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Alopecia
Alopecia is the medical term for the loss of hair. It is not one disease but a collective name for several conditions that differ in cause, in course and in what can be done about them. This text is an informative overview and does not replace an examination by a dermatologist.
The basic distinction
The most important distinction is between non-scarring and scarring alopecia.
In non-scarring alopecia the hair follicle is still present, even though it may be reduced or dormant. In scarring alopecia the follicle is permanently destroyed and replaced by connective tissue, so hair no longer grows in that spot.
That difference is crucial, because it determines what is worth attempting at all.
Androgenetic alopecia
The most common form. Hereditary, gradual thinning of the hair linked to the sensitivity of the follicle to dihydrotestosterone.
In men it starts with the front hairline receding and thinning at the crown. In women it more often appears as diffuse thinning through the middle, with the front hairline preserved.
It develops over years and does not come on suddenly. More in the text Androgenetic alopecia.
Alopecia areata
An autoimmune condition in which the immune system attacks its own follicles. It appears as a clearly defined round or oval hairless area, most often on the scalp, but it can also affect the beard, eyebrows or elsewhere.
It appears relatively suddenly and can involve one or more spots. The course is unpredictable: in some people it resolves spontaneously, in others it recurs.
This is a condition for a dermatologist. Cosmetic preparations have no role here.
Telogen effluvium
Diffuse increased hair shedding that occurs when a larger number of hairs move into the resting phase at the same time and then fall out. It usually appears two to three months after a trigger.
Common triggers are:
- childbirth
- a more severe infection or high fever
- surgery or major physical stress
- rapid weight loss and restrictive diets
- iron deficiency
- a thyroid disorder
- certain medicines
In telogen effluvium hair falls across the whole head, not in defined patches, and there are no changes on the scalp. Once the cause is removed the condition usually resolves, but it takes time.
Scarring alopecia
A group of conditions in which follicles are permanently lost. The causes may be inflammatory processes, certain autoimmune diseases or injuries.
Signs pointing to this group are smooth skin without visible follicular openings, redness, scaling, pain or itching in the affected area.
This is the condition in which seeing a dermatologist is more urgent than in the others. In scarring alopecia time matters, because lost follicles do not come back, while the process can sometimes be stopped.
Traction alopecia
It comes from mechanical pulling: tight hairstyles, buns, braids, extensions. It is most often seen along the front hairline and above the ears.
In the early stage it is reversible if the habit changes. If it lasts for years it can turn into permanent loss.
When to see a doctor
Do not wait in these situations:
- hair falls out in clumps or in clearly defined round patches
- the scalp is red, painful, itchy or scaling
- the shedding is accompanied by fatigue, weight change or other complaints
- eyebrows, eyelashes or body hair are also being lost
- the condition is getting worse quickly
A dermatologist usually starts with a conversation and an examination, including trichoscopy, an examination of the scalp with a magnifying device. If needed, laboratory tests are requested, most often iron and ferritin, a blood count and thyroid hormones. In some cases a scalp biopsy is performed.
Where care fits in
Scalp care and cosmetic products have their place, but that place is not diagnosis. Cosmetics deal with the appearance of the hair and the condition of the skin, while the cause of alopecia is established by a doctor.
If you are certain that this is gradual, hereditary thinning and you want regular scalp care, we have given an overview of what such products contain in the text Hair serums and ampoules.
In short
Alopecia is a collective name for several different conditions. What separates them, whether the follicle is preserved, whether the shedding is diffuse or localised, whether there are changes on the skin, also determines what is done about them. So the first step is not choosing a product but recognising what you are dealing with, and that is the dermatologist’s job.