Alopecia: The sad and lonely life of women without hair
By Gardy Chacha | September 26th 2021
Pointing at the left side of her head, Veronica Achieng’s roommate asked, “Do you have a fungal infection?”
“No. Why do you ask?” Achieng inquired.
“Because you have a patch with no hair on your head,” her roommate responded.
Achieng’s natural reflex was to run her fingers through her head and inspect the patch. Indeed, it was there: terrifyingly smooth and hairless. She was miffed.
She says: “I was advised that it was a fungal infection. I went to the pharmacy and got antifungal medicine.”
She also explored alternative therapies and tried “everything and anything someone would suggest.”
But the patch did not disappear. In fact, it grew – to the size of a large lemon.
“I used to wear head wraps and caps to conceal the patch,” she says.
Covering the head did not come naturally to her. She ditched them for a Mohawk – shaving the sides while maintaining hair in the mid-section.
The patch continued to extend. Eventually, she decided to shave everything and go bald. To date, she recalls the ‘walk-of-shave’ coming from the barber shop with her scalp reflecting the sun above.
“Everyone was staring at me. I could feel eyes trailing me. I wanted to hide,” she says.
Achieng admits that she, too, felt awkward; like something was amiss. She was not used to a bald head. She was grappling with a mixture of emotions.
“I am not used to this look. And then, we live in a society that relates to a woman who has a full head of hair.
“Girls laughed at me. Someone asked me if I had lost my husband. People were making fun of me. It was quite a depressing period in my life,” she says.
Later, Achieng visited a dermatologist who diagnosed the condition as alopecia. The doctor told her that she could not guarantee the hair growing back. It was an uncomfortable discussion but one that forced her to accept the possibility that she might never have her hair back.
“That was when I decided to go online and look for my fellow ‘baldies’ – perhaps for emotional and psychological support,” she says.
She was surprised to meet other women who had experiences similar to hers. Prominent among them was Carol Nkinda.
My dreadlocks were thinning
Nkinda, now aged 48, first developed bald patches in 2015.
“The patches were the size of a coin,” she says. “I had dreadlocks at the time but they were thinning rapidly.”
Nkinda eventually had to shave her head: first into a Mohawk (rings a bell?) then eventually going bald.
It sent her into mild depression. “Everywhere I went people looked and stared. People made nasty comments. Sometimes, loud enough that I could hear.
“I heard one person say, ‘why would a woman shave to look like a man?’. Another person commented that I had cancer. And so on,” she says.
At times she wore wigs just to ward off the unsolicited attention. Nkinda suffers other skin afflictions: eczema and skin ulcers. A dermatologist diagnosed her with Alopecia Ariata (AA).
“It was caused by an autoimmune disease known as Discoid lupus. It means my body recognises my hair follicles as foreign and therefore attacks and kills them,” she says.
Growing up, Nkinda had never paid her hair much attention. Having a full head of hair was a mundane fact of life.
“You don’t know the value of something until you lose it,” she says.
For others, like Lynet*, a 26-year-old in Nairobi, long hair on a woman “is part of her beauty.”
She says: “I don’t feel beautiful. I hate that everywhere I go I have to cover my head with something.”
Looking at Lynet’s pictures in her early twenties, the contrast is undisputable. Back then she spotted a thick, healthy mane.
“I used to get compliments for my hair: men loved commenting about it. And then all of a sudden, the middle is gone.”
It’s been slightly more than a year since Lynet discovered she was losing her hair. She has ‘male-pattern balding’ according to her dermatologist.
Catherine Mbau, a counseling psychologist, says that society has defined femininity to include long hair that fills the head. “Or, if it’s short, it is stylistically maintained at the salon,” she adds.
It is no wonder that Achieng, Nkinda, Lynet and other women who have lost their hair suffer some form of depression and lose self-esteem. “Depression can be deadly. When one is feeling overwhelmed, they should seek professional help. Or at least talk to a trusted friend,” Mbau advises.
Hair loss can be broadly categorized as reversible and irreversible.
Reversible hair loss, says Dr Wambui Muthondi, a dermatologist with the Kenya Defense Forces (KDF), says it comes about because of stress.
She says: “Stress is the main factor. Stress could be psychological or physical. Pregnancy causes stress on a woman. When the stress clears, the hair will grow back.
“One could also lose hair due to medication, like chemotherapy. Once they stop medication the hair usually grows back.
“Fungal infections on the skin could also cause hair loss. These are common in children. It is rare in adults. After treatment the hair would grow back.”
Irreversible hair loss includes male pattern hair loss (MPHL) and female pattern hair loss (FPHL) – which come about with age or genetics.
“Sometimes, even reversible hair loss can progress into irreversible hair loss when a patient has had it for a long time,” Dr Muthondi says.
Nkinda and Achieng’ are fervent alopecia campaigners. They both yearn for a society where bald women will not be subjects of nasty comments.
Alopecia awareness month
Nkinda runs a salon where hair loss and alopecia patients can be attended to in privacy “without unwelcome stares.”
Every September (Alopecia awareness month) they conduct activities to create alopecia awareness.
Ironically, both women no longer want to go back to their full-hair looks.
“I am comfortable like this. I am happy with my looks,” Nkinda, a mother of two, says.
Achieng’s bald head has sort of worked to her advantage. She is now a model – whose baldness is viewed as an asset in the industry.
“I got married last month to my boyfriend. We met when I was bald,” she says.
Bryan Onyango, Achieng’s husband, told The Nairobian that he noticed her bald head first when he laid his eyes on her.
“I know men in our society generally prefer women with long hair. When I decided to pursue her I had to think not as a man, but as me,” he says.
Kenya has no data on alopecia and hair loss. However, a 2016 Boston University survey of almost 6,000 women of African descent found that 48 percent of respondents had hair loss – mostly blamed on traction alopecia.
Modern technologies for re-growing hair: What works and what doesn’t
Dr Pranav Pancholi, a cosmetic dermatologist at Avane Cosmetic and Dermatology Clinic in Nairobi, says that both men and women seek hair loss treatment equally.
“About half of the patients I see are men: half are women,” he says. “Most of the patients want to regain their looks. Many work in jobs where image is important.”
In recent years, hair transplant as a solution for hair loss has become a go-to solution for many hair loss patients. Lynet, too, is considering it. Hair transplant is a surgical procedure where hair is taken from thicker parts of the scalp and grafted to the thinning parts.
According to Dr Muthondi, majority of hair transplants in Kenya are done by trichologists.
“Trichologist are not medical doctors. The solution cannot just be hair transplant. Handling hair loss problems requires much more than that,” she says.
Sometimes, the doctor explains, hair loss is caused by immunosuppression – like in the case of an AIDS patient. Diseases such as syphilis have also been linked to hair loss. Dr Pancholi agrees with Dr Muthondi, saying, “A human being does not just lose hair. There is an underlying cause. Treatment should only proceed once the cause has been clearly established.”
Treatment, Dr Pancholi says, is often specific depending on the case. Dr Muthondi says that hair transplant is only recommended on patients whose hair follicles haven’t blocked.
“Only a dermatological pathologist can determine if follicles are blocked or not. If transplant is done while follicles are closed, it is a waste of time,” she says.
Female (and male) pattern hair loss – where follicles are still open – can undergo various treatments, including transplant. There are other medical hair loss treatments. At Avane, Dr Pancholi says he has performed hundreds of stem cell hair restoration treatments.
“This involves extracting stem-cell rich adipose tissue, under the skin, from the back of the head where hair is dense.
“The adipose tissue is taken through processes to extract stem cells; which are then injected into the scalp on the affected area.
“The stem cells interact with the patient’s hair follicles, repairing them and stimulating hair growth,” he says.
Dr Muthondi, explains that using platelet rich plasma (PRP), is another method dermatologists have used in recent years.
“Some blood is taken from the patient. Plasma and platelets are extracted from the blood and injected on the affected part.
“PRP has lots of growth and healing factors. The injection is done once every month. In about three months a patient should start realizing hair growth,” she says.
In some cases, doctors perform a combination of PRP and stem cell hair restoration treatment.
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