Hide Away, Little Abby!

Recently, I saw a little girl in my office for “bald spots”. I walked in the exam room expecting to see some patchy hair loss due to a common condition called Alopecia Areata, something that I could easily treat with steroid injections (or less). But instead, I saw a 9-year-old girl with the same form of hair loss as I do, a rare and stubborn version of alopecia called Ophiasis. This is a hair loss pattern that would invade from the feet toward the top of the head in a “wavy” fashion: by the time it gets to the head, first the eyebrows will disappear, then the hairline will start receding from all directions, then the sideburns are gone as the forehead appears larger and larger.

Alopecia Areata Ophiasis

“Ophiasis is a subtype of alopecia areata that is characterized as a symmetric, band-like hair loss pattern of the occipital, temporal and parietal regions of the scalp” — quote and image from healthjade.net

You never know when the waves stop advancing: in my case, about an inch and half above my ears, and in this little girl’s case, it appeared to have kept going. Now she is almost all the way bald, but she had her hair pulled up in a thin pony tail, displaying the entirety of the relentless waves. She kept her head so low as my MA and I walked into the room — probably a thing she did all the time since her disease onset, to hide away from any inspection. And I knew immediately how her world had been defined.

This letter is dedicated to Abby, the 9-year-old girl whose self esteem had been washed away brutally by Ophiasis.

Dear Abby,

When I met you, your head was lowered down to your chest throughout our entire interaction, so you didn’t see me.

But I understand you, better than you imagine.

I know you want to hide away from those kids who make fun of you.

Because when your “friend” describes you as “an egg with some hair on top”, or “an up side down mop”,

they don’t know that these words sting,

and will stay with you for a very, very long time.

These words will make you question if you have any true friend,

and if your value is only skin-deep.

Don’t feel obligated to keep those who call you names as your “friends”.

Because one day, you will find people who see you not just as a strange existence, but who you are underneath.

They will defend you when others make fun of you,

and through them, you will learn to defend yourself.

Abby,

I know you probably already hate the wind — the brutal and heartless phenomenon of nature that will blow up your hair,

and therefore effortlessly reveal what you have been trying to hide.

You will subsequently hate any physical activity that will result in the wind blowing up your hair: biking, running, and eventually, playing outside all together.

You will tell people, and yourself, that you simple just “hate to do those”.

But one day, you will reclaim those activities,

once you fully understand your body, and that you didn’t do anything to deserve the balding.

Only then can you take pride in putting yourself out there.

And have a good time.

You will want to wear a hat all the time, even indoors.

And you will wonder about a wig.

And when you have some money, you might even buy a few to try on.

But you will probably hate them.

Because while others wear wigs to feel pretty or simply to change up their look of the day, you wear them to hide who you are.

You will play this game in your head, called “what would I pay to be her”.

When you see beautiful girls around you, or on TV, who have long, thick hair,

you will wish to be her.

You will think to yourself, I’d give up a decade of my life to have her hair,

or I’d give up my good grades to look like her!

But the truth is,

you will never be anybody but yourself, even if you tried.

And the world is better this way, with you as the only one who can be you.

Abby,

Once you say no to its rigid definition of beauty,

you will finally see the world as what it truly is:

simply your play ground,

with the wind becoming your wings,

taking you wherever you want to go.

You can become a doctor, like me.

Or you can be an astronaut,

a lawyer, a farmer, a pilot, or an actress.

And above all, you can be a force to be reckoned with.

But you won’t get there without struggling, or constant hiding.

Like when you met me,

you were so consumed by shame that you didn’t even look at me once,

you didn’t give me a chance to show you,

that I am just like you.

I wanted to hold your hand,

but your were not ready.

And that is ok.

Your mom insisted that you would pull your hair up into a pony tail,

pretending to be just like your peers,

“the other girls” who have hair.

And she wanted me to convince you to simply “gain some confidence”.

But you wanted to keep your hair down,

and you wanted to hide.

So I say,

Hide away, little Abby!

Only by hiding can you find a peaceful place to grow,

and only by keeping your head down can you be truly allowed to focus on what’s important: yourself.

I hid when I was your age, about when I started to lose my hair.

By hiding, I could pretend the world was a gentler place.

And at that age,

I NEEDED it to be.

One day you will come out of hiding,

and you will arrive at a place where you can chin up, and look at people in the eyes, with clarity, and confidence.

But you must find the path to that place yourself!

And you will.

Like I have. Like many of us bald girls have before you.

And when you do,

I hope you will think of me,

as that doctor who treated you just like any other 9-year-old girl,

who told you to brush your teeth and eat less hot cheetos,

that doctor who gave you a space to hide,

and made her office a less harsh place than the rest of the world.

Then you can tell me how many mountains you have climbed,

and how much you enjoyed the breezy fresh air up top.

*The story of the above patient was based on a true story, but the details and names were significantly altered to protect confidentiality.*