What is alopecia areata?
Hair loss in individuals with this condition results from the immune system attacking the hair follicles, causing the hair to fall out. Anyone can be affected, with most cases occurring in the teenage years. Although this condition causes the hair to fall out, it rarely damages the hair follicle, and because of this, the hair can often regrow. However, the more severe or widespread the hair loss, the less likely it is for the hair to regrow.
Alopecia areata is hair loss that occurs in patches and can affect any hair-bearing skin but most commonly affects the scalp. Two severe variants of alopecia areata are alopecia totalis and alopecia universalis. Alopecia totalis is where the individual loses all the hair on the scalp and is completely bald. Alopecia universalis is a rare condition where the individual loses all body hair.
There is no cure for alopecia areata. The medical treatments for alopecia areata aim to control the body’s immune response using steroids (injected for focal lesions, topical or oral steroids for more diffuse or widespread hair loss) or immunosuppressant drugs. Often the hair can regrow on its own, especially if the case is mild and localized. However, if the hair doesn’t regrow on its own, minoxidil may sometimes help with regrowth.
What is cicatricial (scarring) alopecia?
Scarring alopecias are rare conditions that cause permanent hair loss due to inflammation or an autoimmune disorder that permanently destroys the hair follicles. Hair transplants may be considered for a select few patients without evidence of active disease.
Lichen planopilaris is also known as follicular lichen planus. It is characterized by progressive, permanent hair loss, mainly affecting the scalp. Although rare, it is one of the more common causes of scarring alopecia. It primarily affects women of all ages but can also affect men. It is usually slowly progressive and is rarely diffuse. The cause of this disorder is unknown. Symptoms can include pain, itching, burning, and tenderness of the scalp.
Patient response to treatment is variable. Treatments include steroids, immune modulators, and topical minoxidil. Even with currently available treatment, hair loss continues but can be slowed.
Central centrifugal cicatricial alopecia (CCCA)
Central centrifugal cicatricial alopecia starts as a bald patch at the crown of the head and spreads outwards as the process progresses. It is more common in women of African descent but can affect men and individuals of all races.
The hair loss may be accompanied by symptoms such as itching, pain, and burning sensation in the area of hair loss.
This type of hair loss is an inflammatory process that causes the destruction of the hair follicles and is followed by scarring of the scalp. Treatment involves the use of prescription medications that reduce inflammation.
The cause of CCCA is currently unknown, and a scalp biopsy may be necessary to diagnose the condition.
Frontal fibrosing alopecia (FFA)?
FFA is usually a slowly progressive and self-limited disorder. Frontal fibrosing alopecia starts as a receding band at the frontal hairline and sides and can continue to progress to mid-scalp or further back. And because of this, it may look like and be mistakenly diagnosed as a receding hairline caused by androgenic alopecia.
It most commonly affects women, but men may also be affected. It tends to occur slowly, affecting women usually after menopause, but it can occur before menopause. The eyebrows are also involved in more than 80% of individuals with frontal fibrosing alopecia.
The cause of FFA is unknown. Symptoms may also include scalp discomfort and a rash at the affected area preceding the hair loss.
Treatment can prevent hair loss from progressing. Treatments can include steroids, anti-inflammatory antibiotics, and immune modulators. FFA can be stopped if it is diagnosed and treated early.
What is Telogen Effluvium?
It is normal to shed between 100 to 150 hairs each day. However, individuals may experience excessive shedding resulting in significant hair thinning due to a triggering event.
Environmental or physiologic stress shocks the hair into the telogen or resting phase, followed by the shedding of significantly more than usual hair shafts resulting in hair thinning.
About 15% of hairs are in the telogen or resting phase at any given time. However, a triggering event can cause more hair follicles to shift from the anagen or growing phase into telogen. When this occurs, the hair stops actively growing and sheds.
Telogen effluvium is the medical term for the excessive shedding of hair and has several triggers:
- Significant sudden weight loss as in crash dieting
- Medical illness (such as anemia, hypothyroidism)
- Recent surgery
- Hormonal changes such as during pregnancy and birth
- Testosterone replacement therapy
- Nutritional deficiency, including iron, B complex, and zinc
- Emotional stress
- Certain medications (including antidepressants, blood pressure medication, blood thinners, and seizure medications)
No matter the cause, this condition is temporary, and normal hair density and volume will return after the inciting trigger has resolved.