A woman with total baldness

Alopecia – The Types, Causes and Treatments

Alopecia is a broad term that refers to any type of hair loss in both men and women. There are, however, various types, each with its own distinct name, cause, symptoms, and treatments.

Scarring alopecia, non-scarring alopecia, and temporary hair loss are all examples of hair loss. Because scarring alopecia is permanent, the hair follicles are destroyed and unable to regrow hair. Temporary hair loss and non-scarring alopecia are not permanent and respond well to treatment.

Summary

  1. Why Does Alopecia Start?
  2. What Are The Different Types of Alopecia?
  3. What Is The Best Hair Restoration Treatment for Alopecia?
  4. The Psychological Impact
  5. Conclusion

Why Does Alopecia Start?

Alopecia begins with thinning hair or the appearance of circular bald spots. It starts when your cells begin to attack the hair follicles (which can be due to an autoimmune disease or androgens).

What causes hair to fall out?

The type of Alopecia you have will help aid in determining the cause. However, the most common causes of hair loss are:

  • Genetics: There is a strong link between hair loss and family history. In fact, 20% of patients with a form of Alopeica Areata has someone in their family who has the condition. Hence, pattern baldness patients have a relative with pattern baldness.
  • Stress: Can stress cause alopecia? Yes. Stress can trigger your hair to fall out, infact, it’s the primary cause of Tellogen Effluvium. Stress can force hair follicles into the resting phase of the hair growth cycle prematurely, resulting in excessive hair loss.
  • Hormones: Androgenic hair loss (male and female pattern baldness) is triggered by the androgen Dihydrotestosterone (DHT). The gene that causes an icrease in DHT, which shrinks your hair follicles is passed down through genetics on the maternal side.

What Are The Different Types of Alopecia?

Several types of baldness can affect men, women and even children, but there are 3 main types:

  • Alopecia Areata (AA),
  • Alopecia Areata Totalis (AT),
  • and Alopecia Areata Universalis (AU).

These 3 types of Alopecia are caused by an autoimmune disease that attacks the hair follicles because the body’s immune system identifies them as foreign cells. Although they are all caused by the same thing, each type has different symptoms and the hair fall is at different extremities.

Guidelines published by the British Association of Dermatologists’ stated that the symptoms of AA develop into AT or AU in 14-25% of patients with Areata.

Alopecia Areata (AA)

Alopecia Areata starts as 1 or 2 coin-sized and smooth bald spots on your scalp, body, or facial hair. However, in rare cases, hair loss is diffuse instead of defined patches.

The severity varies from person to person. In some cases, the hair grows back whereas other cases develop into AT or AU.

Causes

Alopecia Areata is caused by an autoimmune disease whereby your immune system mistakenly attacks your hair follicles. This causes inflammation in those specific areas of the scalp which causes your hair to fall out.

It’s not fully understood why the body identifies the hair follicles as foreign cells, or which it occurs in localised, defined spots. AA often goes hand-in-hand with other autoimmune diseases e.g. thyroid disease, lupus etc.

Symptoms

  • Coin-sized bald patches on the scalp or body
  • Exclamation mark hairs
  • Fine white hairs left in the bald spots

Alopecia Totalis (AT)

Alopecia Totalis is characterised by total loss of hair on the scalp. It’s an advanced type of AA whereby the patches of hair loss have expanded.

AT is a rare autoimmune disease that is typically triggered by genetics – especially in early-onset Alopecia Totalis.

Causes

AT has the same initial cause as AA. However, for unknown reasons, your immune system attacks your hair follicles across your whole scalp instead of in patches.

Symptoms

  • Scalp discomfort, soreness, itchy scalp or a tingling sensation
  • Total hair loss across the scalp
A woman with alopecia universialis

Alopecia Universialis (AU)

Alopecia Universalis is the next level after AT. After AA develops into AT, you can start to lose your eyebrows, eyelashes, chest hair, armpit hair and pubic hair, arms and legs – which is then defined as Alopecia Universalis. It is the most severe form of Alopecia Areata.

Causes

It can occur at any age and develop at different speeds. AU is also an autoimmune disease that has become more advanced than AA and AT.

Symptoms

  • Total hair loss across the body including arms, face and chest
a black woman with braids suffering from traction alopecia

Traction Alopecia

Traction alopecia, as the name suggests, is hair loss caused by the action of pulling against the hair follicles.

Causes

Wearing tight hairstyles, including ponytails and braids, puts tension on the hair roots which causes this form of hair fall. Repeatedly pulling at your hair damages your hair follicles and slows down hair growth.

This form of Alopecia is also common among Sikh men because, as part of their religious practice, they are forbidden to cut their hair. Consequently, their hair is tied in a tight top bun before wrapping their turban around their head. This puts excessive tension on hair follicles, resulting in traction alopecia.

Symptoms

  • Thinning hair along the hairline
  • Patches of thinning hair where your hair has been pulled tight (e.g. with braids or ponytails)
  • Sparse thinning hair

Androgenic Alopecia

Androgenic Alopecia (aka male/ female pattern baldness) is the most progressive hair loss which spans several years or decades.

Pattern baldness affects approximately 50% of men over the age of 50 and nearly 50% of women above 65. Symptoms can start at any age, but generally the younger it starts the faster it progresses.

Causes

Pattern baldness is genetic, specifically it’s inherited from the maternal side. The male hormone dihydrotestosterone (DHT) shrinks hair follicles which causes Androgenic Alopecia. DHT comes from testosterone which is typically a male hormone, however, it’s also present in women.

DHT causes your hair follicles to become smaller which then causes the strands to become thinner and more fragile and eventually fall out.

Symptoms

In men:

  • Receding hairline
  • Balding crown
  • Thinning hair across the top of the scalp

In women:

  • Thinning hair in the parting
  • Sparse hair thinning across the top of the scalp
A man with patchy hair loss in his beard from alopecia barbae

Alopecia Barbae

Alopecia Barbae is a form of Alopecia that only targets your facial hair. Therefore, in a similar fashion, it’s an autoimmune disease that causes bald patches in your beard.

It’s common for this type of hair loss to occur on and off across several years. During this time the hair can grow back and fall out again for reasons unknown to us yet.

Causes

The cause of alopecia barbae is the same as AA, it’s an autoimmune disease that attacks your hair follicles. Although it causes similar symptoms, it’s unclear why it only affects facial hair.

Symptoms

  • Patchy hair loss on your cheeks, neck, upper lip, and beard
  • Coin-sized bald spots on your face

Frontal Fibrosing Alopecia (FFA)

The symptoms of frontal fibrosing alopecia cause scarring at the top of the forehead which forms band-like baldness. It’s a form of lichen planopilaris that is responsible for slow, progressive hair loss in a symmetrical band on the front and sides of the scalp.

Causes

The cause of frontal fibrosing alopecia is unknown. However, it’s thought to be an autoimmune disease that (like with AA) attacks the hair follicles as it thinks they’re foreign to the body.

Symptoms

  • Hair loss and scarring in a band on the scalp (above the forehead)
  • The bald skin looks pale, shiny or slightly scarred.

What Is the Best Hair Restoration Treatment for Alopecia?

  • Steroid injections/ topical corticosteroids
    Topical corticosteroids are often prescribed as the initial treatment option for alopecia areata. They are used as intralesional injections or tablets.Steroids are anti-inflammatory and suppress immune reactions to promote new hair growth. Nonetheless, these topical treatments needs to be applied daily to the affected areas.
  • Finasteride
    Finasteride blocks the action of 5-alpha reductase which therefore prevents this enzyme from converting testosterone into DHT (the testosterone that attacks the hair follicles). On the other hand, applying 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 numerous 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 having a hair transplant.Hair transplants are effective for certain types of alopecia, for example Androgenic Alopecia is reversible with hair restoration surgery.
  • Immunotherapy
    Topical immunotherapy induces hair growth but for reasons that are unknown. A substance is applied to the affected areas which causes irritation, scaling and itching and hair growth.
  • Hair Pigmentation
    For the types of Alopeica that aren’t treatable, hair pigmentation is the best method for achieving the appearance of hair. In brief, micro dots are tattooed onto the scalp to create the look of fine hairs, as if the head has been shaved.
men anxious about his alopecia

The Psychological Impact

Due to the lack of clinical information and treatments for Alopecia, it causes substantial psychological effects. The emotional impact that it has, can create a loop effect where the hair loss triggers depression which then triggers stress and further hair loss. You can find helpful support on the NAAF Support Group Network.

Which celebrities have alopecia?

Many celebrities have shared their alopecia stories, including Naomi Campell and Matt Lucas. A few years after being hit by a car, Matt Lucas developed alopecia Totalis, aged 6. So, this traumatic event is what’s believed to be the trigger of his hair loss.

In this article in The Guardian Matt Lucas talks about his experience being called a “slaphead” and “skinhead, but mainly “baldy”. He emotionally shares how he felt “eternally self-conscious, constantly stared at, teased, mocked and bullied”.

Conclusion

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

Depending on the cause, 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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