Hair loss (alopecia)

Alopecia is the medical term for hair loss. Management of alopecia depends upon an accurate diagnosis. In most circumstances, this means taking a detailed history of the problem as well as a clinical examination performed by an experienced dermatologist.

Once the likely cause of hair loss is established, the condition can be discussed, as well as prognosis and management options. The term alopecia is not a specific diagnosis – it simply means hair loss. There are many different causes of such hair loss.

The commonest causes are male and female pattern hair loss. Alopecia areata, which usually causes patchy loss, is also common. Hair shedding due to illness or stress is also a frequent diagnosis. Less common causes of hair loss, called scarring alopecias, can cause permanent hair loss.

Management of alopecia may involve cosmetic as well as medical treatments. A few conditions will improve without the need for any treatment. In general, treatment of alopecia involves control of disease rather than cure.

Treatment will depend on the clinical diagnosis.

In some conditions, such as acute telogen effluvium, the hair loss resolves spontaneously.

Small patches of alopecia areata may also resolve without treatment.

Other disorders may require topical or systemic (tablet) medication.

Male pattern hair loss (androgenic alopecia) typically appears as recession at the temples – a receding hairline – and thinning on the crown.

The condition is likely to have a significant genetic basis and occurs as a result of the effect of male hormones on certain hairs in the scalp. There are a number of treatments that have been shown to be of benefit.

However, the alopecia caused cannot be completely reversed. For some, hair restoration surgery may be an appropriate way of managing the problem. Female pattern hair loss is the commonest cause of hair thinning in women. This typically manifests as a gradual thinning of the hair on the top of the scalp.

The causes of this condition are not well understood, but a genetic susceptibility is likely. Some useful treatments are similar to those for androgenic alopecia. Alopecia areata is an autoimmune condition which is characterised by patchy loss of hair. This can start abruptly, and hair loss can be marked.

This type of hair loss is often treated initially with steroid liquid or cream. For larger, more persistent areas of loss, steroid injections can be helpful. Telogen effluvium means hair shedding. Acute telogen effluvium usually begins rather abruptly, several months after an acute illness, major surgery or an episode of marked stress.

Hair loss can be significant, but the condition settles spontaneously, and new hair growth occurs without treatment, although this can take some months. Inflammatory and scarring alopecias can be difficult to treat and in some conditions, once hair is lost, it cannot regrow.

In these conditions, suppression of disease activity is the aim of treatment. However, where hair has been lost, there are many options for camouflaging the loss.