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What Are the 5 Types of Alopecia? Symptoms and Differences Between These Forms of Scalp Hair Loss

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The definition of alopecia is “the partial or complete absence of hair from areas of the body where it normally grows.”

Basically, the term alopecia just means that you have lost some hair, somewhere, for a wide range of reasons.

There are many different reasons why you may be missing hair on your head -- maybe you just had a child, maybe you have hair falling out in clumps from an autoimmune disorder, or, you may be experiencing hereditary pattern hair loss. All of these reasons, though very different, are considered types of alopecias.

Below, we will run through the most common alopecias that occur specifically to the hair on your head. You may be able to gain some insight into what may be causing any hair loss you are experiencing, and help you and your doctor better understand the potential root cause and best treatment options for you.

1. Androgenetic Alopecia

Androgenetic alopecia is also known as male pattern hair loss and female pattern hair loss. This is the most common form of hair loss in men and women.

Androgenetic alopecia is considered to have a genetic and hormonal cause, and is more likely to occur if you have family members which have also lost their hair or had some level of androgenetic alopecia hair loss. The hormone DHT plays a role in damaging the hair follicles which leads to androgenetic alopecia, so helping to reduce DHT levels in the scalp is one of the main goals of treatment for this condition.

In men, this may develop as a receding hairline, hair loss on the crown, and/or a bald spot forming. This can proceed to full baldness in men.

In women, androgenetic alopecia tends to develop as a widening part, thinning hair on the top of the head, and/or a diffuse hair thinning all over the scalp. In women, androgenetic alopecia rarely proceeds to full baldness or affects the shape of the hairline.

Treatments for male pattern hair loss may include DHT-blockers like Finasteride and Dutasteride (off-label), or healthy growth enhancers like Minoxidil. For women, Minoxidil to boost healthy growth or off-label Spironolactone to reduce androgens may be used.

To treat androgenetic alopecia, the best route is to catch it early and to help slow the progression. Some people may be able to regrow a certain amount of hair with treatment, but the main goal is to reduce additional losses and preserve the hair you currently have. 

If you think that your hair loss falls into the androgenetic alopecia category, you can have a free online consultation with our U.S. licensed doctors today to see if a medication is a good route for you. At Strut, we offer topical and oral medications for men, and an innovative topical medication for women.

2. Alopecia Areata

Alopecia areata is an autoimmune condition where the body erroneously attacks the hair follicles. 

This leads to clumps of hair falling out, usually leaving smooth, round, bald quarter-sized patches. This is likely not painful, or have a rash, but the scalp may feel itchy, tingly, or have a burning sensation just before the hair is lost.

The patches may grow back, but since there is no cure for alopecia areata, hair may be lost again in the future.

This condition is not dangerous, but it may be mentally stressful and upsetting to the patient. Alopecia areata may be more common in those that have a relative with alopecia areata, or in those with asthma, down syndrome, pernicious anemia, seasonal allergies, thyroid disease, or vitiligo.

Treatment for alopecia areata may include steroids to calm the immune response (injections, pills, topical applications), topical immunotherapy to produce a local allergic reaction and help regrow the hair, or topical minoxidil to help boost faster regrowth.

3. Traction Alopecia

Traction alopecia can occur from too much tension on portions of the scalp. This can happen from wearing very tight or heavy hairstyles like high ponytails, dreadlocks, hair extensions, tight braids, or just having very long and heavy hair.

Traction alopecia may show up as a receding hairline or lost hair along the edges of the scalp. You may also experience scalp inflammation, redness, itching, ulcers, small pimples, or shiny scarred skin. You may see small broken hairs along the edge of the hair loss area, signifying that there was too much tension on the hair.

The best treatment for traction alopecia is to stop wearing your hair in tight styles. Wear your hair down or in a loose style if you wear it up. While your hair is healing it is also a good idea to avoid damaging chemical treatments, perms, or bleaching to encourage regrowth.

If traction alopecia is caught soon enough, it is likely that your hair will regrow to its normal state (as long as you alter your hairstyle). However, if traction alopecia goes on for too long, it can cause damage and scarring of the hair follicles and may not regrow in those areas.

If the area is irritated, anti-inflammatory creams may be recommended, or topical minoxidil can be tried to help encourage regrowth.

4. Scarring Alopecia

Scarring alopecia is a more rare alopecia diagnosis with only about 3% of hair loss situations being the scarring type.

In this form of alopecia, the hair follicles area destroyed and are replaced with scar tissue. This can extend from scalp folliculitis, cellulitis, follicular degeneration syndrome, or even systemic issues like lupus.

Once the hair follicles are destroyed and replaced with a scar, the hair loss is permanent and hair can’t regrow in those areas. Scarring alopecia can also cause patches of hair loss like alopecia areata, however, the outlines of the patches tend to look more ragged. 

The patches may expand with time and the skin may look smooth, or red, blistered, scaled, have pus or fluids leaking out, or have increased or decreased pigmentation.

Treatment for scarring alopecia may include helping to calm and heal the inflamed skin while trying to reduce the spread of the hair loss. Topical or injectable corticosteroids may be used, as well as certain malarial drugs, antibiotics for inflammation, or isotretinoin.

5. Alopecia Totalis

Alopecia totalis is similar to alopecia areata, although it means that the condition has progressed to all of the hair on your head being lost.

Alopecia totalis is considered an autoimmune skin disorder where the immune system attacks the hair follicles, causing them to fall out. The hair loss is often sudden and rapid.

Alopecia totalis may be more common if you have a family member with alopecia, and it may have a connection to dealing with chronic stress. This situation is more commonly found in adults and children less than 40 years old.

The hair that has been lost with alopecia total may grow back, but since it is a persistent condition, the loss may happen again later.

Treatments for alopecia totalis may include topical corticosteroids to calm the immune system, immunotherapy to boost new growth, minoxidil to enhance regrowth, UV light therapy for growth stimulation, and sometimes tofacitinib.

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