Written by Carsyn Turrentine 

Hair loss, formally known as alopecia, is an issue that affects up to 85% of men and half of women by age fifty. It can feel like an awkward and embarrassing issue, and understandably people often want to treat it as soon as possible. Of course, you can just choose to embrace your hair loss – your hair loss doesn’t make you a disappointment, and a person can look just as presentable without it. But whatever you decide to do, this article will explain the most common types of hair loss and how you can manage.

Androgenic Alopecia

Androgenic alopecia is the number-one cause of hair loss worldwide, accounting for over 95% of cases.1 It is linked to a mutation in the AR gene, and is associated with conditions like prostate issues and hypertension in men. In women, it is associated with polycystic ovary syndrome, characterized by an irregular menstrual cycle, weight gain, and excessive growth of hair on the rest of the body.  It is also known as androgenetic alopecia or male/female-pattern baldness and presents differently in both genders.

For male-pattern baldness, hair starts to fall out in both temples and the scalp, and eventually forms an M-shaped hairline. This can start to appear as early as the teens or younger twenties. Women don’t usually become bald from androgenic alopecia, but their hair thins over the entire scalp, especially at the crown, and their hairline doesn’t recede. Female-pattern baldness manifests a lot later than male-pattern baldness, with most cases not appearing until the 40s or later. In either gender, androgenic alopecia first occurs when the follicles in your scalp shrink; every follicle has three or four hairs in it, so when the follicle shrinks there becomes less room for hair to grow, and the hair thins overall.2

Alopecia Areata

Alopecia areata is an autoimmune disorder causing patches of hair to fall out. It affects approximately seven million Americans and has a lifetime risk of about 2%.3 It’s sometimes caused by genetics, with an estimated 20% of people affected by alopecia areata having a close relative with the same condition; it’s also more common in people with breathing problems, vitiligo or Down syndrome. African-Americans and Hispanics are most likely to be diagnosed with this condition. The effects of alopecia areata usually start before 30 and can cause anxiety and emotional distress.4

The most common subtypes of alopecia areata include patchy – in which coin-sized bald spots appear, most often on the scalp – and can later be classified as persistent patchy alopecia areata if it continues without progressing into the other two main types, totalis and universalis. Alopecia totalis is alopecia across the entire scalp, and alopecia universalis is hair loss across the entire face and rest of the body. Other types of areata include diffuse and ophiasis; diffuse can be difficult to diagnose because it looks similar to other forms of balding, and ophiasis is a unique type that involves hair loss in occipital area. The hair loss from ophiasis areata is also shaped like a band.5

Anagen and Telogen Effluvium

Effluvium is a word that means outflow, which sums up anagen and telogen effluvium – a constant shedding of hair that affects different phases of the hair cycle. Hair doesn’t usually all grow at the same time – normally, about 85% of hair is in the anagen phase of growth at a given time, or when hair is actively growing out of a follicle. This leaves about 15% in the telogen phase, where follicles aren’t active in producing new hair fibers.6

Anagen effluvium most often happens as a result of treatments like chemotherapy. This type of effluvium results in fractured hair shafts, the piece of hair proper – the ends of hairs that fall out in the telogen phase is rounded in the shape of the follicle.  Because most hairs are in the anagen phase at a given time, the hair loss is a lot more noticeable and occurs faster than many types of alopecia. That’s also because it includes hair loss all over the body, not just in the scalp area.

According to the American Hair Loss Association, telogen effluvium is probably the second most common type of alopecia dermatologists see. This type of effluvium often occurs after a type of trauma – emotional as well as physical – that “shocks” a person’s body in such a way that anagen-phase follicles move into the telogen phase, and more hair sheds than usual. Telogen effluvium may not be as noticeable to outside observers as other types of alopecia.

Treatments for Alopecia

The damage from androgenic alopecia is permanent, but there are still ways to slow or minimize hair damage. For androgenic alopecia, treatments that can help with the issue include The development of androgenic alopecia, and logically other types, can be slowed by maintaining healthy habits, i.e. getting enough sleep at night, eating a nutritious and moderate diet, and not drinking excessively.7

While there is no cure for alopecia areata, it may be temporary unlike the androgenic type, as hair can regrow at any time. It’s especially likely for hair to regrow if there’s only a small amount of balding. It can be treated depending on age, subtype, and severity. For young children (under ten), corticosteroids can be applied to the bald spots daily which can cause the bald spots to start growing back. After the use of corticosteroids is stopped, Minoxidil can be taken to continue the growth of hair. Minoxidil can also help with other types of alopecia. The treatment is similar for patients over ten, except the corticosteroids may be applied daily or injected about every month or two. Your dermatologist may also recommend Anthralin, but this will probably cause irritation.

If areata causes wider hair loss, like in the eye area, dermatologists may recommend fake eyelashes and drawing on eyebrows. If you suffer from alopecia totalis or universalis, your dermatologist will likely recommend either topical immunotherapy, certain medications like JAK inhibitors, or scalp prostheses, particularly if the effects of alopecia cause anxiety.8

Anagen effluvium can usually be reversed within if the presumed medication causing it is discontinued. For the time being, it can be managed by wearing wigs, false eyelashes, etc. or taking certain other medications, like the previously mentioned Minoxidil. Some doctors also use cold therapy – covering the scalp with ice as medication is given. Telogen effluvium is generally a temporary issue; since the hairs that are fall out are followed by new ones, it usually corrects itself several months after T.E. becomes visible.

A subject not mentioned before was hair loss due to over-processing, the most common type of actual damage to the hair – for example, excessive use of hair color or using too much heat. Overdoing hair weakens the scales in follicles and can result in brittle and frizzy breakage. The easiest way to manage this type of hair loss is to majorly condition the scalp and take extra care, like increasing protein intake. Tinted conditioner is ideal to lessen a brassy look, especially for people with lighter hair. If the damage done is severe, the easiest way to correct it is to cut it off and then be careful not to process it. If you still want your hair processed, it would be more prudent to use semi-permanent color, which does less damage. 10 11

 Last but not least, traction alopecia can be managed by not wearing your hair in excessively tight or long styles that may strain the follicles; hair grafts may be needed in severe cases.  The damage isn’t usually permanent, especially if this type is diagnosed and treated early.

References

1 Science Direct (2020, Sept 15) Androgenic Alopecia. Retrieved from www.sciencedirect.com/topics/neuroscience/androgenic-alopecia

2 Alopecia UK (2020, Sept 17) Androgenic Alopecia (Pattern Hair Loss). Retrieved from www.alopecia.org.uk/androgenetic-alopecia-pattern-hair-loss

3 National Alopecia Areata Foundation (2020, Sept 13-A) Alopecia Areata. Retrieved from www.naaf.org/alopecia-areata

4 American Academy of Dermatology Association (2020, Sept 13-A) Hair loss types: Alopecia areata causes. Retrieved from www.aad.org/public/diseases/hair-loss/types/alopecia/causes

5 National Alopecia Areata Foundation (2020, Sept 14-B) Types of alopecia areata. Retrieved from www.naaf.org/alopecia-areata/types-of-alopecia-areata

6 American Hair Loss Association (2020, Sept 17) Effluviums. Retrieved from www.americanhairloss.org/types_of_hair_loss/effluviums.html

7 Dermhair Clinic (2020, Sept 17) Q: What are the androgenic alopecia hair loss statistics for men and women? Retrieved from www.dermhairclinic.com/statistics-hair-loss-pattern-baldness/

8 American Academy of Dermatology Association (2020, Sept 14-B) Hair loss types: Alopecia areata diagnosis and treatment. Retrieved from www.aad.org/public/diseases/hair-loss/types/alopecia/treatment

9 Our Everyday Life (2020, Sept 17) What to Do for Dry, Over-Processed Hair. Retrieved from www.oureverydaylife.com/320498-what-to-do-for-dry-over-processed-hair.html

10 Shape (2020, Sept 17) Five Ways to Save Fried, Over-Processed Hair. Retrieved from https://www.shape.com/lifestyle/beauty-style/healthy-beauty-tips-dyed-over-processed-hair