What is alopecia?
Alopecia is the medical term for hair loss. It can affect the scalp, eyebrows, eyelashes, and other areas of the body, leading to patchy, partial, or complete hair loss. Hair follicles, tiny tube-like structures in the skin, control the growth cycle of hair. When they’re damaged or stop functioning, hair loss occurs in different patterns depending on the type of alopecia.
Dermatologists diagnose and treat hair, skin, and nail conditions and may work with other specialists, such as dermatopathologists, to confirm an alopecia diagnosis. Penn Dermatology is ranked highly for its research and clinical trials, which help provide you with the latest treatments for hair loss and other skin conditions.
Types of alopecia
Alopecia is broadly classified as either nonscarring (hair can regrow) or scarring (hair loss is permanent). Nonscarring alopecia is the most common type. It doesn’t destroy the follicles, so hair loss may be temporary. Scarring alopecia happens when hair follicle damage is irreversible, so hair can’t grow back.
In alopecia areata, the immune system mistakenly attacks hair follicles, causing hair loss. There are different types, which vary by the amount and location of hair loss.
- Alopecia areata (patchy) causes one or more round or oval bald patches on the scalp or other places on the body that grow hair.
- Alopecia areata totalis causes complete hair loss on the scalp.
- Alopecia areata universalis causes total hair loss on the body, including eyebrows, eyelashes, chest, armpits, and pubic area.
- Diffuse alopecia areata causes widespread hair thinning across the scalp.
- Ophiasis alopecia areata causes hair loss in a snake-like pattern along the back of the head and around the ears.
Also known as male-pattern baldness and female-pattern baldness, androgenetic alopecia causes gradual hair loss on the scalp after puberty. For people assigned male at birth, hair thinning usually appears in a circular pattern on the top and front of the head. For people assigned female at birth, thinning occurs all over the scalp but maintains a normal hairline.
Traction alopecia happens when tight hairstyles pull on the hair too much. This includes tight braids, buns, ponytails, updos, cornrows, hair extensions, weaves, and sleeping in rollers. It can also be caused by constant rubbing from a hat, headscarf, or other head covering, especially if the hair is pulled back tightly underneath.
Telogen effluvium causes excessive hair shedding when many hair follicles enter the resting phase (telogen) at the same time. It’s usually triggered by stressors like surgery, major weight loss, hormonal changes, or severe illness. Hair typically regrows once the underlying cause is resolved.
Anagen effluvium, also called chemotherapy-induced alopecia, is rapid hair loss that happens when hair follicles are damaged during the growth phase. It’s often caused by chemotherapy, radiation, or toxins, but hair usually grows back once the cause is removed.
Also called cicatricial alopecia, some types of scarring alopecia include:
- Lichen planopilaris (LPP) causes inflammation and scarring of the hair follicles. It’s the most common type of scarring alopecia.
- Central centrifugal cicatricial alopecia (CCCA) starts at the crown and spreads outward. It’s the most common hair loss type in Black people assigned female at birth.
- Frontal fibrosing alopecia (FFA) causes hair loss on the front and sides of the scalp and may also affect the eyebrows, eyelashes, and other body parts.
Alopecia symptoms
Losing around 100 hairs a day is normal as part of the hair growth cycle. However, if more hair is falling out than growing back, or if you notice thinning patches on your scalp or elsewhere, it could be a sign of alopecia.
Other common symptoms include:
- Thinning eyebrows, eyelashes, or beard
- Hair loss with redness, itching, or burning
- Scalp tenderness or pain
- A receding hairline
- Changes in hair texture or color
- Fatigue or weakness
- Brittle or pitted nails
What causes hair loss?
Alopecia can be caused by several factors, including:
- Autoimmune disorders (lupus)
- Hormonal changes (pregnancy and menopause)
- Medications or treatments (chemotherapy, radiation)
- Nutritional deficiencies (vitamin D, zinc, iron, biotin, and folic acid)
- Stress or nervous habits (hair pulling or scalp rubbing)
- Genetics (increased risk if a close relative has alopecia)
- Hair styles that stress the follicles (tightly braided hair, ponytails)
- Bacterial scalp infections (folliculitis decalvans)
- Ringworm of the scalp (tinea capitis)
Getting a hair loss diagnosis
To diagnose alopecia, your provider will examine any affected areas for bald patches. They may gently pull a few hairs to check follicle strength. If the cause isn’t clear, a small scalp sample might be taken and examined under a microscope for signs of inflammation. Blood tests may be needed to rule out other disorders that cause hair loss.
- Complete blood count (CBC) test
- C-reactive protein (CRP) test
- Antinuclear antibody (ANA) test
- Scalp biopsy
Hair loss treatment options
Treatment for alopecia depends on the type of hair loss. For conditions like male pattern baldness, treatment is optional. Other conditions may need oral or topical scalp medications, an antifungal shampoo, low-light therapy, or scalp micropigmentation to stimulate hair follicles into an active growth phase. A surgical hair transplant is also an option. A surgical hair transplant is also an option. For chemotherapy-related alopecia, the Paxman Scalp Cooling System may provide relief.
World-class experts for hair and scalp disorders
Penn Dermatology is nationally and internationally recognized for its expert specialists, the latest technology, and advanced diagnostic and treatment options. It’s one of the few dermatology departments in the country that specializes in treating hair and scalp disorders.
Our specialists use the most advanced methods for diagnosing alopecia from scalp biopsies, including the HoVert method. Developed by Penn Medicine dermatopathologists, this advanced biopsy technique provides more information than conventional biopsies to pinpoint the specific type of alopecia. Few pathology labs offer this service, which can help you find the best treatment more quickly.