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Baldness stress-related, says Bangalore doc

M D Riti in Bangalore

For almost two months, CR, 17, a college girl of Bangalore, had been on a crash diet, eating just one meal a day. One month into the diet, she noticed large clumps of her hair collecting near the drain after her bath, and in her comb.

Distraught, she rushed to her dermatologist, only to be told to get off the silly diet, adopt a more rational one, to exercise to lose weight. And her hair all grew back in less than two months.

When SK's father died suddenly, the 24-year-old businessman had to jump right in and take over the family business. Very soon, he also found that in addition to the business, he also appeared to have inherited his father's tendency of baldness. Something told him that he was losing too much hair much too early, so he asked a skin specialist. A combination of medicines and yoga helped him grow fresh fuzz on bald patches of his scalp in four months.

It was his banker who told AM, 38, an event manager in Bangalore, that he had developed a bald spot on the back of his head. To his horror, more patches appeared all over his scalp and even his moustache over the next fortnight. When he told his doctor about how much he hated his daily commute, with its bad roads, traffic congestion and pollution, the practitioner knew he had found the key to helping him. In addition to treating him with medicine, he told him to play relaxing tapes while he travelled every day and try to work more out of his home. Three weeks later, the patches had disappeared.

Are you losing sleep over falling hair? Do you dread waking up in the morning and finding it on your pillow, or bathing and finding it clogging up your drains? Do you blame it all on your father's balding pate and wish you had more hairy ancestors?

If you are, then you might just be adding to your hair loss problem by increasing your stress levels. According to Dr Anil Abraham, professor of dermatology at St John's Medical College Hospital in Bangalore, stress is a major cause for baldness in both men and women. This is the broad conclusion he draws from a five-year study just completed. Over five years, between 1994 and 1999, he studied over 350 patients who came to him with complaints of hair loss. Interestingly, he found that 75 per cent of them showed high stress levels, in a specially-designed questionnaire that he made them answer.

And specific treatment of such stress, used in combination with medicine, helped reverse the baldness or at least control it better than plain old 'modern medicine'.

"Skin and hair are your social passport," Abraham told rediff.com from his home clinic in Vasanthanagar, Bangalore.

"If you have a liver or heart problem, nobody knows. But a balding head can be a social embarrassment because it is immediately visible to everyone and they all want to comment upon it. The last thing you do before you meet someone is comb your hair, right, because its right up there and its right out there. It's a very important part of life. It's a kind of vicious cycle because hair loss causes stress and stress in turn causes hair loss.

Somewhere, the cycle has to be interrupted. Just giving people lotions, oils and creams to apply, and tablets to swallow just does a part of the job. But you're not tackling the root cause. So we decided to study patients more extensively, rather than just the usual approach of assessing what the patient's hair problem is and starting them on symptomatic treatment, which helps hair to grow."

When a patient comes to Abraham complaining of worrying hair loss, he first takes a case history from them and then puts them on routine medical treatment appropriate to their specific problem. He uses a trichogram test, which involves a hair pull to study the type of hair and possible causes of loss. For example, this test indicated that a particular patient had a severe uncorrected zinc deficiency that needed to be corrected in addition to treating other key causes for hair loss like stress.

Meanwhile, he also gets them to fill out a questionnaire assessing their stress levels. Once he evaluates their stress level, if any, and its cause, he then adds stress-relief treatment to the medical treatment.

"We started looking for the causes, ranging from fungal infections to genetic or hereditary problems," he says. "But we soon found that whatever the other causes were, huge numbers of patients had stress as an underlying factor.

Surprisingly, we tend to think of hair loss as a male problem. Actually, there are large numbers of women suffering from this too. The women were more perturbed about things like how they used to have thick healthy hair, and now you could see their scalps. Was it to do with nutrition, or having babies, they asked? Actually, we don't realise that its largely because women have double stress, managing both home and a job.

Domestic tension and the stress of commuting are much more in women than in men, actually."

Abraham's study, which he concluded with the help of research fellows working under him at the hospital, concluded that work stress was the most frequent type of stress affecting his patients, followed closely by domestic stress. Of the 350 people he has studied and treated, 190 were men and 60 women, indicating that hair loss is a common problem for both sexes.

Abraham says that those people who lead high stress lives might have to make major and permanent lifestyle changes if they want to ward off baldness. Those people who went back to their old ways as soon as their hair started growing back, quickly had setbacks.

"I try to find out what the person's lifestyle is like, what could be the cause of stress to them and first work at eliminating or lessening that," says Abraham. "One of our questions was about commuting stress, and we found this was so high in Bangalore. We just listed a whole lot of things we thought could be stressful: I myself have a long, stressful commute to the hospital from my home every day. We advised people to car pool or find alternative means of travel that did not involve their driving themselves. If a person travels to work by a very congested route, I might advise them to take an easier route even if it's longer."

The stress reduction techniques he might add on could vary from yoga to meditation or even just listening to music. "There's no point in advising a student to attend Bhagavad Gita classes; he would not do it for more than a day or two," says Abraham. "But if you tell him to listen to music on a Walkman and go on a long walk or jog every evening, he probably will do it for a sustained period of time."

Did these additional techniques make such a big difference to the patient's recovery?

"With just medicines, recovery was slow and there were frequent relapses," he says. "With stress relief techniques used in addition to medicine, results showed in just half the time -- three months as against the six months with medication alone -- and relapses were much less. As it was a five-year study, we could follow them up for a long period of time.

In fact, the differences were so dramatic that I shifted the control group to stress-relieving techniques after a year, because it didn't seem fair to deprive them of such a great treatment."

Can Abraham really reverse all kinds of baldness, or is he only focussing on temporary varieties like Alopaecia Ariata, which manifests as sudden bald patches on the scalp and beard?

"There are hair loss problems that are permanent," he admits. "When we took patients on for our study, we eliminated those with scarring hair loss problems due to burns and so on. But lots of patients say that they have permanent hair loss because of genetic factors. But if you take a history from these people, you find the fathers started balding when they were forty plus, but they are balding in their late teens or early twenties.

"Why are they showing signs of baldness 15 years earlier than their fathers? The reason is obviously only stress. Even though we are battling nature here, and they are slowly going to progress to male pattern baldness at some point, it should not start so early, and if it has, we can reverse the process and hold it until they are about 40. Most of them want just that. When they are the peak of their activity, in their twenties, getting jobs, getting married, and having children seeing them at PTA meetings, they want full heads of hair. After that, they are willing to go gracefully bald."

Women, on the other hand, according to Abraham, are more often victims of temporary and reversible baldness, mostly caused by nutrition problems like fad dieting. They suddenly adopt odd food habits to lose weight, which result in hair loss. Another major reason now is the hair treatments like perming and colouring that women go in for to look better.

Abraham says old hair conditioners like coconut oil and henna were very good for the hair, but chemical treatments and perms are very damaging. However, the damage they do is not permanent, but treatable.

"Consistent treatment can help them get back the thick hair that they like to tell their children they once had," says Abraham, who is also an amateur English theatre actor.

Are miracle hair cures quite useless then? "I think we all like to look for miracles to solve problems than to work on them the hard way," says Abraham. "There are more than three million such hair cures being investigated by the FDA in America right now and not one of them had been proved.

"Instead of looking for instant remedies like oils that you can use for 10 days to grow back all your lost hair, it would be far more effective to see what you are doing wrong with your life and seeing how you can correct that."

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