Alopecia is the term given to hair loss in general, however there are many types including patchy, diffuse, traumatic, and scarring. Getting to the root cause of the problem is imperative to enable the right treatment.

Below is a summary of the more frequently seen conditions. Please get in touch with any queries, so I can help further, as no two cases are the same.

Alopecia Areata

Alopecia Areata typically presents with circular patches of hair loss. It is not age specific. In some cases there may be multiple patches, these can also become bigger, and may encroach onto one another.

This type of loss is thought to be autoimmune related, where the immune system attacks the hair follicles as it has incorrectly identified them as foreign. It may be triggered or exacerbated by stress, amongst other factors. With a detailed history it is possible to identify the trigger that has triggered this type of loss.

Areata has varying forms and can also present as totalis which involves the whole scalp, brows and lashes. Universalis which can affect all hair follicles present upon the body. Ophiasic which appears along the nape of the neck and also diffuse areata which creates a generalised thinning throughout the scalp.

Areata can be of an unpredictable nature and thus treatment options are limited, with no universal cure as of yet. Addressing underlying issues and topical stimulation can be of benefit depending on individual case.

Telogen Effluvium

Telogen effluvium is a diffuse loss that results in hair shedding. This is often noticed when washing and brushing the hair, sometimes a reduction in the ponytail size is what alerts you to the loss of density.

This type of loss is often referred to as reflective loss, due to its occurrence from many differing factors, such as metabolic disorders, illness, stress and nutrient deficiencies. These can interfere with our hair growth cycle creating more shedding than usual.

Telogen effluvium can be acute (short term), or chronic (long term), but in both cases it may be remedied if the contributing factors can be established. It is often necessary to consult with the GP, to request any relevant blood tests, to help with a personalised treatment plan.

Electrotherapy can be of benefit in the clinic to help promote a healthy scalp environment, with stimulation to the follicles increasing blood flow, creating improved nutrients and oxygen to the area.

Traumatic Alopecia

This is usually caused by repeated traumatic practices to the hair. The term traction alopecia is sometimes used when the hair loss is due to too much tension on the hair, for example, hair that is repeatedly pulled into tight braids or styles.

These traumatic practices can include heat, chemical and mechanical, once the offending external practice has been identified, the hair will regrow provided it isn’t exposed to further trauma. It may take some time for the hair to recover as once the damage has been done to the hair shaft it will need to be cut out or grown out. Temporary cosmetic treatments are available to help until the damaged hair is removed.

In the rare occasion the follicles can also become inflamed either by the repeated tension on them, or by chemical burns, providing no permanent scarring has occurred this can be rectified.

Trichotillosis or trichotillomania can also be in this category, this is the repeated compulsion of pulling one’s own hair. Which can create patches of loss, caused by the manual trauma of this habit.

Scarring (Cicatricial) Alopecia

Cicatricial alopecia is the term for disorders that involve scarring of the follicles and covers a vast subject area. Early identification is absolutely necessary and in most cases the help of a dermatologist is required to prescribe the necessary treatment.

Your trichologist will liaise with your GP for a referral, and may be able to offer topical treatment in the interim. There are many reasons the follicles can become scarred and unfortunately any follicles that have become scarred will no longer be able to produce hair and will show scarred, smooth, fibrosed skin.

At present I am seeing a high prevalence of a scarring condition called frontal fibrosing cicatricial alopecia and more worryingly patients are putting off seeking treatment as they are putting it down to age and a receding hairline. A thorough differential examination is required in all hair loss conditions in order for a diagnosis to be made before any such assumption is made.

Some scarring conditions can present as a scalp complaint and be extremely sore and itchy with the hair loss not noticed initially by the patient. The take home message is the sooner you seek help the better the chance of halting any damage.