How to deal with balding and hair loss

By Lee Sung-hun

A fifth-grader visited my clinic a few weeks ago with his mother. The boy had a small bald spot, the size of a 50-won coin, near the front of his scalp.

The boy, who already had a sensitive temperament, had recently moved to a new school and was preparing for exams.

The boy’s mother said her husband also suffered from this problem from time to time.

Alopecia areata, or spot baldness, is a rather common condition that can affect the hair follicles and not too uncommonly the fingernails and toenails.

Typically, coin-size bald patches appear, mostly on the scalp. However, they can also affect the beard, eyelashes, eyebrows and other body hair.

A couple of very small bald spots may not concern people much, but hair loss can expand to the entire scalp, which is called alopecia totalis, and even to the whole body, which is called alopecia universalis.

We do not know exactly what causes alopecia areata, but it is considered a type of autoimmune disease.

The most crucial function of our immune system is to distinguish between our own tissue and material that is foreign, so that the foreign objects can be eliminated.

For some unknown reason, the immune system sometimes does not recognize the hair roots as part of the body and attacks these perceived “foreign objects.” This results in spot baldness.

As the immune system fights the hair root, the hair strand typically becomes narrower toward the root and takes the shape of an exclamation point. If you find patches of hair loss and exclamation point-shaped hairs, you can view that as a sign that your immune system is out of sync and alopecia areata is in progress.

Genetic factors may play a role in alopecia areata, as 20 to 30 percent of patients show family history. Stress could also play a role, but it is certainly not the main cause.

Generally, about 35 to 50 percent of alopecia areata patients recover within a year without treatment.

But in children before puberty, the condition can recur frequently and is more likely to progress to alopecia totalis or alopecia universalis. Therefore, it needs to be monitored carefully.

Patients who seek medical assistance usually do so as a last resort, having waited a long time for symptoms to go away on their own. In such cases, patients require more proactive treatment.

In Western medicine, the aim of treatment for alopecia areata is to reduce inflammation around the hair follicles. To that end, steroid-based immunosuppressants are prescribed. Although they can alleviate symptoms temporarily, frequent usage can cause scalp shrinkage and other side effects.

In Oriental medicine, hair as an organ belongs to the kidneys, and thus the health of the kidneys can be known by observing the hair. Sufficient blood qi is said to result in thick hair.

If the qi of the kidneys or blood is insufficient, hair cannot sustain enough nutrients, leading to hair loss. Also, stress causes hwa, meaning fire, to accumulate in the liver and heart. As hwa — a type of yang-qi — tends to rise upward, it “burns” the hair to cause hair loss. For alopecia areata, treatment aims to strengthen the kidneys and blood qi while bringing down the heat of the hwa that has accumulated in the heart and liver.

With the exact cause of spot baldness still unknown, it is difficult to prevent it. Yet it is fair to say stress management can help. That means staying positive, as well as getting sufficient sleep and regular exercise.

I have met some patients who mistakenly believe that using shampoo can promote hair loss if it is already occurring. On the contrary — if dust, sebum and sweat block the pores, this only aggravates inflammation and worsens hair loss.

The best practice is to shampoo at the end of the day to remove dust and other particles and keep the hair clean. Some alopecia areata patients opt to use a toupee or a hat to cover the bald spots, but extended usage can create a heat trap that can directly contribute to further hair loss; thus, care should be taken.

If you notice that the bald spot is larger than a coin or if you do not see improvements within the first three months, it is recommended that you seek professional medical assistance.

The writer practices Korean oriental medicine at the UN Oriental Medical Clinic in Hannam-dong, Seoul.