Renaissance painter Paolo Veronese’s 16th-century <a href="https://www.meisterdrucke.ie/kunstwerke/500px/Paolo_Veronese_-_The_Eternal_Father_-_(MeisterDrucke-1196344).jpg">The Eternal Father</a> features a balding God performing an ethereal miracle. </p>
<p>Rembrandt’s Anatomy Lesson of Dr Nicolaes Tulp (circa 1632) shows multiple balding doctors studying dissection. Impressionist Pierre-August Renoir’s <a href="http://www.artandarchitecture.org.uk/images/gallery/807b72cf.html">Portrait of Ambroise Vollard</a> (1908) depicts the eponymous balding art collector.</p>
<p>And there is plenty of other historical evidence to challenge the claim that baldness is “alarming”.</p>
<p>Balding religious figures exist across <a href="https://www.google.co.uk/books/edition/Hair/PuZFAAAAYAAJ?hl=en">almost every faith</a>. There’s Buddha, the Christian saints Jerome and Augustine, and then there are bald deities including the Japanese gods <a href="https://www.britannica.com/topic/Fukurokuju">Fukurokuju</a> and <a href="https://www.britannica.com/topic/Hotei">Hotei</a>. </p>
<figure class="align-center ">
<img alt="Six balding doctors gather round to watch a demonstration of a dissection." src="https://images.theconversation.com/files/509510/original/file-20230210-713-le3eqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509510/original/file-20230210-713-le3eqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509510/original/file-20230210-713-le3eqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509510/original/file-20230210-713-le3eqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509510/original/file-20230210-713-le3eqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509510/original/file-20230210-713-le3eqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509510/original/file-20230210-713-le3eqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Anatomy Lesson of Dr Nicolaes Tulp by Rembrandt (1632).</span>
<span class="attribution"><a class="source" href="https://www.mauritshuis.nl/en/our-collection/artworks/146-the-anatomy-lesson-of-dr-nicolaes-tulp/">The Hague</a></span>
</figcaption>
</figure>
<p>Religious and political directives have also promoted baldness. This <a href="https://doi.org/10.1016/j.clindermatol.2011.08.004">ranges from</a> Christian monks’ <a href="https://en.wikipedia.org/wiki/Tonsure">tonsure</a>, where hair was grown around a centrally shaved part of the scalp, to the Manchu <a href="https://en.wikipedia.org/wiki/Queue_(hairstyle)">“queue” haircuts</a>, where hair at the back of the head was grown into a long plait while the rest of the head was shaved.</p>
<h2>How baldness became ‘alarming’: advertising and mass media</h2>
<p>The mass marketing of anti-baldness products in the 20th century changed how baldness was seen. It transformed the perception of baldness from a benign aesthetic to a disadvantageous disease in need of “cure”. </p>
<p>Such “cures” ranged from expensive and ineffective “snake oil” products to the regulatory approved formulations that have some (though limited) hair regrowth properties, such as <a href="https://theconversation.com/starting-to-thin-out-hair-loss-doesnt-have-to-lead-to-baldness-34984">minoxidil</a>. </p>
<p>The advertising of these products fostered the idea that baldness is alarming. In 2013, sociolinguistics professor <a href="https://doi.org/10.1080/10350330.2013.777596">Kevin Harvey</a> observed that online anti-baldness adverts characterise haired men as attractive, successful and happy. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/1WhfB4884wo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A Rogaine television advert from 2001.</span></figcaption>
</figure>
<p>In contrast, the same adverts promoted the claim that baldness was a disease that severely distressed and disadvantaged men. Adverts for anti-baldness shampoo <a href="https://www.adsoftheworld.com/campaigns/suicide-hair-cliff">Renaxil</a>, for example, depicted hair follicles on the verge of suicide. Renaxil bottles are shown extending a hand to save them. </p>
<p>In contemporary mass media, baldness is rarely seen beyond the few actors (such as <a href="https://www.youtube.com/watch?v=PqynKYDab2w&t=6s">Jason Statham</a>, <a href="https://www.standardmedia.co.ke/entertainment/news/article/2001458020/vin-diesel-named-hottest-bald-man-alive">Vin Diesel</a> and <a href="https://www.youtube.com/watch?v=Fp9XCwxKPtQ">Bruce Willis</a>) who have made lack of hair their unique selling point. <a href="https://doi.org/10.1207/s15506878jobem5002_7">Research conducted in 2006</a> found that just 3% of 1,356 characters in US popular children’s TV shows were balding. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"518371093694799872"}"></div></p>
<p>In a study I led of 5,000 images of men in <a href="https://doi.org/10.1016/j.bodyim.2014.07.010">popular magazines</a> published between 2011 and 2012, we found that just 8% were balding.</p>
<p>There are also negative stereotypes in many contemporary depictions of baldness. The website <a href="https://tvtropes.org/pmwiki/pmwiki.php/Main/BaldOfEvil">TV Tropes</a> indicates that bald TV and film characters tend to be <a href="https://www.google.co.uk/books/edition/Bald_Like_Me/aL-KAAAACAAJ?hl=en">villains or aged</a>. <a href="https://www.google.co.uk/books/edition/Bald_Like_Me/aL-KAAAACAAJ?hl=en">Another study</a> found that more than 60% of 1980s TV actors portrayed bald characters who were “ugly”, incompetent or lazy. </p>
<p>Alarm around baldness is even promoted in academic research. Myself and Dr Hannah Frith <a href="https://journals.sagepub.com/doi/pdf/10.1177/13591053211024724">recently found</a> that about 80% of baldness psychology studies had links to businesses. The studies tended to depict baldness as a disease (77%), and promoted anti-baldness products (60%) without meaningful discussion of their limitations (68%).</p>
<p>Baldness representation matters. Modern depictions in TV, advertising and research sanction the claims that hair loss is a disadvantage and a disease. But a look at the art history of the balding man shows this hasn’t always been the case. Bald men can be healthy, successful and content – just as much as their haired counterparts.</p><img src="https://counter.theconversation.com/content/199531/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glen Jankowski does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Historically, baldness was treated with neutrality, as a regular part of daily life. Ancient Egyptians had different balding hairstylesGlen Jankowski, Senior Lecturer in the School of Social Sciences, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1812172022-05-13T09:53:16Z2022-05-13T09:53:16ZFour strange COVID symptoms you might not have heard about<figure><img src="https://images.theconversation.com/files/462540/original/file-20220511-9952-grrad.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5152%2C3442&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-comb-problem-hair-on-white-557050852">ShotPrime Studio/Shutterstock</a></span></figcaption></figure><p>Well over two years into the pandemic, hundreds of thousands of <a href="https://covid19.who.int/">COVID cases</a> continue to be recorded around the world every day. </p>
<p>With the rise of new variants, the symptoms of COVID have also evolved. Initially, the NHS regarded a fever, cough, and loss or change in sense of smell or taste as <a href="https://www.theguardian.com/world/2022/apr/04/uk-covid-symptoms-list-expanded-with-nine-more-signs-of-illness">the main symptoms</a> which could indicate COVID infection. Now, recently updated <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/main-symptoms/">NHS guidance</a> suggests also looking out for symptoms including a sore throat, blocked or runny nose, and a headache.</p>
<p>But what about some of the more obscure signs and symptoms? From skin lesions to hearing loss, emerging data is increasingly showing us that COVID symptoms can go beyond what you might expect from a regular cold or a flu.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-the-symptoms-of-omicron-174476">What are the symptoms of omicron?</a>
</strong>
</em>
</p>
<hr>
<p><strong>1. Skin lesions</strong></p>
<p>COVID-related skin complaints are not uncommon. In fact, a <a href="https://pubmed.ncbi.nlm.nih.gov/33448030/">UK study</a> published in 2021 found that one in five patients only exhibited a rash and no other symptom.</p>
<p>COVID can affect the skin in <a href="https://theconversation.com/four-covid-related-skin-complaints-everyone-should-look-out-for-152716">a variety of ways</a>. Some people may experience a widespread maculopapular rash (flat or raised areas of discoloured skin), while others might present with hives (raised areas of itchy skin). </p>
<p>“<a href="https://onlinelibrary.wiley.com/doi/10.1111/dth.15298">COVID toes</a>”, meanwhile, describes red, swollen or blistering skin lesions on the toes. This symptom is more commonly seen in adolescents or young adults with mild or no symptoms.</p>
<p>Most COVID skin lesions tend to go away after a few days, or in some instances a few weeks, without the need for any specialised treatment. If the skin is very itchy or painful though, you can consult a GP or dermatologist, who may recommend treatment such as a cream.</p>
<figure class="align-center ">
<img alt="COVID toes." src="https://images.theconversation.com/files/462835/original/file-20220512-14-206gsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462835/original/file-20220512-14-206gsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462835/original/file-20220512-14-206gsl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462835/original/file-20220512-14-206gsl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462835/original/file-20220512-14-206gsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462835/original/file-20220512-14-206gsl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462835/original/file-20220512-14-206gsl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘COVID toes’ are characterised by red, swollen or blistering skin lesions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid-toes-another-symptom-coronavirus-infection-1712862949">Ternavskaia Olga Alibec/Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>2. COVID nails</strong></p>
<p>During an infection, including that of SARS-CoV-2 (the virus which causes COVID-19), our bodies naturally try to express that they’re under an unusual amount of stress. They can do this in a variety of weird and wonderful ways, including through our nails. “<a href="https://theconversation.com/covid-nails-these-changes-to-your-fingernails-may-show-youve-had-coronavirus-160562">COVID nails</a>” encompasses changes such as:</p>
<ul>
<li><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504889/">Beau’s lines</a> – horizontal indentations that occur at the base of the fingernails or toenails when there’s a temporary interruption in nail growth due to a physical stress on the body</p></li>
<li><p><a href="https://onlinelibrary.wiley.com/doi/10.1111/dth.13863">Mees’ lines</a> – horizontal white lines that appear on the nails, thought to be caused by the abnormal production of proteins in the nail bed</p></li>
<li><p>a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323324/">red half-moon pattern</a> which develops at the base of the fingernails (the mechanism underlying this change is unclear).</p></li>
</ul>
<p>The data on how many people experience COVID nails is limited, but it’s been estimated it could be <a href="https://pubmed.ncbi.nlm.nih.gov/34258268/">up to 1-2%</a> of COVID patients.</p>
<p>COVID nails tend to appear in the days or weeks following COVID infection as the nails grow. Although they might be painful initially, the vast majority tend to return to normal over a few weeks.</p>
<p>Notably, while these changes may be indicative of COVID, they can also be caused by different things. For example, Beau’s lines can be secondary to chemotherapy or another infection.</p>
<p><strong>3. Hair loss</strong></p>
<p>Hair loss is perhaps an understated symptom of COVID-19, usually occurring one month or more after the acute infection. In one study of almost 6,000 people who had previously had COVID, hair loss was the <a href="https://onlinelibrary.wiley.com/doi/10.1111/ijd.16041">most common</a> post-COVID symptom, reported by 48% of participants. It was especially prevalent among people who had severe COVID and white women.</p>
<p>It is thought that this results from the hair “sensing” the stress in the body, leading to excess shedding. Indeed, hair loss can also be triggered by other stressful events, such as childbirth. The <a href="https://healthcare.utah.edu/healthfeed/postings/2022/03/hair-loss-covid19.php">good news</a> is that with time the hair grows back to normal.</p>
<p><strong>4. Hearing loss and tinnitus</strong></p>
<p>As with other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222184/#!po=4.83871">viral infections</a>, such as the flu and measles, COVID has been found to affect the cells in the inner ear, with hearing loss or tinnitus (a constant ringing sensation in the ear) sometimes following infection.</p>
<p>In a <a href="https://pubmed.ncbi.nlm.nih.gov/33843530/">review study</a> that included 560 participants, hearing loss occurred in 3.1% of patients with COVID, while tinnitus occurred in 4.5%.</p>
<figure class="align-center ">
<img alt="A man touches his ear, indicating pain." src="https://images.theconversation.com/files/462836/original/file-20220512-22-c86v2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462836/original/file-20220512-22-c86v2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462836/original/file-20220512-22-c86v2b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462836/original/file-20220512-22-c86v2b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462836/original/file-20220512-22-c86v2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462836/original/file-20220512-22-c86v2b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462836/original/file-20220512-22-c86v2b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID has been associated with hearing loss and tinnitus.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-african-american-millennial-man-suffering-1949022484">DimaBerlin/Shutterstock</a></span>
</figcaption>
</figure>
<p>In <a href="https://www.sciencedirect.com/science/article/pii/S0196070922000552?dgcid=rss_sd_all">one study</a> of 30 people who had been diagnosed with COVID, and 30 who hadn’t – none with pre-existing hearing problems – the researchers found that COVID was associated with damage to the inner ear which led to hearing impairment at higher frequencies. While for the vast majority of patients this resolves on its own, cases of <a href="https://www.bmj.com/company/newsroom/first-reported-uk-case-of-sudden-permanent-hearing-loss-linked-to-covid-19/">permanent hearing loss</a> linked to COVID have been reported.</p>
<h2>Why all these symptoms?</h2>
<p>We don’t understand exactly what causes these symptoms, but we know the most important part is played by a process called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267343/">inflammation</a>. Inflammation is our body’s natural defence mechanism against pathogens; SARS-CoV-2 in this case. It involves the production of “cytokines” – proteins which are important in controlling the activity of immune cells. </p>
<p>Excessive production of these proteins, as a part of the inflammation triggered by COVID infection, can cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267343/">sensory deficits</a>, which potentially explain why some people are presenting with hearing loss and tinnitus. It can also disrupt the capillary networks, very tiny blood vessels which provide blood to organs including the ears, skin and nails.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/four-covid-related-skin-complaints-everyone-should-look-out-for-152716">Four COVID-related skin complaints everyone should look out for</a>
</strong>
</em>
</p>
<hr>
<p>The symptoms we’ve described here are not exclusive to COVID infection. That said, if you notice any of these symptoms, it would be appropriate to consider a COVID test, especially if you’re in an area where COVID is circulating. </p>
<p>You can also contact your GP, particularly if the symptoms are getting worse or causing you significant discomfort. At the same time, you can be reassured that most of these symptoms are likely to improve with time.</p><img src="https://counter.theconversation.com/content/181217/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From skin lesions to hearing loss, unusual symptoms can be troubling for COVID patients.Vassilios Vassiliou, Professor of Cardiac Medicine, University of East AngliaRanu Baral, Visiting Researcher (Academic Foundation Doctor FY2), University of East AngliaVasiliki Tsampasian, Cardiology SpR & NIHR Academic Clinical Fellow, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1444832020-08-21T03:25:33Z2020-08-21T03:25:33Z8 ways the coronavirus can affect your skin, from COVID toes, to rashes and hair loss<figure><img src="https://images.theconversation.com/files/353788/original/file-20200820-18-1hz1hcb.jpg?ixlib=rb-1.1.0&rect=2%2C7%2C995%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid-toes-another-symptom-coronavirus-infection-1712862961">from www.shutterstock.com</a></span></figcaption></figure><p>As the pandemic progresses, we’re growing increasingly aware COVID-19 affects <a href="https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096">multiple parts of the body</a> beyond the lungs. That includes the skin. </p>
<p>We’ve seen reports of skin symptoms ranging from “COVID toes” to hair loss, and different types of rashes.</p>
<p>Some skin symptoms appear soon after infection, while others arise later or in more severe disease. Most <a href="https://www.nature.com/articles/s41591-020-0968-3">get better</a> with time.</p>
<p>Researchers are also beginning to work out what causes these skin conditions, whether it’s the body’s immune response to infection, or whether hormones are involved.</p>
<p>Here are <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19163">some of these symptoms</a>, from the most common to the least:</p>
<p><strong>1. widespread small red bumps and multiple flat red patches.</strong> These so-called maculopapular eruptions are associated with more severe disease</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=321&fit=crop&dpr=1 600w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=321&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=321&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=404&fit=crop&dpr=1 754w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=404&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=404&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These maculopapular eruptions are associated with more severe disease.</span>
<span class="attribution"><a class="source" href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19163">British Journal of Dermatology</a></span>
</figcaption>
</figure>
<p><strong>2. redness of the whites of the eyes</strong>. This <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2764083#246398567">conjunctivitis</a> is most common later in the disease and in more severe disease</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1294699144255287298"}"></div></p>
<p><strong>3. chilblain-like symptoms, commonly called ‘COVID toes’</strong>. These can affect <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.16526">hands or feet</a>, or both at the same time. The red-purple discoloured skin can be painful and itchy, and there are sometimes small blisters or pustules. These chilblain-like lesions often appear late in the disease, after other symptoms, and are most common in children</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1294554279785558017"}"></div></p>
<p><strong>4. hives</strong> or <a href="https://theconversation.com/what-are-hives-the-common-skin-condition-that-gives-you-itchy-red-bumps-121693">urticaria</a> are pink or red itchy rashes that may appear as blotches or raised red lumps (wheals). They range from the size of a pinhead to a dinner plate. Swellings usually disappear within minutes to hours in one spot, but may come and go. Mostly hives clear within ten days. They occur at the same time as other symptoms, in all ages, and are associated with more severe disease</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1248510282281844736"}"></div></p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Vesicular eruptions, or water blisters, on the back" src="https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These water blisters, or vesicular eruptions, are more common in middle-aged people with COVID-19.</span>
<span class="attribution"><a class="source" href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19163">British Journal of Dermatology</a></span>
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<p><strong>5. water blisters</strong>, or vesicular eruptions, are small fluid-filled micro-blisters that may appear early in the disease or at any time, often on the hands. Middle‐aged patients suffer more commonly. The blisters last just over ten days, and are associated with medium-severity disease</p>
<p><strong>6. ‘fishing net-like’ red-blue pattern on the skin</strong>, or livedo, sometimes with tiny bruises (purpura), is associated with more severe disease and older age groups. This pattern is thought to be due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158248/">blockages of the blood vessels</a> that arise as part of the body’s immune response to the virus</p>
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<p><strong>7. rash associated with <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e2.htm">multisystem inflammatory syndrome in children</a></strong> or MIS-C. This “immune system overdrive” triggers an inflammation of the heart and blood vessels, resulting in blood clots and symptoms of shock. This <a href="https://theconversation.com/4-unusual-things-weve-learned-about-the-coronavirus-since-the-start-of-the-pandemic-140168">very rare complication</a> can occur up to three months after a child has had COVID-19</p>
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<p><strong>8. hair loss</strong> (<a href="https://dermnetnz.org/topics/telogen-effluvium/">telogen effluvium</a>) occurs in many severe illnesses, including COVID-19. This is the body shutting down unnecessary activity in times of stress. Provided people’s iron levels are normal, the hair will recover in time</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1292540903047852034"}"></div></p>
<p>COVID-19 serious enough to take people to hospital also seems to be more common in people with <a href="https://www.healthdirect.gov.au/male-pattern-baldness">male-pattern baldness</a>. One study found <a href="https://www.jaad.org/article/S0190-9622(20)30948-8/fulltext">up to 79%</a> of hospital admissions for COVID-19 were balding men.</p>
<p>An increased level of the hormone dihydrotestosterone is thought to increase the numbers of ACE2 receptors, which is how the virus enters the body. In other words, male-pattern baldness may predispose people to more severe disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-what-we-know-so-far-about-the-long-term-symptoms-of-covid-19-142722">Here's what we know so far about the long-term symptoms of COVID-19</a>
</strong>
</em>
</p>
<hr>
<h2>What could be causing these symptoms?</h2>
<p>Some of the COVID-19 rashes are not caused by the virus itself, but by the body’s immune response to the virus.</p>
<p>For instance, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158248/">research suggests</a> some may be caused by over-activation of a part of the immune system known as the “<a href="https://www.britannica.com/science/complement-immune-system-component">complement</a>” response. This leads to the blood vessel damage seen in the chilblain-type symptoms (point 3 above) and in livedo (point 6).</p>
<p>Complement activity is also increased in <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2018.02664/full">elderly people</a> and may well explain many of the more serious COVID-19 outcomes we see in this age group.</p>
<h2>How do I know if my skin rash is COVID-19?</h2>
<p>If you’re concerned about any skin symptoms, check them against the photos in <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19163">this article</a>. Then you can consult your GP or dermatologist via a telehealth appointment for further advice.</p>
<p>You might be infectious. Get tested and self-isolate until you receive your test results. If you feel unwell, your GP or COVID clinic will be able to coordinate your care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-skins-dry-with-all-this-hand-washing-what-can-i-do-134146">My skin's dry with all this hand washing. What can I do?</a>
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<img src="https://counter.theconversation.com/content/144483/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Freeman is the director of dermatology at the Gold Coast Hospital and the principal dermatologist at The Skin Centre.</span></em></p>Some skin symptoms appear soon after infection, while others arise later or in more severe disease. Most get better with time.Michael Freeman, Dermatologist, Associate Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/714692017-06-07T02:06:06Z2017-06-07T02:06:06ZExplainer: what causes alopecia areata and can you treat this type of hair loss?<p>Alopecia is the medical term for hair loss and comes from the Greek word alōpekía referring to the skin condition, mange, in foxes. <a href="https://research-repository.griffith.edu.au/bitstream/handle/10072/69115/102322_1.pdf?sequence=1">Alopecia areata</a> causes a unique form of hair loss different to the more common age-related male and female pattern <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hair?viewAsPdf=true">hair loss</a>.</p>
<p>It’s also the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783422/?report=reader">most common autoimmune disease</a> (when the body’s immune system attacks its own tissues), more common than insulin-dependent diabetes, rheumatoid arthritis or thyroiditis (inflammation of the thyroid).</p>
<h2>Symptoms</h2>
<p>Alopecia areata affects people of all ages including young children. It produces circular patches of hair loss that appear overnight. More patches appear over time and eventually about 5% of people affected lose every hair on their body. This includes eyebrows, eyelashes and even nose hairs. In some people, hair grows back, either in the same place or on a previously unaffected part of the scalp or body.</p>
<p>If alopecia areata is the most common <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC508540/pdf/1010062.pdf">autoimmune</a> disease, why have most people never heard about it?</p>
<p>There are two likely reasons. One is that it’s embarrassing and distressing. Wherever possible, people try to hide it with clever hairstyles and cosmetic camouflage. The other reason is it often comes and goes, and once gone people would rather forget they had it.</p>
<p>So people only tend to see severe cases where people have lost all their hair. Even then people can mistake the condition for the hair loss seen after chemotherapy.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/165803/original/image-20170419-6369-a2opau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/165803/original/image-20170419-6369-a2opau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/165803/original/image-20170419-6369-a2opau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165803/original/image-20170419-6369-a2opau.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165803/original/image-20170419-6369-a2opau.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165803/original/image-20170419-6369-a2opau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165803/original/image-20170419-6369-a2opau.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165803/original/image-20170419-6369-a2opau.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bouts of alopecia areata generally come and go.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/urbanaquariumvideo/3331909832/">Duncan Creamer/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The distress can be severe, especially in boys whose short hair makes it more difficult to conceal the patches of hair loss. <a href="https://www.researchgate.net/profile/Rodney_Sinclair/publication/260216370_Alopecia_areata_and_suicide_of_children/links/55d2efea08aec1b0429f0367.pdf">Suicide</a> among young boys affected by alopecia areata is more common than we would expect for a condition that essentially affects appearance, rather than people’s physical health.</p>
<h2>Causes</h2>
<p>Alopecia areata occurs when the body’s immune system mistakes hair follicles as foreign and attacks them. This causes the hairs to fall out. This specific form of <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=18985">autoimmunity</a> is a lifelong tendency that can be inherited from either parent.</p>
<p>It’s what geneticists call a “complex polygenic disease” meaning it arises due to an interaction between multiple genes as opposed to a mutation in a single gene. More than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921172/">17 genes</a> have been associated with alopecia areata and scientists expect there are still more genes to be discovered. </p>
<p>While your genes are pretty much fixed from birth, alopecia areata tends to come and go, especially in the early stages. This suggests something in our environment triggers individual <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1440-0960.2000.00439.x/full">episodes</a>. </p>
<p>Doctors, patients and their families have hunted for this elusive trigger hoping its discovery would allow people to avoid relapses. However, no convincing dietary or lifestyle modification has emerged that changes the risk of relapse. </p>
<p>While people regularly blame <a href="http://europepmc.org/abstract/med/1357886">stress</a> as a trigger, in my experience of treating patients, the condition causes the stress.</p>
<h2>Current treatment</h2>
<p>For 40 years, there has been little progress in its treatment. Mild cases usually respond to cortisone injections into the bald scalp. Cortisone suppresses inflammation and stops white blood cells from attacking the hair follicles and promotes hair regrowth.</p>
<p>Some patients respond to cortisone tablets or other anti-inflammatory tablets but the results are by no means guaranteed. Some doctors are reluctant to prescribe these medications for fear of side-effects such as weight gain, mood disturbance, diabetes, hypertension and increased risk of infection. </p>
<p>Severe cases, where the scalp is completely bald (called alopecia areata totalis) or where every hair on the body vanishes (called alopeica areata universalis) rarely recover without treatment. These types of hair loss tend to be long lasting or even permanent.</p>
<p>For millions of people worldwide affected by <a href="http://www.nejm.org/doi/full/10.1056/nejmra1103442">alopecia areata</a>, nothing has helped and for many a wig is the only option.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/165804/original/image-20170419-6384-xovjf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/165804/original/image-20170419-6384-xovjf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/165804/original/image-20170419-6384-xovjf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165804/original/image-20170419-6384-xovjf4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165804/original/image-20170419-6384-xovjf4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165804/original/image-20170419-6384-xovjf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165804/original/image-20170419-6384-xovjf4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165804/original/image-20170419-6384-xovjf4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For many people a wig is the only option.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/lwpkommunikacio/16002435741/">Lwp Kommunikáció/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<h2>Future treatments</h2>
<p>Many of the 17 genes associated with alopecia areata are involved in a particular inflammatory pathway called the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362521/">JAK/STAT pathway</a>. Drugs targeting this pathway, known as JAK inhibitors or JAKs, are already in development or are available, but for other conditions.</p>
<p>Some JAK inhibitors are already available on prescription in Australia, Europe and the USA to treat other diseases such as rheumatoid arthritis and myelofibrosis (a blood disorder). But in Australia and elsewhere they are not yet approved for use to treat alopecia areata.</p>
<p><a href="https://www.naaf.org/advance-research/clinical-research">Clinical trials</a> are taking place to see whether the drugs work in alopecia areata patients, who in particular will benefit the most and to see whether the benefits of treatment outweigh the risks.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033755/pdf/jciinsight-1-89776.pdf">Side effects</a> of JAK inhibitors identified so far include stomach upset, an increase in chest and skin infections and transaminaitis (an alteration in liver function identified by blood testing). Mild skin and upper respiratory tract infections have been reported in 25% of patients. Very few patients with alopecia areata elect to stop the medication as a result of side effects. Nevertheless patients receiving these medications require close medical supervision.</p><img src="https://counter.theconversation.com/content/71469/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair is an investigator in a clinical trial which is testing treatments for alopecia areata mentioned in the article. He is also head of Sinclair Dermatology, one of the Australian trial sites.</span></em></p>Hair loss from alopecia areata can be embarrassing and distressing for people of all ages. But new treatments are being trialled.Rodney Sinclair, Professor of Dermatology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/391262015-04-20T04:32:48Z2015-04-20T04:32:48ZHealth Check: why does women’s hair thin out?<figure><img src="https://images.theconversation.com/files/78334/original/image-20150417-20747-1ckgvz9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Almost 60% of Australian women are predisposed to female pattern hair loss.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/44534236@N00/7168701688">faungg's photo/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Balding in men is so common it doesn’t raise an eyebrow. But when a woman starts to lose hair, it can be extremely distressing. Will she end up bald, too? </p>
<h2>Help, I’ve got alopecia!</h2>
<p>The term alopecia means hair loss. It doesn’t describe the type or the cause of a particular sort of hair loss; women can lose significant amounts of hair for a number of very different reasons.</p>
<p>Everyone knows chemotherapy can make hair fall out. But after the medical treatment hair will grow again. </p>
<p>Similarly, hair over the entire scalp can be shed because of other medications, pregnancy, thyroid disorders, major surgery, fever, blood loss, iron deficiency, starvation and crash dieting. The shedding, called <a href="http://dermnetnz.org/hair-nails-sweat/telogen-effluvium.html">telogen effluvium</a>, can last two or three months before the woman recovers completely, although occasionally it can become chronic. </p>
<p>Then there’s <a href="http://www.niams.nih.gov/health_info/alopecia_areata/">alopecia areata</a>, an autoimmune condition said to have affected Marie Antoinette, where clumps of hair fall out and leave bald patches.</p>
<p>Female pattern hair loss (FPHL) is quite distinct from all these types of hair loss. It is a genetic condition and almost <a href="http://www.ncbi.nlm.nih.gov/pubmed/16382660">60%</a> of Australian women are predisposed to it. </p>
<p>The course of FPHL differs from woman to women: some will be affected almost as soon as they reach puberty; others may remain unaffected until after menopause. But once it starts, an additional 5-10% of hair <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684510/">will be lost</a> each year, mostly from the crown.</p>
<p>An additional problem for many women is how little hair and health professionals know about the condition. Initial visits may result in comments such as, “It’s just stress/pregnancy/the weather — it’ll grow back.” Or, “You’re imagining things! You have plenty of hair.”</p>
<p>Women <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.0007-0963.2003.05809.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false">don’t tend to</a> overstate their hair loss as a rule. If anything, they perceive it as less severe than it really is. It can be crushing to have worked up the courage to seek help only to be told you are overreacting. </p>
<h2>What’s the pattern?</h2>
<p><a href="http://www.medical-tribune.de/fileadmin/PDF/S1_Leitlinie_Alopezie_englisch.pdf">Female pattern hair loss</a> begins with diffuse thinning over the top and front parts of the scalp, most noticeably in the centre. While the hair loss is most pronounced on the crown, hair can also thin from ear to ear. The back of the head is least affected. </p>
<p>Most women affected by FPHL notice increased hair shedding before they become aware of a loss of hair volume over the crown. Others don’t notice their hair shedding, yet see their hair has reduced in volume or has less body. Women who have long hair may notice their ponytail becoming thinner.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/78346/original/image-20150417-23992-1m39cr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/78346/original/image-20150417-23992-1m39cr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=459&fit=crop&dpr=1 600w, https://images.theconversation.com/files/78346/original/image-20150417-23992-1m39cr5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=459&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/78346/original/image-20150417-23992-1m39cr5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=459&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/78346/original/image-20150417-23992-1m39cr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=577&fit=crop&dpr=1 754w, https://images.theconversation.com/files/78346/original/image-20150417-23992-1m39cr5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=577&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/78346/original/image-20150417-23992-1m39cr5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=577&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some women may notice their ponytails thinning out.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/mtsofan/2403631219">MTSOfan/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>At first, the shedding or thinning occurs in fits and bursts. Episodes last anywhere between three and six months and may then abate for one to two years before recurring. Over time, the episodes occur progressively closer together, until some women find they are shedding all year round.</p>
<p>Even in advanced FPHL, the affected area does not become completely bald and the hairline is always retained.</p>
<h2>The root of the problem</h2>
<p>When a doctor diagnoses you with FPHL, rest assured nothing you’ve done to your hair or scalp has caused it. Colouring, perming, blow-drying, frequent hair washing (or no washing at all) are not the culprits. Nor are the environment, diet, emotional factors or stress.</p>
<p>While you’re concerned about the appearance of the hair you can see, it’s what you can’t see that’s governing your hair loss. Hair grows from hair follicles: minute, sock-like indentations in the skin. Everyone’s born with more than two million of them over their entire body, including around 100,000 on the scalp. </p>
<p>No new follicles develop after birth. In fact, we lose a small number each year as we age, but each one will produce a number of hairs during the course of our lives. These follicles are where all the action – or inaction – takes place. In fact, the lower part of a follicle is the only section where hair is alive.</p>
<p>In FPHL, the hair follicles don’t disappear. Instead, they undergo a process of <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2006.07409.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false">miniaturisation</a> and produce only short fine miniaturised hairs. Initially only some follicles are affected. Over time more and more follicles <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2011.10630.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false">miniaturise</a>.</p>
<h2>Genes and hormones</h2>
<p>The natural colour and curliness, or otherwise, of your hair is a genetic lottery. So too is the matter of whether or not you are going to keep producing the hair on your head by natural means. Yes, you can blame your parents for FPHL – even if neither they nor your siblings show any sign of hair thinning.</p>
<p>Rather than there being a single gene behind FPHL, scientists now believe that at least five <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1440-0960.2011.00745.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false">genes</a> are involved. How these genes combine determines whether you will develop FPHL, how fast the condition will progress and how much hair you will ultimately lose.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/78351/original/image-20150417-27292-adw5xo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/78351/original/image-20150417-27292-adw5xo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=902&fit=crop&dpr=1 600w, https://images.theconversation.com/files/78351/original/image-20150417-27292-adw5xo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=902&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/78351/original/image-20150417-27292-adw5xo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=902&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/78351/original/image-20150417-27292-adw5xo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1134&fit=crop&dpr=1 754w, https://images.theconversation.com/files/78351/original/image-20150417-27292-adw5xo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1134&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/78351/original/image-20150417-27292-adw5xo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1134&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It comes down to genes, not colouring and blow-drying.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-210375688/stock-photo-caucasian-woman-with-short-hair-dying-her-hair-red-in-front-of-mirror-in-her-own-bathroom.html?src=pp-same_model-210375682-E66XfDOS10vfc7xANYvrVQ-3&ws=1">Imfoto/Shutterstock</a></span>
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<p>One thing we know for certain is that FPHL occurs when a woman with an inherited predisposition to the condition is exposed to androgens: hormones that, among other things, affect cells in the hair follicle at a critical stage of hair growth. </p>
<p>In women with a genetic predisposition to FPHL, androgens cause the miniaturisation of susceptible scalp hair follicles. The affected follicles become smaller and smaller until they are no longer able to support normal hair production. </p>
<p>Over time, this process results in affected scalp hairs becoming smaller, shorter and finer than the ones they are replacing. Hairs on the top of the head are more sensitive to androgens than those on the back of the head which, in part, explains the pattern of hair loss over the scalp.</p>
<h2>Heading for treatment</h2>
<p>Most people with dermatological problems such as psoriasis, eczema or acne don’t think twice about starting medical treatment promptly. Yet six months or even a year may pass before a woman seeks help for losing her hair. During that time she may have put the loss down to stress, hormonal changes, the weather or illness.</p>
<p>This first year is critical. The sooner appropriate treatment is started, the better the results in the long term.</p>
<p>The three principal aims are to: arrest further progression, stimulate hair regrowth and conceal the hair loss. Most treatments achieve only two out of three goals.</p>
<p><a href="http://www.nlm.nih.gov/medlineplus/druginfo/meds/a689003.html">Minoxidil</a> stimulates regrowth but may or may not arrest further progression, at least in the long term. Minoxidil comes both as a lotion, which is applied directly to the scalp, and a tablet. </p>
<p>The lotion is available over-the-counter in pharmacies, while the tablets require a prescription from your doctor. Care is required with the tablets to find the correct dose that grows hair where it is wanted on the scalp without growing unwanted hair elsewhere. </p>
<p>Medications that block the effect of androgen hormones, such as <a href="http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682627.html">spironolactone</a> and cyproterone acetate, can halt further progression and may stimulate regrowth in some women. They can be taken on their own or while minoxidil is being <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1440-0960.2007.00332.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false">applied</a>. </p>
<p>Research shows hair loss is halted in more than 90% of women who use <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2005.06218.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false">oral anti-androgens</a>, while about 30-40% experience some regrowth. But it’s important that women do not become pregnant while taking anti-androgen medication.</p>
<p>A number of new agents are in the pipeline. The discovery that certain <a href="http://www.latisse.com/RealWomenGallery.aspx">eye drops</a> used to treat glaucoma made the eyelashes grow longer and thicker has led to renewed interest in prostaglandin inhibitors to treat hair loss. A number of shampoos and conditioners on the market contain <a href="http://www.faqs.org/patents/app/20080206320">prostaglandin inhibitors</a> and can reduce hair loss and promote regrowth.</p>
<p>If you are losing your hair, remember, the most important thing you can do is seek help early. It’s much easier to prevent hair loss than to try and regrow it once lost.</p><img src="https://counter.theconversation.com/content/39126/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair was granted an innovation patent titled Treatment of male and female androgenetic alopecia with oral minoxidil either alone or in combination with antiandrogens in 2011.</span></em></p>Balding in men is so common it doesn’t raise an eyebrow. But when a woman starts to lose hair, it can be extremely distressing. Will she end up bald, too?Rodney Sinclair, Professor Dermatology, Honorary, Epworth Hospital, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/349842015-01-13T21:44:18Z2015-01-13T21:44:18ZStarting to thin out? Hair loss doesn’t have to lead to baldness<figure><img src="https://images.theconversation.com/files/68800/original/image-20150113-23786-1jvc9lz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The earlier you begin treatment the better. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/jeroenbennink/2866762843">Jeroen Bennink/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Hair loss is no longer an inevitable march to baldness. Medical advances over recent decades mean male hair loss can be treated. And it need not break the bank.</p>
<p>The cause of male pattern baldness is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113949/">well established</a> as an act of nature not nurture. Identical twins go bald at the same age, rate and pattern irrespective of diet, lifestyle or stress levels. </p>
<p>Baldness is a complex polygenic trait: up to five genes are involved, and it is the <a href="http://dx.doi.org/10.1017/S1462399402005112">interplay between these genes</a>, not unlike the interaction between the cards in a poker hand, that determine the specifics of male pattern hair loss. </p>
<p>So, what are the treatment options?</p>
<h2>Finasteride</h2>
<p>Finasteride is a <a href="https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=AF5D7358204F4E5ECA257D2600424FF7&agid=(PrintDetailsPublic)&actionid=1">Therapeutic Goods Administration-approved</a> drug that dermatologists and general practitioners have been prescribing to treat hair loss for around 15 years. </p>
<p>It works by stopping the conversion of testosterone to dihydrotestosterone in the prostate, by blocking an enzyme called <a href="http://ghr.nlm.nih.gov/condition/5-alpha-reductase-deficiency">5-alpha reductase</a>. </p>
<p>You’ll need a prescription for finasteride and your doctor will explain the benefits and risks of the drug before you decide to proceed. </p>
<p>The benefits are clear: men who start taking daily finasteride at the first signs of hair loss will not go bald. Plus there are no interactions with other drugs. </p>
<p>But there is a small risk of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481923/">sexual side effects</a> such as such as erectile dysfunction, ejaculatory problems and reduced libido, which require careful management by an experienced doctor.</p>
<p>An added bonus is that finasteride reduces a man’s future chance of developing of prostate cancer. Though it <a href="http://www.nejm.org/doi/pdf/10.1056/NEJMoa1215932">does not increase longevity</a>, as the reduction in risk is exclusively for low-risk prostate cancer which are not the type men generally die from. </p>
<p>The cost for a year’s supply of tablets starts at around as low as A$200 (plus the extra you will need to put aside for haircuts!). </p>
<h2>Minoxidil</h2>
<p>Developed in the 1950s as a tablet to treat high blood pressure, minoxidil was an abject failure due to unwanted hair growth. Re-invented as a lotion applied directly to the scalp, it was <a href="http://www.rogaine.com/home.do">launched</a> in the United States in 1988 and soon became popular around the world. </p>
<p>Minoxidil is also TGA-approved and available over the counter in pharmacies for between A$15 and A$60 per month, depending on the brand. </p>
<p>No prescription or trip to the doctor is required, but talk to your pharmacist if you are taking any other medicines, especially high-blood-pressure medication.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/68810/original/image-20150113-28437-12os5bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/68810/original/image-20150113-28437-12os5bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/68810/original/image-20150113-28437-12os5bh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/68810/original/image-20150113-28437-12os5bh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/68810/original/image-20150113-28437-12os5bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/68810/original/image-20150113-28437-12os5bh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/68810/original/image-20150113-28437-12os5bh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Minoxidil is better at stimulating new growth than preventing progression.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-36578473/stock-photo-male-head-with-hair-loss-symptoms-front-side.html?src=xJEf4psFEdcCWwoVflaNQw-1-71&ws=1">Adem Demir/Flickr</a></span>
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<p>Hair removal laser has led to a renaissance in the use of minoxidil tablets, as doctors can now effectively manage the unwanted hair that was previously a deal breaker. Low doses of minoxidil, as low as one-fortieth of a tablet, can still grow hair with minimal effect on blood pressure and no need to put anything in your hair.</p>
<h2>How they compare</h2>
<p>While finasteride works best at arresting progression of genetically programmed hair loss, some men will achieve partial regrowth. The sooner you begin treatment, the more hair there is to protect. </p>
<p>Minoxidil is better at stimulating new growth rather than preventing progression. A bit like the bank manager who lends an umbrella when the sun is shining, and wants it back when it starts to rain, minoxidil works better before you go bald. Men who still have hair regrow more hair than men who have lost it all. </p>
<p>When used together, the combination of minoxidil and finasteride is a man’s best chance to both arrest hair loss progression and maximise hair regrowth.</p>
<h2>Hair transplant surgery</h2>
<p>Men whose hair is too far gone to be saved by tablets and lotions might consider <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Hair_transplant_surgery">hair transplantation surgery</a>, a cosmetic surgical procedure that has improved dramatically in recent years. </p>
<p>Various techniques are available, but all involve taking hair-bearing skin from one part of the scalp and grafting these pieces of skin onto bald or thinning areas of the scalp. </p>
<p>The main down side, apart from the cost (A$5,000 to A$10,000, depending on the number of grafts required) is the linear scar left behind on the back of the head locking men into long hair styles.</p>
<p>Another option is <a href="http://en.wikipedia.org/wiki/Follicular_unit_extraction">follicular unit extraction</a>. Rather than a strip of skin and a scar, donor tissue comprises multiple tiny punch grafts that heal invisibly by wound contraction. Further dissection of these grafts releases single hair follicle units that can be implanted one by one into the bald scalp to recreate a natural hair line. </p>
<p>The only limiting factor for follicular unit extraction is whether there is enough remaining donor hair to transplant. While chest and body hair have been used when donor hair is poor, artificial hair implants, also TGA-approved, remain the last resort. Artificial hairs cover the scalp, but do not grow and grey and regenerate like hair transplants.</p>
<h2>Alternative therapies</h2>
<p>What about other suggested treatments such as vitamins, dietary supplements, lasers, stem-cell therapy and platelet rich plasma? At this stage the most generous interpretation of the available data is that they are unproven, expensive and poor value compared with the TGA-approved treatments.</p>
<p>The take home message for boys staring at their bald fathers’ scalp and wondering what their genes have in store for them is, don’t panic, but don’t leave it too late.</p><img src="https://counter.theconversation.com/content/34984/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair is principal investigator in a pharmaceutical company sponsored clinical trial investigating new treatments for male pattern baldness</span></em></p>Hair loss is no longer an inevitable march to baldness. Medical advances over recent decades mean male hair loss can be treated. And it need not break the bank. The cause of male pattern baldness is well…Rodney Sinclair, Professor of Dermatology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.