Alopecia

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

Scarring is the loss of hair follicles. This form causes permanent hair loss. The most prevalent forms of scarring alopecia are:

• Central centrifugal cicatricial alopecia
• Cutaneous lupus erythematous
• Fungal kerions

In the case of non-scarring, the hair shaft is gone, but the follicles are still present. It often is reversible. It can also develop into the scarring type. Non-scarring types include:

• Alopecia areata is an autoimmune process; the cause is not known
• Androgenetic (hereditary) alopecia
• Telogen effluvium

Many things can cause alopecia, including:

• Genes
  • Congenital disorders—can include problems with the hair shaft
  • Male and female-pattern baldness—usually inherited
• Hair pulled too tightly by:
  • Cornrows
  • Hair rollers
  • Pigtails
• Hormonal problems
  • Overactive or underactive thyroid gland
• Infections
  • Fungal infections
  • HIV
  • Herpes simplex and zoster
  • Syphilis
• Medications
  • Drugs for gout
  • Antidepressants
  • Birth control pills
  • Blood pressure and heart medications
  • Blood thinners
  • Chemotherapy for cancer treatment
  • Vitamin A
• Stress that prompts growing hairs to rest and shed
  • Childbirth
  • Crash dieting
  • Emotional/psychological stress
  • Illness or surgery
  • Prolonged fever
  • Vitamin and nutrient deficiencies
• Allergic reaction to medications
• Anemia
• Autoimmune disorders
• Hot comb and oil treatments (can inflame the hair follicle and cause scarring)
• Radiation therapy
• Systemic and discoid lupus erythematosus
• Twisting and pulling hair out due to psychiatric problems

Factors that increase your chance of alopecia include:

• Advancing age (for male and female-pattern baldness only)
• Family history of baldness or hair loss
• Poor nutrition
• Pregnancy
• Stress

Alopecia symptoms depend on the type of hair loss. Some of the more common symptoms include:

Male-pattern baldness:

• Affects men and women
• Hair falls out at the top of the head
• Hair recedes

Female-pattern baldness:

• Hair comes out when brushing
• Hair thins over the entire head

Alopecia areata:

• Fingernails and toenails with pits
• Rapid hair loss
• Round or oval patches of hair loss
• Sometimes tiny hairs are visible in the patches

Stress-related:

• Gradual shedding
• Hairs come out with gentle pulling

Fungal infections:

• Black dots in the patches
• Inflammation (such as redness)
• Itching
• Patches of hair loss
• Scaling

The doctor will ask about your symptoms and medical history. A physical exam will be done. 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:

• Analyzing samples of hair
• Checking for hair loss on other parts of the body
• Gentle pulling on the hair
• Taking samples of scalp areas with inflammation to examine under a microscope

The doctor will ask questions about:

• Diet
• Hair care
• Medication use
• Pregnancies, menopause, and monthly menstrual cycles
• Your personal and family medical history

Other tests may include:

• Biopsy of the scalp—removal of a small tissue sample to be analyzed under the microscope
• Blood tests—to help identify underlying conditions that may be causing the hair loss

Treatment will depend on the cause of the condition. Treatments include:

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.
• Eat healthy, well-balanced meals.
• Learn and practice stress-management techniques.
• Obtain medical care for acute illnesses and to manage chronic conditions.