Wednesday 21 March 2018

Ask the GP:Learning to cope with hereditary conditions

Male pattern baldness affects 30pc of 30-year-olds and 50pc of men over 50. Photo: Getty Images.
Male pattern baldness affects 30pc of 30-year-olds and 50pc of men over 50. Photo: Getty Images.

Nina Byrnes

Q: My dad is bald since his mid-20s. I just turned 21 and I've noticed my hair thinning a bit. Am I destined to be bald too? Is there anything I can do bout it?

Dr Nina replies: Male pattern baldness affects 30pc of 30-year-olds and 50pc of men over 50. In the majority of cases the cause is a hereditary condition called androgenic alopecia. While there are no known physical problems, the psychological impact can be significant. Male pattern hair loss can pass through either side of the family. If you have a first-degree relative who is bald your chances are increased by 50pc.

In male pattern baldness the hairline at the front recedes first, then a bald patch develops at the top of the head. Slowly these areas enlarge and eventually merge. Normal healthy hair grows for three to six years then sheds and a new hair grows. In male pattern baldness the follicles get smaller, leading to thinner weaker hair. The growth cycle becomes shorter until eventually only a small stub of hair, that doesn't make it to the skin surface, remains.

Male hormones play an important role in this. Testosterone is converted to a hormone called dihydrotestosterone (DHT) in the hair follicles. Those with male pattern baldness have increased sensitivity to this, causing the follicle to shrink. It is not clear why only some hairs are affected at a time or why this process doesn't affect hair on other parts of the body.

Diet advice such as low processed, or one high in protein, silica, iron and zinc, is largely based on the fact that hair is composed of protein. Evidence for diet management is largely lacking. There are two medical compounds, which do show some benefit.

Minoxidil (Rogaine) is a solution applied topically, twice daily. It comes in 2pc and 5pc strengths. The 5pc compound has shown more benefit although is more unpleasant to apply. About 15-in-100 users report good results with this. It must be applied everyday and takes about four months for full benefit.

Finasteride (Propecia) is a prescription medicine initially designed to help with prostate problems. It is a tablet taken once daily at a dose of 1mg. It works by blocking the conversion of testosterone to DHT thus allowing the hair to remain thicker.

Some hair regrowth is reported in two to three of men. In studies it only works on hair loss on the top of the head. It did not help with hair loss at the sides.

Both remedies are considered safe although some side effects have been reported. Minoxidil can cause irritation, rash and itch.

Finasteride results in reduced libido in approximately 2pc of users and has also been associated with breast enlargement or tenderness. Finasteride can change the result of the PSA test.

Both remedies are expensive and need to be continued indefinitely as hair loss returns when they are stopped.

Hair transplant surgery is another popular but expensive treatment for hair loss.

Follicles are transplanted from the healthy areas at the back of the head to the thinning areas on top. The process is well tolerated and most men are happy with the result.

The last option is to embrace your hair loss.

Some find it less traumatic than they feared.

Q. I have bumpy, sandpaper-like skin on my upper arms. It is white mainly but red at times. I am really conscious of this and too embarrassed to wear short sleeves, as it looks dreadful. Is there anything I can do about it?

Dr Nina replies: Keratosis pilaris causes coarse, dry, sandpaper-like bumps that appear mainly on the arms, thighs and buttocks.

Keratin is a tough protein that forms a protective layer on the skin when built up in the hair follicles and forms a scaly plug, which leads to the bumpy texture of the skin. Dry skin makes the condition worse and it is more common in those who have conditions such as dermatitis and eczema.

As for many dry skin conditions, effective moisturising is key to management of this condition. Moisturisers, which contain urea, are particularly effective. Hydroxy, lactic and salicylic acid products will also help loosen skin cells and free up keratin plugs. These acids may irritate skin and cause redness and are not recommended in children.

Gentle exfoliation can assist clearing keratin plugs but vigorous scrubbing is likely to make the condition worse.

Topical steroids are occasionally used and can help reduce irritation and inflammation. Retinoids, creams derived from vitamin A, encourage cell turnover and reduce the formation of plugs but may also increase skin dryness and irritation.

General skin care, such as avoiding over-perfumed skin products and patting skin dry rather than rubbing, are also key to treatment. If your home or office environment is very dry, using a humidifier may help reduce skin dryness.

Keratosis pilaris is not a dangerous condition and is not associated with any chronic damage or disease and in many people improves greatly over the age of 30. Treatment, once started, usually needs to be continued as skin changes reoccur upon ceasing it. Fake tan may lessen the appearance.

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