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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


May 09 2008

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Baldness: It's in the Genes

It was the late actor Telly Savalas who once observed, "We're all born bald, baby." For Savalas, who shaved his head to play Pontius Pilate in the movie The Greatest Story Ever Told and then maintained his bare dome for the next three decades, baldness was a signature look. But for about a quarter of all men and a tenth of all women in America, baldness is a fact of life over which they have little control.

Baldness, or alopecia, is the partial or complete loss of hair from where it normally grows. Usually associated with the head, the most common form of baldness is androgenic alopecia, a progressive hair thinning condition also known as male pattern baldness (the female version is androgenetic alopecia). There's also alopecia areata (loss of some of the hair from the head), alopecia totalis (loss of all head hair), and alopecia universalis (loss of all hair from the head and body).

Normal hair loss is about 100 strands a day (out of the 100,000 that the average scalp contains). Baldness, however, is related to aging, heredity, and testosterone in both men and women. Genetic baldness is the result of the body's inability to produce replacements, not due to excessive hair loss. Other causes of baldness include autoimmune conditions (lupus is one), burns, some infectious diseases (including syphilis), chemotherapy or radiation treatment, emotional or physical stress, and nervous habits (such as compulsive hair pulling or scalp rubbing).

As its name implies (and as folklore has long held), androgenic alopecia has a genetic link – and it goes directly back to dear ol' Mom. In 2005, researchers at the University of Bonn in Germany found a gene variation on the X chromosome, which is handed down from mother to son, that they say explains some cases of male pattern baldness. "The fact that family studies of male pattern baldness have typically stressed the resemblance of fathers and sons is understandable, given the differences in patterns of hair loss between males and females," wrote genomics professor and researcher Markus Nothen of the University of Bonn. "Our genetic data, however, stress the relative importance of the maternal line in the inheritance of male pattern baldness. This suggests that the resemblance should be greater between affected males and their maternal grandfathers than between affected males and their fathers."

In February 2008, the same researchers announced the discovery of a gene that plays a role in hair growth, which may lead to therapies for different types of baldness.

Genetics have also been implicated in alopecia areata, an autoimmune disease characterized by patchy hair loss that affects more than 4.5 million Americans of all ages and ethnicities. Scientists supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) have identified four loci, or positions of a gene on a chromosome, that appear to play a role in alopecia areata and other skin and hair disorders.

Lead author of the study Angela Christiano, Ph.D., Professor of Dermatology and Genetics and Development at Columbia University, says the findings could have important implications for a disease that has no effective treatment or cure. "Finding responsible genes could enable scientists to develop new therapies that could be tested in a mouse model, or even facilitate the lead to the design of new treatment strategies for people, like myself, with this common and often emotionally devastating disease," she notes.

As for treatments for the more common male and female pattern baldness, the U.S. Food and Drug Administration has approved only two drug-based treatments (minoxidil, the leading brand of which is Rogaine, and finasteride, marketed as Propecia) and cleared only one product (the Hairmax Lasercomb). Surgery, specifically hair transplantation, is another method for reversing hair loss and baldness that removes hair-producing follicles from the back and sides of the head and inserts them into bald or thinning areas.

Then again, the follicle-challenged among us can always just embrace their state and proudly declare, "God created a few perfect heads, and on the rest He put hair!"