- Alopecia Areata
- Male Pattern Baldness
- Female Pattern Baldness
- Telogen Effluvium
- Infective Alopecia
- Scarring Alopecia
- Reversing Hair Loss
- Normal vs. Abnormal Hair Loss
Alopecia (hair loss) is both a disease and a sign of other conditions. The types of alopecia (baldness) are divided into scarring and non-scarring. Non-scarring alopecia has hair loss but leaves hair follicles intact. Reversing hair loss is possible while the follicles remain undamaged. Scarring alopecia causes permanent hair loss. Some causes of alopecia are also associated with significant disease activity in other parts of the body. In these situations, alopecia gives you and your physician an early warning about these disorders.
In this autoimmune disease, your immune system's cells turn on your hair follicles. The hair shafts fall out in response. Coin-sized areas of complete hair loss develop.
Hair loss can affect any body hair, including the eyebrows and beard. Sometimes, the whole scalp is affected (alopecia totalis). The hair often grows back over months or years. Returning hair might grow in white.
Hair regrowth depends on the extent of hair loss. Small areas of hair loss usually recover hair. If more than half of the scalp has lost its hair, it may not grow back. If you have alopecia totalis, your hair probably will not regrow.
This disease runs in families. Others in your family may have alopecia areata. You may not realize it because people tend to hide baldness. People with alopecia areata are more likely to have other autoimmune diseases like diabetes, lupus, vitiligo, and thyroid disease.
Alopecia areata has no cure, but the hair often grows back. It may fall out again. Your doctor may treat you with steroid creams, tablets, minoxidil lotion, or dithranol. Many immunosuppressive drugs are available now. But this disease doesn't harm your physical health much, and your doctor won't prescribe medications with severe side effects.
Male pattern alopecia
This condition is also known as androgenic alopecia because male hormones (androgens) are the triggering agents. The hairline recedes, leaving the front of your scalp hairless. You may also have thinning hair at the top of your head. Half of all men have some degree of this type of hair loss by age 50.
Female pattern alopecia
Female pattern baldness is similar to male pattern hair loss, but the hair loss is more widespread, and the hairline in the front is preserved. This kind of alopecia often starts as a widening of the part line: while the hair is thinning over much of the scalp, it's most apparent at the part. As hair loss progresses, the thinning of the hair on the top of the head becomes more and more obvious. Hair follicles become smaller, and hair becomes finer and shorter.
The resting phase of your hair follicles is called telogen. Anagen is the growth phase. During any great bodily stress, like childbirth, prolonged illness, or major surgery, a large proportion of your hair follicles go into telogen. Severe nutritional deficiencies and quick weight changes, certain drugs, and hormonal therapy can also cause telogen effluvium.
The telogen phase usually lasts three months. When your hair follicles go into the growth phase again, old hair is shed. Though it looks alarming, your hair will all grow back.
If telogen effluvium is long-lasting, your doctor will test you for thyroid function. They may also prescribe iron, vitamin B12, folate, and zinc.
Physical causes of baldness (alopecia)
Physical causes of alopecia usually involve the hair follicles being pulled out of the scalp. The two frequent conditions are:
The hair follicles are pulled out by constant pulling. Hairstyles that keep your hair firmly pulled back are the usual reason. In the early stages, only the hair is pulled out, and reversing the hair loss is possible. Over time and with ongoing tension on your hair, the follicles die, and hair loss becomes permanent.
This is a condition of hair-pulling. The person compulsively pulls their own hair out. The hair loss is usually seen in irregular patches.
Infections that cause alopecia are usually fungal. This condition, called tinea capitis, is common in children. Two fungi are commonly involved. Trichophyton tonsurans spreads among humans. Your child can also get Microsporum canis from kittens or puppies.
Hair loss in these conditions results from the destruction of the hair follicles. Most of these conditions are inflammatory. In the early stages, some of these diseases look like alopecia areata. Scar tissue replaces the hair follicles, and it's impossible to reverse the hair loss. Treating the disease can only help prevent more hair loss.
Some conditions that cause scarring alopecia include:
- Central centrifugal cicatricial alopecia
- Chronic cutaneous lupus erythematosus
- Folliculitis decalvans
- Frontal fibrosing alopecia
- Lichen planopilaris
Some conditions like burns, injuries to the scalp, and radiotherapy can also cause scarring alopecia. Herpes zoster and bacterial infections like folliculitis and syphilis can sometimes lead to permanent alopecia.
Reversing hair loss
Two well-established treatments for male pattern hair loss are minoxidil and finasteride. Minoxidil is available as a liquid to be applied to the hairless areas of your scalp. You must continue the treatment for four to six months. About 60% of men with androgenic alopecia benefit from this treatment. Finasteride is an oral drug you must take for months or years.
Women with female pattern hair loss may benefit from minoxidil application. Finasteride is not prescribed to women. Combined hormone therapy with estrogens and progestins helps reduce hair fall. This potent hormone therapy needs careful thought about the benefits and risks. Other drugs used are spironolactone and cyproterone acetate.
The alopecia of female pattern hair loss is distressing and unpredictable. There are no known cures for female pattern hair loss. Be careful when sellers and manufacturers of "wonder drugs" make such claims.
Tinea capitis is a fungal infection. Your doctor will prescribe oral medicines like griseofulvin or terbinafine to remove the infection. This is a non-scarring alopecia, and the hair grows back once the underlying infection is cured.
Hair loss is normal. You usually lose 50 to 100 strands of hair every day, which grow back. You should talk to your physician if you have sudden hair loss, your hair falls out in clumps, you develop bald patches, or the hair loss is associated with itching and burning of your scalp. You may need treatment to stop the hair fall and reverse the alopecia in these conditions.
The most common causes of hair loss are male pattern hair loss, female pattern hair loss, alopecia areata, and telogen effluvium. These are conditions by themselves. You only need treatment to reverse hair loss.
Sometimes, alopecia is a sign of another disease. Lupus erythematosus and lichen planopilaris cause alopecia but also cause disease in the skin and other organs. If your hair loss is caused by such diseases, your physician can offer a diagnosis. They may ask for tests to see the extent of the disease's progress. You may need more aggressive treatment than you'd need for simple alopecia.
British Association of Dermatologists: "Alopecia Areata."
Morris-Jones, R. ABC of Dermatology, Wiley, 2019.
National Health Service: "Hair loss."
National Health Trust: "Women and hair loss: coping tips."
Nature reviews. Disease primers: "Alopecia areata."
Skin Therapy Letter: "Promising Therapies for Treating and/or Preventing Androgenic Alopecia."
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