Our grateful thanks to the charity Alopecia UK for their contribution to our radio report (which you can hear again via the audio player further down this page) and for the use of the information below click here to link through to the charity's website or more details, help and support.
Types of Alopecia - an introduction.
Androgenetic Alopecia (Pattern Hair Loss) - What is it. Hairs on the scalp grow in tufts, usually of 3-4 hairs. In Androgenetic Alopecia, the hair tufts gradually shrink, so the number of hairs in each tuft decrease (this is called ‘miniaturisation’). Eventually, when all the hairs in the tuft are gone, the skin of the scalp appears between the hairs. It is often referred to as 'Male Pattern Hair Loss' or 'Female Pattern Hair Loss' and it is the most common type of hair loss, affecting approximately 50% of men over the age of 50 and around 50% of women over the age of 65. It can also affect younger men and women.
What does it look like? It tends to look differently between males and females. In men, the typical pattern of hair loss is a receding hair line with loss of hair from the top and front of the head, often in a classic M-shaped pattern. In women, the usual pattern of hair loss is thinning at the crown of the head, with the frontal hairline over the forehead remaining. It is less likely that a woman will experience total baldness as a result.
Is it permanent? There are treatments which can help to delay the process, but hairs that have been lost will not grow back.
What causes Androgenetic Alopecia? It is caused by both genetic and hormonal factors, many of which are not yet understood. This form of hair loss is related to hormones called androgens, particularly an androgen called dihydrotestosterone (DHT). Increased levels of androgens such as DHT in hair follicles can lead to a shorter cycle of hair growth and the growth of shorter and thinner strands of hair. Follicles can also stay in the resting phase for longer periods of time.
Central Centrifugal Cicatricial Alopecia (CCCA) is a form of scarring alopecia, which starts in the centre of the scalp. It is most common in women of African descent, but it can also affect men and women of any ethnicity.
What does it look like? In CCCA hair tends to start falling out in the middle of the scalp. Hair loss then gradually spreads out from that point. Often, people notice hair being brittle and breaking more easily. Other symptoms include itching, pain or tenderness of the scalp, a spongy texture to the scalp, and flaking or redness of the affected areas.
Is CCCA permanent? Yes, but treatment can help to slow down or stop any more hair loss from occuring.
What causes it? The exact cause of CCCA is unknown, but it has often been linked to hair styling practices, which include: heat (hot combs/hair straighteners, hair dryers and curling irons); traction (tight braids/cornrows, weaves, tight ponytails or hair extensions that pull on the hair); and use of chemical relaxers (especially lye relaxers).
More recently, changes in a gene called PADI3 have been linked with development of the condition in about 25% of cases. Several studies have also reported an association of type 2 diabetes with hair loss, and potentially with CCCA.
Chemotherapy-Induced Alopecia. Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells they also attack other rapidly growing cells in your body, including those in your hair roots. Hair usually begins falling out two to four weeks after starting chemotherapy. The amount of hair loss depends on the type of chemotherapy drug administered - some chemotherapy drugs don’t cause any hair loss at all.
What does Chemotherapy-Induced Alopecia look like? The most common type of Chemotherapy-Induced Alopecia is loss of all of the scalp hair, - some people only lose patches of hair, or experience hair thinning. Hair can fall out gradually, or very quickly in clumps. Other symptoms can include a tender scalp. This form of hair loss usually continues throughout the treatment and often for a few weeks after.
Is it permanent? Most people’s hair will begin to grow back within a few weeks of stopping treatment. Some people have permanent hair loss following chemotherapy, usually after treatment with a drug called docetaxel, or after long term use of targeted cancer drugs called ‘epidermal growth factor receptor inhibitors’.
Frontal Fibrosing Alopecia (FFA) is a type of scarring hair loss that affects the frontal region of the scalp i.e. the forehead and sideburns. It is believed to be localised form of Lichen Planopilaris. It most often affects post-menopausal women, but it can also affect men and younger women. The incidence is increasing.
What does it look like? In Frontal Fibrosing Alopecia, hair loss and scarring make the hairline recede, across the forehead and sideburns of the scalp. The skin of the scalp that is affected often looks normal, but it can look pale or shiny and no hair follicles can be seen. In some cases, redness and scaling can be seen around hair follicles at the edges of the affected scalp. About 50% of people lose hair from their eyebrows and a few may lose hair from their eyelashes and/or other parts of the body. Some people also have skin-coloured bumps on their face, called papules, where the fine hairs on the skin are under attack. Frontal Fibrosing Alopecia often occurs without symptoms, but people can experience an itchy, painful or burning sensation in a band across the frontal hairline.
Is FFA permanent? Yes. In this condition, the hair follicles are destroyed and turned into scar tissue. Its a slowly progressive condition, which means that the areas of the scalp that are affected will gradually increase over time. In some people, the condition stops progressing and there have been some (rare) reports of regrowth.
Lichen Planopilaris is a form of scarring alopecia, that usually affects younger women, although it can affect most age ranges and more rarely, men. Primary scarring alopecias are conditions in which the immune system attacks the stem cells that keep the hair follicle alive. This destroys the hair follicle and replaces it with scar tissue. Although Lichen Planopilaris is rare, it is one of the most common causes of scarring hair loss of the scalp.
People with Lichen Planopilaris may also have Lichen Planus, a condition which affects the skin, mucosa and nails (click here for more information about Lichen Planus).
What does it look like? Lichen Planopilaris causes smooth, shiny patches of scalp hair loss. No hair follicle openings can be seen in the areas of hair loss. At the edges of these patches, there may be scaliness and redness around the base of each hair, which can make it feel rough. Hairs can be easily pulled out. Lichen Planopilaris often occurs in multiple areas of the scalp, which can join as the condition progresses. The most common areas for Lichen Planopilaris to occur are the sides, front and lower back of the scalp. More diffuse hair loss is uncommon.
Telogen Effluvium - What is it ? Most of the hairs on the body are actively growing (the anagen phase) and the others are resting (the telogen phase). A hair stays in the growing phase for two to four years, before moving into the resting phase. A hair rests between two and four months, and then falls out and is replaced by a new, growing hair. The average person loses about 100 hairs a day.
In a person with Telogen Effluvium more hairs move into the resting phase, so instead of shedding 100 hairs every day, you may lose up to 300 hairs a day instead, resulting in a thinness of hair volume.
What does Telogen Effluvium look like? In cases of Telogen Effluvium, hair falls out in a diffuse pattern, all over the scalp. Your hair may feel thinner and you may notice more hair shedding than usual. It can be scary to lose so many hairs so rapidly, but each hair that is goes into the resting phase is replaced by a new, growing hair, so all of the hair will not fall ou
Traction Alopecia is different from other types of hair loss in that it is caused by strain on the hair follicles, often from tight hairstyles. Continuous strain pulls out strands of hair and can damage or destroy the follicles. It can happen to anyone who wears their hair pulled back tightly, whether in braids, dreadlocks, or a ponytail. It can also occur when tight headwear (like a cycle helmet) is used in the same way every day, from using chemical relaxers or even hair extensions.
Trichotillomania is a condition that leads to an overwhelming urge to pull out hair. There are a number of different forms
Trichotillomania is more common in teenagers and young adults and tends to affect girls more often than boys.
Alopecia Areata is thought to be an autoimmune condition, which often starts with isolated patches of hair loss, commonly in one or more coin-sized (usually round or oval) patches on the scalp and/or across the body including the beard, eyebrows, eyelashes or body hair, including pubic hair.
In Alopecia Areata, cells from the immune system (a specific type of T cell, known as NKG2D+ T cells) gather around the hair follicles. These cells attack the follicle, stopping it from producing more hair. The exact way in which this happens is not yet understood. Alopecia areata can take several different forms:
Does the condition affect anything other than hair? Between 10–50% of people with alopecia areata also experience nail complications: the most common symptoms are pitting and ridging of the nails.
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