Hair Health and Identity: A Comprehensive Look at Alopecia

When patients seek advice or treatment for hair problems, there may be a lot at stake. Hair is strongly associated with one’s identity, including personal and professional relationships as well as roles within family, community, and culture. Scalp and hair health can also be reflective of overall health status, and problems can provide clues to systemic conditions.  

The most common reason that patients seek care or advice for a hair problem is hair loss, also known as alopecia (although too much hair in the wrong location can also be a problem). Hair loss can be nonscarring or scarring, and this is an important branching point that can help guide diagnosis and treatment as well as manage patient expectations.  

Microscopic examination of the hair may assist in diagnosis, or a biopsy may be required to establish etiology. Laboratory tests can identify infections, hormone imbalances, or vitamin deficiencies. Depending on the diagnosis, behavior modification, medication, and even surgery may be indicated to reverse hair loss or slow progression of disease. 

So, what do we mean by nonscarring and scarring alopecia? Click on the diagnoses below to learn more in VisualDx.

Scarring Alopecia

Scarring alopecia is inflammatory and destroys hair follicles, causing permanent hair loss. 

Scarring alopecias: 

• Central centrifugal cicatricial alopecia 
• Traction alopecia 
• Folliculitis decalvans 
• Frontal fibrosing alopecia 
• Kerion 
• Halo scalp ring 
• Nevus sebaceous 
• Aplasia cutis congenita 

Nonscarring Alopecia

Nonscarring alopecia does not cause destruction of hair follicles, so hair loss may be temporary / hair may grow back. 

Nonscarring alopecias: 

• Tinea capitis 
• Trichorrhexis nodosa 
• Telogen effluvium 
• Alopecia areata 
• Male pattern alopecia (androgenic alopecia) 
• Female pattern alopecia (androgenic alopecia)