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Alopecia: Causes, Diagnosis, Forms, Treatment

What is Alopecia

Alopecia is the medical term for the loss of hair on the scalp as well as on the beard, eyebrows and other parts of the body. It can have various causes and forms and can affect people of any age, gender or ethnicity. It often has a significant impact on a person’s quality of life, self-esteem and psychological well-being.

  • The most common type of hair loss worldwide is androgenetic alopecia

  • The triptych of treatment: Autologous mesotherapy, minoxidil and in forms of androgenetic alopecia, antiandrogens

  • Cortisone and immunosuppressive drugs are recommended for autoimmune forms of alopecia

  • Trichoscopy and scalp biopsy can complement the clinical diagnosis

  • The DNA test is used to diagnose androgenetic alopecia versus other forms

  • 3 months after the start of treatment the effect starts to show

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The possible causes of alopecia

Heredity. This is the cause of androgenetic alopecia, which affects both men and women. It usually occurs gradually in a predictable pattern with receding frontal hairline in men and thinning of the hair on the scalp in women.

Hormonal disorders and diseases. Hormonal changes due to pregnancy, childbirth, menopause, thyroid disease or polycystic ovary syndrome.

Medications. Hair loss can be a side effect of certain medications, such as for cancer, heart disease, rheumatoid arthritis, gout, contraceptives, antidepressants and antihypertensives.

Severe stress. Can lead to diffuse hair loss, which is transient, although it can last for several months.

Styling. Excessive hair styling or hairstyles that stress your hair, such as ponytails, are implicated in traction alopecia. Hair treatments that use chemicals or dyes or heat treatments can also cause hair loss.

Treatment Options and Effectiveness

The diagnosis of alopecia

In addition to the clinical examination, additional tests may be used, such as:

– Blood tests: Rule out conditions associated with hair loss, such as thyroid disorders, iron deficiency or autoimmune diseases.

– Scalp biopsy: Gives evidence of inflammation, infection or excludes other conditions if differentially diagnosed.

– Trichoscopy: Gives information about the morphology of the hair follicles, as well as the quality and density of the hair.

– Phototrichosogram: A digital method of trichoscopy for accurate information of hair characteristics to help the physician in diagnosis, assessment of the course of the disease and selection of appropriate treatment.

– Traction test: The physician gently pulls small bundles of hair from various areas of the scalp to determine the stage and type of hair loss.

The main types of alopecia

Androgenetic alopecia

Androgenetic alopecia.

Androgenetic alopecia is also known as male or female pattern hair loss. This condition is caused by genetic and hormonal factors that affect the hair growth cycle. Men usually experience receding frontal hairline and thinning at the top of the head, while women usually experience thinning hair at the top of the head and enlargement of the parting. Note that approximately 50% of men and 10% of women are affected by androgenetic alopecia by the age of 50 years.[3]

Gyroid alopecia

Areata alopecia.

Alopecia pedis is an autoimmune condition that affects the hair follicles on the head and body. It is an abnormal reaction of the body that results in localized hair loss, mainly on the scalp, eyebrows or beard, but can also occur on other parts of the body. The size and number of spots may vary, with an increasing trend over time. Sometimes there is hair regrowth, while other times it develops into total alopecia. The exact cause of alopecia pedis has not been fully clarified by scientists, but there are indications that it may be caused by stress, infections, genetic or environmental factors. It affects about 2% of the general population.[4]

Diffuse alopecia

Diffuse alopecia.

Diffuse hair loss is a form of non-scarring alopecia characterized by severe hair loss and diffuse thinning and thinning of hair throughout the scalp. It is divided into anagen and telogen hair loss, depending on whether anagen or telogen hairs are affected, respectively.

Regenerative hair loss

Anagen hair loss.

Anagenous hair loss is characterized by sudden onset and a more severe clinical picture than telogen hair loss, with abrupt inhibition of growth and shedding of anagen hairs. It is the most frequent side effect of chemotherapy. The picture is dramatic with up to 90% of hairs falling off, as the majority of hairs are in the anagen phase. Causes include chemotherapy, radiotherapy, chemical poisoning, hormonal imbalances, trauma or alopecia gyrus.

Telogen hair loss

Telogen hair loss.

Telogen hair loss is characterized by sudden onset and early transition from the anagen phase to the telogen phase, resulting in increased shedding of telogen hairs. It occurs at all ages, even in infants, and is the second most common form of alopecia. The incidence in women is higher than in men, which is due to the fact that most of the causes are related to the female sex.

The main manifestation is the loss of more than 200 hairs per day and is perceived by the patient in the tufts of hair found in the bathtub or in the comb. It usually resolves on its own within 6 weeks, but may last 3 – 6 months (acute form) or longer (chronic form).

It is caused after physical or psychological stress, such as childbirth, emotional distress, serious medical conditions, surgery, certain medications, vitamin and mineral deficiencies such as zinc or iron, hormonal changes, thyroid disease, or a crash diet.

Traction alopecia

Alopecia traction.

Traction alopecia is a type of hair loss that occurs due to excessive pulling or pushing of the hair over a long period of time. It can damage the hair follicles and cause permanent scarring if left untreated. It is often caused by very tight or heavy hairstyles such as braids, ponytails or extensions. It can also be caused by frequent use of heat styling or chemical treatments on the hair.

Frontal fibrotic alopecia

Frontal fibrotic alopecia.

It is a type of scarring alopecia that mainly affects postmenopausal women. It causes a gradual regression of the hairline along the forehead and temples, sometimes accompanied by loss of eyebrows or eyelashes. The causes of frontal fibrotic alopecia have not been fully elucidated, but some research suggests that it may be related to genetic and environmental factors, hormonal changes, or immune system dysfunction.[5]



Trichotillomania is a mental disorder in which a person has a recurring, uncontrollable urge to pull hair from the scalp, eyebrows or other areas of the body, despite trying to stop. Pulling hair from the scalp often leaves localized gaps of hair spots, which cause significant psychological problems, especially at young ages. Once the person manages to stop hair pulling, there are treatment options for hair restoration.