Alopecia

Alopecia refers to hair loss in areas of skin that normally have hair. There are two forms of alopecia:

Scarring – loss of hair follicles. This causes permanent hair loss. Cutaneous lupus erythematous and fungal kerions are the most prevalent forms of scarring alopecia.

Nonscarring – 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 auto-immune process and the cause is not known. Hair loss lasts approximately six months.

Causes

Many things can cause Alopecia, including:
  • Stress that prompts growing hairs to rest and shed
  • Illness or surgery
  • Prolonged fever
  • Childbirth
  • Emotional/psychological
  • Crash dieting
     
  • Hormone problems
  • Overactive or underactive thyroid
  • Hormones that are out of balance
     
  • 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 - hair breaks off near the scalp
  • 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.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Family members who have baldness or hair loss
  • Advancing age (for male-pattern baldness only)
  • Pregnancy
  • Stress
  • Poor nutrition

Symptoms

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)

Diagnosis

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 (women only)
Other tests 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

Treatment

Alopecia treatment depends on the cause of the condition. Treatments include:

Medications

  • Drugs to correct a hormone imbalance or deficiency
  • Switching to a different medication if a drug you are taking is contributing to the hair loss
  • Shampoos and antifungal 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 bit 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.

Lifestyle Changes

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.

Surgery
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.

Prevention

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.