About Alopecia

Androgenic alopecia

This is the big one. Androgenic alopecia — also known as patterned baldness — is the most common cause of hair loss and affects 70 percent of men and 40 percent of women. In men, this type of hair loss is usually characterized by a receding hair line, loss in the crown or “bald spot” or general thinning hair throughout the top of the head. Men generally begin to experience androgenic alopecia in their early 20s, although it can take years before becoming noticeable. Women, on the other hand, usually keep their hairlines but beginning in the late 30s to 40s hair gradually thins throughout the entire scalp.

Androgenetic alopecia is caused by a combination of genetics and hormones. Every hair follicle is genetically programmed to be more or less susceptible to various hormones in the body. More susceptible or weaker follicles will be damaged when confronted with these hormones, causing the hair to first shed and gradually become thinner and finer with each regrowth until, eventually, the follicle itself succumbs and dies. An inherited trait, the amount of susceptible hair a person has is solely reliant on genetic chance and can’t be predicted. Naturally, those born with more of the weaker follicles will experience the greatest loss.

In men, the main hormonal culprit is Dihydrotestosterone (DHT) — a hormone created from testosterone and particularly damaging to genetically weaker hair, often resulting in rapid baldness. Women, on the other hand, have different hormonal shifts than men. They have only a small fraction of men’s testosterone and subsequently considerably less DHT. As a result, women can usually go much longer into their hair loss before the damage is irreversible.

In both sexes the rate of hair loss can be unpredictable — speeding up, slowing down, stopping for a time, and starting again. One thing, however, is a constant. Genetic hair loss is progressive. This means one of two things will definitely happen once it starts: It will get worse quickly or it will get worse slowly.

There are currently only three FDA-approved treatments for androgenic alopecia: finasteride, minoxidil and low-level light therapy (LLLT). The first, finasteride, is marketed as Propecia. Finasteride is a drug that interrupts the production of DHT to stop it from contacting weak hair cells, effectively slowing or stopping hair loss. It’s a prescription medication that must be taken daily, and is only proven effective in men.

The second treatment option is minoxidil, commonly known under the brand Rogaine. Minoxidil is what’s known as a vasodilator. Originally an oral high blood pressure medicine, it’s applied topically and widens the blood vessels to essentially fool the hair into thinking it’s more alive than it is by allowing more blood, oxygen, and nutrients to reach the hair follicles. It’s an over-the-counter medication that must be applied daily to be effective and maintain any results.

Finally, there’s LLLT, which uses red light at a specific strength and frequency to stimulate the follicles, increasing their cellular efficiency and causing the hair to regrow. It’s important to note that all three are treatments rather than cures for genetic hair loss, and require both consistent use and for there to be some hair left in the follicle to be effective.

Alopecia areata

Alopecia areata is an autoimmune disorder in the skin that causes hair loss. This condition usually starts with one or more bald circles on the scalp that usually range in size from a pencil eraser to a quarter. These circles can move, multiply, grow, or go into remission for months or even years. No single treatment has been exceptionally effective for preventing alopecia areata, but doctors often recommend steroid and cortisone injections, scalp irritants like anthralin cream, or topical immunotherapy and LLLT to regrow lost hair.

Traction alopecia

A fairly common type of hair loss, traction alopecia is solely caused by pulling at hair follicles. Any time you pull hair from your head can be called traction alopecia, though it most commonly occurs among men and women who wear tight hair styles, such as corn rows, or use hair pieces or braids woven into the existing hair. These can pull at hair follicles and eventually, after enough time and pressure, leave small bald spots on the scalp or visibly thin out hair. Though it can often grow back, continued pressure over extended periods of time can cause permanent hair loss.

Alopecia totalis/universalis

Alopecia totalis is one of the more serious types of hair loss, and is similar to alopecia areata in that it is an autoimmune disorder that causes the immune system to attack hair follicles. However, rather than the smaller circles found with areata, totalis sufferers lose hair all over their heads while universalis sufferers experience hair loss on the entire body. The precise causes are still unknown and, though many kinds of treatments are used by physicians, none have been shown to be specifically effective.

Cicatricial alopecia

One of the rarest forms of hair loss, cicatricial alopecia (or scarring alopecia) only occurs in about 3 percent of all hair loss cases. Rather than one disease, it refers to a collection of skin disorders that destroy hair follicles and replaces them with scar tissue, causing permanent hair loss and leaving patients with flaky, red bald patches that can run across the whole head. Scarring alopecia is extremely difficult to arrest and treat effectively, and requires biopsies and other medical tests to properly diagnose. Physicians usually need to be very aggressive with treatments, including topical and injectable steroids, antibiotics, and other medications. The hair loss that results is usually permanent, although hair transplantation can often be done in the affected areas to replace the destroyed follicles.

Telogen effluvium

Though it’s the second most common kind of hair loss, telogen effluvium is more a description than a condition. Simply put, it’s a way of describing a situation where more hair is in the dormant phase (telogen) than the growth phase (anagen). It appears as shedding or diffuse thinning over the scalp. This type of hair loss can be very unpredictable and could be related to several causes, including hormonal imbalance. It can also happen after giving birth or possibly be triggered by high stress. It’s typically not permanent, and hair often grows back once stress decreases or hormones regain a healthy balance.

This post gives a basic summary of the different types of hair loss, which is a common plight among men and women. Remember that not all hair loss is the same and genetics, hormones, and the environment can all play a role. If you want a clear diagnosis and treatment plan, be sure to make an appointment with your physician.