Overview
Alopecia refers to hair loss from any part of the body for any reason. There are several types, ranging from thinning hair to complete baldness.
Diffuse alopecia (thinning scalp hair) is common among seniors - both men and women alike.
Androgenic alopecia, also known as "male pattern baldness," can strike younger as well as older people. In spite of its masculine name, women can get this condition. It's genetic, so having a family history can predict if you might inherit it. In both men and women, it's linked to having an excess of male hormones (androgens) around the hair follicles, which can block hair growth. Women are more likely to develop androgenic alopecia after menopause, when they have fewer female hormones.
Most cases of hair loss are due to androgenic alopecia. Approximately 50% of men by the age of 50 years and 15% of women before the time they reach menopause have some degree of androgenic alopecia.
Alopecia areata typically causes a few temporary bald patches on the scalp. It tends to run in families and often strikes in childhood. The hair loss seems to be part of an immune system problem, in which the body's natural defences mistakenly attack its own tissue. Once the hair has fallen out in certain spots, new growth is suppressed for weeks or months. This type of alopecia usually affects people who have other "autoimmune" diseases like thyroidism or pernicious anemia. It rarely produces complete scalp baldness (alopecia totalis) or total loss of body hair (alopecia universalis).
Alopecia areata affects about 1% of the general population, and 20% of these cases may progress to alopecia totalis. Only about 1% will go on to develop alopecia universalis, affecting all body hair, including eyebrows and eyelashes.
Scarring alopecia is a kind of scarring caused by deep bacterial or fungal infections of the skin. Scarred areas will not regrow hair. For example, fungus can leave permanent bald patches.
Causes
There are many different potential causes of alopecia. Hair loss - temporary or permanent - can be triggered by any number of factors. These can include allergies, irritants, toxins, burns, injuries, and infections. We also know that certain medications (especially anabolic steroids), chronic kidney failure, radiation, and chemotherapy can cause hair to fall out. Sometimes, hair loss may be due to a vitamin A overdose, iron deficiency (anemia), a malfunctioning thyroid gland, fever, or pregnancy.
Symptoms
Thinning hair is the most obvious symptom of androgenic alopecia. In men, it begins at the crown, temples, or both. They also tend to get a "high forehead" that's associated with a receding hairline. This is less common in women. While men can go completely bald, women don't usually lose all the hair on the crown of the head.
Alopecia areata appears as sudden losses of small round patches of hair, usually from the scalp, but sometimes from the face or body. The fingernails may be lightly pitted or stippled. Often the disease comes and goes in cycles of a few months, with regrowth in between.
Treatment
While there's no way to prevent most types of hair loss, it's sometimes possible to stop or slow the alopecia.
Medications are available that encourage regrowth of hair. Minoxidil* is a liquid that's rubbed on the affected area twice daily as a treatment for diffuse and androgenic alopecia. For alopecia areata, only minoxidil may be effective, often followed by a topical steroid solution. Minoxidil works to varying degrees in different people, and only triggers complete regrowth in a minority of individuals. It doesn't work at all for people who are completely bald.
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 regrows in the same spot a few months later. It can be uncomfortable, though. Treatment usually lasts about six months, and the approach is more common in Europe and Canada than in the United States.
Finasteride is the latest medication for male pattern baldness. This pill reduces levels of DHT, the specific type of male hormone associated with androgenic alopecia. Like minoxidil, it works best against mild, early-stage baldness. Most people report a positive effect after three to six months of use. Hair loss returns if you stop taking finasteride.
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.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Other tips:
While hair loss can be very distressing, alopecia by itself isn't harmful: the damage is cosmetic. But there's always a chance that alopecia might be a secondary effect or symptom of some other illness. To be sure, only medical tests and a full discussion with your doctor can ensure the right diagnosis. Always see a doctor if you start to lose hair.
Family history will often tell the doctor what type of alopecia a person has. Occasionally, a biopsy may be necessary to rule out an infection or tumour. 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. When examining children for alopecia areata, doctors may want to make sure the hair loss isn't due to a neurotic habit called trichotillomania (hair pulling).
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