The day half my hair fell out

She has got rid of every other picture of the woman she used to be ten years ago.

For Alison, 38, has now only half a head of hair left due to the hair loss condition alopecia areata.

"I have thrown away all the photos of myself with long hair. That person has gone," she says.

Alison, who works in London as an editor for customer magazines, greets me at her home in Kemp Street, Brighton, wearing a black headband. Her make-up shows off her attractive features.

As we sit down she takes off her headband to reveal large bald patches at the front and either side of her head, and more bald patches at the back. She has shaved off what hair remains, but it is growing back as soft black hair.

She has lost patches of hair on her eyebrows, legs and under her arms. Her eyelashes under her eyes have disappeared and parts of her eyelashes above her eyes are missing.

Like TV presenter and alopecia suffer Gail Porter, who rather than cover up decided to show everyone the effects of the condition, Alison doesn't wear a wig.

"One of the reasons I won't wear a wig is because it is like admitting defeat. I refuse to be beaten by it," she says.

Alison doesn't know what caused her to lose her hair. There was no big trauma, no accident or illness and noone else in her family has suffered from the condition.

Experts have put it down to stress but she can't recall any particularly stressful period.

Although the actual causes of alopecia areata are unknown, it is considered to be a disease linked to the immune system.

Alison's alopecia started ten years ago when she was 28. She went to have her hair cut and the hairdresser noticed a bald patch about the size of a two pence coin at the nap of her neck.

"I went home and cried and would not come out of my bedroom," she says.

The patch was hidden by her thick hair, and would last for about six months before the hair grew back again. This cycle lasted for about five years, during which time the patch grew to about two inches square, although it was still hidden.

But the patch started getting more noticeable and Alison began wearing a head scarf. She still had a fringe but if she took off the headscarf it would reveal a large patch on the top and the right side of her scalp.

She decided to visit a trichologist in London. The treatment she had involved stimulating her scalp with UV lamps and after four months, in spring 2002, it had all grown back. "It looked good," she recalls.

But in autumn that year it started falling out again.

"You can almost tell when it is going to fall out again. It's a sort of tingling sensation. It fills you with dread," she says.

"I got really obsessed with looking at the pillow in the morning and counting the hairs on it.

"The absolute worst experience was when my vacuum cleaner stopped working. I turned it upside down and took out a great length of beautiful shiny auburn hair, and that was heartbreaking."

In the summer of 2003 she had a type of permanent wig fitted. When she decided to have it removed at Christmas, real hair had grown underneath it. "I was delighted because I had hair again," she says.

But before long, in February last year, it started falling out again. This time she was losing it quickly. Alison says: "Every time it grows back you are on this massive high because you think it's all over.

When you start losing it again it throws you down into a pit."

In July last year she was due to go to South Africa on a business trip, where she knew she would be standing up to speak in front of people. By this time she had lost 70 per cent of her hair and she decided it would be better to shave off what remained.

She says: "I walked around Brighton plucking up the courage to have it shaved off. It was about 5.30pm before I walked into a men's barber shop.

"That was probably the best thing I did because it looked so much better."

Alison took to shaving her head herself in the shower using a man's razor. "It's quite unpleasant it's quite a depressing thing to have to do," she says.

"One of the worst things about shaving it off was people thought I had cancer and was having chemotherapy."

But shaving her head herself made Alison feel as if she was putting herself in charge.

"One of the most frustrating things about alopecia is this complete loss of control," she says. "People can't tell you what's happening and nobody knows what's caused it. It's incredibly frustrating."

Alison also started losing hair on other parts of her body at around the same time she first decided to shave her head. "I knew it was more serious this time. It wasn't just my head that was affected," she says.

"It was kind of like another level of despair."

She adds: "People think it's just about losing your hair and it's not. It's about losing your confidence, self-esteem, femininity.

"I did get very low. You forget about it and then catch sight of your reflection and it throws you into a pit.

"It is really, really upsetting to look at yourself. I don't spend a lot of time looking in mirrors."

So when Alison hit a particularly low point earlier this year she decided she would take positive steps and give treatment one more try.

She visited her GP who prescribed her anti-depressants and she went back to the original trichologist she first saw.

The UV treatment she first tried didn't work a second time so she was given a drug called Minoxidil to stimulate hair growth. Alison rubs it on to her head twice a day. She has been using it for three months now but it can take a year for it to show results.

However, some of her hair has grown back since she started using it.

A blood test showed she also needed to take iron tablets and she has tried complementary therapies.

Alison's friends, family and employers have supported her over the years and she has thrown herself into her job.

She says: "I have channelled all my energy into my job because that's where I can feel confident. That's one area where I can feel in control and know what I'm doing.

"I have to do a lot of presentations to clients. I have to have as much confidence as possible in a situation like that.

"I don't want them to remember me as the bald-headed woman. But then again, I don't want to hide under a wig."

Alison is currently single.

She avoids making eye contact with people in the street but finds there is a more positive attitude to her condition in the cosmopolitan community of Brighton.

Alison's alopecia has also changed her in a positive way. "It's like you lose your hair so you have to gain strength and determination," she says.

"I have had to find ways of building my confidence in other areas and look for positive things to do. I have started going to the gym a lot. It's another area where you feel you are in control, doing something positive."

But Alison's alopecia has not got any easier to live with. "I will never get used to it," she says.

"The thought of looking like this for the rest of my life fills me with horror, which is why I will do my utmost to try and find something that works.

"I refuse to accept I have got to look like this forever."

Information: The Institute of Trichologists, log on to www.trichologists.org.uk, call 0208 767 7880.

The Brighton Scalp & Hair Clinic, St Peter's Place, Brighton, log on to www.scalphair.co.uk, call 01273 621652.

British Association of Dermatologists, log on to www.bad.org.uk, call 0207 3830266.

Hairline International The Alopecia Patients Society, send a stamped self-addressed A4 envelope to Hairline International, Lyons Court, 1668 High Street, Knowle, West Midlands, BN3 0LY. Log on to www.hairlineinternational.com .

Alopecia UK, log on to www.alopeciaonline.org.uk, call 0208 3331661.

What is alopecia?

There are different types of alopecia and hair loss from which women can suffer.

• Alopecia areata: This is where sufferers get sudden bald patches.
• It is one of the less common types of female hair loss but is what most people mean when they speak of alopecia.

Keith Hobbs is a trichologist based at the Brighton Scalp & Hair Clinic, St Peter's Place, Brighton.

He says: "Although it can be unpredictable, most types of alopecia areata grow back within six months to a year. But some people can go on to suffer much more extensive hair loss.

"Although the actual causes of areata are unknown, it is considered to be an autoimmune disease, where the body's defence mechanism is destroying the hair in the same way as it would defend the body against invading diseases.

"It would seem it attacks people whose immunity is lowered after illness or trauma.

"Many possible causes have been suggested. Bereavement is top of the list, as is acute stress or sudden shock, accident or whiplash.

"Displaced vertebrae, eyestrain, cataracts, impaired vision and thyroid dysfunctions are said to be associated with areata.

"It can often be inherited and seems to attack those who suffer from eczema, asthma and hayfever.

"Treatment is supportive and cannot be guaranteed but eliminating possible causes is essential, while vitamin and mineral supplements can be of help.

"Electrotherapy and scalp massage can be of great help and doctors may prescribe minoxidil.

"Sometimes it gets better by itself with no treatment at all.

"Alopecia areata affects men, women and children. If children get it, it is more serious. "It is important to see either a trichologist or dermatologist. It is important to get as much information as you can."

Other types of hair loss in women:

• Telogen effluvium: This is common. It involves shedding of hair but without leaving bald patches. In the short term it can occur after childbirth, a fever, operation, shock or stress. Long term it can be caused by extended periods of illness.
• Androgenetic hair loss (female pattern alopecia, related to male pattern hair loss): This is uncommon, and means slow, diffuse shedding of hair at the front and/or top. It is inherited and is generally more common in older women.
• Traumatic hair loss: Uncommon, this is patchy hair loss caused by trauma.
• Alopecia totalis: Rarely alopecia areata can affect the whole scalp.
• Alopecia universalis: Rarely alopecia can affect the whole body.
• Both these conditions can last for many years but hair can re-grow spontaneously at any time without treatment.
• Scarring hair loss: Caused by accidental, bacterial or auto-immune factors.