Question
My daughter is 17 years old and is a normal, healthy teenager. However, while studying for her GCSE exams 15 months ago, she started losing some of her hair through stress, and it has not grown back. She is now studying for her A-levels and has a bald patch on the crown of her head, its about 3cm in diameter. She tends not to discuss this with her father or me - she keeps her worries to herself and has not even discussed the problem with her sister. I'm trying to encourage her to go to our family doctor to discuss it, but in the meantime can you give me some practical advice on how to tackle the problem? Luckily, our hairdresser is a family friend who is kind and diplomatic when cutting her hair.
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The Trichologist
Philip Kingsley
Your daughter could have alopecia areata, a condition in which stress triggers an auto-immune response (when the immune system mistakenly attacks healthy tissue) in the hair follicles. It would be unusual, though, for the patch to remain a similar size - it would either regrow or get larger. Or she could have trichotillomania, also associated with stress. It starts primarily in teenage girls when the hair is 'twiddled' absent-mindedly, say while reading, which leads to each hair being pulled out, causing bald patches. A trichologist will recognise which condition she has and recommend treatment - go to www.trichologists.org.uk. In the meantime, treat the hair gently and shampoo and condition it daily. Many people think that not washing will slow their hair loss, but in truth it might speed it up because the hair follicles can't function properly when they're blocked with yeast, microbes and sebum.
· Philip Kingsley is a fellow of the Institute of Trichologists. Visit his website: www.philipkingsley.co.uk
The Gp And Naturopath
Dr Deborah McManners
This could be a variety of conditions, such as alopecia areata or trichotillomania. Your GP will be able to identify many of them or can refer you to an NHS dermatologist, who may refer you to a trichologist (available privately). It could also be a fungal infection, even if it doesn't itch, or the result of a nutritional deficiency, both of which a GP can test for. You don't mention your daughter's diet but avoiding red meat would cause low levels of ferritin, which can impair hair growth. Protein, like fish, eggs, nuts and seeds, is also important for hair growth. In case it is stress-related, ensure that she regularly unwinds - yoga is particularly beneficial, as it teaches calming deep-breathing techniques. Homeopathy could be another option - gelsemium is good for anticipatory anxiety, and arsenicum album is ideal for tense, ambitious perfectionists. A medical homeopath would be able to advise you (www.trusthomeopathy.org).
· Dr Deborah McManners is a naturopathic physician and GP at the Hale Clinic, London (www.haleclinic.com)
The Psychotherapist
Phillip Hodson
The medical advice is that alopecia may be caused by stress. The psychological certainty is that stress is a major consequence. At a time when your daughter wants to look her best, she possibly fears that she looks her worst. It is perfectly natural for teenagers to want to keep their problems private. The direct approach is not always best, as they'll immediately see it as interference - instead, rebuild her sense of security. First, as she approaches her A-levels, make it clear that no exam is worth getting severely stressed out about - the odd mistake is rarely the end of the world. Tell her about your own and try never to make mountains out of molehills. Second, use your hairdresser as the god-given ally - he/she could casually mention 'another customer with a thin patch' who got wise advice from her GP. Lastly, encourage her to exercise - from Pilates to dancing - for stress relief.
· Phillip Hodson is a psychotherapist and fellow of the British Association for Counselling and Psychotherapy (www.bacp.co.uk)