All About Alopecia
While the term “alopecia” may be trending, this medical term for hair loss is anything but new. Dr. Christine Shaver from the Bernstein Medical Center for Hair Restoration in New York City tells us the different types of alopecia, how to treat it and why some people are more susceptible to it.
What is alopecia?
“Alopecia” is the general medical term for any type of hair loss. The most common type of alopecia is called “androgenetic alopecia,” also known as genetic thinning. It occurs in both men and women as they age. However, there are many other causes of alopecia, so if someone is experiencing any type of hair thinning, this should prompt one to have a consultation with a board-certified dermatologist. Dermatologists specialize in diseases of the hair, skin, and nails, and can appropriately diagnose and treat the condition. Fortunately, most types of alopecia are treatable – especially if addressed early.
What kinds of alopecia are there?
Most people are familiar with genetic thinning through personal experience when seeing their own family member’s hair slowly thin as they age. This encompasses the bulk of patients coming to the doctor’s office, but there are many other types of hair loss that people do not readily know about, and these can have a variety of causes.
For instance, there is a type of autoimmune hair loss called ‘alopecia areata’ where the body’s own protective immune cells begin to attack the hair follicles. In the case of alopecia areata, the hair loss presents as localized patches of baldness that respond quite well to injections of cortisone. At times, the condition can be so extensive that it involves all the hair on one’s scalp, face, and body.
There are also scarring types of hair loss where the scalp becomes inflamed and slowly the hair follicles are attacked from this inflammation. This process can lead to scarring of the follicle and loss of the ability to grow hair. These other types of hair loss are less common, and therefore the general public does not often know of them.
Telogen effluvium, or stress-related hair loss, is a period of intense shedding in response to an underlying stressor (medication, weight change, hormonal imbalance, emotional stress). It is entirely self-resolving once the inciting stress has been removed, but it can take up to 1-2 years for hair volumes to return to normal.
What causes alopecia?
There are both primary and secondary causes of hair loss. A primary cause of hair loss is a disease where the primary problem exists at the follicle or scalp and leads to progressive thinning. This can be alopecia areata, androgenetic (genetic thinning), cicatricial (scarring) alopecia. A secondary type of hair loss would be when the disease exists elsewhere in the body, such as a thyroid disorder or a drug reaction, and the disease leads to thinning or shedding. There are many causes for secondary hair loss – such as systemic disease, medicines, and extreme stress. Correction of the primary condition (for example, correction of thyroid hormone abnormalities) will often lead to improvement or resolution of hair loss. In very general terms, primary hair loss presents in a pattern or is localized. Secondary hair loss tends to be more diffuse.
How common is alopecia?
Genetic hair loss is common, involving about 50% of middle-aged men and 25% of middle-aged females. These percentages, of course, increase with age. Alopecia areata, the auto-immune disease that has recently made headlines in the news, occurs in approximately 2% of the population.
How can alopecia be treated? Are there any ways to prevent it?
Each class of alopecia has a unique treatment. Androgenetic (genetic) thinning is often treated with a combination of medicine and/or surgery. Medicines, such as oral finasteride or topical minoxidil, are used to regrow hair that has been lost and to prevent further thinning and are particularly effective in the early stages of balding. If the patient has more extensive hair loss, surgical hair restoration can be considered. Autoimmune alopecia areata is often treated with topical and/or injectable steroids to calm the underlying autoimmune attack on the hair follicles. Inflammatory scarring (cicatricial) alopecia often requires oral antibiotics and topical steroids. Uncontrolled inflammation underneath the scalp can lead to the appearance of smooth scarred follicles that can no longer grow hair. In contrast, telogen effluvium, which is a period of intense shedding in response to an underlying stressor, will resolve without prescription treatments. Instead, the condition is reversible with resolution of the inciting stressor. Hair shedding will resolve with time, so the person should be encouraged to be patient.
It is important that after receiving treatment for your specific type of alopecia, that you continue to monitor the condition with the help of your dermatologist. Genetic hair loss (androgenetic alopecia) requires continual maintenance treatment as the process is ongoing. Other conditions, such as autoimmune or inflammatory alopecia, may become quiescent following treatment and should be monitored for recurrence of symptoms or the return of hair loss. If this occurs, it would be important to follow-up with your doctor for re-initiation of therapy. Minimizing recurrent stressors would be important to prevent further shedding events of telogen effluvium.
As a member of Bernstein Medical, Dr. Shaver combines years of education with compassion and an extraordinary aesthetic eye to empower her patients and offer natural results. Dr. Shaver performs hair transplants daily. In addition to surgery, she runs the Platelet Rich Plasma (PRP) and Scalp Micropigmentation (SMP) programs.