tag:theconversation.com,2011:/uk/topics/alopecia-16007/articlesAlopecia – The Conversation2024-03-18T17:08:07Ztag:theconversation.com,2011:article/2247742024-03-18T17:08:07Z2024-03-18T17:08:07ZWhat your hair can tell you about your health<figure><img src="https://images.theconversation.com/files/579862/original/file-20240305-20-96aic6.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4684%2C3130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Genetics, hormones and age can all affect our hair growth.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/damaged-hair-frustrated-asian-young-woman-2403657911">Kmpzzz/ Shutterstock</a></span></figcaption></figure><p>Hair speaks volumes. The way we cut, style and colour often acts as a representation of who we are.</p>
<p>But hair is more than just aesthetic. It also has many important functions – preventing heat loss from the skin for instance, or (in the case of our eyebrows) stopping sweat dripping into the eyes. </p>
<p>Hair can be a reflection of what’s going on inside our body, too. Many diseases can alter the quality and appearance of our hair. Paying attention to the way it looks can give us clues to the state of our health. </p>
<h2>The hair cycle</h2>
<p>Some of the tiniest organs in our bodies are the follicles which produce and nourish hairs. Hair can only grow where follicles exist. </p>
<p>Hair growth is a complex process. Each tiny follicle goes through different <a href="https://www.sciencedirect.com/science/article/abs/pii/S1064740618300270?via%3Dihub">cyclical stages</a>. The first is the stage of active hair growth (the “anogen” phase), before growth is arrested (the “catagen” phase). This then progresses to the stage when the hair is lost or shed from the follicle (the “telogen” phase). </p>
<p>Many factors – from our genetics to our hormones to our age – can affect these follicles and their growth.</p>
<h2>Excess hair growth</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK534854/#:%7E:text=Introduction-,Hypertrichosis%20is%20defined%20as%20excessive%20hair%20growth%20anywhere%20on%20the,%5D%5B2%5D%5B3%5D">Hypertrichosis</a> is a condition where hair grows in excess all over the body. In most cases, this is a reaction to starting a new medication, such as phenytoin, which is used to treat epilepsy. But it may also be caused by diseases, such as <a href="https://www.sciencedirect.com/science/article/pii/S0738081X23000329?via%3Dihub">anorexia</a> and HIV. </p>
<p>Some conditions also cause hair to grow in places where it shouldn’t. In newborn babies, tufts of hair near the base of the spine may indicate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657727/pdf/cureus-0015-00000047396.pdf">spina bifida occulta</a>. This occurs when the lower vertebrae of the spine haven’t formed properly, leaving the delicate spinal cord covered only by skin. </p>
<p>The hows and whys of these conditions and their ability to trigger hypertrichosis remain poorly understood.</p>
<p>Hirsutism is another condition where hair grows excessively, but in a typically male pattern – on the face, lips, chest and arms. This is driven by androgen hormones, namely testosterone, which in high levels promotes hair growth in these regions. This may be observed in <a href="https://pubmed.ncbi.nlm.nih.gov/27510481/">polycystic ovary syndrome</a>.</p>
<h2>Hair loss</h2>
<p>Hair may also start to fall out in abnormal amounts, making it thinner or absent in certain body regions. The medical term for hair loss is <a href="https://cks.nice.org.uk/topics/alopecia-areata/">alopecia</a> and may either be localised or widespread. <a href="https://www.pcds.org.uk/clinical-guidance/alopecia-an-overview">Causes of alopecia</a> are manifold and include fungal infections, iron-deficiency anaemia, low thyroid hormone levels and use of medications (including chemotherapy). </p>
<figure class="align-center ">
<img alt="A man with hair loss." src="https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.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">Male pattern baldness begins in the mid-20s.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/caucasian-man-hair-loss-problem-2335225091">ANDRANIK HAKOBYAN/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Age, gender and genetics are also to blame. <a href="https://cks.nice.org.uk/topics/male-pattern-hair-loss-male-androgenetic-alopecia/">Male pattern baldness</a>, occurs at the hairline and the crown of the head. It’s influenced by the hormone testosterone, which shortens the growth phase of hairs and makes them finer. Most men with male pattern baldness will begin to observe hair loss by the age of 20-25. </p>
<p><a href="https://cks.nice.org.uk/topics/female-pattern-hair-loss-female-androgenetic-alopecia/">Female pattern baldness</a>, on the other hand, usually affects the front hairline first and causes thinning rather than complete loss. The role of testosterone is more debatable in women, but a hormonal cause is implicated since thinning is more common around and after the menopause. </p>
<p>Hair loss may also arise as a result of hair pulling. Styling hair tightly can cause <a href="https://knowyourskin.britishskinfoundation.org.uk/condition/traction-alopecia/#:%7E:text=Traction%20Alopecia%20is%20a%20type,pulled%20repeatedly%20by%20tight%20hairstyles.">traction</a> on the follicle and loss of hair integrity. Some people may also pull or pluck their hairs out of habit. This is called <a href="https://www.nhs.uk/mental-health/conditions/trichotillomania/">trichotillomania</a>.</p>
<h2>Treating hair problems</h2>
<p>Helping hair to regrow could be as simple as treating the underlying condition causing it. Another treatment to consider is the medication <a href="https://pubmed.ncbi.nlm.nih.gov/31496654/">minoxidil</a> – the active ingredient of Rogaine. It was initially developed as a treatment for high blood pressure, but was observed to also promote hair growth. This may be through a direct effect on hair follicles, or by improving blood flow to the scalp. These uncertainties may explain why some patients see good improvement, and others not. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0190962221009014?via%3Dihub">Hair transplants</a> are also a possibility, relocating crops of hairs to bald patches. There are two ways of performing them – you can either relocate multiple small “punched-out” grafts, or a larger strip of skin. The grafts are taken from hairy skin on the patient’s own body – this is an example of an autograft.</p>
<p>Sometimes the presence of hair in visible areas is not desirable, and there are certain treatments available to stop excessive growth. Aside from traditional hair removal methods, the contraceptive pill and other medications that <a href="https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html">regulate hormonal influence</a> on hair (such as finasteride), can be considered in cases where a hormonal condition is the cause (such as PCOS). </p>
<h2>Test your own hair</h2>
<p>In order to get a better sense of your hair’s health you can perform a simple test at home yourself, known as a <a href="https://dermnetnz.org/cme/principles/examination-of-hair-and-scalp">hair pull</a>. </p>
<p>Select a group of between 30-50 hairs (a small clump) and run your fingers from the base of the hairs at the scalp, up to the ends. You don’t need to pull hard – gentle traction is all that’s needed to dislodge a shedding hair. Look to see how many you’ve pulled out. </p>
<p>It’s normally only one or two hairs that will come out with one pull – but this can vary between people. Greater than ten hairs and your scalp is likely to be shedding more hairs than normal. This could be suggestive of alopecia – though having a dermatologist perform a <a href="https://pubmed.ncbi.nlm.nih.gov/31479564">more detailed inspection</a> may help you know if your hair loss indicates a more serious problem.</p>
<p>Changes in your hair may not simply be a case of age or how you’ve been styling it. There are many patterns of hair growth and loss to be aware of. Take heed of any differences noticed by you, or your hairdresser.</p><img src="https://counter.theconversation.com/content/224774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Baumgardt 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>Many diseases can alter the quality and appearance of your hair.Dan Baumgardt, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of BristolLicensed 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>
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<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">
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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/1806312022-04-05T15:37:45Z2022-04-05T15:37:45ZJada Pinkett Smith and Black women’s hair: History of disrespect leads to the CROWN Act<figure><img src="https://images.theconversation.com/files/456139/original/file-20220404-10072-qie35j.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5105%2C3805&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black women have been fighting for decades for the right to wear their natural hair. Here Jada Pinkett Smith arrives at the premiere of 'The Matrix Resurrections' on Dec. 18, 2021, in San Francisco. </span> <span class="attribution"><span class="source">(AP/Noah Berger)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/jada-pinkett-smith-and-black-women-s-hair--history-of-disrespect-leads-to-the-crown-act" width="100%" height="400"></iframe>
<p>The fallout from “the slap” at this year’s Oscars continues. Last week, Will Smith <a href="https://www.cbsnews.com/news/will-smith-resigns-from-the-academy-slapped-chris-rock-at-oscars/">resigned from the Academy of Motion Picture Arts and Sciences</a>, after the academy issued a statement <a href="https://www.cbsnews.com/news/will-smith-chris-rock-slap-oscars-academy-formal-review/">condemning</a> Smith’s actions.</p>
<p>There have been innumerable media stories about “the slap,” including <a href="https://theconversation.com/will-smiths-oscar-slap-reveals-fault-lines-as-he-defends-jada-pinkett-smith-against-chris-rock-podcast-180280">an episode of <em>Don’t Call Me Resilient</em></a>. “The joke,” however, has received less attention. <a href="https://www.capitalfm.com/news/chris-rock-will-smith-jada-pinkett-slap-oscars-gi-jane-joke/">“Jada, I love you. G.I. Jane 2 can’t wait to see you</a>,” is what Rock said to Jada Pinkett Smith and the Oscar night audience before Smith got up and slapped him.</p>
<p><a href="https://www.imdb.com/title/tt0119173/"><em>G.I. Jane</em></a> is a 1997 fictional drama starring Demi Moore about the first woman to undergo training in the United States Navy Seals. Moore’s “feminine” character, Jane O'Neil, is <a href="https://www.washingtonpost.com/wp-srv/style/longterm/movies/review97/fgijane.htm">chosen</a> by a female politician attempting to make a point in her battle against the <a href="https://blogs.lse.ac.uk/gender/2021/04/22/the-hidden-masculinization-and-militarization-of-the-canadian-citizenship-guide/">inherent sexism in the military</a>. To “keep hanging,” O'Neil “divests herself of any trace of femininity” and <a href="https://www.youtube.com/watch?v=LU_mJDOB7ZM">shaves her head</a>. </p>
<p>Although a shaven head for a woman should not signify anything but a <a href="https://www.etalk.ca/celebrity/celebrities-who-shaved-their-heads-and-looked-absolutely-amazing.html">style choice</a>, Pinkett Smith’s shaven head is also due to alopecia. In 2021, she <a href="https://www.youtube.com/watch?v=8a93q1We4E0">shared a video on Instagram</a> explaining <a href="https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926">the disorder</a>.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/tv/CYB7dMppvjk/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Regardless of the reasons for Pinkett Smith’s hairstyle, Rock’s joke was yet <a href="https://screencrush.com/g-i-jane-oscars-joke/">another jab at a Black woman’s hair</a>. We Black women have learned to love our hair, despite a wider culture that has, historically, not accepted its diversity. </p>
<p>In fact, Black women have been fighting the court system for 40 years to get protection from hair discrimination.</p>
<h2>Alopecia disproportionately affects Black women</h2>
<p>In my 2019 book, <a href="https://www.wlupress.wlu.ca/Books/B/Beauty-in-a-Box2"><em>Beauty in a Box</em></a> I examined the <a href="https://doi.org/10.1001/jamadermatol.2017.5163">dermatological research on hair loss</a>. Two U.S. studies, from 2009 and 2017, found that <a href="https://dermnetnz.org/topics/central-centrifugal-cicatricial-alopecia">central centrifugal cicatricial alopecia</a> (CCCA) is often underdiagnosed; some estimates report that 17 per cent of Black women have this condition.</p>
<p>Some of the reasons why Black women are more adversely affected by CCCA are due to tight braiding hairstyles, long-term use of hair weaves, lace-front wigs and chemical relaxers. </p>
<p>While Rock might not have known of Pinkett Smith’s alopecia, in his 2009 documentary <a href="https://www.imdb.com/title/tt1213585/"><em>Good Hair</em></a> he spoke to Black women about their hair, especially about <a href="https://www.youtube.com/watch?v=vCEX34-1o6M">chemical relaxers</a>.</p>
<p><em>Good Hair</em> was a successful film for Rock, but that does not mean he grew from the project. </p>
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Read more:
<a href="https://theconversation.com/will-smiths-oscar-slap-reveals-fault-lines-as-he-defends-jada-pinkett-smith-against-chris-rock-podcast-180280">Will Smith's Oscar slap reveals fault lines as he defends Jada Pinkett Smith against Chris Rock: Podcast</a>
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<h2>Black hair discrimination and the CROWN Act</h2>
<p><em>Glamour</em>’s <a href="https://www.glamour.com/story/the-crown-act-september-2020-cover-story">September 2020 cover story</a> was dedicated to six Black women who endured discrimination at work because of their hair. The feature explained how curly, “kinky” or big hair carries meaning for Black women. </p>
<p>For example, a <a href="https://www.ellecanada.com/beauty/hair/how-to-style-a-messy-topknot-so-it-looks-chic-not-just-out-of-bed">messy topknot is considered chic</a> on a white woman, while a Black woman with natural hair such as large Afro or locs would be considered unkempt and has <a href="https://www.dailymail.co.uk/femail/article-2513893/Florida-girl-threatened-expulsion-afro-hair.html">led to workplace reprimand</a>.</p>
<p>On March 18, 2022, the U.S. House of Representatives passed the <a href="https://www.npr.org/2022/03/18/1087661765/house-votes-crown-act-discrimination-hair-style">CROWN Act</a>, banning hair discrimination at private places of work, federal programs and public accommodations. CROWN stands for <a href="https://www.congress.gov/bill/117th-congress/house-bill/2116">Creating a Respectful and Open World for Natural Hair</a>.</p>
<p><a href="https://static1.squarespace.com/static/5edc69fd622c36173f56651f/t/5edeaa2fe5ddef345e087361/1591650865168/Dove_research_brochure2020_FINAL3.pdf">A 2019 Dove study</a> found that Black women were 80 per cent more likely to feel pressure to change their hairstyles to fit in at the office. Black women were also 83 per cent more likely to report being judged on her looks than other women.</p>
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<figcaption><span class="caption">‘Subjects of Desire’ by Jennifer Holeness delves into issues of race, power and beauty.</span></figcaption>
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<p>The CROWN Act is not yet an official law. Despite <a href="https://thehill.com/homenews/house/598757-house-passes-crown-act-banning-race-based-hair-discrimination/">President Joe Biden expressing strong support for the bill</a>, there may not be enough votes to pass it. </p>
<h2>Rogers vs. American Airlines</h2>
<p>In 1981, American Airlines fired ticket agent Renee Rogers for wearing cornrows. She <a href="https://scholar.google.ca/scholar_case?case=6092364812619612919&q=Rogers+v.+American+Airlines&hl=en&as_sdt=2006&as_vis=1">filed a discrimination suit</a> challenging the airline’s policy prohibiting employees from wearing an all-braided hairstyle, claiming that such a policy violated the Civil Rights Act of 1964 and discriminated against her as a woman, and also as a Black person. </p>
<p>Legal scholar <a href="https://doi.org/10.2307/1372731">Paulette Cladwell</a> explained how and why the U.S. Federal District Court of New York rejected Rogers’s claim that the style evoked her African heritage. </p>
<p>The court said her hairstyle was a result of having seen the <a href="https://www.imdb.com/title/tt0078721/">1979 film <em>10</em></a>, starring <a href="https://www.youtube.com/watch?v=au0Pp_9oQbo">Bo Derek who makes an appearance wearing long braids</a> with beads at the ends. It became known as the “<a href="https://law.fiu.edu/2019/10/11/the-unnatural-treatment-of-natural-hair-courts-failure-to-recognize-hairstyle-discrimination-as-race-discrimination-the-need-for-state-legislature-action/">Bo Derek defence</a>.” <em>Rogers vs. American Airlines</em> was a landmark case because it set a precedent that sanctioned the firing of Black women on the basis of their hair.</p>
<p>In 2016, the 11th U.S. Circuit Court of Appeals ruled against a lawsuit filed by the <a href="https://www.vox.com/2018/4/18/17242788/chastity-jones-dreadlock-job-discrimination">Equal Employment Opportunity Commission (EEOC) against Catastrophe Management Solutions (CMS) for firing Chastity Jones, a Black woman</a>, because she wore her hair in locs. The lawsuit shared much in common with <em>Rogers vs. American Airlines</em>. Lawyers for Jones also argued that her termination was in violation of the Civil Rights Act. </p>
<p>The court of appeals ruled that <a href="https://www.nbcnews.com/news/nbcblk/u-s-court-rules-dreadlock-ban-during-hiring-process-legal-n652211">CMS’s “race-neutral grooming policy” was not discriminatory</a> because while hairstyles are “culturally associated with race” they are “not immutable physical characteristics.” The court ruled that a hairstyle might be closely associated with one’s culture but because it is changeable, it is not protectable under the law and an employer is within its rights to use it as a reason to deny employment.</p>
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<img alt="Supreme Court nominee Judge Ketanji Brown smiles." src="https://images.theconversation.com/files/456215/original/file-20220404-12538-fk7qau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456215/original/file-20220404-12538-fk7qau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456215/original/file-20220404-12538-fk7qau.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456215/original/file-20220404-12538-fk7qau.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456215/original/file-20220404-12538-fk7qau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456215/original/file-20220404-12538-fk7qau.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456215/original/file-20220404-12538-fk7qau.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">
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<span class="caption">Supreme Court nominee Judge Ketanji Brown Jackson smiles in Washington on March 31, 2022.</span>
<span class="attribution"><span class="source">(AP Photo/J. Scott Applewhite)</span></span>
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<p>Hair has also come up in discussions on <a href="https://www.oprahdaily.com/entertainment/a39520244/judge-ketanji-brown-jacksons-locs/">Ketanji Brown Jackson’s Supreme Court confirmation hearings</a> because the legal profession has often discouraged natural hairdos. In 2007, an editor from <em>Glamour</em> in a “do’s and don'ts” fashion event at a New York law firm <a href="https://www.law.com/nationallawjournal/almID/1188161099761/?slreturn=20220304144452">called locs “truly dreadful.” </a></p>
<h2>Why Black hair jokes aren’t funny</h2>
<p>When Black women are in legal and cultural battles for the right to wear their hair as they choose, jokes about our hair just aren’t funny. The <a href="https://www.npr.org/sections/codeswitch/2019/02/06/685506578/is-beauty-in-the-eyes-of-the-colonizer">straight hair standard of beauty has been called toxic</a> not only to Black women but women in general for the ways it valorizes white, western beauty ideals.</p>
<p>One may argue that public figures should be open to criticism. For example, United Kingdom Prime Minister Boris Johnson often shows up with his hair in disarray <a href="https://www.politico.eu/article/how-boris-johnsons-hair-defined-britain/">which gets poked fun at by media</a>. The difference is that there is no threat to his livelihood. </p>
<p>Until Black women can wear their hair how they want without risk of ridicule, reprimand or termination, a joke targeting Black hair is no laughing matter.</p>
<iframe height="200px" width="100%" frameborder="no" scrolling="no" seamless="" src="https://player.simplecast.com/7fc4af1d-0547-4ca1-9455-74fa87cd7a74?dark=true"></iframe><img src="https://counter.theconversation.com/content/180631/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cheryl Thompson receives funding from SSHRC Insight Development Grant.</span></em></p>Until Black women can wear their hair how they want without risk of ridicule, reprimand or termination, a joke targeting Black hair is no laughing matter.Cheryl Thompson, Assistant Professor, Performance, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1802802022-03-30T18:35:10Z2022-03-30T18:35:10ZWill Smith’s Oscar slap reveals fault lines as he defends Jada Pinkett Smith against Chris Rock: Podcast<figure><img src="https://images.theconversation.com/files/455034/original/file-20220329-17-hgmem0.jpg?ixlib=rb-1.1.0&rect=40%2C20%2C4500%2C2883&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Will Smith won the best actor Oscar for his performance in 'King Richard.' </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe height="200px" width="100%" frameborder="no" scrolling="no" seamless="" src="https://player.simplecast.com/7fc4af1d-0547-4ca1-9455-74fa87cd7a74?dark=true"></iframe>
<p><iframe id="tc-infographic-572" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/572/661898416fdc21fc4fdef6a5379efd7cac19d9d5/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>It felt like these Oscars were the first ones that <a href="https://www.nytimes.com/2020/02/06/movies/oscarssowhite-history.html">weren’t actually so white</a>. The whole event felt different. With attempts to display <a href="https://variety.com/2022/awards/news/hollywood-diversity-chloe-zhao-ava-duvernay-1235153061/">a more inclusive Hollywood</a>, the showcase seemed to go beyond its usual tokenism.</p>
<p>There was <a href="https://www.essence.com/awards-events/red-carpet/oscars/memorable-moments-94th-annual-academy-awards-2022/">gospel music during the In Memoriam segment</a>, <a href="https://www.nationalgeographic.com/history/article/questlove-on-the-summer-of-soul-an-awesome-look-at-beautiful-people-having-fun/">Ahmir “Questlove” Thompson won an Oscar for his beautiful documentary <em>Summer of Soul</em></a> and he gave a moving speech to accept the honour. The best picture <a href="https://www.theguardian.com/film/2022/mar/28/coda-wins-best-picture-oscar#:%7E:text=Family%20drama%20Coda%20has%20won,to%20win%20the%20top%20prize">was directed by a woman.</a> <a href="https://www.nytimes.com/2022/03/27/movies/oscars-hosts-monologue.html">Wanda Sykes, Regina Hall and Amy Schumer hosted</a> with verve and sass. Masks were off. The entire program opened with <a href="https://www.espn.com/tennis/story/_/id/33611843/oscars-2022-venus-serena-williams-introduce-beyonce-compton-tennis-court-performance-king-richard-song">queens Serena and Venus Williams and they introduced Queen Beyoncé</a>, who <a href="https://youtu.be/4aeDlZOD-B0">stepped out in glorious chartreuse</a>. It felt like a genuine celebration. </p>
<p>And then there was the <a href="https://www.washingtonpost.com/opinions/2022/03/28/oscars-slap-will-smith-chris-rock-defending-black-women/?utm_campaign=wp_follow_karen_attiah&utm_medium=email&utm_source=newsletter&wpisrc=nl-karenattiah">Will Smith-Chris Rock fiasco</a> taking attention away from all this. In what became one of the most infamous moments in the history of the Oscars, Smith got out of his seat to slap Rock for a bad joke aimed at Jada Pinkett Smith. </p>
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Read more:
<a href="https://theconversation.com/jada-pinkett-smith-and-black-womens-hair-history-of-disrespect-leads-to-the-crown-act-180631">Jada Pinkett Smith and Black women's hair: History of disrespect leads to the CROWN Act</a>
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<p>These flashpoints are always about other things – they are evidence of a layered story. In this case, it’s a story that’s divided people. Is it a story about toxic masculinity? It is a story of intergenerational trauma? Is it about a Black man <a href="https://www.nytimes.com/2022/03/29/opinion/culture/will-smith-oscars-roxane-gay.html">standing up for Black women</a>? </p>
<p><a href="https://dont-call-me-resilient.simplecast.com/">In this special episode of <em>Don’t Call Me Resilient</em></a>, we discuss this moment as a cultural flash point. We chat about how <a href="https://timesofindia.indiatimes.com/world/us/a-slap-at-oscars-heard-around-the-world/articleshow/90501314.cms">“the slap heard around the world”</a> is evidence of a <a href="https://www.refinery29.com/en-us/2022/03/10920053/chris-rock-will-smith-jada-slap-oscars">layered story</a> of racism, <a href="https://www.washingtonpost.com/opinions/2022/03/28/oscars-slap-will-smith-chris-rock-defending-black-women/?utm_campaign=wp_follow_karen_attiah&utm_medium=email&utm_source=newsletter&wpisrc=nl-karenattiah">sexism</a>, power and performance. Will Smith’s violent behaviour towards Chris Rock <a href="https://www.inquirer.com/columnists/will-smith-chris-rock-smack-oscars-20220328.html">raises questions</a> about toxic masculinity and also reveals the fault lines of a man who is perhaps still wrestling with his traumatic past.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CbqmaY1p7Pz/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Even though we’re not ready to start rolling out our regular season, which we plan to do in May, we couldn’t wait to talk about this cultural moment, so we produced this special episode. </p>
<p>Our guest is Cheryl Thompson, assistant professor in performance at the Creative School, Ryerson University, where she looks at race and representation. Thompson is the author of <em><a href="https://www.wlupress.wlu.ca/Books/B/Beauty-in-a-Box2">Beauty in a Box</a></em> about the politics of Black women and beauty, as well as <em><a href="https://chbooks.com/Books/U/Uncle">Uncle: Race, Nostalgia and Loyalty</a></em>. She’s also the director of the <a href="https://www.ryerson.ca/the-catalyst/residents/offices/media-representation-and-archives-lab/">Media Representation and Archives Lab</a> at Ryerson. </p>
<p>Thompson was the guest of <a href="https://theconversation.com/whats-in-a-word-how-to-confront-150-years-of-racial-stereotypes-dont-call-me-resilient-ep-1-153790">our very first episode</a> of <em>Don’t Call Me Resilient</em>, where we had a fascinating conversation about the n-word. If you have not heard that one, please check it out. </p>
<p>In the meantime, here is our <a href="https://podcasts.apple.com/ca/podcast/will-smiths-oscar-slap-reveals-fault-lines-as-he-defends/id1549798876?i=1000555742477">conversation on “the slap</a>.”</p>
<p>For an unedited transcript go <a href="https://dont-call-me-resilient.simplecast.com/episodes/will-smiths-oscar-slap-reveals-fault-lines-as-he-defends-jada-pinkett-against-chris-rock/transcript">here.</a></p>
<h2>Listen and follow</h2>
<p>You can listen or follow <em>Don’t Call Me Resilient</em> on <a href="https://podcasts.apple.com/ca/podcast/dont-call-me-resilient/id1549798876">Apple Podcasts</a>, <a href="https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9qZFg0Ql9DOA">Google Podcasts</a>, <a href="https://open.spotify.com/show/37tK4zmjWvq2Sh6jLIpzp7">Spotify</a> or <a href="https://dont-call-me-resilient.simplecast.com/">wherever you listen to your favourite podcasts</a>. <a href="mailto:theculturedesk@theconversation.com">We’d love to hear from you</a>, including any ideas for future episodes. Join The Conversation on <a href="https://twitter.com/ConversationCA">Twitter</a>, <a href="https://www.facebook.com/TheConversationCanada">Facebook</a> and <a href="https://www.instagram.com/theconversationdotcom/">Instagram</a> and use #DontCallMeResilient.</p>
<p><em>Don’t Call Me Resilient is a production of The Conversation Canada. This podcast was produced with a grant for Journalism Innovation from the Social Sciences and Humanities Research Council of Canada. The series is produced and hosted by Vinita Srivastava. Our producer for this episode is Nahid Buie. Our other producers are: Haley Lewis, Vaishnavi Dandekar, Folarin Odunayo and Latifa Abdin. Reza Dahya is our sound producer. Our consulting producer is Jennifer Moroz. Lisa Varano is our audience development editor and Anowa Quarcoo helps with outreach. Scott White is the CEO of The Conversation Canada. Zaki Ibrahim wrote and performed the music we use on the pod. The track is called ‘Something in the Water.’</em></p><img src="https://counter.theconversation.com/content/180280/count.gif" alt="The Conversation" width="1" height="1" />
In this special edition of ‘Don’t Call Me Resilient,’ we chat about how “the slap heard around the world” is part of a layered story of racism, sexism, power and performance.Vinita Srivastava, Host + Producer, Don't Call Me ResilientLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1802132022-03-29T12:35:36Z2022-03-29T12:35:36ZWhat is alopecia? It’s no laughing matter for millions of Black American women<figure><img src="https://images.theconversation.com/files/454828/original/file-20220328-23-burw6b.jpg?ixlib=rb-1.1.0&rect=0%2C32%2C4313%2C2754&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jada Pinkett Smith has spoken about her struggles with hair loss.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/jada-pinkett-smith-attends-the-94th-annual-academy-awards-news-photo/1388067835?adppopup=true">Jeff Kravitz/FilmMagic</a></span></figcaption></figure><p><em>The <a href="https://www.nytimes.com/2022/03/28/movies/oscars-will-smith-slap-reactions.html">Oscar slap that overshadowed the Academy Awards ceremony</a> was sparked by a joke about Jada Pinkett Smith’s lack of hair – with husband Will Smith objecting violently to comedian Chris Rock mocking the actress’s shaved head.</em></p>
<p><em>Away from the recriminations over what could be perceived as <a href="https://nypost.com/2022/03/28/fresh-prince-co-star-defends-will-smiths-chris-rock-slap/">a mean-spirited jibe</a> and <a href="https://www.theguardian.com/film/2022/mar/28/celebrities-react-will-smith-hitting-chris-rock-the-oscars">a disproportionate response</a>, many people will sympathize with Pinkett Smith. As millions of women in the U.S. will attest, hair loss <a href="https://www.doi.org/10.1001/jamadermatol.2020.5732">is no laughing matter</a>.</em></p>
<p><em>The Conversation asked <a href="https://dermatology.med.wayne.edu/profile/ds8312">dermatologist Danita Peoples</a> of Wayne State University’s School of Medicine about alopecia and why certain forms of it can <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/hair-loss-in-black-women-tips-from-an-expert">disproportionately affect Black women</a>.</em></p>
<h2>1. What is alopecia?</h2>
<p>Alopecia is a medical word that refers to hair loss generally. And there are descriptors added which can refer to where the hair loss is occurring, or to the cause of it. Traction alopecia, for example, is hair loss from trauma or chronic inflammatory changes to the hair follicles. </p>
<h2>2. What causes alopecia?</h2>
<p>Traction alopecia happens when there is trauma to the scalp, where the hair is being pulled or rubbed on a regular basis, causing inflammation around the hair follicles. This can lead to hair loss or thinning. </p>
<p>Alopecia areata describes hair loss to a particular area. It has different levels of severity, so there might be just a coin-sized area of hair loss on the scalp, or it could affect large areas. It can occur any place on the body.</p>
<p>Or it might result in complete hair loss on the scalp, alopecia totalis. Some people lose eyebrows or see a thinning of their eyelashes. </p>
<p>People can even have alopecia universalis, which is a loss of hair on the entire body. </p>
<p>Alopecia areata is considered an “immune-mediated” type of hair loss. The immune system is attacking the hair follicles. It has to do <a href="https://doi.org/10.3389/fimmu.2019.01198">with T cells</a>, the important white blood cells in the immune system.</p>
<p>And then other autoimmune disorders can have alopecia associated with them. This is the form of alopecia that <a href="https://www.prevention.com/health/health-conditions/a38634649/jada-pinkett-smith-hair-loss-journey-alopecia/">Jada Pinkett Smith has said she has</a>.</p>
<p>Lupus is an autoimmune disorder that can lead to hair loss. One type is systemic lupus erythematosus. Another type, discoid lupus erythematosus, primarily affects the skin and can cause hair loss with scarring on the scalp.</p>
<p>Thyroid abnormalities can be related to hair loss as well. In fact, when patients come to me with hair loss, the first test that I may order is a thyroid study.</p>
<h2>3. Who does it affect?</h2>
<p>Anyone can get alopecia. Alopecia areata can show up at any age, from children to adults, and both men and women. But it’s more likely <a href="https://doi.org/10.1016/j.jaad.2019.06.1300">to affect African Americans</a> than white or Asian Americans. About 1 million people in the U.S. <a href="https://dx.doi.org/10.2147%2FCCID.S245649">have alopecia areata</a>. </p>
<p>Traction alopecia can affect people in certain professions, like ballerinas, who wear their hair up in buns all the time. The pressure and friction from sports headgear, like helmets or baseball caps, can also cause hair loss. And in some parts of northern Europe, where it is common for people to pull their hair back tight on a regular basis, there are higher rates of traction alopecia. Traction alopecia <a href="https://doi.org/10.2147/ccid.s137296">affects one-third</a> of women of African descent, making it the most common type of alopecia affecting Black women.</p>
<h2>4. Why is traction alopecia so common among Black women?</h2>
<p>That is due to certain hair styling practices that Black women use on their hair – wearing tight weaves or extensions, straightening with heat, that sort of thing. Hair is a big deal among African American women in a way that it isn’t for others. When I was growing up, my older relatives told us girls that our hair was our “crowning glory.” And they made a big deal about us keeping our hair looking stylish and well groomed, and that usually meant straightening it.</p>
<p>But I believe there’s less pressure than there used to be for Black women to keep our hair straightened, in the workplace or elsewhere.</p>
<h2>5. How is alopecia treated?</h2>
<p>It depends on the cause. There are injected or topical corticosteroids for alopecia areata. If it’s due to a nutritional deficiency, like iron or protein, obviously you simply need to correct the deficiencies with supplements or by changing the diet. When it is caused by traction or discoid lupus, if you don’t treat the inflammation on the scalp soon enough, the hair loss can become permanent.</p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p>
<p>When it comes to traction, though, it’s much more about eliminating the practices that cause the problem in the first place. What’s happening now is more people are aware of the downsides of chemical or heat applications to straighten the hair and are using those damaging processes less. </p>
<p>One thing that may help is the CROWN Act, legislation introduced last year, which the U.S. House passed on March 18, 2022. That would make it <a href="https://www.congress.gov/bill/117th-congress/house-bill/2116/text">illegal to discriminate</a> against people wearing natural styles, such as afros and braids, so I am hopeful that it will contribute to a lot less traction alopecia in the future.</p><img src="https://counter.theconversation.com/content/180213/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danita Peoples does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The joke that sparked a violent reaction from actor Will Smith at the Oscars centered on his wife, Jada Pinkett Smith’s hair loss. A dermatologist explains the causes and treatment for alopecia.Danita Peoples, Clinical Associate Professor of Dermatology, Wayne State 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>
</figcaption>
</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>
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<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/399432015-04-14T12:26:29Z2015-04-14T12:26:29ZCuring baldness may just be about having enough pluck<figure><img src="https://images.theconversation.com/files/77517/original/image-20150409-15216-1c8pjzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ok, when will it come back?</span> <span class="attribution"><a class="source" href="http://i.huffpost.com/gen/1294515/images/o-BALD-facebook.jpg">HuffingtonPost.com </a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Shaved heads have come in and out of fashion over the past few decades, but some people don’t have the option of allowing their locks to grow. Thankfully, for those who do suffer from hair loss, or alopecia, help may be at hand. Somewhat counter-intuitively an effective treatment for baldness may come from plucking a certain number of hairs – in a specific formation – from the scalp. </p>
<p><a href="http://www.nejm.org/doi/full/10.1056/NEJM199908123410706">Hair follicles</a> – the skin organ responsible for hair growth – contain stem cells that constantly divide, they are the driving force behind new hair growth. A healthy hair follicle produces about six inches of hair every year, but if the follicle stem cells malfunction and stop dividing, hair growth ceases and conditions such alopecia are observed. </p>
<p>Androgenic alopecia – or male pattern baldness – is the most common form of hair loss and will effect around two-thirds of men and one-third of women during their lifetime. </p>
<h2>Regeneration response</h2>
<p>Our <a href="http://www.cell.com/cell/abstract/S0092-8674%2815%2900182-8">recent study</a>, published in Cell, and completed on a mouse model, is unique because it not only studies the regeneration of a single hair follicle, but focuses on the regrowth of several follicles that had previously been effected by alopecia. </p>
<p>We demonstrated that plucking a few properly arranged hairs can trigger regeneration of hair follicles stem cells in up to five times more neighbouring, un-plucked surrounding hairs.</p>
<p>It is not surprising that follicle stem cell injury – caused by plucking – can cause a regeneration response. But, generally the stimulation of one stem cell through injury is only thought to cause regeneration in that stem cell alone. Triggering the regeneration of a whole head of hair in this way would be highly inefficient. But can the regeneration response of several stem cells be triggered by stimulating only a few key cells or signals? </p>
<h2>Decision making in stem cell populations</h2>
<p>Recently, we accidentally discovered that regeneration could occur through a collective decision-making process. By plucking the correct number of hairs with a proper arrangement, up to five times more neighbouring, unplucked resting hairs were activated to regrow. But if the number of plucked hairs was below a threshold, no hairs regenerated. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/77519/original/image-20150409-15223-1g3lzxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/77519/original/image-20150409-15223-1g3lzxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/77519/original/image-20150409-15223-1g3lzxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=638&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77519/original/image-20150409-15223-1g3lzxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=638&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77519/original/image-20150409-15223-1g3lzxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=638&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77519/original/image-20150409-15223-1g3lzxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=801&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77519/original/image-20150409-15223-1g3lzxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=801&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77519/original/image-20150409-15223-1g3lzxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=801&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Collective-decision time.</span>
<span class="attribution"><a class="source" href="http://www.eurekalert.org/multimedia/emb/89363.php">Cheng-Ming Chuong</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>This type of regeneration is an all-or-nothing process which is dependent on the signals produced by a fraction of hairs being plucked, and is an example of the process known as <a href="https://www.nottingham.ac.uk/quorum/what.htm">“quorum sensing”</a>. </p>
<p>Quorum sensing can be thought of as a decision-making process which is dependant on certain criteria being met within a population. Signalling molecules are released by each stimulated component of the population, the more components that are stimulated the more signal molecules are released. As the elements in the system are able sense the number of signal molecules released by the population as a whole, they can also sense the degree of stimulation. When a certain threshold of stimulation is reached, a collective response from the components in the system will follow. </p>
<p>The process of quorum sensing has been used to describe bacteria cell-to-cell communication, where the expression of certain genes is coordinated between many bacteria in response to environmental factors such as an increase in the presence of bacterial toxins. Quorum sensing has also been used successfully to explain the <a href="http://jackknife.med.yale.edu/nsci590-2009/pdfs/pratt2002.pdf">behaviour of social insects</a> such as ants and honey bees for their collective decision-making.</p>
<h2>Cast and count</h2>
<p>But in reality, how does the population of hair follicles “cast and count its vote” in quorum sensing?. First, there is a stimulus – such as hair plucking, which stimulates follicle stem cells – to some, but not all, hair follicles. Second, the plucked hair sends out a signal to surrounding cells. Third, the group of cells gauges the intensity of signal from its surroundings. Finally, a local decision is made within the population in an all-or-nothing fashion: if enough hairs have been plucked, mass hair regrowth will occur, but if not, there will be no response at all. </p>
<p>In the most simple cases of quorum sensing, the signal molecule spreads by diffusion from the secreting cell. But it was found that the signals being released by plucked hair follicles were travelling further than could be achieved by simple diffusion, suggesting that a something more complicated was involved. </p>
<p>Molecular and genetic analysis revealed that the signals were transmitted through a two-step immune response, triggered by the plucking of the hair follicle. First injured hair follicle stem cells will release a small signal molecule, this recruits a specific cell type involved in the immune response called a <a href="http://www.nature.com/nri/focus/macrophages/index.html">macrophage</a>. This then secretes a signal molecule involved in the immune response called a <a href="http://www.news-medical.net/health/What-are-Cytokines.aspx">cytokine</a>, which acts directly on surrounding hair follicle cells by stimulating various cellular regeneration signal pathways. </p>
<h2>Repair and regeneration</h2>
<p>This work shows that a quorum-sensing system can sense cell injury and use immune response to quantify how much damage has occurred. The stem cell population then disregards the stimulus if the minimum number of hairs has not been plucked, or responds to it with a full-scale regenerative response in many hair follicles when a threshold is reached. </p>
<p>This finding also is important in the field of regeneration medicine as a whole. We believe that the quorum-sensing behaviour principle is likely to be present in the regeneration of tissue and organs beyond the skin. Using such efficient regenerative strategies opens a new window in treating hair loss as well as many other degenerative disorders.</p>
<p><strong><em>This article was co-written with Chih-Chiang Chen from the Taipei Veterans General Hospital</em></strong></p><img src="https://counter.theconversation.com/content/39943/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cheng-Ming Chuong has receive funding from National Institutes of Health (NIH)</span></em></p>Plucking hairs from the scalp causes surrounding hairs to regenerate, and could be a novel treatment for alopecia sufferers.Cheng-Ming Chuong, Professor of Tissue Development and Regeneration, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.