Types of alopecia include alopecia areata, frontal fibrosing alopecia, telogen effluvium, androgenetic alopecia, and traction alopecia, which can be caused by a variety of factors, including hormonal changes, a genetic predisposition, the use of chemical products, and lupus.
Alopecia is a condition characterized by the loss of large quantities of hair on the scalp or other regions of the body, exposing areas of the skin previously covered by hair.
It is recommended to consult a dermatologist if you are concerned you might have alopecia. A dermatologist can perform a full workup and prescribe the most appropriate treatment, which may include medications like minoxidil, finasteride, and spironolactone, in addition to cortisone injections and hair transplants.
The main types of alopecia are:
1. Alopecia areata
Main symptoms: Alopecia areata causes sudden hair loss involving the scalp, eyelashes, or other areas of the body covered by hair, typically in a circular or oval pattern, leaving shiny, round bald patches where the hair used to be. Alopecia can also involve total loss of hair on the scalp, also known as alopecia totalis (AT).
Causes: The cause of alopecia areata is unknown, but is believed to be related to certain factors like genetic predisposition; autoimmune diseases like vitiligo and lupus; stress; anxiety; and thyroid disease.
Treatment: Treatment of alopecia areata is managed by a dermatologist, and may involve cortisone injections or minoxidil lotion applied to the affected area. Corticosteroids and immunosuppressants may be indicated for more serious cases of hair loss affecting various parts of the body.
2. Frontal fibrosing alopecia
Main symptoms: Symptoms of frontal fibrosing alopecia (FFA) include hair loss on the front and sides of the the scalp, itching, loss of eyebrow hair, and hair loss affecting the beard and sideburns.
Causes: The cause of frontal fibrosing alopecia is unknown, however it is believed that factors like genetic predisposition, hormone changes, contact dermatitis, autoimmune diseases, viral infections, and sun exposure may be involved in triggering the condition.
Treatment: Treatment of frontal fibrosing alopecia involves oral medications like antibiotics, immunomodulators, and antiandrogens; topical medications; steroid injections; and hair transplants. A dermatologist can prescribe these medications to help manage the condition and stop hair loss in some people.
3. Scarring alopecia
Main symptoms: The most common symptoms of scarring alopecia are inflammation of the hair follicle, which is the structure responsible for hair formation and growth; a burning or itching sensation; sensitive skin; skin redness or peeling; and permanent hair loss.
Causes: Scarring alopecia occurs due to inflammation and destruction of the hair follicle, which may be caused by inflammatory and autoimmune diseases; the use of chemical products like chemical hair straighteners and hair relaxer treatments; trauma from hair extensions or braids; or radiation.
Treatment: Depending on the cause and severity of the condition, a dermatologist may prescribe topical or oral medications containing corticosteroids, antimalarials, immunosuppressants, antibiotics, or retinoids.
Your provider may also recommend corticosteroid injections, phototherapy sessions, or a hair transplant.
4. Androgenetic alopecia
Main symptoms: The main symptoms of androgenetic alopecia, commonly known as baldness, are increased hair loss; thinner, finer, shorter hair; thinning hair close to the forehead; and hair loss at the temples (known as a a receding hair line) and the top of the head.
Causes: Androgenetic alopecia is genetic, and is caused by an excessive response to increased testosterone production in the body, primarily dihydrotestosterone. This response involves excessive activation of androgen receptors, shortening the normal growth phase and resulting in shorter, thinner strands of hair.
Treatment: Androgenetic alopecia is treated with oral and topical medications like minoxidil, finasteride, and spironolactone, which require a prescription from your dermatologist.
Your provider may also recommend low-level laser therapy (LLLT), platelet-rich plasma (PRP) injections, or a hair transplant.
5. Telogen effluvium
Main symptoms: The main symptom of telogen effluvium is increased hair shedding throughout the day that can last between 6 to 9 months. It typically happens more while brushing or washing your hair, with more hair noted on your brush or in the drain.
Causes: The main causes of telogen effluvium are hormone changes, thyroid disease, stress, anxiety, medications, nutritional deficiencies, and infections, such as dengue and Chikungunya.
People who had COVID-19 have also presented with telogen effluvium, possibly related to the increase in circulating inflammatory cytokines in the body, as well as symptoms like stress, anxiety, and/or high fever that are common with COVID.
Treatment: Telogen effluvium does not usually require treatment, as hair loss typically improves on its own over time. However, when hair loss is the result of hormonal changes, a doctor may prescribe medications like minoxidil, finasteride, and spironolactone to stimulate hair growth and slow down hair loss.
6. Traction alopecia
Main symptoms: The main signs and symptoms of traction alopecia are redness at the edge of the scalp, primarily in the front and on the sides; small bumps and peeling of the skin; and shorter, sparser hair along the hairline.
Causes: Traction alopecia is caused by tight hairstyles like ponytails, buns, and braids. These tight hairstyles pull at individual strands of hair, causing them to fall out, and can also interfere with hair growth by causing damage to the hair follicle. This type of alopecia is more common in women.
Treatment: Traction alopecia is treated by a dermatologist using medications to simulate hair growth, such as minoxidil and finasteride, for example. In cases of inflammation, your provider may also prescribe the use of topical corticosteroid medications and antibiotics.
Alopecia in women
The most common type of hair loss affecting women is androgenetic alopecia, also known as female pattern hair loss or female pattern baldness when it occurs in women. Androgenetic alopecia in women typically presents as increased hair loss; thinner, finer hair on the top of the head; and the appearance of bald spots.
Traction alopecia is also more common in women, especially those who wear tight hairstyles.
Confirming a diagnosis
The diagnosis of alopecia is made by a dermatologist based on an examination of the scalp and skin.
In order to confirm the diagnosis, a dermatologist may also collect a few strands of hair to be evaluated in the lab to help determine the cause of the alopecia.