What is Alopecia?
Alopecia areata, a condition characterized by hair loss, manifests primarily on the scalp or facial hair regions but can affect any part of the body. Diagnosis by a certified dermatologist is essential for determining the presence of this type of hair loss and exploring potential solutions for hair regrowth.
Contrary to some misconceptions, alopecia areata is not contagious and does not spread between individuals. Its onset typically involves the appearance of circular or oval bald patches, which can vary in size and visibility, on the scalp or beard area.
As one of the more prevalent forms of hair loss, alopecia areata frequently initiates during childhood or young adulthood, although it can emerge at any age and affects individuals across diverse skin tones and genders. Its nomenclature, derived from the Latin term "areata," meaning patchy, reflects the characteristic pattern of sporadic hair loss associated with the condition.
Various terms describe specific manifestations of alopecia areata, such as alopecia barbae for beard hair loss, alopecia ophiasis for band-like scalp hair loss, alopecia totalis for complete scalp hair loss, and alopecia universalis for the loss of hair across the entire body, albeit the latter is relatively rare. While hair regrowth is possible, its outcomes vary widely among individuals, with some experiencing full regrowth, while others may observe only partial restoration, often accompanied by changes in color and texture.
The duration of an alopecia areata episode varies considerably, with spontaneous hair regrowth occurring within a year for some individuals, leading to prolonged remission without further hair loss. However, recurrent episodes may necessitate intervention for regrowth, as untreated cases can persist or exacerbate. Timely treatment can facilitate regrowth within weeks to months, although subsequent episodes of hair loss remain a possibility, with the interval between occurrences being variable.
What are the causes of Alopecia?
Hair loss can be attributed to various factors, with heredity being a significant contributor. Both men and women may experience a reduction in hair thickness and volume as they age, often linked to genetic predispositions and hormonal changes, particularly involving testosterone. Male pattern baldness, affecting a majority of men by age 70, exemplifies this hereditary influence, typically manifesting post-puberty.
Another prominent cause of hair loss is physical or emotional stress, which can trigger a condition known as telogen effluvium. During episodes of stress, up to three-quarters of scalp hair may shed, often noticeable during routine activities like shampooing or combing. While this type of hair loss is usually temporary, it can become chronic in some cases, lasting beyond the initial stressor.
Various factors can precipitate telogen effluvium, including high fever, childbirth, major surgeries, severe emotional stress, and certain medications like retinoids and beta-blockers. Women aged 30 to 60 may also experience diffuse hair thinning across the scalp, with no discernible cause identified. Additionally, other conditions such as autoimmune disorders, anemia, thyroid diseases, and infectious diseases like syphilis or ringworm, among others, can lead to hair loss, often exhibiting distinct patterns or symptoms.
Unusual patterns of hair loss may signal underlying issues such as alopecia areata, autoimmune conditions like lupus, or hormonal imbalances. External factors such as excessive shampooing, tight hairstyles, or bacterial infections of the scalp can also contribute to hair loss. Understanding the diverse array of potential causes is essential for accurate diagnosis and effective management of hair loss conditions.
Types Of Alopecia:
Androgenetic Alopecia
Alopecia, commonly referred to as hair loss, denotes a disruption in the body's natural cycle of hair production, with the scalp being the most frequently affected area. Typically, the scalp hosts around 100,000 hairs, each undergoing cycles of growth, rest, shedding, and regeneration.
The hair growth cycle comprises three distinct phases: anagen, catagen, and telogen. During the anagen phase, hair actively grows, a period that may span years. Subsequently, the catagen phase ensues, during which hair growth halts, and the hair separates from its follicle. Lasting approximately 10 days, this phase precedes the telogen phase, characterized by follicle rest for two to three months, followed by hair shedding. A new hair then initiates growth in the same follicle, marking the start of another anagen phase. Typically, individuals naturally shed 50 to 100 hairs daily as part of this cycle.
Disruption of this natural cycle or damage to hair follicles can lead to accelerated hair loss compared to regeneration, resulting in symptoms such as receding hairlines, patchy hair loss, or overall thinning.
While genetic predispositions may contribute to hair loss, various medical and behavioral factors can also interrupt the growth cycle. Dermatologists at NYU Langone specialize in diagnosing and treating hair and scalp disorders, discerning the type and underlying cause of hair loss.
Androgenetic alopecia, the most prevalent form of hair loss, affects over 50 million men and 30 million women in the United States. Commonly known as male pattern hair loss or female pattern hair loss, it has a hereditary basis but can be managed through medication or surgical interventions.
Male pattern hair loss typically begins post-puberty and progresses gradually over years or decades, often commencing above the temples and advancing across the scalp's perimeter and top. This progression frequently culminates in baldness, with many affected men eventually losing most of their scalp hair.
In contrast, female pattern hair loss entails gradual thinning of hair across the scalp, with the hairline generally remaining intact. While this type of hair loss is considered a natural aspect of aging for many women, it may commence post-puberty and can lead to significant hair thinning, although baldness is rare.
Telogen effluvium
Telogen effluvium, categorized as a form of hair loss, arises when numerous scalp follicles enter the resting phase of the hair growth cycle, termed telogen, but fail to progress to the subsequent growth phase. Consequently, hair falls out across the entire scalp without replacement by new growth.
Although telogen effluvium seldom results in complete baldness, individuals may experience significant hair shedding, with estimates ranging from 300 to 500 hairs lost per day. Notably, hair may appear visibly thinner, particularly around the crown and temples.
This type of hair loss is often precipitated by a medical event or underlying condition, such as thyroid dysfunction, childbirth, surgical procedures, or febrile illnesses. Additionally, deficiencies in essential vitamins or minerals, notably iron, can contribute to hair loss, as can the use of specific medications like isotretinoin for acne or warfarin as a blood thinner. Discontinuation or initiation of oral contraceptives may also trigger telogen effluvium. Typically manifesting approximately three months post-event, the condition may resolve if the triggering factor is temporary, with hair regrowth expected within six months. However, if hair loss persists beyond six months, it is classified as chronic, warranting medical intervention such as prescribed medication from dermatologists.
Alopecia areata
Alopecia areata, an autoimmune disorder, entails the body's immune system targeting healthy tissues, including the hair follicles, resulting in hair loss and inhibiting new hair growth. This condition is not exclusive to any age group, affecting both adults and children, and often manifests suddenly and unexpectedly. Hair loss typically occurs in small patches on the scalp and is typically painless. Additionally, hair loss may extend beyond the scalp, affecting areas such as the eyebrows and eyelashes. With prolonged progression, alopecia areata may advance to alopecia totalis, characterized by complete hair loss.
Cicatricial Alopecia
Cicatricial alopecia, commonly known as scarring alopecia, represents a rare form of hair loss characterized by inflammation that damages hair follicles, leading to the formation of scar tissue in their place, impeding hair regrowth. The onset of symptoms may be gradual, with hair loss progressing slowly, or sudden, marked by rapid shedding. Additional indicators include intense itching, swelling, and the presence of red or white lesions on the scalp, resembling a rash. Notably, this condition can affect individuals of any age, impacting both men and women.
Treatment strategies for cicatricial alopecia hinge on the specific subtype responsible for the symptoms. Dermatologists with extensive experience in managing cicatricial alopecia can offer various treatment modalities tailored to individual needs. Subtypes of cicatricial alopecia encompass conditions such as lichen planopilaris, discoid lupus erythematosus, folliculitis decalvans, dissecting cellulitis of the scalp, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia.
Lichen planopilaris, a variant of alopecia, arises when the scalp is affected by lichen planus, a prevalent skin condition. This subtype may present with a dry, flaky rash, causing clumps of hair to fall out, accompanied by scalp redness, irritation, and the appearance of small white or red bumps. Although less common, lichen planopilaris predominantly affects women, prompting medical intervention to arrest hair loss.
Discoid lupus erythematosus, categorized as a cutaneous lupus variant, induces inflamed sores and scarring on the scalp, ears, and face, with hair loss being a hallmark symptom. Scar tissue formation on the scalp precludes hair regrowth in affected areas. Similarly, folliculitis decalvans, an inflammatory disorder, elicits redness, swelling, and scalp lesions, potentially containing pus, known as pustules. While irreversible, symptom management via medication can mitigate disease progression.
Dissecting cellulitis of the scalp, an infrequent condition, precipitates the formation of scalp pustules or lumps, leading to scar tissue development and subsequent hair follicle destruction. Treatment modalities, including medications, aim to alleviate symptoms. Frontal fibrosing alopecia typically manifests as a receding hairline pattern, potentially extending to eyebrow and underarm hair loss, predominantly affecting postmenopausal women. The etiology remains elusive, but certain medications can mitigate disease progression. Lastly, central centrifugal cicatricial alopecia may result from hair product usage or styling techniques that damage hair follicles, with cessation of harmful practices and medication offering potential for hair regrowth.
Folliculitis decalvans is a condition characterized by hair loss resulting from inflammation that damages hair follicles, leading to their destruction. Typically, individuals affected by folliculitis decalvans experience symptoms such as scalp redness, swelling, and the formation of lesions that may contain pus, known as pustules. These lesions can be accompanied by itching and discomfort. Unfortunately, this form of hair loss is irreversible, and once hair follicles are destroyed, regrowth is unlikely.
Central Centrifugal Cicatricial Alopecia
Central Centrifugal Cicatricial Alopecia (CCCA) can be triggered by the use of hair products or styling practices that inflict harm upon hair follicles. This includes the application of hair relaxers, blow dryers, curling irons, hair extensions, and the process of creating a permanent wave, colloquially known as a "perm."
Hair Shaft Abnormalities
Various hair shaft abnormalities can contribute to hair loss by causing strands of hair to become thin and fragile, rendering them prone to breakage. Unlike other forms of hair loss that originate from the follicle, these abnormalities result in hair loss along the shaft itself, the visible portion of a hair strand. Consequently, individuals may experience overall thinning of the hair, accompanied by the presence of numerous small and brittle hairs.
Addressing hair shaft abnormalities often necessitates implementing changes in hair styling and treatment practices. Simple adjustments in hair care routines can sometimes reverse these conditions, aiding in the restoration of hair health. However, for more severe cases, medical intervention may be required to effectively manage hair shaft abnormalities and prevent further loss.
Types of hair shaft abnormalities include:
Loose anagen syndrome, predominantly observed in young children, manifests when hair lacks firm anchorage in the follicle, rendering it susceptible to easy removal. Typically, hair sheds once it attains a seemingly arbitrary maximum length, restricting the ability of affected children to grow their hair beyond a relatively short extent. This syndrome is more prevalent among girls with blond or brown hair.
Individuals with loose anagen syndrome experience hair loss even during the growth phase. For instance, hair may shed readily, including overnight due to friction from a pillow. The exact etiology of loose anagen syndrome remains elusive, although it may stem from disruptions in the hair growth cycle, impeding hair retention within the follicle.
Treatment options for loose anagen syndrome are limited, although the condition often exhibits significant improvement with the onset of puberty. Additionally, certain medications may offer benefits in promoting fuller hair growth. While management strategies may be limited, monitoring by dermatologists or specialists can provide insights into potential interventions and support in navigating this condition.
Traction alopecia is a type of hair loss caused by certain hairstyles that exert excessive tension on the hair follicles, such as tight ponytails or braids. This excessive pulling force damages the hair strands, resulting in their eventual shedding. If the triggering hairstyle persists, traction alopecia can progress to more severe manifestations, including hair thinning or the development of bald spots. However, in many cases, hair regrowth occurs once the hairstyle is modified or discontinued, alleviating the tension on the follicles.
We recommend our Pure Aura Alopecia Rescue Serum $60
Trichotillomania is a psychological disorder characterized by the compulsive urge to pull out one's hair, leading to noticeable hair loss on the scalp or other parts of the body. Individuals affected by this condition often find it challenging to control or cease the hair-pulling behavior. While hair may regrow if the pulling behavior is discontinued, prolonged and persistent pulling over many years can result in permanent hair loss.
Effective treatment for trichotillomania often involves psychotherapy, wherein individuals engage in therapeutic sessions with counselors or mental health professionals. Through psychotherapy, individuals explore the underlying causes of stress or emotional triggers that contribute to the urge to pull out hair. By addressing these root causes and developing coping mechanisms, individuals can learn to manage and overcome the compulsive behavior associated with trichotillomania.
How To Prevent Hair Loss In Women
Preventing women's hair loss and thinning hair entails adopting certain practices to maintain scalp and hair follicle health while promoting robust hair growth. While female pattern hair loss is often hereditary and cannot be entirely prevented, adopting a few key behaviors can contribute to overall hair health. Ensuring a balanced diet rich in essential nutrients like iron, zinc, and Vitamin D is crucial, as these nutrients support the health and growth of hair follicles during the anagen phase. Incorporating foods such as red meat, beans, chickpeas, fish, and eggs into your diet can provide these essential nutrients to support healthy hair growth. Additionally, biotin supplements have shown promise in improving hair and nail health, although ongoing research is necessary to confirm their efficacy. Some natural ingredients, like rosemary oil, keratin, vitamin B5, and creatine, can also be applied topically to combat thinning hair and promote hair growth.
Managing stress levels is another important aspect of preventing hair loss in women, as chronic stress can trigger excessive hair shedding. Implementing stress reduction techniques such as mindfulness, meditation, or regular exercise can help alleviate stress and minimize its impact on hair health. Furthermore, opting for hairstyles that do not exert excessive tension on the scalp is crucial for preventing damage to hair follicles. Choosing loose hairstyles like soft ponytails, clips, or gentle coverings can help prevent hair follicle damage and minimize the risk of hair loss due to hairstyling practices.
For women with a family history of thinning hair or hair loss who are seeking comprehensive prevention strategies, consulting with a hair loss specialist is recommended.