What is alopecia? Causes, symptoms and treatment

Reviewed by our clinical team

Hair plays a big role in our lives, and hair loss - also known as alopecia - can cause serious anxiety and depression for people of all genders. According to Alopecia UK, alopecia areata - the most common kind - affects 15 in 10,000 people in the UK. 

Although living with alopecia can be difficult, there are treatments available for some types of hair loss. You can also choose certain hairstyles that make it less obvious, helping you to feel less self-conscious and more confident. In this article, we’ll take a look at how alopecia can affect you, and what you can do about it.

What is alopecia?

Alopecia is the medical term for hair loss in both men and women. Although there are a few potential causes, such as hair loss from a particular medicine or hormonal and immune changes, the most common causes are age and genetics.

Types of alopecia

As mentioned above, there are a few different types of alopecia, which range in severity and can be caused by a number of factors. Some types of alopecia occur more often in women than men, and vice versa.

Alopecia areata

Alopecia areata causes hair to fall out in round or oval patches, and can occur not just on the head but in other areas including the beard, eyebrows, and eyelashes. It’s thought to be an autoimmune condition, when the body's natural defence system can't tell the difference between your own cells and outside cells. 

Subtypes of alopecia areata include patchy alopecia areata, alopecia totalis (complete loss of hair from the scalp), and alopecia universalis (complete loss of hair on the body.)

Traction alopecia 

Traction alopecia is where the hair falls out due to being pulled in one direction for too long, such as with a tight ponytail. It can usually be reversed by changing how you wear your hair, read on for the best hairstyles for traction alopecia. Although, if you don’t intervene quickly enough this type of alopecia can be permanent. 

Trichotillomania

A psychological condition which causes you to pull out the hairs due to stress and anxiety. The urge to pull out your hair can be compulsive, if you notice you’re pulling out your hair or feeling particularly stressed you should speak to your GP. 

Androgenetic alopecia 

Hairs grow in ‘tufts’ or groups of three to four hairs, and Androgenetic Alopecia causes these tufts of hair to shrink, reducing the total number of hairs. This process of ‘miniaturisation’ eventually means all the hairs disappear, leaving bare scalp visible between each tuft. 

Androgenetic Alopecia is very common and is sometimes called “male/female pattern hair loss”. It’s thought to affect 50% of males over 50 and around 50% of females over 65. It generally shows in men with a receding hairline and loss of hair on the top and front of the head. In women, it generally starts on the crown. It’s less likely that women will experience complete hair loss with androgenetic alopecia than with other types.

Chemotherapy induced alopecia

Chemotherapy drugs work by attacking fast-growing cancer cells, but this, unfortunately, means they also attack rapidly-growing cells elsewhere, such as those in your hair roots. Hair loss usually starts around two to four weeks after starting chemotherapy, and the amount you’ll lose depends on the drug. Some drugs don’t cause any kind of hair loss.

Other symptoms can include a tender scalp, and hair might fall out gradually or in clumps. The hair loss usually continues throughout treatment and often for a few weeks after. This type of alopecia isn’t generally permanent, though your hair might grow back different to how it was before.

Central centrifugal cicatricial alopecia 

Central centrifugal cicatricial alopecia (CCCA) is a type of scarring that usually starts in the centre of the scalp and spreads outwards slowly. It’s very common in women of African descent but isn’t limited to any one ethnicity or sex. You might also experience itching, pain, or tenderness. Your scalp might also be spongy, flaky, or red.

Lichen planopilaris

Similar to CCCA, Lichen Planopilaris is a type of scarring alopecia caused by an autoimmune response. It’s usually found in younger women but also in men. The hair follicle is destroyed, causing smooth, shiny patches of bare scalp. The scalp may also be red and scaly. Lichen Planopilaris occurs most frequently on the sides, front, and lower back of the scalp.

This type of alopecia is very similar to another type of scarring alopecia - Frontal Fibrosing Alopecia - which occurs at the front of the scalp. Hair loss due to scarring alopecia is usually permanent as the hair follicles themselves are destroyed.

Alopecia symptoms

The most common symptom of alopecia is hair loss. However, depending on the type, it can occur in different ways. You might notice alopecia symptoms such as:

• Small patches of hair loss on your scalp or body
• Patches of hair loss growing together into larger patches
• Hair growing back in one spot and falling out in another
• You lose a lot of hair very quickly
• More hair loss when the weather is cold
• The bare scalp is smooth without being red

As well as hair loss, you might also find that your fingernails and toenails become red, brittle, or pitted, or you might experience tingling, itching or burning before the hair falls out.

Alopecia causes

There are a few different causes of alopecia. The most common are:

Autoimmune disease

Autoimmune disease is when your immune system attacks your body rather than foreign cells like it’s supposed to. In the case of alopecia areata, it attacks your hair follicles. We don’t really know what causes it, but it’s thought to be genetic.

You’re more likely to experience immune response alopecia if you have a family history of:

• Asthma
• Down syndrome
• Pernicious anaemia
• Seasonal allergies
• Thyroid disease
• Vitiligo

Medicines and treatments

As mentioned above, chemotherapy medications can cause hair loss as a side effect, as they attack not just cancer cells but healthy cells too, including the cells in your hair follicles. Other medications can also cause hair loss, including:

• Some acne medications with Vitamin A
• Some anti-depressants
• Some birth control options
• Some drugs that suppress the immune system
• Some anti-clotting drugs
• Some antibiotics and anti-fungal medications
• Some medications for high cholesterol

You should discuss any medications with your doctor before you start taking them if you’re concerned about hair loss.

Can COVID-19 cause hair loss?

Studies have shown that a side effect of COVID-19 and the stress caused by the pandemic is hair loss. COVID-19 can potentially trigger Telogen Effluvium, where natural hair loss is accelerated by severe illness, stress or significant life changes/events. Hair loss from Telogen Effluvium is usually temporary, and the hair generally grows back.
You can learn more about the link between COVID-19 and alopecia here.

Is alopecia genetic?

Alopecia can be hereditary and your genetics can make it more likely for you to experience hair loss. If there is hair loss on your maternal or paternal side, you may be more likely to lose your hair. However hair loss is influenced by environmental factors too, so the exact risk of someone developing the condition due to their genetics is unclear. 

Best hairstyles for alopecia 

Some people with alopecia change their hairstyle to make the hair loss less obvious and feel more confident.

Hairstyles for women with alopecia 

Grow a fringe

If your alopecia is causing your hairline to recede, you can grow out your fringe to cover it. Cut your fringe near the eyebrows for the most effective coverage, or you can sweep your fringe to one side if only one side is affected.

Short/mid-length hair with layers

You can easily bulk up thinning hair by cutting it shorter, stopping the hair from being weighed down and looking flat on the scalp. Layers will also help frame your face and cover up your hairline if needs be.

Side parting

Changing the position where your hair parts is a great way to hide hair loss. If you have a widening centre part or a patch on one specific side, you can try a deep side parting to cover it and create volume. 

Low ponytail

Hair loss near the nape of your neck makes it harder to wear a high ponytail or an updo. Instead, you should try a low ponytail to cover the spot and secure your style.

Buzzcut

No longer just for men, many women are opting for an all-over buzzcut as a statement against the stigma of hair loss and as a way to regain their confidence. Although it’s not for everyone, buzzcuts are becoming increasingly popular for women.

You can also wear headscarves, hats, and other coverings to help cover up the hair loss and boost your confidence.

Hairstyles for men with alopecia

There are a few different styles men can try to make hair loss less noticeable.

Buzzcut

If you don’t mind sporting a shorter look, you can try the buzzcut, where you shave all the hair on your head with clippers. You can combine it with a fade on the sides and try different clipper guards for different lengths.

The crew cut

If you’re experiencing hair loss more at the back of your head, the crew cut could be a great option. The crew cut consists of shorter hair on top of the head, longer at the front than at the back, and faded/very short hair on the sides.

The mop

Let it grow! If the hair loss isn’t too excessive, you can grow out the rest of your hair and use it to cover up any bald patches.

Slick back

If the hair loss is mainly at the top and back of the head, you can grow out the hair at the front and comb/slick it back with gel or wax to cover it.

Facial hair

If the hair loss is quite extensive, or none of these options appeals to you, why not grow facial hair? You can combine it with a buzz cut to draw attention away from your hairline and enhance your jawline and other features.

Alopecia treatment for men

Male pattern hair loss can be treated with medication and there are two options: 

Finasteride

Also known as Propecia, Finasteride is a prescription pill used in males to block the production of the hormone that causes male pattern baldness. You’ll usually see results within three to six months but should take it for at least a year before stopping. You'll need to continue taking finasteride to see lasting results.

It’s unsafe for women to use Finasteride.

If you have male pattern baldness, you can also use Finasteride and minoxidil together.

Propecia

Propecia is the branded version of finasteride, they’re essentially the same treatment for hair loss. The daily tablet halts hair loss and stimulates hair to grow on the head. Like finasteride, you need to continue to take Propecia for it to work. 

Other treatments

If your alopecia is caused by a medical condition, such as a low vitamin D or iron levels, your doctor will work with you to treat the condition, stopping the hair loss and allowing the hair to return.

In more serious cases, or where the hair loss is seriously impacting your self-confidence and wellbeing, and depending on your type of hair loss, your doctor might recommend:

• Steroid injections or creams
• Immunotherapy for alopecia caused by an immune disorder
• Ultraviolet light treatment
• Tattooing
• Hair transplant (either artificial hair or hair from elsewhere on your head)
• Scalp reduction surgery

Alopecia treatment for women

At LloydsPharmacy Online Doctor female pattern hair loss can be treated with medication including: 

Regaine

Regaine is available without a prescription and contains the active ingredient minoxidil which is clinically proven to help stop women’s hereditary hair loss. For fuller and thicker hair, Regaine foam and solutions, work at the root to strengthen hair. 

Minoxidil

Minoxidil (also known as Regaine for women), can be bought over the counter without a prescription. You apply it daily to your scalp and you should see results within three months. Minoxidil can also sometimes be prescribed for alopecia areata.

Other treatments

Alopecia can be caused by a variety of factors. If you and your doctor think your vitamin levels could be an influence there are vitamins you can take alongside a healthy balanced diet. 

Other treatments available will depend upon the severity of your hair loss, these can include: 

• Hair tattoos
• Wigs
• Surgery to reduce your scalp 
• Hair transplant 
• Light treatment
• Steroid creams and injections
• Immunotherapy if your alopecia is caused by an immune disorder

If you’re finding losing your hair upsetting you can talk to your GP about counselling. Remember you’re not alone, talk to friends and family for support as well.

Conclusion

Although it can be a natural part of getting older, hair loss can seriously damage your self-confidence and wellbeing. Alopecia is not always permanent and there are options available for treatment for both men and women depending on the cause.

If you are worried about your hair loss, the best thing to do is to speak to a doctor and identify the cause. They can then work with you to find the best treatment and course of action. 

References

https://www.alopecia.org.uk/blog/epic-epidemiology-study-for-alopecia-areata
https://www.alopecia.org.uk/androgenetic-alopecia-pattern-hair-loss
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262270/