What is it?

Alopecia and hair loss mean the same thing; reduction in hair density and increased hair fall. This can be a diffuse process or occur in localised areas on the scalp or other areas of the body. It can occur slowly over many years, or be rapidly progressive, occurring over days or weeks. There are many causes for alopcia (listed below) which can broadly be grouped into three categories: internal deficiencies, scalp disease or ‘other’ causes. The most important distinction is whether scarring is a feature or not, because this will dictate how successful treatment can be.

What does it look like?

Hair loss may be diffuse (i.e. androgenic) or localised (i.e. alopecia areata). If there is scarring, the skin might be featureless with loss of hair follicles and pigment. Please see images of some common causes of alopecia.

How might it affect me?

The degree of psychological stress caused by alopecia is usually related to the extent of alopecia and the ease (or lack thereof) with which the condition can be covered or hidden.

Causes of alopecia:

Non-Scarring

• Androgenic or genetic alopecia is the commonest cause of hair loss in men and women
• Iron deficiency or low ferritin can cause hair loss
• Thyroid related hair loss might be due to over or under-active thyroid
• Alopecia Areata is usually patches of hair loss caused by the immune system
• Telogen effluvium is stress or illness related hair loss
• Age related hair loss occurs in all people over time
• Drug induced hair loss can occur as a result of some medications i.e. Roaccutane®
• Trichotillomania; self induced hair loss through uncontrolled plucking
• Stress can exacerbate any of the above conditions

Scarring

• Traction/Traumatic alopecia is due to scalp damage (often through excessive braiding)
• Lichen plano-pilaris; an inflammatory scalp condition
• Lupus; an autoimmune condition that can affect the scalp
• Folliculitis/dissecting Cellulitis; hair follicle inflammation that can lead to scarring
• Pseudopelade is end stage scarring alopecia of uncertain cause

What are the treatments?

The most important part of treatment is to make the correct diagnosis and there is nobody more qualified than a consultant dermatologist. Diagnosis will involve a consultation, full scalp examination and sometimes blood testing to establish if there is a deficiency or hormonal problem. If scalp disease is present or a diagnosis is not straightforward, a scalp biopsy might be undertaken to examine the process at a microscopic level. The key to treatment is establishing if the condition is scarring or not. If it is scarring, it is important to switch off the process as quickly as possible to prevent progression, as scarred areas will NOT regrow. Non-scarring alopecia can recover fully with treatment, but may gradually progress over time.

Remember, it is vital to make the correct diagnosis and prevent any scarring or alopecia can become irreversible.

For further information on alopecia, see the British Association of Dermatologists websites patient information pages:
Alopecia Areata
Androgenic Alopecia
Discoid Lupus
Dissecting Cellulitis
Folliculitis Decalvans
Lichen Planopilaris
Telogen Effluvium

Did you know?

Most moles are not a cause for concern and present a purely cosmetic problem. However, moles can occasionally undergo changes that lead to them becoming cancerous.

Acne is a common condition characterised by blackheads, whiteheads and cysts. It affects the greasy and hair-bearing areas such as the face, chest and back.

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