Alopecia refers to hair loss in areas of skin that normally have hair. There
are two forms of alopecia:
- Scarring—This is the loss of hair follicles, causing permanent
hair loss. Cutaneous lupus erythematous and fungal
kerions are the most prevalent forms of scarring alopecia.
- Nonscarring—In this case, the hair shaft is gone, but the
follicles are still present. Because the hair follicles still exist, it often is
reversible. It can, however, develop into the scarring type. Alopecia areata is
a type of non-scarring alopecia. It is an autoimmune process and the cause is
not known. Hair loss lasts approximately six months.
Many things can cause alopecia, including:
- Stress that prompts growing hairs to rest and shed
- Illness or surgery
- Prolonged fever
- Childbirth
- Emotional/psychological stress
- Crash dieting
- Hormonal problems
- Overactive or underactive thyroid gland
- Medications
- Blood thinners
- Drugs for gout
- Chemotherapy for cancer treatment
- Vitamin A
- Birth control pills
- Antidepressants
- Blood pressure and heart medications
- Allergic reaction to medications
- Radiation therapy
- Infections
- Fungal infections
- Syphilis
- HIV
- Herpes simplex
- Autoimmune disorders
- Systemic and discoid lupus erythematosus
- Anemia
- Hair pulled too tightly by:
- Hair rollers
- Pigtails
- Cornrows
- Hot oil treatments (can inflame the hair follicle and cause scarring)
- Twisting and pulling hair out due to psychiatric problems
- Genes
- Male-pattern baldness is usually inherited.
- Birth defects can include problems with the hair
shaft.
A risk factor is something that increases your chance of getting a disease or
condition.
- Family history of baldness or hair loss
- Advancing age (for male-pattern baldness only)
- Pregnancy
- Stress
- Poor nutrition
Alopecia symptoms depend on the type of hair loss. Some of the more common
symptoms include:
Male-pattern baldness:
- Hair recedes
- Hair falls out at the top of the head
- Affects men and women
Female-pattern baldness:
- Hair thins over the entire head
- Hair comes out when brushing
Alopecia areata:
- Rapid hair loss
- Round or oval patches of hair loss
- Sometimes tiny hairs are visible in the patches
- Brittle and discolored fingernails and toenails with
ridges
Stress-related:
- Gradual shedding
- Hairs come out with gentle pulling
Fungal infections:
- Patches of hair loss
- Black dots in the patches
- Itching
- Scaling
- Inflammation (such as redness)
The doctor will ask about your symptoms and medical history, and perform a
physical exam. The doctor will examine the area(s) of hair loss, noting the
pattern of hair loss and condition of the scalp.
This physical exam may include:
- Gentle pulling on the hair
- Taking samples of scalp areas with inflammation and examining them under a
microscope
- Analyzing samples of hair
- Checking for hair loss on other parts of the body
The doctor will ask questions about:
- Diet
- Hair care
- Medication use
- Your personal and family medical history
- Pregnancies, menopause, and monthly menstrual cycles
Other tests may include:
- Blood tests to help identify underlying conditions that may be
causing the hair loss
- Biopsy of the scalp—removal of a small tissue sample to be
analyzed under the microscope
Alopecia treatment depends on the cause of the condition. Treatments
include:
- Drugs to correct a hormonal imbalance or deficiency
- Switching to a different medication if a drug you are taking is contributing
to the hair loss
- Antifungal shampoos and pills to treat fungal infections
- For baldness in men, a prescription drug taken in pill form (finasteride)
Note: Pregnant women should not even handle this medication. Even a small amount
absorbed through the skin of the hands can cause birth defects in baby boys.
- Over-the-counter medication (minoxidil) that is applied to the scalp daily
(must be used on a regular basis) Note: If you have heart problems, discuss this
drug with the doctor before using it.
- To help speed-up hair re-growth in alopecia areata, your doctor may inject a
steroid preparation into your scalp.
- For some patients, not responding to other therapies, topical immunotherapy
(usually administered by a dermatologist) may be helpful. It involves applying
an allergen to scalp that causes local reaction like redness, itching and also
induces hair growth.
- Phototherapy is another potential
treatment for patients with alopecia areata. Therapy is usually administered for
4 to 6 months.
Be gentle with your hair. Avoid pulling it tightly. If pulled over a long
period of time, scarring can occur resulting in permanent hair loss. If
treatment does not correct the hair loss, you may opt for a wig, hairpiece, or
hair weaving. If emotional stress is the cause, learn and practice
stress-management techniques.
This can involve:
- Hair transplant—taking hair from the back and sides of the head
and transplanting it in bald areas. As many as 300 grafts may be needed. You
must return multiple times for the grafts.
- Scalp reduction with flaps—cutting the scalp and pulling the
areas with hair closer together.
- It could be minimal, moderate or severe.
- It is transient and completely reversible after discontinuation of
chemotherapy.
- Currently, there are no medications available that were shown to
reduce the risk of alopecia associated with cancer
treatments.
There are no prevention guidelines for the most common type of hair loss,
male-pattern baldness. However, the following tips may help you avoid other
types of hair loss:
- Do not pull your hair tightly into a ponytail, cornrows, or
curlers.
- Learn and practice stress-management techniques.
- Obtain medical care for acute illnesses and to manage chronic conditions.
- Eat healthy, well-balanced meals.