
The medical term for hair loss is alopecia. Although hair loss is caused by many different conditions such as chemotherapy, medications, and stress among others.
The main types of hair loss are summarized in this article.
Male pattern baldness also known as androgenic alopecia is the most common type of hair loss in men. It affects males beginning in their early 20′s or 30′s and slowly progresses.
Its typical onset is a thinner, shorter, and finer hair that then continues to create a receding hairline or horseshoe hairline (U shaped) pattern that forms around the sides of the head.
This type of hair loss is produced by the male sex hormone testosterone, and by our genes. The main hormone involved is dihidrotestosterone DHT which is a more potent form of testosterone. In susceptible individuals with a genetic predisposition to hair loss DHT acts on the hair follicles causing them to shrink with time.
This type of hair loss is diagnosed based on appearance, and does not require treatment if the patient is comfortable with his appearance. However many patients have a difficult time coping with this disorder and search endlessly for treatment options without success in most cases. Male pattern baldness does not indicate a medical disease, but may affect self esteem and be an important cause of anxiety and psychological stress in some patients.
Hair loss generally progresses with time and does not grow back if left untreated. There are many treatment options available for this type of hair loss, only few have been clinically proven to provide positive results.
Female pattern baldness and is produced by the same mechanism as male pattern baldness. The appearance and clinical presentation are different from male pattern baldness. Hair thins mainly on the top and crown of the scalp, the front hairline is conserved, and there is not a horseshoe hairline.
Alopecia Areata is another type of hair loss that is less common than male and female pattern baldness. It typically produces round patches of baldness that come and go and eventually can lead to total baldness. It can present itself in men, woman, and children. Its onset is usually during teenage years and early adulthood. Over 50 percent of people with alopecia areata have their first round patch before age 20. Its cause is unknown but our immune system (our bodies defense system) is believed to play a role in the development of this disease. It is possible that a major life event (such as accident, severe illness, trauma, personal loss, pregnancy) occurs before the first onset of symptoms but only in a small percentage of patients. The most common clinical presentation is a patchy hairloss that presents on the scalp which may produce an itching or burning sensation. Symptoms may also present on the beard, arms, or legs although this is less common. When diagnosed blood tests are often performed to rule out autoimmune diseases due to the association that exists between these conditions. As for treatment options it is important to know that if the hair loss is not widespread, hair growth will likely occur within months with or without treatment. Even with severe cases with widespread hairloss it is unclear as to if treatment will improve hair growth. Among the treatment options available are local use steroids, topical corticosteriods, topical immunetherapy, minoxidil, ultraviolet light, among other treatment options. As for the outcome (prognosis), most people have full recovery but among those with a poorer outcome are those who have an onset of symptoms at a young age, eczema, long term alopecia areata, and complete body alopecia areata.
There are 2 more severe forms of alopecia areata known as alopecia totalis (no scalp hair) and alopecia universalis.(no scalp and body hair).
Scarring Alopecia also known as cicatricial alopecia is due to complications from other conditions. This accounts for about 3 percent of hair loss patients. In this condition, the hair follicle is completely destroyed therefore hair growth is not possible. There are many conditions that produce scarring alopecia such as scleroderma, lichen planus, shingles, cellulitis, follicular degeneration syndrome, discoide lupus just to name a few. Treatment options for scarring alopecia are directed towards the underlining condition. Outcome varies depending on the underlining condition.
Telogen Effluvium is a form of non scarring alopecia characterized by diffuse hair shedding which often has a very acute onset. Hair is shed from the scalp and is often associated to the use of certain medications or stress. Patients typically complain that their hair is falling out at an increased rate. Hair is lost from the entire scalp but complete baldness is not seen. Patients fully recover without treatment once the responsible medication is suspended or stress is relieved.
Author: Dr. Julian Hakim MD