Physically, hair is strands of keratin proteins mixed with water, lipids, and pigment cells, but our hair is so much more. It’s a visual representation of our personality that is as much a statement of our identity as the clothes we choose, so when alopecia, hair loss, occurs, it can change our self-image. According to Dr. Rehan Karim of U.S. Dermatology Partners North Dallas, “Alopecia is an umbrella term used to define multiple underlying causes of hair loss. From hormonal imbalance to autoimmune diseases, alopecia can be an outward sign of more serious health issues, or it can occur as the result of genetic predisposition. Whatever the underlying cause of alopecia, hair loss doesn’t have to be unavoidable. Today, there are numerous oral and topical medications and dermatologic treatments that prevent and reverse alopecia.” In this blog, Dr. Karim answers common questions about hair loss, including what is alopecia, do I have alopecia, and how can I reverse hair loss and thinning from alopecia?
What Is Alopecia?
Alopecia is a general term that refers to any type of hair loss. Most often thought of as related to hair on the head, alopecia may also refer to hair loss in the eyebrows, eyelashes, and beard as well as loss of body hair. It can range in severity from mild thinning or small patches to complete hair loss on the head and body. According to Dr. Karim, “Most people shed between 50 and 100 hairs each day. When people start noticing excessive shedding that’s persistent or seems to be creating an abnormal pattern in hair, they should talk to a dermatologist. Early intervention can prevent further hair loss, and many forms of alopecia can be reversed if properly treated in the earliest stages. Accurate diagnosis is an essential part of alopecia treatment planning, so it’s important to work with a professional to receive the right care, especially since hair loss can be a symptom of more serious underlying health conditions that require medical treatment.” Some important things to remember about alopecia include:
- Alopecia is not a contagious condition.
- It impacts both men and women.
- It’s often treatable with proper diagnosis.
Types of Alopecia & Their Treatments
Because alopecia is an umbrella term used to describe hair loss with many different origins, it’s important to receive an accurate diagnosis to determine the specific type of alopecia to ensure proper treatment. Below, we outline the most common types of alopecia, their hair loss patterns, causes, and treatment options.
Androgenetic Alopecia (Male and Female Pattern Hair Loss)
The most common form of alopecia is male and female pattern hair loss, which is referred to clinically as androgenetic alopecia. It impacts millions of men and women each year. This form of alopecia is genetically inherited. Androgen hormones, which give this form of alopecia its name, shrink hair follicles, which causes them to produce thinner hair. Then, it begins to slow the hair growth cycle, which eventually stops completely. When it comes to androgenetic alopecia, Dr. Karim says, “Early intervention is essential to effectively treat this form of hair loss. Once hair follicles shrink significantly, treatment becomes much more difficult. If you have a family history of male or female pattern baldness, work with a dermatologist as soon as you notice hair thinning or slowing growth.”
Symptoms
- Male pattern baldness starts with gradual thinning at the crown and temples that may form an “M” shape as the hairline recedes.
- Female pattern baldness usually develops as thinning hair along the part line or an overall diminishing of hair volume.
- In both men and women, the hair loss process is gradual as hair follicles shrink.
Causes
- One or more family members with male or female pattern baldness.
- Hormonal imbalance.
- Shrinking hair follicles.
Treatment Options
- Topical – Rogaine (minoxidil) is a common topical treatment to slow or prevent hair loss from androgenetic alopecia. This topical medication is FDA-approved for both men and women. It works by prolonging the growth phase of the hair growth cycle.
- Oral medications – in most cases, oral medications are prescribed to address hormonal imbalance in men and women. Finasteride, A dihydrotestosterone-blocking medication for men, slows or reverses hair loss. Spironolactone is prescribed for women to reduce androgen activity that causes shrinking hair follicles and is effective in restoring hair thickness.
- Low-level laser therapy (LLLT) – these treatments use products like laser combs or caps at home or in-office laser therapies utilizing red light to stimulate hair follicles, encouraging hair growth.
- Hair transplant surgery – once hair follicles have shrunken beyond the point where hair regrowth is likely, hair transplant surgery may be recommended to redistribute healthy hair from thicker areas to those impacted by thinning.
Alopecia Areata
Alopecia areata develops due to an autoimmune disease that causes the body to attack hair follicles, leading to hair loss. According to research conducted by the National Alopecia Areata Foundation, about 7 million people in the U.S. develop this condition every year with up to 160 million diagnosed around the globe. While this condition can impact anyone of any age, it’s most common in children and adolescents. Dr. Karim says, “This unique form of alopecia can be permanent, but many people experience spontaneous regrowth. It’s important to see a dermatologist as soon as signs of alopecia areata are present. Symptoms of this lifelong condition can be managed with consistent treatment.”
Symptoms
- Characterized by round bald patches on the scalp or body.
- Patches of hairless skin with a smooth texture.
- Can lead to alopecia totalis, complete loss of hair on the head, or alopecia universalis, total loss of hair on the whole body.
- Spontaneous hair regrowth in some areas can coincide with hair loss in other areas.
Causes
- Immune cells attack hair follicles, which stops hair growth.
- Can be triggered by stress.
- Those with other autoimmune conditions, like thyroid disease or vitiligo, may be at greater risk.
Treatment Options
- Corticosteroids – these can be used topically or through injections to reduce inflammation and encourage typical hair follicle function.
- Immunotherapy – topical diphenylcyclopropenone may be used to trigger a mild allergic reaction that keeps the immune system busy, preventing more severe inflammation.
- Biologics – these medications, called JAK inhibitors, are FDA-approved to prompt hair regrowth in those with alopecia areata.
Telogen Effluvium
Telogen Effluvium is a temporary and widespread form of hair loss. It occurs when a large number of hairs enter the telogen (rest) phase of the hair growth cycle at the same time, leading to sudden, significant hair shedding. It’s often linked to distress as telogen effluvium usually occurs a few months after a major physical or emotional stressor. When it comes to telogen effluvium, Dr. Karim says, “The good news about this form of hair loss is that it typically resolves itself within a year. Patience and consistent treatment are essential to clear up this condition more quickly.”
Symptoms
- Increased hair shedding across the scalp.
- More hair in shower drains, on pillows, or in hairbrushes.
- Thinning of hair without forming bald spots or patches.
Causes
- Illness or fever.
- Sudden weight loss, especially due to crash diets.
- Deficiencies in iron, protein, or vitamin D.
- Taking antidepressants, beta-blockers, or birth control.
- Emotional distress.
Treatment Options
- Addressing triggers – identifying stressors, nutritional deficiencies, and other underlying triggers and addressing them.
- Nutritional supplements – consuming a diet rich in iron, zinc, vitamin D, and protein or taking supplements for more advanced deficiencies.
- Topical minoxidil – this topical treatment is beneficial for hair regrowth as it can improve hair’s growth cycle.
Traction Alopecia
Traction alopecia is often associated with wearing tight hairstyles like braids, dreadlocks, or hair extensions. Traction alopecia occurs when tension and pulling damage hair follicles, causing hair to fall out. Dr. Karim says, “This is one of the few types of alopecia that can both be prevented and reversed. When the hair follicle is scarred due to repeated damage, it can be more difficult to address, so it’s important to make changes in hairstyle or other lifestyle choices right away to avoid permanent damage and hair loss.”
Symptoms
- Thinning hair or bald spots along the hairline, temples, or behind the ears.
- Bumps or redness along the scalp, indicating skin inflammation and irritation.
- Receding hairline, especially if tension on hair continues.
Causes
- Wearing a tight hairstyle, especially for long periods of time.
- Using chemical hair relaxers.
- Repeated use of heated styling tools, especially close to the scalp or those that pull on hair.
- Friction from hats, helmets, wigs, or headbands.
Treatment Options
- Change hairstyles – removing the hairstyle that causes tension on the follicles is the first step to undoing hair loss.
- Lifestyle adjustments – alternate hairstyles more frequently to give scalp rest and avoid overly tight hairstyles altogether.
- Topical treatment – topical application of minoxidil or corticosteroids may be beneficial after the hairstyle is removed to reduce inflammation and stimulate hair regrowth.
Cicatricial Alopecia (Scarring Alopecia)
Cicatricial alopecia occurs when inflammation destroys hair follicles. Scar tissue left behind replaces the follicles, meaning lost hair can’t be regrown. This makes cicatricial alopecia one of the most severe forms of this condition. Dr. Karim says, “While follicles destroyed by inflammation won’t grow hair, diagnosing and treating this condition before it reaches this level of severity can halt hair loss. To effectively treat this form of alopecia, it’s essential to understand what causes hair loss as numerous immune disorders are linked to this condition.”
Symptoms
- Smooth patches of scalp where hair doesn’t grow.
- Pain, redness, and itching.
- Thickening of skin called scaling.
- Small pus-filled bumps on skin called pustules.
Causes
- Lichen planopilaris – an inflammatory skin condition with hair loss as a main symptom.
- Discoid lupus erythematosus – an autoimmune disease that causes painful lesions that prevent hair growth.
- Central centrifugal cicatricial alopecia – causes scarring and hair loss in a circular pattern from the center of the scalp outward.
Treatment Options
- Early intervention – diagnosis through scalp biopsy and professional intervention in the early stages of cicatricial alopecia is the best way to stop hair loss.
- Medications – oral anti-inflammatory medications like corticosteroids or hydroxychloroquine may be recommended. Immunosuppressants may also be prescribed to suppress overactive immune function.
- Hair transplants – once the condition is stabilized, a hair transplant procedure may be successfully performed.
When to See a Dermatologist
While alopecia is a general term used to describe hair loss, understanding what form of alopecia you’re dealing with ensures you can address it properly. The best way to accurately diagnose alopecia is to work with a dermatologist. Early intervention makes it easier to reverse hair loss and thinning, so the sooner you start working with a dermatologist the better. Some additional reasons to see a dermatologist for hair loss and thinning include:
- Examination of hair loss and thinning patterns.
- Test for hormonal changes and nutritional deficiencies that may contribute to hair loss.
- Biopsy affected areas to look for autoimmune disease or other systemic issues contributing to hair loss.
- Develop a personalized plan to improve hair health and thickness.
Conclusion: Know Your Alopecia Type & Develop a Personalized Treatment Plan
In conclusion, Dr. Karim says, “When hair loss and thinning occur, it can be distressing. For many people, alopecia is manageable with the right treatment plan. You don’t have to accept hair loss as your new normal. Work with your dermatologist to understand the underlying causes of alopecia and begin a personalized hair loss treatment plan that fits your needs.”
Schedule a Dermatology Visit
Noticed hair thinning, loss, or patchiness? Contact a board-certified dermatologist and start discussing your options to reverse hair loss. Working with the U.S. Dermatology Partners team is simple. Take just a few moments to fill out our online scheduling request. A local team will be in touch to finalize the details of your upcoming visit.
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