Alopecia

Over the past 3 years, I have lost and regrown my hair. At various points, it has made me feel confused, frustrated, ashamed, and relieved.

My alopecia areata developed over 18 months, getting worse and worse until, at my lowest ebb, I had lost around 60% of the hair on my head. During this time, I saw three different GPs. The third was fantastic. Seeing that my alopecia was well progressed, she swiftly asked the question that — with hindsight — I had been hoping to be asked by a doctor for some time; ‘how are you feeling?’

It was an emotional moment and there were some tears but, in my view, it’s the single most important question that a GP can ask. No one likes losing their hair, particularly when you aren’t sure whether or when it might grow back. That GP’s compassion meant that I felt much more positive about tackling, or at least coming to terms with, having alopecia.

Treatment options for alopecia can be confusing for patients, given that none are conclusively proven to work and some are quite invasive. On the one hand, there are treatments where the effects are only skin-deep, namely topical steroids and wigs. Then there are oral steroids, steroid injections, and UV treatments: all viable options but with material side effects. My personal experience of dealing with having alopecia was very important in terms of framing the risk I was comfortable taking when trying to treat it. The challenge I faced with my first consultant and, to some extent, my first two GPs was that, instead of treating me as a person coming to terms with going bald, they considered me simply as a patient with a physical condition. The result was that I was presented with a shopping list of treatment options and no real guidance on how to make a decision to suit me. In contrast, my third GP and second consultant helped me think through what risks I was willing to take and for what potential results.

In the end, I tried and, after 6–9 months, gave up on topical treatments; it’s a pain to slather them on your head morning and night and some are really slimy. For the worst 9 months, I resorted to an NHS wig. I received many compliments on my new hair from unsuspecting friends and colleagues but it was, emotionally, a big step. Initially, at least, getting a wig felt like an admission of defeat and I held off until sometime after I could reasonably hide my bald patches with my remaining hair. I’ve heard the same from other people who have had alopecia, particularly a 20-something male friend. Wigs can also really itch; I have more sympathy with Roald Dahl’s Grand High Witch than I could have ever imagined possible. Finally, you do have to pay, unlike those undergoing chemotherapy. Although this was never an issue for me financially, it did reinforce in some small way the feeling that I was experiencing something others considered to be minor, and that I should really be able to handle.

I am fortunate in that, for the past 9 months, my hair has been steadily growing back. A frankly miraculous haircut by my childhood hairdresser has allowed me to cast off my wig and enjoy my own hair again; its look, feel, and naturalness. I am acutely aware that my alopecia might, once again, get worse, but as I can’t do anything about it I try not to worry too much.

• © British Journal of General Practice 2014