Alopecia is a vast subject – ‘alopecia’ literally just means ‘hair loss’ and can be applied to all types of hair loss, not just the total and somewhat dramatic loss that most of us consider when we hear the word. A wide variation can occur in the amount of hair fall seen between each condition, and what is ‘normal’ does not necessarily mean normal for you! Some people do not see visible shedding of hair but a general thinning or visible patch appearing.
Some types of alopecia are ‘treatable’, unfortunately however, there are some types of alopecia that currently scientists do not have a cure for, however may respond to careful consideration of the factors and correct management at your consultation.
Below is a summary of some of the most common types of hair loss, but is not an exhaustive list!
The first step to understanding hair loss is to understand the healthy hair growth cycle; healthy hair grows in ‘anagen’ for approximately 5 years, before transitioning into ‘catagen’ for 2 weeks and finally the ‘telogen’ resting phase. It is this last phase that is one of the most important as the hair has already stopped growing and finally falls out at the end of the 3 months to be replaced by a short newly growing hair and the growth cycle continues.
Please note that in the UK, Trichologists are not the same as Dermatologist, but has specialist knowledge to advise and guide you. Trichologists are able refer to medical practitioners if needed.
This is can be either acute (sudden but relatively short lived) or chronic (longer lasting and often less dramatic). The hair feels generally thinner with increased hair fall caused by a disruption to the normal growth cycle above. Correct identification and treatment of the underlying causes will rectify this type of hair loss in most cases.
This can occur in men and women, this causes within the hair follicle are the same; hormones and genetics, but present differently between the sexes. There are specific signs on the scalp that are visible that can confirm the diagnosis and exclude others. There are a variety of treatments that are available to suit different preferences, however are more effective the earlier they are started. For those with a more progressed pattern of loss, hair transplant surgery is a viable option, please see the British Association of Hair Transplant Surgeons website for a list of reputable surgeons.
This is a type of hair loss caused by an auto-immune condition; the immune system that usually fights virues and infection, incorrectly identifies the hair follicles as ‘foreign’ and attacks it. This results in hair loss that is often patchy, and can result in different patterns, such as ophiasis along the nape of the neck, or totals, where the whole scalp is affected.
Addressing any underlying immune-regulatory causes, combined with topical stimulation of the hair follicles and further investigation can be effective, however treatment can be unpredictable and there is no one universal cure for this type of alopecia yet.
Cicatricial (scarring) Hair Loss
In this type of alopecia, the hair follicles are no longer present resulting in scarred, smooth, fibrosed skin. There are different types and patterns of scarring hair loss, from the more obvious wound or trauma to the head (that can include excess traction over time) to bacterial infections or autoimmune types that destroy the follicle, such as in frontal fibrosing alopecia or lichen planopilaris.
Early identification is key as once the follicle has been destroyed then regrowth is unfortunately not possible. Depending on the cause, many cases will also require a dermatology referral to start swift preventative treatment.
Scalp health is key when tackling all hair loss and is always considered. Scaling conditions can be intensely itchy, affect your self confidence and your ability to wear black! Whether you have mild dandruff, more adherent build up of scale as in seborrhoeic dermatitis, or chronic scalp psoriasis, a shampoo alone is generally not enough… Understanding the causes, the contributing factors can help give more long term relief, along with scalp treatments to lift any scale and soothe the scalp.
Traumatic Hair Loss
This can occur from damage from heat, chemicals or traction from styling procedures or hair extensions. Traumatic hair loss is also the category that covers the compulsion to pull out ones own hair, called ‘trichotillomania’. Examination will reveal the differences between the types of hair loss above and loss caused by external factors in order to advise on either temporary cosmetic measures whilst the hair re-grows or the likelihood of more prolonged damage to the follicle.