Understanding Alopecia: Causes, Treatments, and Emotional Impact
- Zelovie Digital
- Apr 18
- 4 min read
Recently, I had an enlightening conversation with a patient who is a well-known hairstylist in Antigua. She revealed that a significant portion of her clientele suffers from varying degrees of alopecia. While she strives to create hairstyles that camouflage their hair loss, she understands that this approach merely provides a superficial remedy and does not address the underlying issue. She inquired whether more permanent solutions were available to offer her clients some relief. Let me give some insight into the causes and treatment options available for alopecia.
Alopecia, a term that encompasses a range of hair loss conditions, is a prevalent issue that affects millions of people around the world. It doesn’t discriminate between men, women or children, and manifests in various forms, each with unique characteristics and treatment protocols.
The four common types of alopecia include:
1. Traction Alopecia: (forceful removal of hair follicles at the roots)
2. Androgenetic Alopecia: (male or female pattern baldness)
3. Cicatricial Alopecia: (permanent hair loss)
4. Alopecia Areata, which itself has three subtypes:
- Areata Patchy: (unpredictable patchy hair loss)
- Areata Totalis: (complete loss of scalp hair)
- Areata Universalis: (an all-encompassing condition that affects every hair on the body).
Traction Alopecia is particularly common among women and arises from prolonged tension on hair follicles, often due to tight hairstyles like braids, weaves, and tight ponytails. This condition can also affect individuals with locs, as the weight of the hair can pull on the roots. Additionally, improperly removing glued wigs can contribute to hair loss. Characterised by a receding hairline, thinning edges, and hair loss primarily at the temples and nape, traction alopecia is often preventable by avoiding certain hairstyles and minimising tension during styling. Treatment typically involves reducing stress on the hair and may include topical solutions such as minoxidil. In more severe cases, procedures like vampire hair restoration may be necessary to encourage regrowth.
Androgenetic Alopecia, also known as male or female pattern baldness, is the most prevalent form of hair loss, affecting approximately 50% of men and about 30% of women by age 50. This condition is mark
ed by gradual hair thinning, often starting at the crown for men and widening the part or thinning at the crown for women. Its primary causes are genetic predisposition and hormonal factors, particularly the influence of dihydrotestosterone (DHT) on hair follicles. Testosterone converts into DHT, and in individuals predisposed to hair loss, DHT shortens the hair growth cycle and gradually miniaturises the hair follicles. This process results in thinner, weaker hair that may stop growing altogether, leading to bald patches on the scalp. Treatment options include topical minoxidil, oral finasteride for men, and hair transplant surgery, all of which aim to stimulate hair growth and slow the progression of hair loss.
Cicatricial Alopecia, or scarring alopecia, is characterised by damage to hair follicles and scarring on the scalp, which can result in permanent hair loss. Various underlying factors, including infections, autoimmune diseases, or inflammatory skin disorders, can cause Cicatricial Alopecia. Because cicatricial alopecia can lead to irreversible hair loss, early detection and treatment of the underlying causes are critical. In some instances, hair transplantation may be the only solution. This underscores the importance of early detection and proactive management in dealing with alopecia.
Areata Patchy and its causes are not fully understood. However, it is commonly believed to be an autoimmune disorder, where the body attacks its hair follicles, causing sudden hair loss in small round patches on the body, but most noticeable on the scalp. It affects about 2% of the global population at some point in their lives. While some individuals may experience spontaneous regrowth without treatment—especially if the hair loss is recent and not extensive —recurrences often occur and can be frustrating. In some cases, medical treatment may be necessary. Standard treatment options include corticosteroid injections, topical medications, light therapy, and PRP (Platelet-Rich Plasma) injections into the scalp.
Areata Totalis is a more severe form of Alopecia Areata characterised by total hair loss on the scalp. It is less common, affecting approximately 0.1% of the population. The speed at which Areata Patchy transitions to Totalis can be alarming, presenting individuals with both physical and emotional challenges associated with significant hair loss. Treatment options for Areata Totalis may include immunotherapy, where a solution applied to the scalp provokes a mild allergic reaction to stimulate hair regrowth. Other treatments may consist of systemic medications such as JAK inhibitors (e.g., baricitinib (Olumiant), ritlecitinib (Litfulo), and deuruxolitinib (Leqselvi)). These JAK inhibitors are often used with exosomes or stem cells to modulate the immune response.
Areata Universalis is the most severe form, resulting in complete hair loss across the body, including eyebrows and eyelashes. This rare condition affects only about 0.02% of the population and is believed to be caused by similar autoimmune mechanisms. While there are no guaranteed treatments for Areata Universalis, some patients report success with methods akin to those used for other types of areata. Ongoing clinical trials aim to discover more effective therapies, reflecting the increasing understanding of this complex condition.
While alopecia can have significant physical and psychological impacts, it’s crucial to remember that there is a wide range of solutions available. Treatment options often require consistency and dedication for optimal results, whether medical or therapeutic. Additionally, support groups and counselling can provide vital emotional support for those coping with the effects of hair loss. It is important to remember that alopecia does not define the person or hinder their lifestyle, and it most definitely does not determine their self-worth. You are beautiful no matter the alopecia diagnosis that you may have.
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