Alopecia

26 Jun 2020 | Skedoc

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What Is Alopecia?

Alopecia is the loss of hair on the head or the body, while the term balding is specific to the loss of hair on the head. Alopecia can present in different forms and is seen in both men and women. It may be a normal part of aging and heredity in some, while in others it may have other underlying causes.

Alternate names

  • Baldness, Hair loss

Is this condition a medical emergency?

Alopecia is not a medical emergency.

Types of this condition

The following are the different types of alopecia:

  • Androgenic alopecia or male pattern baldness: This is the most common type, seen in both men and women. The loss or thinning is either at the back of the head or the temples, leaving behind a U shaped area of hair growth.
  • Alopecia areata: It is patchy baldness that is caused by the hair follicles being targeted by the immune system.
  • Alopecia Universalis: It is the most advanced form of alopecia, where there is the complete loss of hair all over the body, including the nostril hairs, and eyelashes.
  • Alopecia totalis: It is an immune-mediated complete hair loss that is limited to the scalp or head. It may start as patchy hair loss and progress to complete hair loss, or it may result in complete hair loss in a very short time.
  • Traction alopecia: It is a hair loss that results from tension being applied to the hair follicles such as tying hair in tight braids, or due to cosmetic surgery such as facelifts. It is usually seen in the region around the temples.
  • Chignon alopecia: Is another form of traction alopecia that is usually seen at the top of the head, and is secondary to the hair being tied in a tight bundle. Usually seen in ballet dancers.
  • Alopecia mucosa: Is a hair loss that occurs due to the deposit of mucinous material in the hair follicles and the oil-producing sebaceous glands, triggering an immune reaction
  • Cicatricial alopecia or Scarring alopecia: It is a hair loss that is accompanied by scarring.
  • Telogen and Anagen Effluvium: Is the increased shedding of the hair follicles either in the normal shedding (telogen) or the normal growth (anagen) phase of the hair life cycle.
  • Congenital triangular alopecia is a triangular or oval-shaped hair loss near the temple area that is seen in young children.
  • Hypotrichosis: Is the absence of hair growth. This is different from the oft-seen alopecia in that in alopecia there is the hair which is lost, in hypotrichosis, there is no hair at all.

Causes of alopecia

The normal hair loss per day is usually around 75-100 follicles. When this shedding of hair follicles is markedly increased, and subsequently not replaced by new hair follicles, thinning of the hair and baldness ensue. Some of the causes of alopecia include:

  • Family history: Heredity and genetics play an important role in the development of baldness, both in men and women.
  • Emotional stress
  • Systemic Diseases: Diabetes, lupus erythematosus, biotinidase deficiency.
  • Infections-
    • Ringworm infection of the scalp,
    • Cellulitis
    • Folliculitis
    • Secondary syphilis
    • Hair mite: Demodex folliculorum
  • Hormonal changes
  • Medications and supplements: Especially those used in the management of cancer, arthritis, gout, heart disease, psychiatric illnesses, corticosteroids, and birth control pills.
  • Psychiatric disorders: Such as trichotillomania (hair-pulling disorder).
  • Radiotherapy: To the head.
  • Certain hair treatments, cosmetics, and hairstyles.
  • Pregnancy: Only thinning of hair occurs in the post-delivery period.

Risk factors for alopecia

The following are the risk factors for alopecia are:

  • Emotional stress and trauma
  • Age
  • Excessive weight loss
  • Family history
  • Medications and medical conditions such as diabetes, lupus, etc.
  • Smoking

Symptoms & signs of alopecia

The symptoms and signs of alopecia may include:

  • Gradual thinning of hair followed by the complete absence of hair.
  • Loss of hair in patches.
  • Loss of hair followed by scarring.

Investigations

The following tests and investigations may be done through:

  • Laboratory tests: Routine lab tests may be done to evaluate the presence of systemic diseases that may contribute to hair loss.
  • Pull tests and pluck tests: Are done to evaluate the hair follicle and the stage of the life cycle of the hair follicles at which the hair loss is happening.
  • Scalp skin biopsy: To look for infections or inflammation on the scalp.
  • Trichoscopy: Done using a handheld dermoscopy or a video dermoscopy.

Diagnosis of alopecia

The diagnosis of alopecia is done based on medical history, clinical evaluation, and the results of the investigations if any.

Alopecia treatment options

The treatment of alopecia aims to treat the underlying cause if any, reduce the hair fall, and restore hair growth in conditions with reversible hair loss.

A. Medical management

The medical management of hair loss includes the use of the following:

  • Minoxidil: It causes dilation of the blood vessels and subsequent increase in hair growth. Its effects are seen over 6 - 8 months and the application needs to be continued to retain the benefits.
  • Anti-androgens: Such as finasteride act by reducing the levels of testosterone, and increase in hair growth. It is effective in male pattern baldness. The benefits of hair growth remain as long as the medicine is being administered. May not be effective in men older than 60 years.
  • Corticosteroids and Immunosuppressants: May be effective in alopecia areata.
  • Oral contraceptive pills, Spironolactone, flutamide: have an anti-androgenic effect, may be effective in some women.

B. Interventional including surgery and indications for surgery

Interventional management of alopecia includes:

  • Hair transplant surgery is done when the hair loss is significant, or if the individual desires it for cosmetic purposes. It may use one of the following methods of hair follicle harvesting.
    • Strip harvesting or Follicular Unit Transplanting (FUT)
    • Follicle Unit Extraction (FUE): gives a more natural appearance, less surgical scars, no suture removal, and recovery is faster in less than a week.
  • Robotic Hair transplant surgery: Done using robotic arms and cameras, for more precise harvesting and transplant.
  • Laser therapy: May be done using low-intensity laser equipment and may provide an increase in the density of hair in some men and women with hereditary baldness.

C. Role of diet/exercise/lifestyle changes/preventive measures

Alopecia that is caused due to hereditary, immune, or genetic causes cannot be prevented. Some measures that can be taken to prevent hair loss due to other causes may include:

  • Cessation of smoking
  • Avoiding the use of harsh chemicals for washing, treating, or styling hair
  • Avoiding excessive treating or styling of hair
  • Avoid hairstyles that put excess tension on the hair strands and scalp
  • Maintaining good scalp hygiene to avoid infections of the scalp
  • Avoiding playing, pulling, twisting, or toying with the hair
  • Avoiding medications and supplements that can cause hair loss
  • Avoiding excessive exposure to sunlight or ultraviolet light
  • Using a cooling cap if undergoing chemotherapy

Complications of alopecia

Some individuals may develop excessive psychological stress and anxiety due to hair loss.

Prognosis

The prognosis for alopecia depends on the type of alopecia and the underlying cause. While some conditions can be reversed, most cannot and would require intervention.

When to contact the doctor or hospital/How to identify the emergency or complications?

It is advisable to seek medical advice if the hair loss is sudden and patchy, as it may require an investigation to identify an underlying condition. Seeking medical help at an early stage may help to provide better long term options for alopecia in general.

Indications for hospitalization if required

Hospitalization is not required for hair loss.

Suggested clinical specialist/Departments to consult for this condition

Hair loss will be attended to by a specialist from the Department of Dermatology.

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