What is alopecia?
Alopecia is a medical term that is generally used to describe hair loss.
Although it is normal for everyone to lose a small number of hairs each day, the hair that we do lose is usually replaced by new hair. For some people however, this doesn’t always happen. This means that when some people lose their hair, there is no new hair that grows in its place, and this leaves behind bald patches of skin.
There are many different types of hair loss. Each type of hair loss can cause different symptoms to develop, and they can each have different underlying causes.
Pictures of alopecia (hair loss)
What are the different types of alopecia?
The different types of alopecia can be split into two groups:
- Non-scarring alopecia
- Scarring alopecia
These are described in further detail below.
Non-scarring alopecia, also known as non-scarring hair loss, is a term that is used to describe the types of alopecia that do not leave behind any scars in the areas where hair has been lost.
Androgenic alopecia, which is often called male pattern baldness, or female patterned baldness, is a type of alopecia that causes a progressive loss of hair from the scalp. It is the most common type of alopecia, and it approximately affects:
- 50% of men over the age of 50
- 50% of women over the age of 65
What causes androgenic alopecia?
Androgenic alopecia tends to be caused by your genetics, which means that it can often run in your family. For example, if either of your parents have this type of alopecia, you are more likely to get it too.
Hormones may also play a role in causing androgenic alopecia to develop.
How does androgenic alopecia develop?
The hormone that is responsible for causing hair loss in androgenic alopecia is called dihydrotestosterone (DHT). This hormone causes hair loss by damaging the hair follicles in people who are genetically prone to getting androgenic alopecia.
After the hair follicles have been damaged, they start to produce progressively smaller hairs, until they shrink so much that they stop producing hair completely.
Where do men with male pattern baldness tend to lose hair?
Men with male pattern baldness tend to lose hair from their hairline and top of the head first.
Where do women with female pattern baldness tend to lose hair?
Women with female pattern baldness generally notice the hair thinning all over the head, but in particular around the top of their head (which is also called the crown).
Women are much less likely to suffer from total baldness than men are.
Is hair loss in male and female pattern baldness permanent?
Yes, this kind of hair loss is permanent, which means that the lost hair will not grow back.
Alopecia areata is the most common type of hair loss after androgenic alopecia, and it is thought to affect up to 2% of the world’s population at some point in their lives.
What causes alopecia areata?
Alopecia areata is thought to be an autoimmune disease. An autoimmune disease is a disease that develops when the immune system (which is usually supposed to help protect the body from infections), begins to attack the hair follicles by mistake. This accidental attack damages the hair follicles, which then leads to hair loss in different parts of the body.
What are the symptoms of alopecia areata?
The symptoms of this type of alopecia can come and go at different stages of people’s lives. This means that when someone loses their hair, after a while that hair may grow back, but at a later stage in their lives that hair may be lost again.
Often people with alopecia areata are more likely to have family members who also have alopecia areata related hair loss, and they may also have other common autoimmune diseases such as:
- Rheumatoid arthritis
- Thyroid disease
- Inflammatory bowel disease (IBD)
People who have alopecia areata are also more likely to have other medical conditions such as:
- Eczema (atopic dermatitis)
What are the different types of alopecia areata?
Alopecia areata can show several different patterns of hair loss:
- Patchy Alopecia: This is the most common type of alopecia areata. The patches of hair loss in patchy alopecia are usually round or circle shaped, well defined, and they tend to be randomly located all over the scalp.
- Alopecia Totalis: This is the total loss of hair on the scalp, and is commonly seen as a progression of patchy alopecia areata. Generally people that suffer with alopecia totalis are less likely to regrow hair on their scalp.
- Alopecia Universalis: This is the total loss of hair on the body, and is commonly seen as a progression of alopecia areata. Again, people with alopecia universalis are less likely to regrow their hair.
- Alopecia Barbae: Alopecia areata can also affect the beard. This is called alopecia barbae. It can cause small areas of circular hair loss around the jawline, and can even lead to total hair loss on the whole face.
- Alopecia Ophiasis: This is hair loss that appears in the shape of a wave at the sides and back of the head, above the hairline.
- Alopecia Areata Incognita: This is also known as diffuse alopecia areata. It is a rare type of hair loss that is found mainly in young women, where much more intense hair loss is seen on the scalp. It usually develops over the course of a few weeks. If this type of alopecia is treated correctly however, the hair tends to grow back.
This is generally seen in women and is considered to be unintentional hair loss caused by physical damage to the hair follicles.
Traction alopecia can be caused from:
- Repeatedly pulling hair into a tight ponytail or buns
- Using hair extensions
- Having tight braids
It is usually reversible in the early stages, but it may become permanent if the cause of the damage is ongoing.
Triangular alopecia, also known as temporal triangular alopecia, is a type of hair loss that develops at the front of the hairline, on either side, in the shape of a triangle. It can affect one or both sides of the head, and is thought to be an inherited condition. It usually is present from birth.
This is when there is an excessive amount of hair shedding, which happens over a relatively short period of time. It is usually triggered by a specific event such as:
- An illness that causes a fever to develop
- Rapid weight loss
It is worth noting that sometimes, no specific cause can be found for telogen effluvium.
After this type of alopecia develops, the lost hair will often start to regrow within 6 months of the triggering event.
This is hair loss caused by a hair-pulling disorder which develops when someone cannot stop themselves from pulling out their hair. It can usually affect the:
This is a term used to describe different types of alopecia that leave behind scars in areas where hair has been lost.
Scarring alopecias can also be known as cicatricial alopecias. In these types of alopecia, the hair follicles are completely destroyed, causing scars to develop under the surface of the skin. In general, scarring alopecias cause much more permanent hair loss than non-scarring alopecias.
This is a rare condition that causes permanent, patchy hair loss on the scalp. There can also be redness surrounding these patches.
Lichen planopilaris is sometimes associated with a condition called lichen planus (which is a type of non-infectious itchy rash affecting the skin, mouth or genitals).
This is a type of lichen planopilaris, but with a different pattern of hair loss. It usually affects women who have already gone through menopause. The hair loss normally occurs from the hairline backwards, and it can also include the eyebrows.
This is a rare type of localised hair loss that develops in areas where there are a lot of hair follicles. It is caused when a white substance called mucin (which is naturally produced by our skin), starts to build up in the hair follicles. This build up of mucin causes the hair follicles to become inflamed, and stops them from being able to produce hair.
Areas affected by alopecia mucinosa appear as dry patches that are red.
Although this condition is reversible in its early stages, as more hair follicles are destroyed over time, scars begin to develop around them which then means that the hair follicles can no longer produce hair.
Alopecia mucinosa can affect people of all ages, but it generally occurs in people over the age of 40. In very rare cases, it can be associated with some cancers like lymphoma.
Who usually gets alopecia?
A wide variety of people can suffer from alopecia. It is a condition that can occur at any age, but it is thought that around half of all cases of alopecia begin in childhood, with 80% of cases occurring before the age of 40.
It is generally considered that the symptoms of alopecia tend to be milder if they start later on in life.
Alopecia in babies
Most babies lose some, or even all, of their hair in the first few months of life. The triggers that can cause this tend to be:
- Cradle cap (a skin condition that causes oily, crusty patches of skin to develop on a baby’s scalp)
- Sleeping positions that cause friction on the hair follicles
Most of these babies however, do regrow their hair by their first birthday.
Alopecia in children
Children most commonly suffer from alopecia caused by the following:
- Telogen effluvium (an event-triggered hair loss)
- Fungal infections like ringworm
- Traction alopecia caused from physical damage to the hair follicles
Alopecia in teenagers
Teenagers can suffer from alopecia that is caused by the following:
- Hormonal changes
- Certain medications
- Poor nutrition
- Mental health disorders such as pulling hair out (trichotillomania)
- Traction alopecia from over-styling
- Fungal infections
- An underlying medical illness
Women can suffer with androgenic alopecia as they get older, alopecia areata, and telogen effluvium after pregnancy or other triggering event.
Men are most likely to suffer with androgenic alopecia as they get older, but they can also suffer with autoimmune hair loss (alopecia areata) and some of the other rarer types of hair loss.
What causes alopecia?
There are many different causes of hair loss.
You can be born with some types of alopecia, like those types that develop in babies.
Other types of alopecia, such as triangular alopecia (hair loss in the temples), can also be present from birth.
In men, it is thought that 80% of cases of aging hair loss are caused by their genetics. This may be because men are thought to have a gene that makes them more susceptible to having higher levels of the hormone (DHT) which is linked to hair loss.
There is also thought to be a genetic link with alopecia areata, as 42% of people with this type of alopecia tend to have a family history of the condition. This family history tends to be more prominent in those who develop alopecia areata at a younger age.
In alopecia areata, the immune system (which is a system usually helps protect the body from infections), begins to accidentally attack the hair follicles. This attack begins to damage the hair follicles, which then leads to hair loss in different parts of the scalp, face and body.
Alongside this problem with the immune system, some genetic and environmental factors (such as stress) can also have a role to play in alopecia areata developing in certain people prone to getting the condition.
While they are pregnant, women often see an increase in the amount of hair on their scalp and body. This is usually caused by the hormonal changes that develop during pregnancy.
After they give birth to the baby however, women often start to shed a large amount of hair (telogen effluvium). This is completely normal, and again, is related to the normal hormonal changes that occur during pregnancy.
Young women and men in their adolescence can also develop hair loss. This is thought to be due to the hormonal changes that occur throughout puberty.
In girls, this can be due to the decreased amount of testosterone in their bodies, and it can also be caused by taking the contraceptive pill.
Young girls are more likely to experience hair loss in adolescence than boys are.
There is a strong link between hair loss and stress. Hair loss can be both triggered or worsened by stress. The exact way in which this happens is still somewhat unknown, but it is thought that stress can increase the release of certain hormones, which can cause damage to hair follicles, and therefore cause hair loss.
There are a number of medications that can cause hair loss.
Cancer medication (chemotherapy)
Medications that people receive when they are being treated for cancer (which is called chemotherapy) can cause hair loss.
Medications that suppress the immune system (immunosuppressants)
People with autoimmune conditions, like rheumatoid arthritis, can also suffer from hair loss caused by the medications that they take to suppress their immune system (which are called immunosuppressants).
Examples of the most common chemotherapy or immunosuppressant medications that can cause alopecia are:
- Biologic injections (e.g adalimumab/etanercept)
Some other medications that can cause hair loss in rare cases include:
- Thyroid medications
- Blood -thinning medications
- Seizure medications
- Oral contraceptive pill
- Hormone replacement therapy
- Blood pressure tablets
What are the symptoms of alopecia?
The exact symptoms of alopecia can vary from person to person, but they can include:
- Gradual hair thinning on top of the head
- Receding hairline due to hair loss
- Patchy hair loss of bald spots
- Sudden hair loss
- Full body hair loss
- Patchy or full hair loss of the beard
- Bald patches surrounded by redness
- Itchiness and burning sensation
- Scaly skin on the scalp that is associated with hair loss
How is alopecia diagnosed?
Usually, your family doctor will be able to diagnose your alopecia. If they have any further questions about the type of alopecia that you have, they may refer you to see a skin specialist, called a dermatologist.
The dermatologist will most likely:
- Ask more detailed questions during their assessment
- Perform a physical examination
- Look at the hair follicles with a hand-held microscope (this is called a dermatoscope)
When the dermatologist is doing the physical exam, they are usually looking for certain things that would help diagnose a specific type of alopecia, for example:
- Yellow dots (found in 95% of patients with alopecia areata)
- Exclamation point hairs (broken hair shafts visible under the microscope)
- Short regrowing hairs
- Positive pull-test (a test that checks for hair loss when pulling the hair)
In some cases, the dermatologist may take a sample of the scalp to send to the laboratory for testing. This is called a biopsy.
Can alopecia kill you?
Alopecia is not life-threatening and it can not directly cause death. However, the psychological effects of hair loss can be devastating to some people, and this can sometimes cause depression, which can lead to an increased risk of death through suicide.
Where can you get alopecia?
You can suffer with hair loss anywhere on the body that has hair. However, alopecia most commonly affects the head. Other areas where hair loss may occur include the:
- Arms & legs
- Pubic hair
Which other conditions have similar symptoms to alopecia?
There are some other medical conditions which can have similar symptoms to alopecia. These include:
Fungal infections on the scalp or body such as ringworm can also cause hair loss.
Folliculitis is a condition that causes inflammation of the hair follicles caused by a bacterial infection which can lead to hair loss.
Diseases of the skin such as lichen planus and lupus can cause scarring which can lead to permanent hair loss.
Hypothyroidism, also called underactive thyroid, is a condition that causes the hair to become more brittle, causing it to break more easily. Some people with this condition can notice only hair thinning, and no other symptoms.
Anaemia, specifically iron-deficiency anaemia, can cause hair loss in ladies that have heavy periods, or in people that don’t eat enough iron-rich foods. Sometimes anaemia can be associated with a serious underlying medical condition. If you’re concerned that you may have anaemia and have symptoms of being pale, low in energy, short of breath and/or light-headed in addition to your hair loss, you should speak to your doctor.
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
How do you treat alopecia?
Currently there are no treatments that work for absolutely everyone with alopecia, but there are a variety of different treatment options that are available.
Things you can do at home
Hair loss is not a dangerous condition, although it can be very distressing. Some people may choose not to try any treatments at all, especially in mild cases. This is always an option if that’s your preference.
If however, you do want to treat your hair loss, there are some non-medical options for managing the effects of alopecia, which include:
These can be worn by men and women to disguise their hair loss. Head scarves and hats can also be used.
These can be used to disguise small bald patches.
These can be used to cover up areas of hair loss. However, you should be aware that hair extensions may cause further pulling on existing hair follicles, and can lead to traction alopecia.
These can be used if the eyelashes have been affected.
This can be helpful if the eyebrows have been affected, as semi-permanent make-up can be used to create the appearance of eyebrows.
Some men and women with extensive alopecia prefer to shave off the remainder of their hair.
In all types of alopecia, it is important to protect any uncovered skin from the sunlight. You can do this either by applying sun creams, or by using physical coverings such as wigs, head scarves or something similar.
There are several different treatments available for alopecia, which may help to slow down hair loss, or stimulate the regrowth of hairs.
It is worth mentioning however, that most tablets or creams used to treat hair loss will only continue working whilst you are actively using the treatment.
This is sometimes recommended to help maintain healthy hair follicles. Research has also shown that people with alopecia areata often have lower levels of vitamin D.
This is thought to decrease the severity of alopecia areata in some cases. Research showed that people with lower levels of zinc had more severe disease than people with higher levels.
Anthralin is a tar-like substance that is used in the treatment of psoriasis. It causes irritation of the skin and occasionally, it stimulates hair follicles to produce new hairs. One of its side effects can however, stain the skin a yellowy-brown colour.
Minoxidil lotion is thought to stimulate new hair growth in people with androgenic hair loss (male and female pattern baldness). The way in which it does this is however, still unclear. It is available over the counter as a shampoo, but your doctor can also prescribe it as a topical treatment in stronger concentrations (2% and 5%).
Finasteride is a medication that has been used in men with male pattern hair loss to try and stimulate new hair growth. Treatment needs to be taken for a minimum of 1 year. Finasteride is not recommended for treatment of female pattern hair loss.
Steroid creams can be used to treat alopecia areata. A strong steroid cream is usually applied to the bald patches twice daily, for a limited time. If the hair loss affects more than 50% of the scalp, a steroid foam can be used instead.
Steroid injections can be used on the scalp in people who suffer with alopecia areata. This treatment is usually carried out by a specialist skin doctor. The skin doctor will usually give multiple injections of steroids directly to the areas that have lost hair. Although this treatment does help hair to grow back, the effect is usually temporary.
People can find these injections uncomfortable, and they may also cause a loss in colour of the surrounding skin.
Topical immunotherapy can be offered by skin specialists (dermatologists) to people with extensive patchy hair loss in alopecia areata. An allergen is first applied to the skin to cause an allergic reaction. This reaction then alters the immune system, which in turn stimulates new hair growth.
Due to the allergic reaction that is induced, some people can develop blisters in their skin.
PUVA, also called photochemotherapy, is a type of light therapy that is sometimes used to treat alopecia areata. There is limited evidence for its success, and it often increases the risk of developing certain types of skin cancer.
Immunosuppressants therapies are medications that suppress your immune system. They are a relatively new treatment for alopecia areata. A lot more research is needed to confirm how safe and effective they are, but they are a potentially new and exciting option for future alopecia aeata treatment.
An example of a potentially new immunosuppressant therapy is JAK (Janus Kinase) inhibitors.
What are JAK inhibitors?
JAK inhibitors are medications that are most commonly used to treat certain medical conditions such as rheumatoid arthritis and psoriasis. They work by helping to reduce inflammation in the body.
Some very new research has shown that using this type of medication in people with alopecia areata has helped some of these people regrow their hair.
Examples of JAK inhibitors include:
Cosmetic treatments & surgeries
There are some cosmetic treatments and surgeries that may be suitable for some people.
This is a relatively new type of treatment that is most commonly used to treat androgenic alopecia.
How does it work?
A blood sample is first taken from the patient, and then spun in a machine to extract the plasma part of our blood which is rich in proteins. This plasma that has been taken from our blood is then injected back into the scalp in areas where there is hair loss. Multiple treatments are often needed, and it is expensive, but the early stages of research have shown promising results.
Hair transplant surgery can be an option for those suffering with male pattern hair loss or female pattern hair loss.
How does it work?
Hair is first removed from another part of the body, and then it is transplanted into the scalp. Hair transplant surgery is usually an expensive procedure, and does not always produce successful results.
Some people find complementary therapies such as herbal remedies helpful. If you are thinking about using homeopathy, speak to your doctor first to ensure the therapy is safe for you to use.
Is there a cure for alopecia?
There is currently no cure for alopecia, but medications can improve or slow down hair loss in some cases.
In the cases of alopecia areata, spontaneous hair regrowth can occur in over 50% of people with patchy alopecia.
Can alopecia affect quality of life?
Yes, it can. Some people may find that the symptoms of their alopecia can affect their mental health and psychological well being. In this instance, it is important that you speak to your family doctor to find out what kind of help and support is available for you. Your doctor may suggest the following:
- Support groups
- Antidepressant medications
Can you prevent alopecia?
Most types of alopecia cannot be prevented.
- Androgenic alopecia cannot be prevented as it is thought to have a genetic cause
- Alopecia areata cannot be prevented as it is a disease caused by the immune system
One sub-type of alopecia that can be prevented however, is traction alopecia. By avoiding over-styling the hair, applying hair extensions, or applying physical force onto the hair, you should be able to prevent hair loss.
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