Alopecia = Hair loss

Alopecia is a vast subject – its definition is purely ‘hair loss’ and can be applied to all types of hair loss.

I believe that hair is more than just hair! Anything that affects the way you feel on a daily basis, from a never ending itch or the worry of seeing more hair in the plug hole than ever before and wondering ‘when will it end’, deserves to be taken seriously. In todays’ society more than ever, we are surrounded by idealistic, although rarely realistic images, which can significantly affect our own self-perception and confidence.

Hair is considered a ‘barometer of health’ and there are a lot of factors, symptoms and signs that can be overlooked when seen in isolation. A Trichologist is able to spend the time to ‘join up the dots’ and look at the whole picture of your health to come to a diagnosis.

Some types of alopecia and scalp complaint are treatable, unfortunately however, there are some conditions that currently science does not have a cure for. However taking positive action to understand your condition, whatever it may be and discussing the next steps and options, can bring peace of mind and reassurance about what the future may hold.

Below, you will find brief descriptions of common hair and scalp problems, however as with any condition, there are often other subcategories that exist and these descriptions are intended for guidance only. A personal consultation at the Surrey Trichology Clinic will identify all contributing symptoms and signs to reach a full and detailed diagnosis, which will enable me to explain your condition in a sensitive and friendly manner and offer valuable advice.

Alopecia Areata and Alopecia Totalis

These types of alopecia are perhaps the ones that many people commonly think of when we hear the word ‘alopecia’. Areata can take different forms, but with the same autoimmune cause; from a scattered diffuse loss or more distinct patches of loss in different areas of the head and around the edges, to a complete loss of scalp hair, known as totalis. The autoimmune nature of this disorder makes it very unpredictable. Itching and scalp irritation are commonly reported along side an increase in hair shedding and noticeable patches of loss.

Androgenetic Alopecia

Androgenetic alopecia is the name given to a type of hair loss that is related to the androgen hormone, more commonly known as male pattern hair loss or female pattern hair loss. Both male and female types present differently, however the both types have the same cause. Male pattern hair loss presents with thinning to the frontal recession areas, followed by thinning to the crown. This type of hair loss is progressive and over time, the two separate areas merge across the top of the head. Female pattern hair loss is a more diffuse thinning, with patients noting a wider parting but usually retaining the front hairline.

Testosterone is the androgen hormone implicated and is naturally present in both men and women in differing amounts. It is the conversion of testosterone to a more potent type, called dihydrotestosterone that causes the miniaturisation of hair follicles in sensitive individuals.

Excess Hair Shedding (Telogen Effluvium)

As the hair is reflective of our bodies health, there are a huge range of factors that can lead to an excess of hair follicles, sometimes up to 50% compared to just 10% normally, to enter the telogen phase prematurely. This causes you to experience thinner hair and more noticeable hair shedding. There are many factors to consider when diagnosing telogen effluvium, which an in-depth trichological consultation will take into account.

Scarring Alopecia

In recent years, there has been an increase in a type of alopecia that attacks the hair follicles and results in scarring, meaning that the hair follicle no longer exists resulting in smooth shiny, scarred skin.

Scarring hair loss falls into three categories:

  • Autoimmune scarring; such as frontal fibrosing alopecia, lichen planopilaris, discoid lupus erythematosus, pseudopelade, and folliculititis decalvens
  • Bacterial scarring; such as acne necrotica miliaris and folliculitis keloidalis.
  • Traumatic scarring from an injury to the scalp, or over time, excessive tension placed on the follicles, such as from poorly applied hair extensions or trichotillomania (compulsive pulling) causing atrophy.

Hair Shaft Disorders

There are a number of disorders (many inherited) that affect the successful production of a healthy hair shaft with irregularities and fractures making the hair very brittle and easily breakable. Such conditions may exist within other syndromes such as Ichthyosis and Nethertons Syndrome, and are monilethrix, pili torti, trichorhexis invaginata (bamboo hair), pili annulati (spangled hair)

Two more commonly seen conditions can also be caused by external weathering and damage to the hair shaft. Trichoptilosis or fragilitas crinium is more commonly known as split ends and trichorrhexis nodosa describes fractured nodes along the hair shaft that easily break away when pulled.

Loss of hair condition

Loss of hair condition can arise from the weathering of incorrect treatment of your hair, including excessive heat use, the incorrect use of shampoos, conditioners, products and oils, poorly applied hairdressing chemicals, to internal causes such as medication, mineral and vitamin deficiencies and protein deficiency.

Any and all of these combined can leave the hair feeling brittle, dull, dry, prone to breakage from loss of tensile strength and elasticity, more split ends (trichoptilosis/fragilitas crinium), fractured nodules (trichorrhexis nodosa), loss of moisture and knotty, tangled matting hair from open, raised cuticles.

Advice in the correct hair care regime and reconditioning treatments can help to prevent reoccurrence in the future.

*The recent rise in products that create new bonds in the hair, should still be approached with caution – the damage to the natural structure of the hair still takes place and the artificial bonds created may not be as strong the natural disulphide bonds of the hair, leading to hair breakage further down the line. When used properly and respectfully to the hair, by a professional qualified hairdresser, the results may prove to be beneficial to the hair in the short term.

Itching and Scalp Irritation

While itching can also exist entirely on its own, it can also be a symptom of other disorders with a multitude of causes; from infection, infestation, systemic disorder or reaction to a hairdressing chemical or sensitising product.

On examination I will be able to distinguish any contributing factors and offer advice and treatments to reduce the feeling of irritation and soothe the area.

Dandruff and Scalp Scaling

Pityriasis Capitis is the full name given to common dandruff and it exists within a family of conditions, all with the same persistent cause; a sensitivity a yeast found on everyone’s scalp, Malassezia farfur. M. farfur is also known as Pityrosporum Ovale, which lends its name to the condition. Treatment with the correct products and identifying factors that can cause the condition to flare up offers an effective way of managing the condition.

• Pitryiasis Capitis (dandruff): small, loose, white flakes
• Infantile seborrhoeic dermatitis (Cradle cap): adherent build up of skin cells
• Seborrhoeic dermatitis: commonly itchy with more pronounced flaking, but these symptoms can appear individually.
• Pityriasis Amiantacea: Thick adherent patches of skin cells, often in small patches and can be itchy and sore. Can co-exist with other forms.

Oily Scalp (seborrhoea oleosa)

Excess oil production is caused by an over-active sebaceous gland, which produces sebum to lubricate and give natural moisture to the skin. Sufferers may also experience acne and scalp scaling as described above. The production of sebum is controlled by hormone function and with the correct advice and treatments, the condition can be bought under control.


Psoriasis is recognised by adherent, silvery plaques, seen over a reddened area of skin, feelings of itching and ‘tightness’ are reported but not experience by everyone. It commonly occurs in only in patches on the scalp, and is also seen in other areas of the body such as the tops of the knees and outside of the elbows. Psoriasis is an autoimmune disorder, that treatments and the use of the correct products can manage successfully bringing relief to sufferers.