What Is Alopecia?

Alopecia is a group of conditions characterized by partial or complete hair loss. Alopecia areata symptoms, for example, include patchy hair loss that affects the scalp or rapid hair loss that grows back over time. Hair loss may occur anywhere on the body, depending on the type of alopecia you have.

Some types are common, while others are very rare. The most common form of alopecia is male- or female-pattern baldness, which is genetic. Researchers estimate that half the population will develop this form of alopecia at some point in their lives. Other forms may be caused by stress, hair damage, an autoimmune reaction, or as a consequence of chemotherapy.

Types

There are two different overarching types of alopecia. These types describe whether the hair follicle becomes damaged, preventing hair from regrowing.

Traction alopecia can fall into either category. This type of alopecia occurs when hair falls out due to physical tension, which certain hairstyles can cause. It may begin as a reversible, non-scarring type of hair loss. Chronic traction alopecia may lead to scars and permanent hair loss.

Non-Scarring Alopecia

Most forms of alopecia are non-scarring. The hair follicle is left intact, and it's possible for hair to regrow.

The types of non-scarring alopecia include:

• Alopecia areata: A condition that causes patchy baldness anywhere on the body
• Androgenetic alopecia (male- and female-pattern hair loss): A common form of hair loss tied to genetic factors and sex hormones, causing the hair to stop growing and start falling out
• Chemotherapy-induced alopecia (anagen effluvium): Hair loss that occurs as a side effect of cancer treatments
• Postpartum alopecia: A form of telogen effluvium that occurs months after childbirth
• Telogen effluvium: A temporary form of hair loss that occurs a few months after physical or emotional stress
  
• Trichotillomania: A psychiatric condition involving compulsive hair-pulling

Scarring Alopecia

This form of alopecia involves damage to the hair follicles. Scarring alopecia occurs when the immune system attacks the hair follicles, causing scaly or scarred skin, inflammation, and pain. This type is more difficult to treat, but there are interventions that can help manage the symptoms.

Types of scarring alopecia include:  

• Central centrifugal cicatricial alopecia (CCCA): A permanent form of hair loss that leads to circular patches of baldness on the top of the scalp and inflammation
• Frontal fibrosing alopecia (FFA): A form of lichen planopilaris that usually affects post-menopausal people
• Lichen planopilaris (LPP): An inflammatory scalp disorder that causes band-like patches of hair to fall out and a thickening of the outer layer of the skin, which causes excessive skin shedding
  

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Signs and Symptoms of Alopecia

Alopecia Symptoms

There are many symptoms of alopecia. Some, like hair loss on the scalp, are very common. Other symptoms, such as the loss of eyelashes, are less common.

Other common symptoms include:

• A pattern of hair falling out in strips
• Gradual thinning of the hair on your head
• Growing bald spot
• Receding hairline

You may experience these symptoms when the hair loss occurs quickly:

• A patch or strip of hair falling out in a day or two
• Hair falling out in clumps when you’re brushing it or showering
• Most or all of the hair falling out at once

Alopecia may also cause hair loss elsewhere on the body. A person may experience hair loss with their eyelashes, eyebrows, facial hair, nose hair, and pubic hair.

Other symptoms of alopecia include:

• Black or yellow spots on the scalp
• Brittle or fragile nails
• Burning or itching on the scalp
• Burning or stinging before sudden hair loss
• Redness, swelling, or sores
• Scaly bald patches
  

Causes

There are many reasons why someone may experience hair loss. For example, hairstyles, products, and treatments that put stress on the hair, such as excessive hair washing or blow drying, can cause traction alopecia.

Another cause may be that the hair follicles themselves shrink. The immune system sometimes attacks and destroys hair follicles, and hair can become fragile or fall out faster than normal in other cases.

Non-Scarring Alopecia

There are many factors causing non-scarring alopecia, which differ by type:

• Alopecia areata: A condition caused by an overactive immune system attacking hair follicles. There is a genetic component to this condition, but more research is needed.
• Androgenetic alopecia (male- and female-pattern hair loss): This form of hair loss is caused by genetic factors and an increase in the sex hormone dihydrotestosterone. It shrinks hair follicles and stops hair growth, causing it to fall out. 
• Chemotherapy-induced alopecia (anagen effluvium): Hair loss that occurs as a side effect of cancer treatments that stop cells from growing.
• Postpartum alopecia: A form of telogen effluvium that occurs due to the stress of pregnancy and changes in hormones. 
• Telogen effluvium: A temporary form of hair loss that is caused by physical or emotional stress.
  
• Trichotillomania: Hair loss is caused by an underlying psychiatric condition that causes compulsive hair pulling.

Other potential causes of non-scarring alopecia include:

• Age-related hair loss
• Consuming a low-protein diet
• High fever or severe infection
• Hormonal changes
• Medications, including retinoids, hormonal birth control, beta-blockers, calcium blockers, antidepressants, and non-steroidal anti-inflammatory drugs (NSAIDs)
• Thyroid disease
  

Scarring Alopecia

The immune system sometimes attacks the hair follicles for an unknown reason. This damage prevents hair from growing back. 

Scientists speculate the following might cause these forms of hair loss:    

• Central centrifugal cicatricial alopecia (CCCA): Scientists believe low levels of a particular keratin protein or an underlying immune condition may cause it.
• Frontal fibrosing alopecia (FFA): A variety of factors may cause FFA, including an overactive immune response, genetics, hormonal changes, or surgeries that affect the face or scalp. More research is needed.   
• Lichen planopilaris (LPP): Scientists believe an overactive immune response to drugs, viruses, infection, or other allergens causes this.

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Diagnosis

Alopecia is diagnosed by a dermatologist (who specializes in hair, skin, and nails). They'll perform a physical examination and medical history. 

Diagnosing alopecia may also require one or more of the following tests:

• Biopsy: This test is used to differentiate between different forms of scarring alopecia. It involves removing a small 4-millimeter piece of tissue from the scalp near the receding hairline for further analysis of the tissue. 
• Blood test: This test helps determine whether conditions like thyroid disease or vitamin deficiency cause hair loss. It can also measure factors that influence hair loss, including sex hormones and inflammation.
• Dermoscopy: A handheld device (dermatoscope) magnifies scalp features for the dermatologist. Features such as black dots, hair that becomes thinner along the strand, and broken hairs can all be indicators of alopecia.
• Hair pull test: A dermatologist pulls on a small group of hairs, typically 50–60, and counts how many are pulled out. A test is considered positive if more than 10% of the hairs are pulled out. You may have telogen or anagen effluvium if the test is positive in more than one scalp area. The test may signal alopecia areata affecting only one part of the scalp if it's positive in one region.
• Wood's lamp: A Wood's lamp is an ultraviolet (UV) light that is shone on the scalp to diagnose alopecia caused by infection. Certain bacteria, fungi, or changes in skin pigment cause the scalp color to change under light or fluorescence.

Treatments

There are many treatments available for alopecia. Treatments for non-scarring alopecia help slow hair loss and promote hair regrowth. Some therapies target inflammation and other symptoms when alopecia is caused by the immune system attacking the hair follicles and scalp. 

Drug-Based Treatments

There are many drug treatments for alopecia. Drugs that work to regrow hair or slow hair loss tend to take six months or longer to work. Drug-based treatments include:

• Aldactone (spironolactone): A drug prescribed off-label to slow hair loss in women. It works by slowing the production of sex hormones that contribute to hair loss.
• Corticosteroids like Adcortyl (triamcinolone acetonide): These drugs are prescribed to slow inflammation. You apply them directly to or inject them into the scalp. This stops the immune system from attacking the hair follicles. 
• Immunotherapy (diphenlcyclopropenone): A drug that is rubbed into the scalp weekly to help regrow hair. The immunosuppressant has a strong effect on the immune system, preventing allergic reactions that attack the hair follicles.
• Proscar/Propecia (finasteride): A prescription drug that slows hair loss. It stops the process that converts testosterone to dihydrotestosterone, a sex hormone linked to hair loss.
• Rogaine (minoxidil): An over-the-counter (OTC) drug that promotes hair growth. Rogaine may activate cellular pathways that promote growth in hair follicles when you apply it to the scalp once or twice per day. It may also increase the blood flow of nutrients to the follicle. 

Non-Drug Treatments

There are other treatments that involve surgery, cosmetic procedures, or hair loss concealers. These include:

• Concealers: These are OTC sprays or powders that can temporarily hide hair loss. 
• Hair transplant: This procedure implants donor hair—along with the follicles—into bald patches. The implanted hair will then grow from the area it was implanted on.
• Microneedling: This device has hundreds of small needles used to massage the scalp. Some preliminary studies have found this treatment to be effective. More studies are needed to confirm these findings.  
• Platelet-rich plasma injections: This treatment involves isolating white blood cells (platelets) from your blood and reinjecting them into the scalp. Some evidence suggests that this treatment may be helpful, but more research is needed.
• Red light therapy: This device shines red light onto the scalp to promote hair growth. More studies are needed to confirm whether red light therapy works. 
• Wigs: These are immediate, temporary cosmetic items that can cover hair loss on the head.

Prevention

The most common causes of alopecia are genetic and difficult to prevent. There are still some ways you can reduce the risk of other forms of alopecia caused by hair damage:

• Avoid processed foods and low-protein diets.
• Do not use damaging hair products and relaxers.
• Stop smoking.
• Switch to a gentle shampoo.
• Use a moisturizing conditioner.
• Use soft towels, brush your hair gently, and stop pulling or twirling your hair.
• Use the blow-dryer only in lower heat settings.
  

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Related Conditions

There are multiple conditions that are related to alopecia. Many of these are autoimmune disorders, in which the immune system mistakenly attacks.

Related conditions include:

• Anemia: Causes low blood iron levels 
• Eczema and other skin conditions: Involves the immune system attacking the body, similar to some types of alopecia
• Lupus erythematosus: Causes the immune system to attack many different organs
• Mental health conditions: Includes conditions like depression and anxiety, which may involve abnormal brain inflammation
• Metabolic syndrome: Includes conditions involving inflammation that increases the risk of heart attack, stroke, and type 2 diabetes
• Ovarian cysts: Are fluid-filled growths that develop on the ovary and may increase the production of sex hormones that lead to hair loss
• Thyroid disease: Causes the immune system to attack the thyroid
• Tinea capitis (ringworm of the scalp): Is a fungal infection that can cause hair loss, often occurring in children
• Vitamin D deficiency: Causes low levels of vitamin D, which helps hair follicles regulate growth and shedding
  

Living With Alopecia

Most people who get alopecia live healthy lives. Some tips for day-to-day hair care and management of symptoms include:

• Connect with a therapist or organization that supports others with your condition: It may help to talk to someone who understands the unique challenges of living with alopecia.
• Consider false eyelashes or stick-on brows: Your eyes lose a layer of protection if alopecia affects your eyebrows or eyelashes. False eyelashes or eyebrows can help protect your eyes.
• Find meaningful ways to express yourself: Some people with alopecia feel a loss of identity over losing their hair. Finding a way to express yourself and your style can help you feel more like youself.
• Wear hats and scarves in winter: The places where hair is lost become more sensitive to cold weather.