Alopecia

What is Hair Loss (Alopecia)?

If you’re noticing your hair is starting to thin on your scalp, recede back, or that hair falls out more frequently, you might have a form of hair loss (alopecia). Hair loss may occur on the scalp, eyebrows, eyelashes, beard, and other areas of the body. While some patients lose hair in only a few places, others lose it in many areas.

What Causes Alopecia?

Alopecia can occur for a variety of reasons, and it often depends on the specific type of hair loss you’re experiencing. One of the most common causes is androgenic alopecia, also known as male pattern baldness or female pattern hair loss, which is often hereditary and related to hormone levels.

Sometimes, individuals develop alopecia areata suddenly, without warning. Others may have a family history of alopecia or other autoimmune diseases. It’s important to understand that alopecia areata is not contagious, and early intervention can help prevent alopecia areata from progressing to severe cases.

Common Symptoms of Alopecia Areata

• Thinning hair
• Hair shedding- finding it in the shower drain, sink, hair brushes, pillowcases
• Itchy scalp
• Hair that doesn’t grow
• Finding bald patches

How is Alopecia Areata Diagnosed?

When diagnosing alopecia, dermatologists evaluate many factors to determine the type and cause of hair loss. This includes assessing hair thinning, patchy alopecia areata, and patterns such as a receding hairline, diffuse alopecia areata, or complete baldness. Your provider may ask if you’ve noticed sudden hair loss, if your hair regrows in some areas but not others, or if there is body hair loss as well. There are several different types of alopecia areata, including:

• Androgenic alopecia: Male or female pattern baldness
• Alopecia areata: Coin-sized patchy hair loss
• Alopecia totalis
• Telogen effluvium
• Central centrifugal cicatricial alopecia (CCCA)
• Frontal fibrosing alopecia (FFA)
• Traction alopecia
• Tinea capitis: Ringworm
• Lichen planopilaris (LPP)
• Discoid lupus erythematosus (DLE)

Who is a Good Candidate for Alopecia Treatment?

Individuals who believe they may have alopecia should see a dermatologist for assessment. During your consultation, your dermatologist will speak with you regarding your signs and symptoms and examine the areas of hair loss. The dermatologist may gently pull on the hairs at the edge of bald patches to see if they come out easily, and check individual hairs and hair follicles to see if they are abnormally shaped. An examination of your nails may also be performed. A dermatoscope might be employed during the examination.  In some cases, a scalp biopsy or a fungal culture may be performed.

Alopecia Treatments

There are treatment options to help the hair grow back. These treatments include:

Corticosteroids: These anti-inflammatory drugs are often used to treat alopecia areata, CCCA, LPP, FFA, and DLE. They are available as an injection into the scalp or other areas of the body, as a pill, or as an ointment, cream, foam, gel, or solution.

Spironolactone: A hormonal therapy aimed at treating female pattern alopecia.

Low dose oral minoxidil (LDOM): An exciting newer therapy employed to treat female pattern hair loss and other hard-to-treat forms of alopecia.

Finasteride: Frontal fibrosing alopecia and pattern alopecias often respond well to 5-alpha reductase inhibitors.

Hydroxychloroquine (Plaquenil): Can be used to treat immune-mediated hair loss conditions such as lupus and lichen planopilaris.

Topical immunotherapy:  When there is a large amount of hair loss in alopecia areata, treatment with squaric acid dibutyl ester (SADBE) or diphencyprone (DPCP) may be a viable option. Chemicals are applied to the scalp to create an allergic reaction, which makes the hair grow back. This treatment must be repeated several times to keep the new hair growing.

JAK inhibitors: Baricitinib (Olumiant) is an oral therapy used for adults with severe alopecia areata universalis that is unable to be treated effectively with standard therapy. Laboratory monitoring and close dermatologist follow-up is required.

Alternative Topical therapies: Our office uses the full spectrum of studied agents including topical minoxidil, retinoids, anthralin, calcineurin inhibitors, nutritional supplements, doxycycline,  and compounded JAK inhibitors to help our patients regrow their hair.

What to Expect During Alopecia Treatments

Starting treatment for alopecia areata totalis or other forms of hair loss requires patience, as hair regrowth takes time and results can vary from person to person. Your dermatologist will personalize your treatment plan based on the specific type of alopecia, the extent of your hair loss, and your overall health.

Most treatments involve little to no downtime, allowing you to resume normal activities quickly, though ongoing sessions may be necessary to sustain hair regrowth. For those with alopecia universalis or complete hair loss, results may take longer and may not be guaranteed. In these situations, some patients choose to wear wigs or explore cosmetic alternatives while waiting for new hair to grow.

Following Alopecia Treatment

Following alopecia treatment, many patients notice an improvement in their hair growth. There is no downtime required following treatment, so patients can return to their everyday activities as soon as they feel comfortable. Your dermatologist will provide you with instructions on how to properly receive treatment, as well as post-treatment tips.

Schedule a Consultation

If you believe that you may have alopecia or are experiencing a great amount of hair loss, contact HMGS Dermatology today! We will be happy to help you schedule your consultation appointment with one of our dermatology team members.