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Alopecia Hair: Understanding Different Types & Treatment Options

Feb 4

6 min read

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Alopecia, the medical term for hair loss, affects millions globally. It impacts not only appearance but also emotional and psychological well-being. Experiencing hair loss can be intimidating, especially when it happens unexpectedly.

Understanding the different types of alopecia and their causes is essential for effective management and treatment. Whether you're dealing with male pattern hair loss, female pattern hair loss, or various forms of alopecia areata, remember you're not alone.

This article will help you navigate the complexities of alopecia. You'll learn to identify the type you have and explore treatment options to restore your hair growth and confidence.

Types of Alopecia and Their Characteristics

Smiling woman with curly hair in a sleeveless top poses against a plain background. The image is in black and white, creating a classic mood. A replacement for alopecia hair

Alopecia Areata

Alopecia areata is an autoimmune disease where the immune system attacks hair follicles, causing hair loss. It appears in several forms, each with unique features. The most common is patchy alopecia areata, where hair falls out in round patches on the scalp or other body areas like the beard.

These patches often have "exclamation point hairs," which have wide tips and narrow bases. A severe form is alopecia totalis, leading to complete scalp hair loss. Alopecia universalis is the most extreme, causing total hair loss across the entire body.

Diffuse alopecia areata, also known as telogen effluvium, involves hair thinning and loss in scattered scalp areas, often due to stress, hormonal changes, or medication side effects. Ophiasis alopecia mainly affects the sides and back of the scalp, especially in young people. This autoimmune condition is difficult to manage.

Androgenetic Alopecia

Androgenetic alopecia, or male and female pattern hair loss, is genetic and influenced by hormones. In men, it usually starts with a receding hairline and crown hair loss, forming an M shape. Women experience diffuse thinning on the crown without a receding hairline.

This condition is caused by hair follicles' sensitivity to androgens, leading to follicle miniaturization and transformation of terminal hairs to vellus hairs. Androgenetic alopecia is the most common type, affecting nearly 50% of men and 25% of women by age 50.

Genetics play a significant role, with sons of balding fathers at higher risk of developing this condition.

Traction Alopecia

Traction alopecia results from constant pulling or tension on the hair. Tight hairstyles like braids, ponytails, or buns often cause this type. It's more common in individuals, especially women of African descent, who wear hairstyles that put mechanical stress on hair follicles.

Hair loss usually occurs at the front, sides, or back of the scalp. If tension stops early, the condition can be reversible. However, prolonged tension may cause permanent follicle damage and hair loss.

Affected areas may show a "fringe sign," where a rim of slightly longer hairs appears at the patch's edge opposite the traction. Severe cases result in a smooth, shiny scalp due to follicle destruction.

Cicatricial Alopecia

Cicatricial alopecia, or scarring alopecia, includes rare inflammatory conditions causing permanent hair loss. These often develop after skin damage, like burns or severe infections, and can result from autoimmune diseases such as lichen planopilaris.

Hair loss in cicatricial alopecia can be slow in patches or rapid in larger areas. The underlying skin may become itchy and inflamed. Lichen planopilaris, a type of cicatricial alopecia, commonly affects young women and creates smooth scalp patches.

Frontal fibrosing alopecia, a variant of lichen planopilaris, causes slow, progressive hair loss above the forehead and can also affect eyebrows and eyelashes.

Symptoms and Causes of Alopecia

Common Symptoms

Alopecia symptoms vary by type, but common signs include sudden hair loss in specific patterns. For alopecia areata, round or oval bald patches appear on the scalp or other body areas like the beard, eyebrows, or eyelashes.

These patches usually lack scarring, rash, or redness. "Exclamation point hairs" may surround these areas. People with alopecia areata might feel itching, tingling, or burning in hair loss areas.

Nail changes, such as ridges, pitting, or brittleness, are also common. In severe cases like alopecia universalis, nails can become very brittle. Androgenetic alopecia presents as a receding hairline and crown thinning in men and diffuse crown thinning in women.

Hair loss from androgenetic alopecia is gradual and follows a pattern, like the M shape in men and the "Christmas tree" pattern in women. Traction alopecia shows hair loss where tension is applied, often with a "fringe sign." Cicatricial alopecia results in permanent hair loss with smooth, shiny scalp patches, sometimes with inflammation and itching.

Underlying Causes

Alopecia has multiple causes, including genetic, autoimmune, hormonal, and environmental factors. Alopecia areata is an autoimmune disease where the immune system attacks hair follicles, often linked to genetic factors and other autoimmune conditions like vitiligo, lupus, and dermatitis.

Androgenetic alopecia is driven by hair follicles' sensitivity to androgens, especially dihydrotestosterone (DHT). This sensitivity causes follicle miniaturization and hair transformation. A family history increases the risk of this condition.

Traction alopecia results from mechanical stress on hair follicles due to tight hairstyles, leading to hair breakage and follicle damage if not addressed early. Cicatricial alopecia involves scalp inflammation and scarring from autoimmune diseases like lichen planopilaris or frontal fibrosing alopecia.

These conditions can be triggered by skin damage, infections, or other autoimmune diseases. Understanding these causes is vital for effective treatment and management.

Treatment Options for Different Types of Alopecia

alopecia hair treatment options

Medical Treatments

Medical treatments vary by alopecia type and severity. For patchy alopecia areata, dermatologists often recommend corticosteroid injections into affected areas. These are usually given every 4 to 6 weeks and can show hair regrowth within 3 months.

Topical corticosteroids, applied once or twice daily, work well, especially in children. Anthralin, a skin-irritating medication, can also stimulate hair growth.

After regrowth, I recommend minoxidil (Rogaine®) to maintain it. Apply it 2 to 3 times daily to the scalp, beard, or eyebrows. For extensive hair loss like alopecia totalis or universalis, contact immunotherapy and JAK inhibitors are options.

Contact immunotherapy involves applying an irritant to induce an allergic reaction, helping the immune system stop attacking follicles. JAK inhibitors, such as baricitinib, deuruxolitinib, and ritlecitinib, are oral medications that calm the immune system, promoting significant hair regrowth. Many patients see 50% or more regrowth with these treatments.

For androgenetic alopecia, treatments include minoxidil and finasteride. Minoxidil stimulates hair growth and slows loss when applied topically. Finasteride, an oral medication, lowers dihydrotestosterone (DHT) levels, reducing hair loss.

For cicatricial alopecia, treatments focus on the underlying inflammation. This may include topical or oral corticosteroids and other immunosuppressive medications to reduce inflammation and prevent further hair loss.

Lifestyle and Home Remedies

Alongside medical treatments, lifestyle and home remedies can support hair regrowth. For alopecia areata, I suggest scalp massages with essential oils like lavender, rosemary, or peppermint to boost blood flow to hair follicles.

Combine these oils with gentle massage for better results. Applying onion or garlic juice, rich in sulfur, can stimulate follicles and reduce inflammation.

Aloe vera gel soothes the scalp, reducing irritation and creating a healthy environment for hair regrowth. Using oils like coconut, olive, almond, or rosemary benefits overall hair health.

Coconut oil restores the scalp's pH balance, strengthens hair with vitamin E, and offers antimicrobial properties. Olive oil, rich in vitamins E and K, repairs and strengthens hair, making it less brittle and more resilient.

Green tea, high in antioxidants, can be used as a hair tonic to enhance growth and strength. Biotin, a key nutrient for skin, nails, and hair, can be added to your diet or used in hair products to improve hair condition and prevent brittleness.

Advanced Therapies

Advanced therapies are emerging as promising treatments for alopecia. These include gene therapy, mesenchymal stem cells, and tissue engineering products designed to regenerate or repair human tissue. These therapies target hair loss causes at a cellular level, offering potential long-term solutions.

Gene therapy involves modifying genes to stop the immune system's attack on hair follicles in alopecia areata. Mesenchymal stem cells promote tissue repair and regeneration, beneficial for cicatricial alopecia.

Tissue engineering products support hair follicle growth environments and reduce inflammation. While these advanced therapies are still in clinical trials and research phases, they hold promise for the future of alopecia treatment, offering new hope for those affected.

Conclusion

Understanding the various types of alopecia and their causes is key to effective management and treatment. Whether you have alopecia areata, androgenetic alopecia, traction alopecia, or cicatricial alopecia, recognize each condition's unique features and symptoms.

Medical treatments like corticosteroids, minoxidil, and finasteride are effective. Lifestyle changes such as a balanced diet, regular scalp massages, and avoiding tight hairstyles also support hair health.

Advanced therapies like low-level laser light therapy and micro-needling offer promising alternatives. Consult a dermatologist for a personalized treatment plan. Taking proactive steps and seeking professional advice can greatly improve your chances of managing and even reversing hair loss, restoring your confidence and well-being.

FAQ

What is the major cause of alopecia?

The major cause of alopecia, especially alopecia areata, is an autoimmune response. The immune system mistakenly attacks hair follicles, often influenced by genetic factors and linked to other autoimmune diseases like vitiligo, lupus, and atopic dermatitis.

What is the best way to treat alopecia?

The best treatment for alopecia areata depends on its severity and individual circumstances. Mild cases often respond to topical minoxidil or corticosteroid creams and injections. For extensive hair loss, topical immunotherapy or Janus kinase (JAK) inhibitors like baricitinib, deuruxolitinib, and ritlecitinib may be recommended.

Can alopecia grow back hair?

Yes, hair can grow back in alopecia areata. Many cases see hair regrowth within 6 to 12 months, though relapses are common. Treatments like corticosteroids, minoxidil, and JAK inhibitors can also promote hair regrowth.

Is alopecia areata caused by stress?

Alopecia areata isn't solely caused by stress, but psychological stress and emotional factors can play a role. The disease is primarily an autoimmune condition where the immune system attacks hair follicles, and stress may trigger or worsen it.Alopecia Hair: Understanding Different Types & Treatment Options

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