ASK THE GP: Dr Martin Scurr answers your health questions27/11/2018
ASK THE GP: Am I now going to be bald for the rest of my life? Dr Martin Scurr answers your health questions
Within three weeks last year, I became completely bald, losing my eyebrows, lashes and moustache.
A blood test indicated a low testosterone reading and I was prescribed a 2 per cent Tostran gel and Regaine hair-loss treatment (I’ve delayed using these in the hope it would regrow naturally). I’ve been using shampoos purporting to strengthen the hair roots, too.
Could stress have brought on the condition? Will my hair regrow? I am in my 80s.
Name and address supplied.
I am sorry that you have been affected in this dramatic way. The condition from which you suffer is a version of alopecia areata — with this, the hair follicles come under attack from your own immune cells, causing intense inflammation that damages the follicles and the hair production process.
Did you know? At least 10 per cent of patients with alopecia areata also develop symptoms affecting the nails — pitting or separation from the nail bed, known as onycholysis
This common type of hair loss can occur at any age, in men and women. Typically, the condition presents with disc-like patches of baldness of variable sizes on the scalp (although hair elsewhere, such as the beard, eyebrows, eyelashes and on the body and limbs, can be affected).
At least 10 per cent of patients with alopecia areata also develop symptoms affecting the nails — pitting or separation from the nail bed, known as onycholysis.
In about one in ten people, the condition progresses either to alopecia totalis, loss of all scalp hair, or alopecia universalis, the complete loss of all hair from the scalp, face and body.
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In your case, what you describe is the most advanced form of alopecia universalis. Why the immune system should commence this attack, often suddenly, over just a few days or weeks, is uncertain.
There are genetic factors: around 20 per cent of those with the condition have a first-degree relative who is affected. Other factors such as stress are less well confirmed. Alopecia areata may co-exist with other autoimmune diseases, too.
Vitiligo — where the pigment cells in the skin are destroyed in some areas, leading to white patches —psoriasis, thyroid disease (ensure your doctor has done blood tests to check for this) and allergic rhinitis are all more common in patients with alopecia areata than in the general population.
Adjust: Taking practical steps to protect the head is important — so wear sunscreen when you are exposed to the sun and a hat to protect the head, or to keep it warm in winter
If there are just small patches of hair loss on the scalp, around half of cases spontaneously recover within a year, although there may be further episodes of hair loss in the future.
If the hair loss lasts for longer than a year, and if the nails are affected, or you have allergies or a family history of alopecia, none of the treatments you’ve used so far is likely to be of any benefit, because this is an issue of the immune system and there is currently no cure.
Similarly, the Tostran and Regaine won’t help, as they won’t tackle the underlying problem (they are intended for male pattern hair loss, caused by hair follicles that shrink with age, and work by extending the growth phase of hair follicles — which means there must be actively growing hairs for them to be effective).
It will take some time for you to adapt to the change in your appearance, but I’m afraid that is what you must do.
Taking practical steps to protect the head is important — so wear sunscreen when you are exposed to the sun and a hat to protect the head, or to keep it warm in winter.
Following repeated stiffness and pain in my neck, an X-ray has revealed degeneration in discs five and six. I’ve also had headaches, which seem to come from the base of my neck.
I have taken ibuprofen and paracetamol, but am loath to take either on a regular basis.
A. E. Haywood, Newport.
THE neck is a vulnerable structure — it has seven vertebrae that are articulated to allow it considerable mobility, yet which must also carry the weight of the head: about 5kg.
The greatest wear and tear occurs between the fourth and seventh vertebrae (the first being at the top, articulating with the skull).
Most people over 30 would show degenerative changes in the neck if you X-rayed them, but there is little correlation between what a scan indicates and whether the individual experiences pain.
Some people with X-rays showing much wear and tear may experience little pain, and vice versa.
In some cases, degeneration in the neck may contribute to muscular tension, which may explain your headaches.
Write to Dr Scurr
To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — including contact details.
Dr Scurr cannot enter into personal correspondence.
His replies cannot apply to individual cases and should be taken in a general context.
Always consult your own GP with any health worries.
I agree that taking painkillers is not a good long-term strategy — they should be kept for times when symptoms are more severe (options include prescription medications, such as low-dose antidepressants, including duloxetine and venlafaxine).
Your treatment must include physiotherapy — the physiotherapist can help by showing you how to sit and stand, to ease muscle tension.
They will also help to modify your sleep position — for instance, not using too many pillows. Other specialist interventions include cognitive behavioural therapy, to help with chronic pain.
I’d also recommend trying acupuncture as a first step — although this will not be available on the NHS, a review of studies found it effective in treating neck pain.
Another alternative I would recommend is Qigong, a Chinese technique involving slow movement, meditation and breathing exercises (Tai Chi is a form of Qigong).
I have found two studies confirming the benefits in relieving persistent neck pain, one reported in the Journal of Pain.
These two techniques may help by unlocking tension, correcting faulty postural habits and increasing awareness of our body’s response to our emotions.
Finding a suitable class should not be difficult — and there is much to gain and little to lose.
IN MY VIEW: Not giving a child their jabs is a form of abuse…
Until recently, we thought measles would soon join the ranks of the infectious diseases that, thanks to vaccines, have been all but eradicated — yet it would appear not.
Already this year, there have been more than 900 cases in England alone, compared with 259 in 2017 and just 55 in 1998. By any definition, that is a steep rise: enough for Public Health England to declare a national measles outbreak.
Measles is a highly contagious viral illness — infected particles can linger in the air for two hours after a person has sneezed. It starts with a high temperature, followed by a cough, runny nose, conjunctivitis and, by the third or fourth day, a widespread rash, initially on the face.
Just before the rash breaks out, spots can be seen in the mouth that look like grains of salt — these Koplik’s spots confirm the diagnosis.
But it rarely stops there. Measles temporarily suppresses immune response so, in 30 per cent of cases, another infection, such as pneumonia, can occur. There is also a risk of complications including corneal scarring, convulsion in infants and brain inflammation, which can result in lifelong brain damage. A deeply unpleasant, but rare, complication is subacute sclerosing panencephalitis, a progressive degenerative brain disease occurring ten years or more after the measles infection. It starts with personality and behaviour change, leading on to dementia and, finally, a vegetative state and death.
In developing countries, the death rate from measles is 4 to 10 per cent of affected children — but, as measles is a virus, there is no effective treatment, just hope. And we escape none of the dangers of measles in a civilised society.
But what we do have is easy access to the MMR (measles, mumps and rubella) vaccine — two injections, given at 12 months and three years, to ensure protection from this disease.
Yet, in England, take-up has fallen for the fourth year in a row. In my view, parents who opt not to let their child have the MMR are at best foolhardy and at worst guilty of neglect.
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