Alopecia is the medical term that describes a loss of hair and sometimes baldness. Sometimes, hair loss is a side effect of the cancer treatment medicines that are used in chemotherapy. In these cases, hair loss is usually temporary. However, any type of hair loss can reduce confidence and self-esteem.
Types of hair loss
The main types of hair loss are summarised below.
Male-pattern baldness is the commonest type of hair loss. As well as affecting men, it can sometimes affect women (female-pattern baldness). It can be particularly difficult for both men and women to cope with. Male- and female-pattern baldness follows a pattern of a receding hairline, followed by thinning of the hair on the crown and temples.
Male- and female-pattern baldness is also called androgenic alopecia. ‘Androgenic’ means linked to male hormones. This type of hair loss is linked to the hormone dihydrotestosterone (DHT), which is made from the male hormone testosterone. See Hair loss – causes for more information.
Alopecia areata is another type of hair loss, involving patches of baldness that may come and go. It can occur at any age, but mostly affects teenagers and young adults. Six of 10 people who are affected develop their first bald patch before they are 20 years old. Alopecia areata is thought to be caused by a problem with the immune system (the body’s natural defence against infection and illness). There is no proven effective treatment. In most cases the hair grows back after about a year. Some people with alopecia areata go on to develop a more severe form of hair loss, such as:
- alopecia totalis (no scalp hair)
- alopecia universalis (no hair on the scalp and body)
Scarring alopecia is hair loss that occurs as a result of complications from another condition. In this type of alopecia, the hair follicle (the small hole in your skin that an individual hair grows out of) is completely destroyed. This means that your hair will not grow back. Conditions that can cause scarring alopecia include:
- Scleroderma – a condition that affects the body’s connective (supporting) tissues, resulting in hard, puffy and itchy skin
- Lichen planus – a non-infectious, itchy rash that can affect many areas of the body
- Shingles – an infection of a nerve and the area of skin around it, caused by the herpes varicella-zoster virus, which is also responsible for causing chickenpox
Rarer conditions that can cause scarring alopecia include:
- Folliculitis decalvans – a rare form of alopecia that most commonly affects men; it causes baldness and scarring of the affected areas
- Frontal fibrosing alopecia – a type of alopecia that affects post-menopausal women; it damages the hair follicles so that the hair falls out and is unable to grow back
- Discoid lupus – a mild form of lupus that affects the skin, causing scaly marks and hair loss
Telogen effluvium is a common type of alopecia where there is widespread thinning of the hair, rather than specific bald patches. Hair is shed from the scalp, usually as a reaction to stress or medication. This type of hair loss tends to improve without treatment after a few months.
Male-pattern baldness is more common than female-pattern baldness, affecting around half of all men at some point. Female-pattern baldness becomes more common in women over 40 years old, particularly after the menopause (when a woman’s periods stop at around age 52). See Live Well for more information about women and hair loss. Alopecia areata will affect one or two people in every 100 over the course of their lifetime. Up to 1 in 5 people with alopecia areata have a family member with the condition. This suggests that it can run in families in some cases.
The symptoms of the different types of hair loss are outlined below.
Male-pattern baldness is hereditary, which means it runs in families. It usually starts around the late twenties or early thirties. By their late thirties, most men have some degree of hair loss. Male-pattern baldness is so called because it generally follows a set pattern. The first stage is usually a receding hairline, followed by thinning of the hair on the crown and temples. This can leave a horseshoe shape of hair around the back and sides of the head. Sometimes it can progress to complete baldness, although this is rare. Women’s hair gradually thins with age, but women generally lose hair from the top of their head only. This is usually more noticeable after the menopause (when a woman’s periods stop at around 52 years of age).
Alopecia areata causes patches of baldness that are about the size of a large coin. They usually appear on the scalp but can occur anywhere on the body. Other areas that can be affected include the:
If the patches of hair loss are mainly around the hairline it is called an ophiasis pattern. The skin of the bald patches is normal. There are usually no other symptoms, although in 1 in 10 people the finger nails may also be affected, and may have a pitted appearance. In some cases of alopecia areata, a person’s hair often grows back but it will appear fine and white before it regains its original colour. This hair can be dyed, if necessary.
As scarring alopecia is caused by another health condition, you will have symptoms relating to this condition besides hair loss. Unlike other forms of hair loss, the skin where the hair has fallen out is likely to be affected in some way.
For example, lichen planus is a non-infectious rash that can lead to scarring alopecia and can cause:
- An itchy rash with purple-red coloured bumps
- Inflammation (redness and swelling) of the skin of your scalp
- Pain or a burning sensation
Discoid lupus is another possible cause of scarring alopecia. It can cause red, circular, scaly marks on your skin. It may also cause itchiness and pain.
In telogen effluvium, there is widespread hair loss from all over your scalp, rather than specific bald patches. Your hair may feel thinner than before but you are unlikely to lose it all. Your other body hair will not usually be affected.
In most cases of telogen effluvium, your hair will stop falling out and start to grow back within six months. On average there are 100,000 hairs on the human head. Hairs develop in follicles, which are small holes in the skin that contain the roots of each hair. Each hair grows for about three years before it falls out and a new one grows. Around 50 to 100 hairs fall out every day.
Male and female pattern baldness
Male-pattern and female-pattern baldness is caused by oversensitive hair follicles. This is linked to the hormone dihydrotestosterone (DHT), which is made from the male hormone testosterone. If there is too much DHT, the follicles react to it. The hair becomes thinner and grows for a shorter length of time than normal. The balding process is gradual because different follicles are affected at different times.
Immune system imbalance
Alopecia areata is an autoimmune condition. The immune system is the body’s natural defence system, which helps protect it from infection by bacteria and viruses. Usually, the immune system attacks the cause of an infection, but in the case of alopecia areata, it damages the hair follicles instead. The hair follicles are not permanently damaged, and in many cases the hair grows back within a few months.
It is thought that some people may be genetically predisposed (susceptible) to alopecia areata. Certain genes (units of genetic material) may make the condition more likely. Alopecia areata runs in the family in up to 1 in 5 cases, suggesting that the tendency to develop the condition may be inherited.
Some conditions and treatments can make you lose some of your hair, such as:
- Anaemia (lack of red blood cells)
- Stress (including bereavement)
- Fungal infections
- Chemotherapy – medicines that are used to treat cancer
Women who are pregnant or have recently given birth may also have some hair loss. Alopecia areata is more common among people with other autoimmune conditions, such as:
- Thyroid disease – conditions that affect your thyroid gland, such as an overactive thyroid(hyperthyroidism)
- Diabetes – a condition caused by too much glucose (sugar) in the blood
- Vitiligo – a condition that produces white patches on the skin
Alopecia areata is also more common among people withDown’s syndrome, a genetic condition that causes learning difficulties and affects physical development. More than 1 in 20 people with Down’s syndrome have alopecia areata.
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