Definition

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:

• Cutaneous lupus erythematous
• Central centrifugal cicatricial alopecia
• 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:

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

Hair Loss

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Causes

Many things can cause alopecia, including:

• Stress that prompts growing hairs to rest and shed
  • Illness or surgery
  • Vitamin and nutrient deficiencies
  • 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 and zoster
• Autoimmune disorders
• Systemic and discoid lupus erythematosus
• Anemia
• Hair pulled too tightly by:
  • Hair rollers
  • Pigtails
  • Cornrows
• Hot comb and oil treatments (can inflame the hair follicle and cause scarring)
• Twisting and pulling hair out due to psychiatric problems
• Genes
  • Male and female-pattern baldness—usually inherited
  • Congenital disorders—can include problems with the hair shaft

Risk Factors

Factors that increase your chance of alopecia include:

• Family history of baldness or hair loss
• Advancing age (for male and female-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
• Fingernails and toenails with pits

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. 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:

• Gentle pulling on the hair.
• Taking samples of scalp areas with inflammation. The sample will be examined 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

Treatment

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

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.