ALOPECIA

Types

Alopecia areata is an autoimmune condition which causes patchy hair loss. It can result in a single bald patch or extensive patchy hair loss.

Alopecia totalis is a more advanced form of alopecia areata which results in total loss of all hair on the scalp.

Alopecia universalis is the most advanced form of alopecia areata which results in total loss of all hair on the body, including eyelashes and eyebrows.

Alopecia barbae is alopecia areata that is localised to the beard area. It can be a single bald patch or more extensive hair loss across the whole of the beard area.

Androgenetic alopecia, also known as male pattern baldness or female pattern baldness, is a thinning of the hair to an almost transparent state, in both men or women. It is thought to be a hereditary form of hair loss and is the most common type of progressive hair loss.

Scarring alopecias, also known as cicatricial alopecias, refers to a group of rare disorders which cause permanent hair loss.

Traction alopecia is usually due to excessive pulling or tension on hair shafts as a result of certain hair styles. It is seen more often in women, particularly those of East Indian and Afro-Caribbean origin. Hair loss depends on the way the hair is being pulled. Prolonged traction alopecia can stop new hair follicles developing and lead to permanent hair loss.

Anagen effluvium is generally caused by chemicals such as those used to treat cancer. Initially it causes patchy hair loss, which often then becomes total hair loss. The good news is that when you stop using these chemicals the hair normally grows back (usually about 6 months later). Other drugs also can cause hair loss. Many medicines used to treat even common diseases can cause hair loss.

Telogen effluvium is a form of hair loss where more than normal amounts of hair fall out. There is a general ‘thinning’ of the hair. Unlike some other hair and scalp conditions, it is temporary and the hair growth usually recovers.

DIAGNOSIS

Family history will often tell the doctor what type of alopecia a person has. Occasionally, a biopsy may be necessary to determine the type of hair loss. Looking at plucked hairs under a microscope can help to tell the difference between alopecia areata and androgenic alopecia. Other tests might be done to check for autoimmune diseases like lupus that can accompany alopecia.

RECOMMENDED MEDICATIONS

Medications are available that encourage regrowth of hair. These medications, such as minoxidil and finasteride, are not appropriate for everyone with hair loss. Hair growth medications work to varying degrees in different people, and only trigger complete regrowth in a minority of individuals. They work best for people who have smaller amounts of hair loss. Hair loss returns if you stop taking the medication. Finasteride is not appropriate for women.

Corticosteroids are another type of medication that may be used for some types of hair loss. Less severe cases of alopecia areata are sometimes treated with corticosteroids injected into the affected area. Systemic (pill-form) corticosteroids have long-term side effects and are reserved for more severe cases.

Another treatment for unresponsive alopecia areata is to deliberately provoke an allergic reaction (contact dermatitis) with a chemical applied to the scalp. A rash develops, and hair often grows back in the same spot a few months later. It can be uncomfortable, though.

Some people with hair loss have slightly low iron or zinc levels and may benefit from iron and zinc supplements.

For severe alopecia of any type, medication may improve the condition, but not cure it. The remaining options are to undergo surgery or wear a wig or hairpiece. The other option is to learn to live with the condition and not pursue medical options.

Surgery usually means a hair transplant. Small plugs of scalp, each with two or three hairs attached, are taken from areas of thick hair, and planted in the affected part of the scalp. Fewer hairs per square inch are needed for people with wavy or curly hair, or people whose hair and skin colours match.

Unfortunately, further hair loss can ruin any transplant, and leave you without enough donor hairs. The least successful candidates for transplant are men in their 20s who are balding fast. Such men, especially those whose fathers were or are bald by the age of 55 years, should know that a very expensive transplant won’t last forever.

Although wigs may not sound like the best option, they often are. Good quality modern hairpieces can be undetectable (though expensive). Many grip by vacuum and won’t fall off – even during contact sports.