The primary symptom of alopecia is the loss of hair, especially from the scalp. You may have accompanying symptoms with the hair loss that are caused by a coexisting condition, such as psoriasis, folliculitis decalvans (inflammation of the hair follicles), or fungal infection. Common symptoms of alopecia include:

• Thinning of hair on top of the head
• Bald spots that appear circular or occur in patches
• Burning or stinging sensation before sudden hair loss
• Redness, swelling, and open sores
• Scaly patches of skin on the scalp

Androgenic alopecia. This type of hair loss is a genetic condition that occurs in both men and women, but it manifests differently depending on the sex.

• Male pattern baldness – Male pattern baldness starts with a receding hairline in the front of the head just above the forehead. The hair ceases growth and forms a “U” around the sides and the crown of the head can become completely bald.Female pattern baldness.
• Female pattern baldness – Characterized by thinning all over the head. The hair thins out on the top of the head at the crown and the front of the hairline does not recede. Unlike men, women usually do not completely lose their hair. Nonetheless, the thinning of hair can be severe.

Alopecia areata. This type of hair loss is caused by an auto-immune skin disease. Hair loss occurs on the scalp, face, and can affect the entire body. There are three forms of alopecia areata: patchy, totalis, and universalis. The patchy form or alopecia areata is the most common where the hair tends to fall out in quarter-size round patches on the head. In more severe cases, hair loss can be complete from the scalp (alopecia totalis) and the body (alopecia universalis), can occur.Scarring alopecia.

Scarring alopecia (cicatricial alopecia). starts with hair falling out in small patches. There are rough edges where the hair is lost. Cicatricial alopecia is accompanied by other symptoms such as pain, burning, and itching. Some people experience fluid-filled blisters at the site of hair loss.

Telogen effluvium. This type of hair loss is a temporary condition brought on by extreme stress. Hair becomes noticeably thin all over the scalp. Pieces that do fall out have a small keratin bulb on the end of the hair. The hairline does not recede, and the head never goes completely bald.

Anagen effluvium. Anagen effluvium is the loss of new hair growth in a short amount of time. This type is mostly due to chemotherapy, but other conditions can cause it. The hair falls out very rapidly and balding occurs. In these cases, hair usually does grow back.

The causes of alopecia also depend on the type:

Androgenic alopecia. This is a genetic disorder usually caused by imbalanced hormone levels. There is some question as to whether androgenic alopecia has a different cause for females than it does for males.

Alopecia areata. Caused by an autoimmune disease where the immune system attacks the hair follicles.

Cicatricial or scarring alopecia. Scarring alopecia is caused by inflammation at the site of the hair follicle caused by infection or autoimmune disease (e.g., lupus). This inflammation causes the hair follicle to die off, leaving scar tissue and permanent hair loss.

Telogen effluvium. Caused by many different things that put stress on the body including acute illness with fever, surgery, weight loss, anemia, thyroid disease, hormonal changes, and physical trauma. Hair loss is usually reversed after recovery.

Anagen effluvium. Caused by exposure to toxic chemicals, chemotherapy treatments, poisoning, or disease flares. Hair loss occurs within days to weeks of chemotherapy treatments.

Alopecia is diagnosed with a thorough examination and medical history. If the cause is due to inflammation, the doctor may take a scalp scraping to determine the cause. Usually, alopecia can be diagnosed by simply looking at the pattern of hair loss. Common tests your physician will ask for include:

Blood test. Some blood tests used to test for alopecia are hormone level (i.e., testosterone, FSH, LH), serum iron level, thyroid-stimulating hormone level, and complete blood count (CBC) diagnostic tests.

Light microscopy. Uncovers disorders of the hair shift by using a light microscope to examine trimmed hairs.

Pull test. In this simple test, your physician will gently pull a small section of your to determine if they come out easily. This test stages shedding processes.x

Scalp biopsy. Samples of your scalp will be scraped from the skin or a few hairs removed at the roots to examine scalp tissue under a microscope. This biopsy determines if an infection is present.

Common topical and restorative treatments include:

Rogaine (minoxidil). A topical medication that is applied to the scalp. It can be purchased over the counter. It does more to prevent future hair loss and helps a little with hair regrowth.

Propecia (finasteride). An oral prescription drug for male pattern baldness. Taken once daily, it may help to regrow hair and helps existing hair to stay in the scalp. This drug should not be used by pregnant women due to the risk of birth defects. It is currently only FDA approved for men.

Latisse (bimatoprost). A topical prostaglandin that is approved for hair loss anywhere on the body other than the scalp. It is typically used for eyelash loss.

Fibers. Hair fibers come in powder form and can be sprinkled onto areas of hair loss to cover bald spots. They are available over the counter and are only intended for short-term use.

Transplant. Hairs are taken from one part of the head and transplanted into another. These procedures can be costly (from $1,000 to $20,000) depending on how much hair needs to be restored.

There are a few all-natural home remedies that you can try at home for hair loss. While not a cure, they can help the body get what it needs to thicken hair and stimulate follicles. These include:

Biotin. A type of B vitamin that is known to nourish the hair.

Zinc and copper. May help with autoimmune hair loss.Saw palmetto. May increase hair growth.

Vitamin E. Helps prevent hair from breaking.

Rosemary oil. Rubbed on the scalp may increase circulation to the scalp area.

Hair loss due to genetic causes cannot be prevented but can be slowed if treated early on. Any other causes may be reversible with treatment of the underlying cause such as hormones (thyroid), autoimmune disease (lupus), and medications. For male pattern baldness, Rogaine is successful if it is used in the first five years of the balding phase.

There are several clinical trials available for those patients who have alopecia areata. Secukinumab is an immunosuppressant drug used to treat psoriasis that is now in a trial to be a possible treatment for this form of hair loss. Other clinical trials involve hair implant devices and novel drugs to treat this hair loss autoimmune disease.

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Norwood, O. T. (2007, July 16). Incidence of female androgenetic alopecia (female pattern alopecia). Dermatologic Surgery, 27(1). Retrieved from Wiley Online Library: https://doi.org/10.1111/j.1524-4725.2001.00124.x

Ralph, M., Trueb, M. D. (2009). Chemotherapy-induced alopecia. Seminars in Cutaneous Medicine and Surgery. https://doi:10.1016/j.sder.2008.12.001

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