INTRODUCTION
Scalp hair plays an important function in humans. In addition to providing cranial cushioning and shielding the scalp from direct sun rays, hair has sociological meanings in terms of gender, age, values and status (Cash 2001). Scalp hair is also a vital aspect of an individual’s physical appearance and helps to project a positive image (Cash 2001). Hair loss and balding, on the other hand, are associated with negative attributes (Rushton et al. 2002). Hair loss or alopecia is a common problem suffered by both sexes and has been reported to cause significant psychological effects, such as diminished self-esteem, emotional distress, embarrassment and social inadequacy, with these detrimental effects being more significant in women (Cash et al. 1993). Van der Donk et al. (1994) observed that alopecia could severely affect the quality of life of the majority of the sufferers, whereby 88% of sufferers experienced negative effects in their daily life and 75% and 50% encountered negative self-esteem and social problems, respectively.
There are many types of alopecia, such as androgenetic alopecia (AGA), alopecia areata, telogen effluvium, hair loss due to systemic medical problems such as thyroid disease and adverse drug effects, as well as hair loss due to scalp or hair trauma, discoid lupus erythematosus, lichen planus and structural shaft abnormalities, to name a few (Hogan & Chamberlain 2000). The causes for the above are numerous and vary between the different types of alopecia. In most instances, the aetiology is still unknown. However, one of the universal causes of increased hair thinning or shedding is nutritional deficiency. It was previously reported that children with protein malnutrition would exhibit fragile and finer hairs that easily fall or break off and display a lower daily rate of growth (Bradfield & Bailey 1969; Sims 1968). Nutritional factors that have been identified to be essential in preventing hair loss include iron and an essential amino acid, L-lysine (Rushton et al. 1990; Rushton 2002). Rushton et al. (2002) reported that women with chronic telogen effluvium have low serum ferritin levels and proceeded to demonstrate that daily supplementation of iron and L-lysine for 6 months could cause significant increases in hair numbers.
Recently, Naziroglu and Kokcam (2000) showed that there was an association between oxidative stress and alopecia. They reported that the levels of reduced glutathione (GSH) and activities of glutathione peroxidase (GSH-Px), which are present to protect against damages caused by reactive oxygen species such as free radicals and peroxides, were significantly lower in patients with alopecia than in controls, whereas the levels of thiobarbituric acid reactive substances (TBARS), which indicate lipid peroxidation and oxidative stress, were significantly higher.
Tocotrienols together with tocopherols are members of the vitamin E family. They share similar structural features of a chroman head and a 16-carbon phytyl chain. The structural difference between them lies mainly in the latter possessing a saturated phytyl chain whereas that of the former possesses three unsaturated double bonds (Papas 1999; Theriault et al. 1999). Tocotrienols also possess more potent antioxidant property, and Serbinova et al. (1991) showed that α-tocotrienol was 40- to 60-fold more potent than α-tocopherol against lipid peroxidation in rat liver microsomal membranes. This superiority has been ascribed to the ability of tocotrienols to better distribute within the fatty layers of the cell membranes and hence permit better interaction with lipid radicals. Moreover, tocotrienols have been shown to afford protection to the skin against UV light- and ozone-induced oxidative stress (Traber et al. 1997).
In view of the association between alopecia and oxidative stress and the high antioxidant potency of the tocotrienols, a study was thus performed in volunteers with alopecia to evaluate the efficacy of tocotrienol supplementation in improving hair coverage of the scalp and preventing hair thinning in patients suffering from alopecia.