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Last updated September 26, 2019. 6 minute read

Alopecia: causes, symptoms, and treatments

Alopecia is hair loss and can affect both men and women. Androgenic alopecia is the most common type, affecting 80 million Americans. Minoxidil is the only hair regrowth treatment that is FDA-approved for both men and women

Dr Chimene Richa Md Written by Dr. Chimene Richa, MD
Reviewed by Dr. Mike Bohl, MD, MPH

Losing hair is a normal part of life; everyone loses 50-100 hairs a day (AAD, n.d.). However, if your hair is thinning or you are starting to notice bald patches (areas where hair no longer grows), you may have alopecia (hair loss). Alopecia usually affects your scalp, but may affect hair on other parts of your body, such as eyebrows and eyelashes. Depending on the cause, the alopecia may be reversible. Hair loss, while not dangerous, can be distressing for both men and women. Discuss your medical history and any medications you are taking with your healthcare provider, especially before trying any alopecia treatments. 

Vitals

  • Alopecia is hair loss and can affect both men and women.
  • Androgenic alopecia is the most common type, affecting 80 million Americans.
  • Alopecia areata is an autoimmune form of hair loss.
  • Minoxidil is the only hair regrowth treatment that is FDA-approved for both men and women

Symptoms of alopecia

Men and women show hair loss differently (Phillips, 2017). In men, alopecia looks like thinning on the top of the head or on the sides of the scalp; they can also have hair loss at the hairline (receding hairline). Women typically see thinning on the tops of their heads or throughout their hair; the first sign is often a widening part. Women generally do not get a receding hairline.

What causes alopecia?

Many factors can cause alopecia, including genetics, illness, stress, diet, medications, childbirth, and certain hair care habits (AAD, n.d.). Hereditary hair loss that occurs with aging is the most common cause of alopecia. Others causes include:

  • Autoimmune disease—Sometimes the immune system attacks the body, or in this case, its hair follicles (hair-producing cells); this leads to a condition known as alopecia areata
  • Medical conditions—These include thyroid disease and anemia, among others
  • Chronic illness—Major surgery, high fevers, severe infection, etc. can lead to temporary hair loss, also known as telogen effluvium
  • Cancer treatments like radiation and chemotherapy
  • Scalp ringworm—This is usually seen in children and is a fungal infection that can lead to hair loss and eventually balding if not treated appropriately. 
  • Mental disorder—Trichotillomania is a condition where a person pulls out the hair on their scalp, eyebrows, and eyelashes. 
  • Hormonal changes—Childbirth, menopause, and stress can all cause alopecia
  • Nutrition issues—Weight loss, eating disorders, too much vitamin A, too little iron (anemia), and too little protein in your diet can all cause hair loss
  • Prescription medications—Certain medications can lead to hair loss in some people; these include birth control pills, blood thinners, high dose vitamin A, as well as drugs used to treat arthritis, depression, gout, high blood pressure, and heart problems
  • Haircare—excessive use of high heat on hair, chemicals in hair products, and long-term use of styles that pull or tug on hair can lead to alopecia

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Types of alopecia

  • Androgenic alopecia, also known as hereditary thinning or baldness — This is the most common type of alopecia and causes the typical “male pattern” or “female pattern” baldness; it usually runs in the family. According to the American Academy of Dermatology (AAD), approximately 80 million people in the U.S. have this type of hair loss (AAD, n.d.). Androgenic alopecia is seen most often in white men. Its prevalence varies with age as 30% experience it at age 30, 40% at age 40, and 50% at age 50. This type of alopecia is less common in women, affecting about 38% of women over the age of 70 (Phillips, 2017). 
  • Alopecia areata—This type of alopecia is an autoimmune condition where the body attacks its own hair, leading to one of three different types of baldness patterns (NAAF, n.d.):
    • Alopecia areata patchy—round patches of hair loss on the scalp and other places on the body
    • Alopecia totalis—total loss of hair on the scalp
    • Alopecia universalis—complete loss of all body hair

The National Alopecia Areata Foundation estimates that 6.8 million people in the U.S. are affected and 20% of these are children (NAAF, n.d.). It is not clear what triggers a person’s immune system to attack their hair follicles; most likely, it’s caused by a combination of genetic and environmental factors. People who have the genes for alopecia areata get exposed to something that triggers the disease, and they develop hair loss; these triggers are not well understood. Alopecia areata can get better on its own or with treatment; it comes and goes in an unpredictable pattern, which can be frustrating for people with this condition. Alopecia areata is associated with other autoimmune diseases like thyroid disease, celiac disease, rheumatoid arthritis, vitiligo, and type 1 diabetes, though most people with alopecia areata are otherwise healthy (Jabbari, 2013).

  • Cicatricial (scarring) alopecia—In this type of alopecia, inflammation kills the hair follicles and replaces them with scar tissue; scar tissue cannot grow hair and results in a bald spot. Several skin disorders can cause this, including folliculitis (inflammation of the hair follicles) and lupus. 
  • Telogen effluvium—Sometimes an illness or a medication you are taking can disrupt the hair growth cycle. When this happens, too many hairs enter the resting (telogen) phase and then fall out at the same time a few months later. Telogen effluvium can result from any number of conditions like a severe chronic illness, pregnancy, surgery, severe infection, or endocrine (hormone) problems (Phillips, 2017). You can also have this type of hair loss while using certain medications like those for treating acne, seizures, thyroid problems, and blood pressure, among others. If you have this problem, you may notice your hair coming out in clumps several months after the illness or medication use. Fortunately, once you address the underlying cause, the hair usually regrows.
  • Tinea capitis—This type is caused by a contagious fungal infection that you can get from contaminated hats, brushes, etc. The infection gets into the hair follicles and leads to itching and hair loss; it can cause balding if left untreated. Tinea capitis mainly affects children.
  • Traction alopecia—Wearing hairstyles that pull on the hair can lead to hair loss over time. This condition is more prevalent in African American women and hairstyles that can cause this include braiding, ponytails, etc. Treatment involves stopping the use of high-tension hairstyles.
  • Trichotillomania—This is an impulse-control disorder where you cannot stop pulling your hair, usually on your scalp, but sometimes also the hair from your eyebrows, eyelashes or other places on your body. The hairs in the thinning patches often look broken; treatment usually involves a combination of medication and therapy. Trichotillomania affects 4% of Americans, often children and teenagers (Phillips, 2017).   

Treatment options

There are many different causes and types of alopecia; your healthcare provider or dermatologist may need to perform additional tests on your hair or scalp to determine the actual cause of your hair loss. Finding the cause of your alopecia will help guide your treatment plan. Many treatments exist, and your provider can help you identify which ones are right for you; this can involve a combination of treatments.

Both over-the-counter and prescription medications are available to help with alopecia. 

  • Minoxidil—This is an over-the-counter treatment that is FDA approved for androgenic alopecia in both men and women to decrease hair loss and stimulate hair re-growth; it is applied directly to the scalp.
  • Finasteride—This is a prescription medication that is FDA approved to help slow hair loss and stimulate hair re-growth in men with androgenic alopecia. It works by halting a man’s production of dihydrotestosterone (DHT), a male hormone. Women who are pregnant should not touch any broken tablets.
  • Immunosuppressants—If inflammation is one of the causes of your alopecia, your provider may recommend the use of medications to decrease the body’s ability to attack its own hair follicles. This class of drugs includes corticosteroids, methotrexate, sulfasalazine, and cyclosporine.
  • Scalp sensitizers—These medications stimulate a particular type of inflammation of the skin (dermatitis) of the scalp to redirect the body’s immune system; this group includes anthralin and diphencyprone (DPCP) (Spano, 2015).

In addition to medical treatments, some procedures can be used to help restore hair. Hair transplantation is one option; scalp skin that still has good hair growth is transplanted to balding areas of the scalp. There is an FDA-cleared low-level laser device that might improve hair growth in some people. Lastly, non-medical options like wigs, scarves, shaving, etc. can be used to camouflage hair loss. Talk to your provider to see which hair loss treatment options are right for you.