Our easy-to-read fact sheets provide clinicians with reliable information to share with patients and their caregivers.
Alopecia Overview
Alopecia is a medical term that characterizes conditions that lead to temporary or permanent hair loss on the body where hair typically grows. Hair loss characteristics vary widely between the types of alopecia, with differences including the area of impact, onset that may be gradual to sudden, extent of hair loss ranging from localized patches to diffuse overall loss, and involvement of scarring. Moreover, the conditions affect patients of any age and sex.1,2
The cause of alopecia is multifactorial, including risk factors such as genetics, aging, medications (eg, certain chemotherapy agents), environmental exposures (eg, radiation), smoking, other medical conditions (eg, thyroid diseases), and hormonal changes (eg, changes in androgens).1,2 In addition to the visible clinical effects, alopecia often takes an emotional toll on patients, which can ultimately lead to a patient’s lower quality of life and the need for other support resources. Some types of alopecia include androgenetic alopecia, alopecia areata, telogen effluvium, traction alopecia, and trichotillomania.1
Androgenetic Alopecia
Androgenetic alopecia is a genetic condition that causes nonscarring, progressive loss of hair on the scalp after puberty. This is due to an excessive reaction from the body to a group of hormones called androgens. In men, the hair loss is most prominent at the crown of the scalp, hairline, temples, and forehead. In women, hair thinning at the top of the scalp forms a wider center part. Moreover, White patients are most likely to be affected by this type of alopecia, with Asian patients and Black patients the next likely groups to be affected. Treatment can include the use of topical minoxidil or finasteride. Both of these require 4 to 6 months of consistent use before seeing results.3
Alopecia Areata
Alopecia areata is another type of nonscarring alopecia that causes localized hair loss on the scalp or body. Alopecia areata presents as defined patches of smooth hair loss in which the now-exposed skin is normal in color and texture without scarring and without clinical inflammatory symptoms. Nail changes are also commonly seen with the condition, such as superficial pits distributed along the nail or rough, brittle nail texture. Both men and women are equally likely to have the condition, with an overall prevalence of 0.1% to 0.2% within the general population. Age of onset is typically before 30 years. Alopecia areata affects Asian patients most frequently and White patients least frequently. Treatment includes the use of corticosteroids as the main therapy option due to their anti-inflammatory activities, but other options include minoxidil, immunotherapy agents, and phototherapy.4,5
Telogen Effluvium
Telogen effluvium is another type of nonscarring alopecia in which patients face acute or chronic diffuse hair loss of the scalp. The hair shedding is not usually accompanied by other symptoms and has an abrupt onset that is typically triggered by metabolic stress, hormonal changes, or medication. Complete scalp hair loss does not occur. In this condition, the hairs in the growing phase suddenly enter the resting phase and then fall out once the growing phase begins again. While the exact prevalence is unknown, telogen effluvium affects both men and women of any age and racial/ethnic background. Women tend to be more susceptible to this type of alopecia due to hormone changes postpartum. Telogen effluvium is self-limiting, therefore there is no need for further treatment once the causative agent (eg, hormone imbalance, vitamin deficiency, etc) has been determined and addressed.6
Traction Alopecia
Traction alopecia is a preventable type of alopecia that results from the hair root sustaining constant tension and force. Acute traction alopecia is often nonscarring, while chronic disease is scarring. The condition does not come from the type of hair but rather the hair care practices involved, such as the use of frequent ponytails, hair twisting, and tight braids. It occurs most commonly at the temples and around the ears, but the area of hair loss depends on where the force is exerted. For example, in patients with corn rows, traction alopecia is seen on the scalp in areas that follow the pattern of the corn rows, which include the sides of the head, areas in front of the ears, and areas next to the ears. Traction alopecia is commonly seen in Black women and typically begins in childhood. Treatment includes education regarding hairstyles that can help decrease tension on the hair follicles, corticosteroids in early stages if inflammation is seen, and surgical options to replace hair in chronic stages.7
Trichotillomania
Trichotillomania is a condition in which patients feel compelled to pull hair from any area of the body which ultimately appears like hair loss. It falls under the spectrum of obsessive-compulsive disorders and anxiety disorders. Most often, patients pull hair follicles from the scalp, though hair can be missing from any area of the body. Many patients experience stressors or feelings of boredom that prompt them to pull the hair from their bodies. On inspection, the patient’s hair is often found in different stages of the hair cycle and to have various lengths. While the condition frequently goes underreported, more women are diagnosed with the condition than men. Conversely, more boys are diagnosed than girls in adolescence. Treatment includes therapy approaches (eg, cognitive behavioral therapy and habit reversal training) and psychiatric medications (eg, selective serotonin reuptake inhibitors) to manage the hair pulling behavior.8
Central Centrifugal Cicatricial Alopecia
Central centrifugal cicatricial alopecia is a type of scarring alopecia which starts with patchy, permanent hair loss on the crown of the scalp before the patches of hair loss spread outward in a centrifugal pattern to affect the entire scalp. It is associated with symptoms of inflammation, such as tenderness. The condition has a strong genetic component though further research is needed on its etiology. It commonly manifests in middle-aged Black women and is infrequently seen in men and children. Treatment is limited but includes the use of anti-inflammatory agents such as triamcinolone acetonide and corticosteroids.9
Frequently Asked Questions
Can stress cause alopecia?
Yes, emotional or physical stress can be contributing factors for several types of hair loss. The reasons are not fully understood, but studies showcase the link between stress and hair loss.1
Are there any dietary changes that can help with hair loss due to alopecia?
Maintaining a balanced diet with fruits and vegetables may help decrease hair loss and promote hair growth as a balanced diet provides patients with the nutrients and vitamins needed for hair development. The Mediterranean diet as well as diets with sufficient protein and soy intake have shown beneficial effects for hair loss.10
What are some hair care practices that I can incorporate? What are some practices I should avoid?
Some hair practices to incorporate include using mild shampoos and conditioners, using soft strokes when washing, and detangling hair with gentle maneuvers and brushes/combs. Some hair practices to avoid include wearing tight hairstyles, harsh chemical treatments (eg, perms and dyes), and heat products.7,11
What should I expect from my dermatologist regarding hair loss?
Dermatologists can identify the cause or type of alopecia using several tools including observation, dermatoscopy, biopsy, or blood testing. Once the cause of a patient’s hair loss has been identified, dermatologists will determine if treatment is a viable option to slow hair loss or regrow hair. Dermatologist-based treatments include topical prescription medications, corticosteroid injections, and laser therapy, among others. Dermatologists will help to tailor individualized treatment as treatment is not one size fits all.11
Who can I talk to to help with the emotional toll alopecia takes?
There are local support groups and national organizations, such as the National Alopecia Areata Foundation, that have resources to help patients with alopecia. Moreover, some patients benefit from talking to a therapist or confiding in loved ones.12
Download this fact sheet as a PDF
