What are the different kinds of alopecia?

Table of Content:
What causes alopecia? | Types of alopecia | Androgenetic alopecia | Alopecia areata | Alopecia totalis | Alopecia universalis | Telogen effluvium | Anagen effluvium | Scarring alopecia | Frontal fibrosing alopecia | Treatment | Traction alopecia | Trichotillomania | Alopecia syphilitica

What is alopecia?

Hair loss, also known as alopecia, refers to the absence or loss of hair in areas where it is expected to grow, and it can manifest as localized or diffuse, temporary or permanent hair loss, affecting people of all ages and both genders. 

Hair loss can impact either specific regions of your scalp or your entire body and may be either temporary or permanent. It can be attributed to factors such as genetics, hormonal fluctuations, underlying medical conditions, or it can simply be a natural part of the aging process. While hair loss can affect anyone, it is more commonly observed in men.

What causes hair loss?

Hair loss (alopecia) can be caused by many different underlying factors and it is typically categorized as non-scarring, where hair follicles are still viable and hair can potentially regrow, and scarring (cicatricial), which involves irreversible damage to hair follicles¹. 

The primary cause of hair loss is often age-related hereditary hair loss. Individuals facing hair loss have various choices for managing it. Some opt to let the hair loss occur naturally without intervention, while others may employ hairstyles, cosmetics, hats, or scarves to conceal it. Additionally, some individuals explore available treatments aimed at preventing further hair loss or stimulating hair regrowth².

Consult with an online dermatologist to identify the underlying cause of your hair loss and discuss potential treatment options.

If you have recently started working out and have heard rumors about whether creatine causes hair loss, read our article by a board-certified dermatologist.

Are there any medications for alopecia?

Yes, there are currently several medications that you can take/apply for the different types of hair loss. For example: oral minoxidil, finasteride, dutasteride and spironolactone. There are also topical formulations of these same medications, if you want to avoid systemic side-effects.

How to get a prescription for alopecia (hair loss)?

You can get a prescription for hair loss via Miiskin. All you need to do is take some photos of your head, answer some questions and enter your credit card details to pay the $59 fee. Medication renewals are only $39.

What are the different forms (types) of alopecia?

There are many different types of hair loss and each one of them has their own cause. However, the good news is that although there may be a genetic component in alopecia, this does not mean that you will necessarily inherit it from your parents or will pass it along to your children.

Keep reading to learn more about the different types of hair loss, their cause, if they are hereditary and the best treatment. 

How many types of alopecia are there?

There are several types of alopecia, each with distinct characteristics and causes. The main types include:

• Androgenetic alopecia
• Alopecia areata
• Alopecia totalis
• Alopecia universalis
• Telogen effluvium
• Anagen effluvium
• Scarring alopecia
• Frontal fibrosis alopecia

Non scarring alopecia

Androgenetic alopecia

Androgenetic alopecia (also known as male or female pattern baldness) can affect as many as 50% of both males and females and it is primarily caused by a hormone called DHT (dihydrotestosterone) which affects hair follicles and leads to thinning and hair loss.

Androgenetic alopecia is characterized by a gradual and progressive loss of terminal hair (thicker, longer hair) on the scalp, which typically occurs at any time after puberty. In males, the most noticeable hair loss occurs in the vertex (crown) and frontotemporal (forehead and temples) regions. In contrast, women tend to retain their frontal hairline, but they experience diffuse hair loss on the top part of the scalp (apical), resulting in a broader area of thinning hair towards the front³. Typically the earliest sign of female androgenetic alopecia is a broadening of the part line in a Christmas-tree like pattern.

Learn more about the role of DHT and DHT blockers for androgenetic alopecia in our article: Best DHT blockers available in the market.

Alopecia areata

Alopecia areata is a chronic condition caused by the immune system attacking hair follicles, nails, and sometimes the retinal pigment epithelium. It leads to hair loss, but it is non-scarring which means hair follicles are not damaged permanently. Alopecia areata manifests as smooth, non-scarring patches of hair loss on the scalp or other hairy parts. While some people see their hair grow back on its own within a year, it may become a recurring issue with episodes of hair loss. Several new treatments have become available to treat this condition in recent years so consulting with a dermatologist early in the course can help greatly improve the chance of stopping further hair loss and promoting normal hair growth⁴. 

Types of alopecia areata

Alopecia totalis

Alopecia totalis is a persistent condition characterized by the complete loss of hair on the scalp, and it only affects a small portion of individuals with alopecia areata. Achieving better treatment results is more likely when this condition is identified and addressed during its early stages⁶.

Alopecia universalis

This is the most severe form of alopecia areata, causing complete hair loss on the scalp and body, including eyebrows and eyelashes. The symptoms of this disease can appear at any age⁷. 

Telogen effluvium

Telogen effluvium is characterized by excessive shedding of resting or telogen hair, often triggered by factors such as acute illness, severe infections, major surgery, hormonal fluctuations, postpartum, hypothyroidism, dietary deficiencies, heavy metal exposure, iron deficiency, and the use of specific medications, including beta-blockers, retinoids, anticoagulants, propylthiouracil, carbamazepine, and certain immunizations. It can also be triggered by dramatic dietary changes or certain weight loss supplements¹⁰.

Anagen effluvium (chemotherapy-induced alopecia)

Anagen effluvium is a type of non-scarring hair loss often associated with chemotherapy treatment. In this condition, the hair follicles in the growth phase (anagen) are subjected to harmful substances or inflammation, leading to the breaking of hair shafts. It is commonly known as chemotherapy-induced alopecia since it can be triggered by certain chemotherapy drugs like antimetabolites, alkylating agents, and mitotic inhibitors. Hair shedding typically occurs within two weeks of receiving these medications. Fortunately, in many cases, anagen effluvium is reversible, and hair regrows once the drug is discontinued¹¹.

Scarring alopecia

Scarring alopecia (also known as cicatricial alopecia) is a form of hair loss resulting from the damage and destruction of hair follicles. This type of hair loss is typically triggered by factors such as infections, exposure to chemicals, burns, or autoimmune disorders. Hair loss associated with scarring alopecia is often permanent because the absence of healthy hair follicles prevents the regrowth of hair¹².

Frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is a specific type of scarring alopecia that destroys hair follicles, leading to permanent hair loss. It typically begins gradually, resembling a receding hairline along the front and sides of the head. FFA can also result in hair loss in other areas of the body, including eyebrows, pubic hair, underarm hair, or the arms and legs. While FFA is often diagnosed in women after menopause, it can occur earlier in life, particularly in black women. More research is needed to determine if black women are more likely to experience FFA symptoms before menopause. Early diagnosis and medical treatment from a dermatologist is critical in preventing permanent hair loss in FFA¹³. Delaying diagnosis and treatment of any form of scarring hair loss can result in rapidly progressive and irreversible changes, so time is definitely of the essence when dealing with this type of hair loss.

What is the best treatment for alopecia?

Only a healthcare professional (usually a dermatologist) can diagnose the specific cause of hair loss and determine what is the best treatment plan for you since they will review your personal medical history. 

However, these are some common treatments used for different types of hair loss. 

• Oral minoxidil 
• Finasteride (men only)
• Dutasteride (men only)
• Spironolactone (women only)
• Topical finasteride + minoxidil (men and women)
• Topical dutasteride + minoxidil (men and women)
• Topical spironolactone + minoxidil (men and women)
• Topical and Intralesional corticosteroids 
• Prescription medications for autoimmune conditions 
• Low-Level Laser Therapy (LLLT)
• Platelet-Rich Plasma (PRP) Therapy
• Hair Transplant Surgery
• Scalp micropigmentation (tattooing the scalp to create the appearance of a closely shaved head)

Is there oral medications for hair loss?

Yes, some types of hair loss, especially androgenetic alopecia (which is the most common type of hair loss) can be treated with a low dose of minoxidil, finasteride or dutasteride. 

Alopecia-related disorders 

Traction alopecia

Traction alopecia results from continuous pulling force on the hair roots, often seen in women of African descent with tight, spiral-curled hair. It’s commonly associated with Afro-Caribbean hairstyles like tight braids, and the issue typically begins in childhood, initially being reversible but progressing to permanent and scarring hair loss in chronic cases. Preventable with education, traction alopecia highlights the importance of proper hair care practices, as it affects both children and adults, as evidenced by population data from South Africa¹⁴.

Trichotillomania

Trichotillomania, also known as hair-pulling disorder, is a condition that falls under the spectrum of obsessive-compulsive disorder (OCD). OCD encompasses a wide range of disorders characterized by repeated thoughts (obsessions) and repeated activities (compulsions). Trichotillomania is thought to be closely related to anxiety disorders and is marked by the compulsive act of hair pulling¹⁵. 

Alopecia syphilitica

Alopecia syphilitica (AS) is a relatively uncommon manifestation of syphilis. It is a type of nonscarring hair loss that can appear in various patterns, including diffuse, moth-eaten, or a combination of these. Due to its low prevalence and similarity in presentation to other forms of alopecia, such as alopecia areata, telogen effluvium, and tinea capitis, dermatologists need to obtain the patient’s medical history, conducting serologic tests, and examining histopathologic or dermatoscopic findings. The primary treatment involves benzathine penicillin G injections, which can lead to hair regrowth over weeks to months. 

What are the 3 (most common) types of alopecia?

The three most common types of alopecia are:

Androgenetic Alopecia: Also known as male or female pattern baldness, this is the most prevalent form of hair loss. It is primarily caused by genetic factors and hormonal changes, specifically the influence of dihydrotestosterone (DHT) on hair follicles.

Alopecia Areata: This autoimmune disorder leads to patchy hair loss on the scalp and other parts of the body. The immune system mistakenly attacks hair follicles, causing sudden and often unpredictable hair loss.

Telogen Effluvium: This condition results in temporary hair thinning and shedding due to a disruption in the hair growth cycle. It can be triggered by factors such as stress, illness, hormonal changes, or nutritional deficiencies.

Conclusion

Although most types of alopecia have a genetic component to it, it does not necessarily mean that they will be passed from one generation to the next as there are many factors involved in the development of an autoimmune, skin or scalp condition. 

If you are concerned about your hair loss, consult with an online dermatologist, or find a dermatologist in your area to get treatment. 

Lee el artículo en Español: Tipos de alopecia y su tratamiento.

Article References:
https://www.ncbi.nlm.nih.gov/books/NBK538178/
https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926
https://www.ncbi.nlm.nih.gov/books/NBK430924/
https://www.ncbi.nlm.nih.gov/books/NBK537000/
https://rarediseases.info.nih.gov/diseases/614/alopecia-universalis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8865268/
https://www.ncbi.nlm.nih.gov/books/NBK430848/
https://www.ncbi.nlm.nih.gov/books/NBK482293/
https://www.ncbi.nlm.nih.gov/books/NBK559187/
https://www.aad.org/public/diseases/hair-loss/types/frontal-fibrosing-alopecia
https://www.ncbi.nlm.nih.gov/books/NBK470434/
https://www.ncbi.nlm.nih.gov/books/NBK493186/