Alopecia

Alopecia is defined as loss of hair or baldness in areas where hair usually grows.

There are several types of alopecia. The most common are:

• Androgenetic alopecia – male pattern baldness

• Alopecia areata – most commonly when small patches of hair loss appear on the scalp

In the UK, alopecia areata affects an estimated 15 in 10,000 people, both men and women. It can occur at any age, though about half the cases occur in childhood. Around 80 percent of cases happen before the age of 40.

Androgenetic alopecia generally affects half of men before the age of 50.


What are the different types of alopecia?

Alopecia ranges greatly in severity and type. The main types of alopecia include:

• Male pattern baldness – androgenetic alopecia in men

• Female pattern baldness – androgenetic alopecia in women

• Alopecia areata – small patches of hair loss on the scalp and sometimes on other parts of the body

• More extensive forms of alopecia areata are alopecia totalis (complete loss of scalp hair) and alopecia universalis (total loss of all body hair)

• Telogen effluvium – hair loss usually triggered by a major stressful event or hormonal change

• Trichotillomania – a hair-pulling disorder that may be connected to obsessive-compulsive disorder

• Anagen effluvium – this sudden loss of most or all of the body hair is due to the interruption of the anagen (growing) phase and usually occurs when cancer chemotherapy, immunosuppression or radiotherapy causes hair loss

• Alopecia caused by skin conditions or illness  

• Traction alopecia – caused by tight hairstyles and grooming tools, such as curlers and straighteners


What are the causes of alopecia?

The cause of alopecia depends on the type of hair loss you’re experiencing.


Androgenetic alopecia

Androgenetic alopecia is often caused by a genetic predisposition.


Alopecia areata

The exact cause of alopecia areata is unknown. Some research suggests that autoimmune conditions may play a role in alopecia areata, as it's more common in people with thyroid conditions or diabetes. Stress or certain genes may also be factors in developing alopecia areata.

If you have alopecia areata, you may have a slightly greater than average chance of developing other autoimmune conditions, such as thyroid disorders, pernicious anaemia and vitiligo.


Telogen effluvium

Telogen effluvium is often caused by a major stressful event or hormonal change. In about a third of cases, no cause can be identified, but common causes include:

• Childbirth

• Iron deficiency

• Changes in medicine

• Thyroid problems

• Heavy metal poisoning (selenium, arsenic, thallium)

• Crash dieting

• Severe illness

• Major surgery and severe trauma

• Significant weight loss


Anagen effluvium

Anagen effluvium is caused by the anagen (growing) phase being interrupted, mostly due to cancer chemotherapy, immunosuppression, or radiotherapy. This causes sudden hair loss. Less commonly, anagen effluvium can also be caused by trauma, pressure or exposure to chemicals (such as arsenic, thallium, boron).


Trichotillomania

Trichotillomania is hair pulling generally thought to be caused by obsessive-compulsive disorder. It’s also usually associated with other mood disorders, such as anxiety and depression.


Other causes of hair loss

Other possible causes include:

• Scalp conditions such as infection or psoriasis

• Atopic dermatitis (also known as atopic eczema), which makes the skin red and itchy

• Trauma, such as traction alopecia from tight hairstyles or grooming tools

• Conditions that cause non-scarring alopecia such as secondary syphilis (a sexually transmitted infection)


What are the treatment options for alopecia?

Treating pattern baldness

For pattern baldness, there are a few treatment options. Bear in mind that they can be expensive and they don't work for everyone. Your GP can advise you on which might be most suitable for you.

There are two pharmacological treatments for pattern baldness: minoxidil and finasteride. Neither is available on the NHS. Minoxidil is a topical treatment which can be applied on the scalp and is available over the counter or by private prescription. Your pharmacist can advise you about this.

Finasteride is an oral prescription medicine only available by private prescription. It is used in the treatment of male pattern baldness in men aged 18 and over. Finasteride is not suitable for women.

You can access generic finasteride or the branded version Propecia online from the Boots Hair Loss Online Clinic, after completing an online consultation (subject to availability and clinician approval. Charges apply).


Treating alopecia areata

Alopecia areata requires different treatment options. Before considering treatment at private clinics that could be costly, it's advisable to see your GP first to understand the possible cause of hair loss.

Some doctors may advise you not to treat your alopecia at all. If the hair loss is not too drastic, there’s a chance it will grow back within a few months. Some options for treating alopecia areata include:

• Steroid injections given into bald patches (believed to be the most effective treatment for alopecia areata)

• Topical steroids (if growth occurs with topical steroids, it takes around 3-6 months)

• Topical immunotherapy (an option in which a substance that acts like an allergen is rubbed into the skin)

• If you decide not to have treatment, counselling or support groups may be helpful


Other hair loss treatments

Other treatment options for alopecia include:

• Using wigs or hairpieces 

• Tatooing (which can be used to create the appearance of eyebrows that have fallen out)

• Hair transplant

Counselling may also benefit people having difficulty coping with hair loss.

This isn't a complete list of treatment options. Some people choose to try complementary therapies like acupuncture. However, these haven't been proved to be effective.

It's worth noting that alopecia can’t necessarily be cured, but it can be treated using the options listed above.

If you or your child are experiencing alopecia, it’s important to visit a GP to discuss treatment options.


Next steps

• If you’re experiencing hair loss, visit your GP to find out the cause

• Once you’ve decided on a treatment, follow up with your GP or pharmacist every few months or so

• Remember, hair loss treatments don't work for everyone