Trichotillomania: nice name, nasty condition

Finger on the Pulse

After my third baby, my hair fell out in handfuls. I was left with some patches of fine downy hair growing, and the rest of it looking thin and lank. I recognised this as one stage before false teeth and saggy boobs. Years later, I can now say it was. However, as a doctor, I did know what was happening, although it didn't help very much. This was telogen effluvium. In pregnancy, your hair rests, and doesn't shed as normal. When people say how thick and shiny your hair is when you're pregnant, it is nature playing a con trick. It spits in your eye afterwards, when you lose this glossy hair, and even a bit more. Medically, I knew it would eventually recover. But like the next person, I tried massage and special shampoos to restore it to its former natural lustre and thickness.

Hair loss, however little, provokes great anxiety, both for men and women. It is usually one of several types. The first of these is alopecia areata - coin-shaped hair loss. With this, people may lose hair from several areas on their scalp. There is no specific treatment that works miracles and it's difficult to predict whether hair will grow back. This may not be the answer a patient wants to hear, and usually leads to a demand for a referral to a dermatologist. Occasionally, injections of a steroid are tried, but still may not end in great success. Some patients then go to see a trichologist, to seek some sort of ointment. Faced with the facts, that the hair may grow back or just get worse, most of us would try anything.

I have a friend whose father woke up one morning when he was 30, and all his hair had dropped out. I mean all. This is called alopecia totalis et universalis. Too bad. It was a shock to him, and to his family. He had to learn to live with a different man in the mirror, and so did his wife.

Several months ago a mum asked me to go and visit her daughter at home, as she refused to go to school because she had lost a lot of her hair. At the house, I saw a 14-year-old girl lying on a settee with a towel wrapped around her head like a turban. She allowed me one peek below the towel. She had straggly hair with big bald patches. This girl had been pulling out her own hair to avoid school. This is called trichotillomania (brilliant name, but nasty condition) and usually requires psychological help.

Of course we know male-pattern baldness is common. A report in the British Medical Journal recently showed a link between smoking and baldness. There are always exceptions, as my two brothers prove. They had lost most of their hair before the age of 30, and neither of them were smokers. It is said that women don't mind their partners going bald. Is this really true? Or is it actually that when this happens, that no one else will fancy them and they have an in-built security device?

Men certainly believe they look more attractive with hair. Minoxidil ointment was heralded as a miracle cure. Hair regrowth with it may be quite sparse, and you do have to keep using it. Hair transplantation has become a more popular option. In early days, men seemed to end up with tram lines on their head, with the new hair in all-too-perfect rows. Now, for pounds 2,000, you can take hair from the back of the head, seed it in the front area, and wait for it to grow! The results can be good, especially if your hair has a bit of curl.

One patient I knew had lost all her hair after chemotherapy, and would not go out at all - or go near her husband. Her husband said he loved her just the way she was, but she still felt unattractive. I suggested she got a wig. One Monday morning a few weeks later, she came into surgery with it on, beaming. She had been away with her husband for the weekend and all was well again. She reminded me that beauty was only skin deep. It wasn't what he had thought, but how she felt that had really mattered.