Is a cure for baldness such a hair-raising idea?
'Scientists have found a cure for baldness' ran the banner headline this week - and I turned immediately to the small print. It's not just the general population who are interested in hair loss - my patients ask me about it on a daily basis in my practice, and I hate the fact that I have so little to offer. I'm as keen as anyone for a cure - but sadly, for most people, this won't be it.
Your hair goes through three phases of in its life cycle. In the 'anagen' phase it grows at about 6 mm a month (in people of Afro-Caribbean origin) to 1.2 cm a month (in Caucasians). This goes on for an average of three years, although the anagen phase can last from two to seven years. People of Asian origin often have a much longer anagen phase, so can grow their hair much longer.
The 'catagen' stage lasts just a couple of weeks, as the hair follicle stops actively producing hair and prepared for the four-month(-ish) 'telogen' or resting phase. Hair can fall out during this phase or at the start of the new anagen phase. Usually different hairs are at different stages of their life cycle, so the thickness of your hair stays about the same.
However, a major life stress can cut short the growth cycle of your hair, causing more to fall out at the same time. As if the stress you've gone through isn't bad enough, you find yourself losing handfuls of hair to boot. The good news is that this form of hair loss, called telogen effluvium, is usually temporary and your crowning glory should be back to normal in a few months.
Male pattern baldness is a bit like death and taxes - if you're a man, it's bound to get you if you live long enough. It does happen in women, too, although it's less common and tends to affect the top of the head rather than leading to a receding hairline. Some of my patients try to comfort themselves by saying it's related to high testosterone. Nice try, chaps, but testosterone levels in men with male pattern balding are usually normal. In fact, it's usually due to increased sensitivity of the hair follicles to a hormone called dihydrotestosterone - a product of testosterone. And this study wasn't even looking at male pattern balding.
The latest research was actually targeting only one form of hair loss, called alopecia areata, which causes patches of baldness that can affect anything from a few millimetres of scalp to the whole head (and even eyebrows and pubic hair). Thought to be an auto-immune condition, your body's own immune system, which usually fights off infection and other invaders, turns on part of your own hair follicles.
The drug in question, ruxolitinib, is already used to treat cancer and pre-cancerous conditions of the blood and bone marrow. In this study of people with alopecia areata, three quarters of sufferers responded, with an average hair regrowth of 92%. So far, so exciting. But the study was small (just 12 people) and only those with more than 30% hair loss were included. Even for people who have exactly these symptoms, it's likely to be years before the drug is licensed on the NHS even if future studies go well.
Still, overall the drug was well tolerated in this study and there were no major side effects seen. The researchers apparently plan more studies on larger groups of patients, and may well be looking at those with scarring alopecia and male pattern baldness. But this is a serious drug with a long list of drug interactions and potential complications, including a drop in red and white blood cells and platelets. Baldness may be distressing but it won't kill you. And that means the risks and benefits of this treatment will have to be scrutinised very carefully indeed.