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:
erythematousCentral centrifugal cicatricial alopeciaFungal kerions
In the case of non-scarring alopecia, the hair shaft is gone, but the follicles are still present. This form is often reversible. It can also develop into scarring alopecia. Non-scarring types include:
Androgenetic (hereditary) alopeciaTelogen effluviumAlopecia areata is an autoimmune process; the cause is unknown
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Many things can cause alopecia, including:
Stress that prompts growing hairs to rest and shed Illness or surgeryVitamin and nutrient deficienciesProlonged feverChildbirthEmotional/psychological stressCrash dieting
Hormonal problems Overactive
Medications Blood thinners
for cancer treatment
Vitamin ABirth control pillsAntidepressantsBlood pressure and heart medicationsAllergic reaction to medicationsRadiation therapy
Fungal infectionsSyphilisHIVHerpes simplex
Autoimmune disordersSystemic and discoid lupus erythematosusAnemia
Hair pulled too tightly by:
Hair rollersPigtailsCornrowsHot comb and oil treatments (can inflame the hair follicle and cause scarring)Twisting and pulling hair out due to psychiatric problems
Male and female pattern baldness—Usually inheritedCongenital disorders—Can include problems with the hair shaft
Factors that increase your chance of alopecia include:
Family history of baldness or hair lossIncreased age (for male- and female-pattern baldness only)PregnancyStressPoor nutrition
Alopecia symptoms depend on the type of hair loss. Some of the more common symptoms include:
Hair recedesHair falls out at the top of the headAffects men and women
Hair thins over the entire headHair comes out when brushing
Rapid hair lossRound or oval patches of hair lossSometimes tiny hairs are visible in the patchesFingernails and toenails with pits
Gradual sheddingHairs come out with gentle pulling
Patches of hair lossBlack dots in the patchesItchingScalingInflammation (such as redness)
The doctor will ask about your symptoms and medical history and perform a physical exam. The doctor will examine the location of hair loss, noting the pattern of hair loss and condition of the scalp.
This physical exam may include:
Gentle pulling on the hairTaking samples of scalp areas with inflammation to examine under a microscopeAnalyzing samples of hairChecking for hair loss on other parts of the body
The doctor will ask questions about:
DietHair careMedication useYour personal and family medical historyPregnancies, menopause, and monthly menstrual cycles
Other tests may include:
Blood testsBiopsy of the scalp
Treatment will depend on the cause of the condition. Treatments include:
To treat related conditions:
Drugs to correct a hormonal imbalance or deficiencyChanging medication that may be causing the hair lossAntifungal shampoos and pills—To treat fungal infections
Direct treatment for baldness:
For men—A prescription drug (finasteride)
Note: Pregnant women should not handle this medication. Even a small amount absorbed through the skin of the hands can cause birth defects in baby boys.
Over-the-counter medication (minoxidil)—Applied to the scalp daily (must be used on a regular basis)
Note: If you have heart problems, discuss this drug with your doctor before using it.
Steroid injection into your scalp to help speed-up hair re-growth in alopecia areata
Topical immunotherapy—Apply an allergen to the scalp that causes local reaction like redness, itching, and also induces hair growth; done if other efforts do not workPhototherapy—Potential treatment for patients with alopecia areata; usually done over 4-6 months
Be gentle with your hair. Avoid pulling it tightly. If pulled over a long period of time, scarring can occur. Permanent hair loss is also possible.
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
This can involve:
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.
It could be minimal, moderate, or severe.It is transient and completely reversible after chemotherapy is done.Currently, there are no medications available that were shown to reduce the risk of alopecia associated with cancer treatments.
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.
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Last reviewed October 2012 by Purvee S. Shah, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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