Forms of Alopecia: Diagnosis & available treatments

Hair loss is a reality affecting millions of people worldwide. While often associated with aging or genetic predisposition, hair loss can result from various causes. Alopecia is the medical term for hair loss and is categorized into different forms, each with its own characteristics and causes.

What is alopecia?

The term “alopecia” refers to hair loss on any part of the body, with loss from the scalp being the most common. This loss can be temporary or permanent, widespread or localized to specific areas. The reasons can be genetic, autoimmune, hormonal, or environmental. Alopecia is not just a cosmetic issue; it can affect an individual’s self-esteem and psychological well-being. Correctly identifying its type and cause is crucial for selecting the appropriate treatment.

What are the main types of alopecia?

There are many forms of alopecia, differing in cause, appearance, duration, and potential for hair regrowth. Below are the five most common and clinically significant forms:

Androgenetic Alopecia (Male/Female Pattern Hair Loss)

• The most prevalent form of alopecia, affecting up to 70% of men and 40% of women at some point in their lives.
• In men, it begins with a receding hairline and gradual thinning at the crown (vertex), which can progress to complete baldness.
• In women, diffuse thinning primarily on the top of the head is observed, without a receding hairline, often leading to diagnostic confusion.
• The main cause is the sensitivity of hair follicles to dihydrotestosterone (DHT), which weakens them and leads to premature telogen phase. The condition is chronic and progressive.

Alopecia Areata

• An autoimmune disorder where the immune system mistakenly identifies hair follicles as “foreign” and attacks them.
• Symptoms appear suddenly, with hair loss in small, round, smooth patches on the scalp. In more severe forms (Alopecia totalis or universalis), all hair on the head or body, respectively, may be lost.
• The course is unpredictable; in some, hair regrows, while in others, relapses recur.
• Can co-exist with other autoimmune diseases such as Hashimoto’s thyroiditis, vitiligo, or rheumatoid arthritis.

Telogen Effluvium

Characterized by diffuse hair loss across the entire scalp, not localized to specific areas. It usually appears 2-3 months after intense physical or psychological stress, such as:

• Surgery.
• Childbirth.
• Sudden weight loss or nutritional deficiency.
• Hormonal changes.
• COVID-19 or other infections.

Hairs massively enter the resting phase (telogen phase), resulting in more hair shedding than normal.

Fortunately, it’s a reversible condition if the underlying cause is identified and addressed.

Cicatricial Alopecia (Scarring Alopecia)

In this form, hair loss is accompanied by destruction of the follicles and formation of scar tissue on the scalp. The result is permanent hair loss.

Often accompanied by inflammatory symptoms such as:

• Redness
• Pain or burning
• Scaling and exudation

Causes can include autoimmune diseases like lichen planus, bacterial or fungal infections, or chemical burns.

Immediate diagnosis and treatment are crucial to limit the spread of damage.

Trichotillomania

A psychiatric disorder belonging to impulse control disorders. The individual compulsively pulls their hair, often unconsciously, leading to irregularly shaped patches of alopecia.

Often observed in children, adolescents, or individuals with anxiety disorders.

Treatment includes cognitive-behavioral psychotherapy (CBT) and, in some cases, medication.

How is alopecia diagnosed?

The diagnosis of alopecia is crucial for successful hair loss treatment and must always be made by a specialist, such as a dermatologist or a specialized trichologist. Each form of alopecia has a different cause, mechanism, and therapeutic approach, so correct differential diagnosis is essential.

The evaluation involves a comprehensive and multifactorial process:

Detailed Medical History

The specialist gathers information about the onset and progression of hair loss, family predisposition, and factors such as intense stress, nutritional deficiencies, hormonal disorders, or medication use (e.g., antidepressants, contraceptives).

Clinical Examination of the Scalp and Follicles

The density, hair quality, areas of thinning, and possible accompanying manifestations such as redness, inflammation, scaling, or scarring are examined.

Dermatoscopy

Using a special device (dermatoscope), the doctor accurately assesses the morphology of the follicles, the presence of inflammation, the hair growth phases, and possible indications for alopecia areata, cicatricial, or other forms of alopecia.

Pull Test or Trichogram

The pull test is performed by gently pulling a bundle of hairs to assess the activity of hair loss. The trichogram is more specialized: microscopic analysis of hair roots is performed to show how many are in the anagen, catagen, or telogen phase, a crucial element for diagnosing telogen effluvium or other hair cycle disorders.

Blood and Hormonal Tests

Tests are requested for:

• Iron and ferritin (low levels are associated with thinning).
• Thyroid function (TSH, FT4, FT3).
• Vitamins D, B12, folic acid.
• Hormonal profile (testosterone, DHEA-S, prolactin, LH/FSH), especially in women with signs of androgenetic alopecia.

In rare cases, when there is suspicion of a cicatricial form or autoimmune etiology, a scalp biopsy may be needed for histological analysis.

Early and comprehensive diagnosis is the foundation for selecting the correct treatment and preventing permanent hair loss.

What are the available treatments?

Treatments vary depending on the type of alopecia, severity, and duration of symptoms. They may include:

Topical Treatments

• Minoxidil (solution or foam): FDA-approved for androgenetic alopecia. Applied topically, it enhances blood flow to the follicles.
• Topical corticosteroids for alopecia areata.

Oral Medications

• Finasteride (men only): Inhibits the conversion of testosterone to DHT.
• Nutritional supplements (iron, biotin, vitamin D) in cases of deficiency.

PRP (Platelet-Rich Plasma)

Treatment involving injecting plasma from the patient’s own blood into the scalp to rejuvenate follicles.

Hair Transplantation

Ideal for androgenetic or cicatricial alopecia when hair loss is permanent. The modern FUE technique offers natural results.

Psychological Support

Essential in cases of trichotillomania or when hair loss has a strong psychological impact.

Modification of Daily Habits

• Avoiding tight hairstyles.
• Using mild hair care products.
• Stress reduction through techniques like yoga or meditation.

Conclusion

Alopecia is a complex condition with multiple causes and forms. Correct diagnosis is fundamental for the success of any treatment. Fortunately, medical advancements have provided solutions, both pharmaceutical and surgical, that can restore hair density and patient confidence.

If you notice thinning or sudden hair loss, do not hesitate to consult a specialist. Early intervention increases the chances of success. Caring for your hair begins with knowledge and prevention, and science is now more ready than ever to offer solutions.