What Is Hair Loss (Alopecia)? What Is Baldness?

The word alopecia refers to any type of hair loss, thinning hair or baldness in any hairy region of the body. Baldness tends to be a more specific term among lay people, as it usually refers to hair loss on the scalp - however, it can mean hair loss in any part of the body. Alopecia areata means "hair loss in areas". In the majority of cases hair loss is a normal process of aging, and not a disease. Because it is not seen as life-threatening to doctors it is often disregarded. This is unfortunate because hair loss can cause serious distress in some people, with some far reaching psychological effects. In some cases hair loss may be a consequence of some medical treatment, especially cancer treatment drugs - when the hair loss is generally temporary.

There are several types of alopecia, below is a list of the main types:

Alopecia areata - hair loss occurring in patches anywhere on the body. Hair is lost from some or all areas of the body, generally from the scalp. As it causes bald spots on the scalp, especially during its early phase, it is sometimes referred to as "spot baldness". A small proportion of alopecia areata cases spread to the whole scalp, or even the entire body. Approximately 0.1% to 0.2% of all humans are affected. It occurs in both men and women, but more commonly among women.

Most people who develop alopecia areata are apparently healthy and have no skin problems. When it does occur, it tends to start during the late teenage years, early childhood, or early adulthood. However, it can strike at any age.

Alopecia areata is not contagious. It is more commonly found among people who have close family member who have/had it. People who have a close relative with some kind of autoimmune disease are more likely to develop alopecia areata. That is why most experts believe it is an autoimmune disease - a disease where the body attacks good parts of the body as if they were foreign undesirable objects, such as some bacteria or viruses; in this case the body is attacking its own hair follicles. Studies indicate that T cell lymphocytes cluster around attacked follicles, causing inflammation and hair loss. Scientists say something, combined with hereditary factors, trigger the condition - we do not know what that something is, although some suspect it may be emotional stress or a pathogen. A pathogen is a disease-producing agent, e.g. a virus, bacterium or other microorganism. A study found that there is a close relationship between infection outbreaks on teeth and the presence of alopecia areata.

Symptoms usually appear as small, soft, bald patches. They may be of various shapes, but are generally round or oval. The scalp and beard are the most commonly affected areas; but can occur in any hairy part of the body. The patient may feel tingling, or even some slight pain in affected areas. Some parts of the body may experience hair re-growth while others will not. It can go into remission for long or short periods, and even forever (gets better and never comes back).

When the hair falls out on the scalp it tends to do so over a short period, and more so on one side than the other.

People with this type of alopecia also have "exclamation point hairs" - hairs that become narrower along the length of the strand closer to the base.

Alopecia totalis - total hair loss of the scalp. This could happen rapidly, or from progression of alopecia areata. Experts are not sure what causes it, but know that it is an autoimmune disorder. Although many believe mental stress is a contributory factor, a sizeable number of people with alopecia totalis lead relatively stress-free lives.

This type of alopecia may be an intermediary condition between Alopecia areata and Alopecia Universalis (total body hair loss). It usually emerges as a fairly sudden total scalp hair loss, or more gradual. When it is gradual it tends to be a development from alopecia areata.

The majority of sufferers are either children or young adults under 40. However alopecia totalis can affect people of any age. The patient's nails may also become ridged, pitted or brittle in appearance.

Alopecia universalis - all hair is lost throughout the body. It generally involves rapid loss of hair, including eyebrows and eyelashes. Experts consider it to be the most severe form of alopecia areata. It affects approximately 1 in every 100,000 people in North America and Western Europe. It is an autoimmune condition.

Alopecia barbae - loss of facial hear. Barbae comes from Latin and refers to the bearded area of the face. It does, in fact, affect both men and women. However, it is of more interest to men as only men are generally bothered by it.

Alopecia mucinosa - also referred to as follicular mucinosis. It is an inflammatory condition of both the hair follicle and sebaceous glands (pilosebaceous unit) which can result in scarring as well as non-scarring hair loss. Severity of scarring indicates how advanced the disease is. There is mucin around hair follicles when examined under the microscope. Mucins appear like stringy, clear or whitish gunk in the skin, and are made up mostly of hyaluronic acid - this is a normal component of the ground substance surrounding collagen of the dermis (part of the skin).

Alopecia mucinosa generally affects the face, neck, and scalp, but can affect any part of the body.

Alopecia mucinosa can be one of three types: 1. Primary and acute disorder - this affects children and teenagers (Pinkus type). 2. Primary and chronic disorder - this occurs in people over 40. 3. Secondary disorder - this is associated with benign (non-cancerous) or malignant (cancerous) skin disease.

Experts are not sure why it occurs, but it is seen as an autoimmune disease. Early signs include raised spots (follicular papules) which appear in reddened plaques or patches, about 2.5 centimeters in diameter, but they can be bigger. Some patients may start with one or more lesions, while others may have a single lesion that develops to multiple lesions over several weeks or months. The affected follicles will commonly result in hair loss.

If treated early enough it is reversible - hair will grow back. In more severe cases hair will not grow back, even after the disease has cleared up.

Androgenetic alopecia (male pattern hair loss) - this is also known as male pattern baldness. The hair gradually thins out, to an almost transparent state. It can affect both men and women. Experts say this type of alopecia is most likely to be hereditary - the person can inherit from either the mother or the father. Androgens means hormones. This type of alopecia is the type most lay people refer to when talking about balding.

Male pattern baldness usually starts with a receding hairline, and/or hair loss on the top of the head.

The person has a genetically determined sensitivity to the effects of DHT (dihydrotestosterone). Experts believe DHT shortens the growth phase (anagen phase) of the hair cycle, causing miniaturization of the follicles, resulting in finer hair. DHT production is regulated by 5-alpha reductase, an enzyme. DHT exists in several tissues of the body, including the scalp.

About 50% of men are affected by this type of hair loss at some time in their lives. Men of Chinese or Japanese ancestry are less likely to be affected.

A Chinese study found that men who smoked were more prone to age-related hair loss.

A study identified two genetic variants in Caucasians that together produce an astounding sevenfold increase in the risk of male pattern baldness.

Adrogenetic alopecia (female pattern hair loss) - this is also known as female pattern baldness. Women have a higher risk of female pattern baldness when they undergo hormonal changes during the menopause. The hair on the head is thinner, while facial hair may be coarser. Although new hair is not produced, the follicles are still alive. This suggests that hair regrowth is possible.

Generally, female pattern baldness is different from male pattern baldness. The woman will experience hair thinning all over the head, but will not usually lose her frontal hairline (it will not recede). Loss of hair on the crown may be moderate, but his hardly ever progresses to total or near baldness. Women can lose hair for other reasons than female pattern baldness:

• Teologen effluvium (temporary shedding of hair)
• The hair may breaks after styling treatments, or the twisting and pulling of hair
• Alopecia areata
• Some skin diseases
• Iron deficiency
• Hormonal problems
• Underactive thyroid
• Vitamin deficiency

Traction alopecia - this refers to hair loss as a result of too much pulling or tension on the hair shafts - usually the result of some hair styles. This type of alopecia is more commonly found among women. If the traction alopecia is prolonged the person's hair, where lost, may never come back.

Very tight ponytails, braids, or pigtails may cause traction alopecia if the person frequently uses them. Toy dogs whose owners use barrettes to keep hair out of their faces may also develop this type of alopecia.

Anagen effluvium - generally brought on by the use of chemotherapy or radiotherapy to treat cancer. Hair loss starts off as patchy, and then becomes total. Fortunately, in the vast majority of cases, as soon as the treatment is stopped the hair comes back within about six or so months. Some other medications can also cause hair loss. Compulsive hair pulling can also cause this type of hair loss, as well as poisoning from toxic plants, and some other diseases.

Anagen effluvium is caused by sudden, profound disturbances to the matrix cells of the hair follicles.

Telogen effluvium - more than normal amounts of hair fall out. It is characterized by excessive and early entry of hairs into the telogen phase (resting phase). This is a temporary condition - the hair comes back. It is thought to be caused by marked emotional or physiological stressful events that may result in an alteration of the normal hair cycle. The events may include childbirth, chronic illness, major surgery, anemia, crash diets, severe emotional disorders, or drugs.

What are the treatments for alopecia?

If the hair loss is caused by an infection or a condition, treating that infection/condition may prevent further hair loss, and in many cases re-growth will occur.

Male-pattern baldness treatment

• Finasteride - this works by preventing the hormone testosterone converting to the hormone DHT (dihydrotestosterone) which causes hair follicles to shrink. Finasteride effectively brings back normal hair size (from being very fine hair). According the National Health Service, UK, two-thirds of males who are given finasteride experience some hair regrowth. However, even among the other third who experience no regrowth, most stop becoming balder. The effects of finasteride are not evident for at least four months. If the patient stops taking finasteride the balding process will resume. About 1 in every 50 men who take finasteride experiences a loss of libido (sex drive).


• Minoxidil - this is available as a lotion. The person rubs it into the scalp on a daily basis. In the UK, and most other countries it is available over-the-counter (no prescription needed). About 15% of men who use it experience hair regrowth, while half of all men notice that the balding process stops. For about 32% of all men, minoxidil has no effect at all. It is only after four months of daily applications that those who do benefit from minoxidil notice it. If treatment is stopped the balding process will resume. Side effects are uncommon.


• Laser phototherapy - a controlled clinical trial proved the clinical efficacy and safety of a laser phototherapy device for treating hereditary hair loss.


• Dermabrasion gel - scientists have found a way to make the skin of laboratory mice give have fully working hair follicles complete with new hair by using a protein that stimulates follicle generating genes in skin cells under wound conditions.

Female-pattern baldness treatment

The only effective medication for women with female-pattern baldness is minoxidil. About 20% to 25% of UK women who take it experience hair regrowth, while the majority finds the treatment stops or slows the loss of hair. Other treatments include hair transplants, wigs, hair weaving, changes in hairstyle, plastic surgery (scalp reduction).

Alopecia areata treatment

There is no current reliable, safe, effective, long term treatment for alopecia areata, a study showed. Fortunately, about 80% of cases resolve themselves after a year without treatment and hair grows back. Therefore, watchful waiting may be the best initial strategy. If it does not resolve itself, some treatments are possible:

• Steroid injections - effective when the patient has small patches. A steroid solution is injected straight into the scalp, several times. The steroid stops the immune system from attacking hair follicles. After about four weeks this treatment may stimulate regrowth. Treatment might be repeated every few months. With some patients alopecia returns some time after treatment is stopped, while with others the regrowth is permanent.


• Topical steroids (creams and ointments) and steroid tablets - although these medications are widely prescribed for alopecia areata treatment, their long-term benefits are not clear. It seems there is a chance hair will regrow. Side effects become more common the longer the patient takes the steroid tablets or creams/ointments; they may include diabetes and stomach ulcers. Some patients experience itching, and sometimes hair growth in other areas.


• Minoxidil - applied in lotion form to the scalp every day, this treatment can stimulate hair growth. Benefits, if they do appear, do so after about two or three months. In the UK they are not recommended for people under the age of 16.


• Immunotherapy - this is the most effective treatment for total hair loss. DPCP (diphencyprone) is applied to the bald skin. The patient applies the chemical solution once a week, and the dosage is stronger each time. The DPCP generally causes an allergic reaction and the patient will develop mild dermatitis (mild eczema). Hair starts to regrow after about three months among patients who respond. Some patients may have a severe skin reaction. This can be dealt with by reducing the rate of dosage increase. A very small percentage of patients may develop vitiligo (patchy colored skin). Most patients find that hair continues falling out after treatment is stopped.


• Dithranol cream - this treatment is much less popular than immunotherapy because it is less effective and there is a greater risk of causing a skin reaction and itchiness. It can also stain the scalp and hair.


• UV light treatment - the patient is given about two to three sessions of light therapy each week. This is usually done in a hospital. After about 12 months patients may see some good results. It is not very popular as response rates are not so good.


• Tattooing the eyebrows - this is known as dermatography.


• Alternative therapies - alternative therapists commonly offer aromatherapy, massage, or acupuncture for alopecia treatment. Not enough studies exist to determine how effective these treatments are.