A man holding a tuft of hair concerned about his alopecia

Alopecia – everything you need to know about the causes and the effective remedies

The general term to describe hair loss is alopecia. It’s often confused with alopecia areata, an autoimmune disorder that affects billions of people worldwide. However, there are numerous types of hair fall that affect both men and women.

Male pattern baldness is a common form of hair loss, but women can also experience pattern hair fall. Medication, medical conditions, genetics, or hormonal changes are also common causes.

It isn’t contagious and it doesn’t make you “sick”, but due to the effect on your mental health, it warrants treatment.

Summary


  1. What are the 3 main types of alopecia?
  2. What are the 4 main causes of alopecia?
  3. Which treatment options are best for hair fall?
  4. Conclusion

What are the 3 main types of alopecia?


Several types of baldness can affect men, women and even children, but there are 3 main types. The loss of hair can occur all at once and gradually expand. So for children, it can be extremely distressing – especially for those under 5 when they start comparing themselves to their peers.

Each type of balding (on the head or body) benefits from a slightly different treatment method. The extent of the hair loss, and other symptoms, defines which form of the condition it is. The 3 main types of alopecia are:

  1. Alopecia Areata (AA): This is the “patchy” form of hair loss whereby bald patches occur. The coin-sized patches that occur on the head or anywhere on the body distinguish it. Exposure to the elements causes the patches of hair loss to cause an itchy scalp. The condition will change into AT or AU if the affected areas remain untreated. There is usually a family history of this type of hair loss because it’s caused by genetics.
  2. Alopecia Totalis (AT): This variant is noticeable by a total loss of hair on the scalp – hence the name “totalis”. AT develops from AA through the expansion of the initial coin-sized patches. Thus, alopecia areata can turn into alopecia totalis but this isn’t the case for everyone.There’s currently no cure for Alopecia Totalis, and hair transplants aren’t possible due to the lack of hair in the donor area. Treatments like hair pigmentation can be beneficial in this situation in order to create the appearance of stubble.
  3. Alopecia Universalis (AU): AU is is the most extreme form of hair loss. In this case, hair shedding doesn’t just affect the scalp. As well as hair loss on the scalp, you will lose hair on other parts of the body including; your eyebrows, eyelashes, beard, arms and legs.

Other kinds of alopecia

Due to the loose use of the term “alopecia”, hair loss can be broken down into further categories. They are the following:

Diffuse Alopecia Areata

Diffuse alopecia, as the name suggests, refers to hair loss that’s spread over a wide area without being concentrated. Therefore, hair loss affects the whole scalp, for example, but instead of extreme hair loss, it causes widespread hair thinning. Thus, instead of circular patches of hair loss, sudden hair thinning occurs

Ophiasis Alopecia Areata

This type of baldness causes a band of baldness around the sides and back of the head. The immune system attacks hair follicles in the occipital, temporal and parietal areas of the scalp. Microneedling is a promising treatment for ophiasis alopecia.

Androgenetic Alopecia

Commonly known as male pattern baldness (MPB) or female pattern baldness (FPB), androgenetic alopecia (AGA) is genetic. The condition usually presents at the temples first, causing a receding hairline. In men, pattern baldness starts at the temples and the crown, whereas in women it usually starts at the temples or the parting.

Traction Alopecia

Traction alopecia, as the name suggests, describes hair loss caused by the action of pulling. Wearing tight hairstyles, including ponytails and braids, puts tension on the hair follicles which causes this form of hair fall.

Cicatricial Alopecia

Cicatricial alopecia is a rare and permanent type of balding caused by the inflammatory destruction of hair follicles, forming scar tissue. This results in scarring alopecia. Scar tissue doesn’t contain any active hair follicles, therefore hair can’t grow back naturally here. The only cure is a hair transplant to implant new hair follicles back into the scar tissue.

What are the 4 main causes of alopecia?


A young girl with hair missing at the back of her head caused by ophiasis alopecia areataAs mentioned above, the different types of baldness have different causes. However, the main triggers of hair loss are:

  1. Genetics: There’s a strong correlation of heredity in AT, as one in five patients have a family history of hair loss. Extreme cases of stress can trigger the disorder, but it’s more commonly caused by genes. In addition, other medical conditions contribute to it, including other autoimmune disorders.Balding of any type, at any age, can be a source of anxiety and depression among individuals. You can suffer greatly emotionally, socially, and psychologically. Should you suffer from those, you can find local support groups on the Alopecia UK website.
  2. Stress: Alopecia can be caused by stress, especially telogen effluvium whereby stress forces hair follicles into the resting phase prematurely. Severe stress also causes AT to flare up.
  3. Anxiety: Anxiety-induced stress can trigger hair loss in the same way as mentioned above. However, anxiety also leads to traction alopecia as people pull their hair as a way to soothe their anxiety. The medical term for this is trichotillomania.
  4. Not seeking treatment at the first signs of hair loss: Although not seeing treatment isn’t the first cause of hair fall, it plays a significant role in why hair loss develops into more severe, untreatable cases. Leaving hair loss to worsen reduces your treatment options, therefore we highly recommend seeking medical advice early on.

What causes alopecia in females?

Female baldness can present itself similarly to men, however, because women typically have longer hair, they can hide the symptoms of alopecia areata (and other types of hair loss) for longer. The main causes of hair fall in females include traction alopecia, genetics, medication and hormones.

Which treatment options are best for hair fall?


Steroids

Topical corticosteroids are often prescribed as the initial treatment option for alopecia areata. They are used as intralesional injections or tablets. Steroids suppress immune reactions and promote new hair growth. Steroid treatment for hair fall takes only a few weeks before it starts to work.

Finasteride

Finasteride blocks the action of 5-alpha reductase which therefore prevents this enzyme from converting into the testosterone that attacks the hair follicles. Applying minoxidil or finasteride every day is imperative in order to see results.

Minoxidil

By accelerating the natural hair cycle, 5% topical minoxidil stimulates hair growth. When combined with steroids it’s even more effective. Before using minoxidil, you should first consult your doctor because it has well-known side effects.

Hair Transplant

If hair loss isn’t responding to medication or lifestyle changes, or if it’s not caused by an autoimmune disease, then we recommend making a hair transplant.

This is because, with autoimmune diseases, the body will continue to attack the hair follicles even after moving them to the new location.

Thus, a hair transplant doesn’t work for alopecia areata, however, it’s an effective long-term solution for conditions like pattern hair loss.

Conclusion


A large part of a person’s life is their appearance thus when this is compromised by uncontrollable hair loss it’s distressing.

With advancements in treatment methods, you can find natural remedies and medical treatments for every type of balding issue.

However, some treatments take time before hair grows. Thus, hair transplants are leading the way, across the world, as the most effective form of hair loss treatment.

Depending on the cause of alopecia, there are numerous effective treatments. However, a hair transplant is the only treatment option that is a long-term one-off procedure, as others require a daily application or have numerous and significant side effects.

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