Signs and Symptoms of Alopecia

If you're wondering how to know if you have alopecia, the main symptom is gradual and complete or partial hair loss. Rare forms of alopecia lead to distinct patterns of hair loss and other unique symptoms.

Hair loss can occur on the scalp, eyebrows, eyelashes, and other regions of the body. When the immune system plays a role in the disease—such as with alopecia areata—it can cause burning or discomfort on the scalp in rare cases.

Common Symptoms

A few common symptoms exist across different forms of alopecia, including:

• Gradual thinning of the hair on your head
• A growing bald spot
• Hair falling out in patches or strips
• Receding hairline
  

Symptoms by Type of Alopecia

Some symptoms can vary depending on the type of alopecia. There are two major categories of alopecia: non-scarring and scarring.

Scarring alopecia damages the hair follicle—the skin pore where your hair grows from—and leads to permanent hair loss. With non-scarring alopecia, the hair follicle is not permanently damaged, and the hair can possibly grow back.

Non-scarring types of alopecia include:

• Alopecia areata
  
• Androgenetic alopecia, though in this case the hair will not grow back when it is damaged
• Telogen effluvium
• Traction alopecia
• Trichotillomania

Scarring types of alopecia include:

• Central centrifugal centripital alopecia (CCCA)
  
• Frontal fibrosing alopecia (FFA)
• Lichen planopilaris (LP)
  

Some types of alopecia can be associated with infections. Depending on the type of infection, these can be non-scarring or scarring.

Androgenetic Alopecia

The most common type of alopecia is androgenetic alopecia, a genetic condition. It can occur in anyone regardless of sex assigned at birth, though symptoms can vary across sexes. As a result, the condition is more commonly called male-pattern hair loss or female-pattern hair loss, depending on the person.

Male-pattern hair loss can include:

• A bald patch in the middle of the scalp (the vertex) grows
• Hair follicles appear shrunken
• Hairline recedes from the forehead in an M shape
  

Female-pattern hair loss can include:

• Hair thinning near the front of the scalp and in the ponytail
  
• Thinning or hair loss that occurs after menopause
• Widening hair partition in the middle of the scalp

Alopecia Areata

Alopecia areata is an autoimmune condition in which the immune system attacks the hair follicles. Signs of this alopecia include:

• A burning or stinging feeling before sudden hair loss
• Hair loss in the scalp, eyebrows, eyelashes, beard, nose, and pubic hair
• A patchy or band-like pattern of hair loss
• Red or brittle nails
• Short, thin hairs visible on the scalp
• Yellow and black dots on the scalp 

Telogen Effluvium

Telogen effluvium is a more common form of alopecia. It is specific to the scalp (instead of the whole body) and is characterized by excessive shedding.

It usually happens after intense emotional or physical trauma. It can also occur after a fever, pregnancy, or surgery, or from nutritional deficiencies, infection (like COVID), weight loss, or hypothyroidism (a thyroid condition). Signs of telogen effluvium can include:

• Changes in hair color, such as turning from dark brown to red—only in the case of severe protein malnutrition, such as kwashiorkor
• Dry hair that is easy to pluck
• Hair falling in spread-out areas, which is known as increased diffuse shedding
• Shedding of white bulb hair—hair that has the white bulb at the end that was in the scalp without a gel-like covering
• Sudden, dramatic hair loss

Telogen effluvium is almost always temporary. Hair regrowth can take time and require consistent care.

Traction Alopecia

Traction alopecia occurs when hair follicles are damaged by repeated pulling, such as from tight hairstyles. It's often seen on the temples. Some symptoms include:

• Hair that becomes shorter and thinner
  
• Pain or soreness of the scalp
• Pimples and pustules on the scalp
• Redness of the skin
• Scaly and itchy skin near hair follicles

Trichotillomania

This form of alopecia is a type of mental health condition characterized by hair pulling. Signs and symptoms include:

• A compulsion to pluck out hair from the scalp and other body regions such as the eyebrows, legs, arms, or pubic area
  
• Hair pulling causes distress or impairment that negatively impacts a person’s life
• No symptoms characteristic of other forms of alopecia
• A repeated effort to cut down on hair-pulling behavior
  

Lichen Planopilaris (LP)

Lichen planopilaris is a type of inflammatory alopecia that can cause scarring of the hair follicles and gradual hair loss. Symptoms include:

• Itching, sensitivity, or burning on the scalp
• Permanent hair loss due to scarring of the hair follicle
• Redness around the hair follicle, known as perifollicular erythema
• Rough, raised bumps of the hair follicles—follicular hyperkeratosis—due to excess keratin, a hair and skin protein

Frontal Fibrosing Alopecia (FFA)

Frontal fibrosing alopecia is a variant type of LP characterized by hair loss at the front and sides of the scalp. It can cause scarring of the hair follicles and prevent hair from growing back. You may experience the following if you have FFA:

• Bumps on the face or skin
• Noticeable hair loss on the scalp, face, arms, legs, or pubic area
• Rash near the hairline
• Scalp itching or pain
• Thinning or loss of hairs from the edges of the eyebrows

It is possible to stop the progression of FFA with early diagnosis and treatment. Talk to a healthcare provider if you are experiencing symptoms of FFA.

Central Centrifugal Cicatricial Alopecia (CCCA)

Central centrifugal cicatricial alopecia (CCCA) is a type of hair loss that starts at the center of the scalp and can lead to scarring of the hair follicles. The bald spot can get larger with time, and scarring can cause permanent hair loss. The cause of CCCA is unknown, but a healthcare provider can prescribe treatments to help maintain the hair.

Alopecia Associated With Infection

Different infections can be connected to alopecia, including fungal infections of the scalp, which may cause alopecia. These infections may include:

• Folliculitis: Inflammation of hair follicles, which can also be caused by bacteria
• Piedra: A type of fungal infection that occurs in the hair cells
• Ringworm: A common fungal infection of the scalp or
• Seborrheic dermatitis: A condition that causes scaly, oily skin

If you have alopecia associated with infection, you may experience:

• Burning or itching of the scalp
• Open sores or blisters on the scalp
• Scaly skin near bald patches
  

When To See a Healthcare Provider

Alopecia can affect people of any age. You can talk to a healthcare provider about how to manage symptoms and treatments, depending on your condition—especially if your hair loss is sudden or occurs in your 20s or earlier. You may also speak with a healthcare provider or dermatologist if you have:

• Acne, facial hair, or changes to your menstrual cycle
• An unusual pattern of hair loss
• Bald spots on the beard or eyebrows
• Cold sensitivity
• Emotional or physical stress that affects your self-esteem or mental health
  
• Pain and itching of the skin, especially on your scalp
• Red or scaly scalp
• Visible scalp infections
  
• Weight gain, muscle weakness, or fatigue
  

A Quick Review

Gradual hair loss is a telltale sign of alopecia, though the signs of the condition can vary across types. Other symptoms, such as scalp pain or redness, bald spots, pimples, or a receding hairline may accompany it.

Speak with a healthcare provider or a dermatologist if you are experiencing hair loss. They can diagnose the type of alopecia you have and provide a treatment regimen.