What is Alopecia?

Alopecia simply means ‘hair loss’

 

It’s derived from the Greek word alopekia

 

There are many different kinds of alopecia.

 

They can be temporary or permanent and have different causes or origins.

 

Alopecia can present as diffuse loss, pattern loss or patchy loss.

 

When people hear alopecia they tend to think of or picture alopecia areata which is a type of alopecia. This kind of alopecia is actually an autoimmune condition where our own immune cells or white blood cells mistakenly attack our hair as if it’s a pathogen.

 

Alopecia areata can present in patchy hair loss and usually recovers on its own, however, sometimes the patches can coalesce resulting in total hair loss on the scalp which is known as alopecia areata totalis. This can progress to total hair loss throughout the whole body and it’s then known as alopecia areata universalis.

 

However this is only one kind of alopecia.

 

Another kind is a diffuse kind called telogen effluvium, where your hair sheds more than normal. We usually lose around 100-150 hairs a day and having telogen effluvium can cause 300-450 hairs to be shed. This can continue for more than 6 months in which case it becomes chronic telogen effluvium.

 

Telogen effluvium is a very common kind of alopecia that I see in patients regularly.

 

Androgenetic alopecia is another condition, also known as pattern hair loss - male pattern hair loss or female pattern hair loss.

This tends to happen for women later on in life when they have perhaps hit menopausal age and it happens much earlier in men, from late teens and can lead to typical baldness before they turn thirty. This kind of alopecia is inherited in our genes and we need to look at people in our family to try to predict how ours will turn out. We can also monitor in trichology and there are treatments available. 

 

Scarring alopecia or cicatricial alopecia is another kind I see in older women, this is again to do with our immune system, where our cells attack the hair follicle causing it to atrophy and then become scar tissue. Once this has happened to a hair follicle, we cannot grow another new one.

 

We are born with all of our hair follicles; they develop in utero at around 16-18 weeks so if they are damaged or destroyed then we cannot grow a new hair in that place.

 

Traction alopecia is another kind of hair loss which can over time atrophy the hair follicle causing permanent alopecia or scarring hair loss. It is caused by tension or pulling on the hair causing the hair follicle to be damaged over time. If the causative factor is removed for traction alopecia then the hair follicles can usually recover. This kind of hair loss is common in black/African hair.

 

There is a scarring condition which only affects black/African women called central centrifugal cicatricial alopecia or CCCA. This condition can be incredibly sore and irritating and has multiple contributing factors which are thought to cause stress on the hair follicles leading them to atrophy over time. It used to be called hot comb alopecia, but it does not only affect people who relax/straighten their hair, it can affect women with locs and natural hair. It presents as irregular hair loss on the vertex or crown and parting, usually sparing the front. Even though this is said to be a scarring condition, we can actually get some good results from treatments. 

 

Psychological conditions can result in hair loss or alopecia and hair pulling also known as trichotillomania is a self-inflicted alopecia where the patient pulls or twists their hair out. This can present in irregular areas of hair loss varying in size. Upon close inspection, short broken hairs present with new hair growth. Sometimes people admit to hair pulling and sometimes they deny it. If it happens in children, it’s best to ignore it and they will hopefully shop or give them a doll so they can cut/pull the dolls hair instead, once it progresses into adulthood, it’s harder to stop.

 

Scaley itchy scalps can sometimes lead to hair loss or alopecia, usually from where the patient has picked or scratched their scalp and removed part of their epidermis (excoriation) or damaged their hair follicle. This can happen in psoriasis as there can be thick plaque like scales on the scalp and if they are picked off, it can damage the hair follicles leading to hair loss.

 

To be able to treat any kind of alopecia, it’s important to have a diagnosis and then we can look at what possible treatments are available for your specific condition. Some kinds of alopecia can be corrected and reversed with a healthy balanced diet and lifestyle changes. Sometimes more than one condition can be present, and this is very common to have more than one thing going on at once and we may need to monitor patients to reach a definite diagnosis.