Hair loss can be a major source of distress. Learn about different types of hair loss for better diagnosis and management of alopecia conditions in your patients.
Communication is key:
- Recognize the psychological and social impact on patients.
- Discuss the diagnosis thoroughly.
- Establish realistic expectations and goals for treatment.
Female pattern alopecia
Male pattern alopecia
Androgenic alopecia
Androgenic alopecia, also known as male-pattern alopecia and female-pattern alopecia, is the most common type of hair loss and, as the names suggest, can affect both men and women, although with different patterns of hair loss. Individuals with a positive family history have an increased risk.
- Patient pearls: Explain that androgenic hair loss is nonscarring, so there is a population of cells that can grow and increase hair with treatment. Also, reassure patients that normal hair grooming practices, including regular hair washing, are not harmful.
Alopecia areata
Alopecia areata is a relatively common autoimmune disease affecting hair follicles. Hair loss usually occurs in one or a couple of small patches involving the scalp, eyebrows, eyelashes, or body hair. History of sudden onset is characteristic. More severe cases involve loss of all the hair on the scalp, or all the hair on the scalp and body.
- Patient pearls: Help patients understand the unpredictable nature of the disease; there is often a chance for some regrowth. Wigs, hats, caps, and scarves are important options for some patients. The National Alopecia Areata Foundation is a valuable patient resource.
Central centrifugal cicatricial alopecia
Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia predominantly affecting middle-aged women of African descent. The exact pathogenesis is unknown, but its cause is likely multifactorial. Look for progressive hair loss, starting as a single patch at the vertex of the scalp and then expanding in a centrifugal and symmetrical pattern.
- Patient pearls: Advise patients that early intervention affords the best outcome, as areas that have scarred will not reverse. Encourage patients to minimize hair grooming. Early treatment may include topical, intralesional, or systemic medication.
Frontal fibrosing alopecia
Frontal fibrosing alopecia is a scarring alopecia that presents as a progressive, symmetric band-like zone of hair loss along the anterior hairline. Women aged 55-65 years are most commonly affected, but younger women and men may be affected as well. The eyebrows are often thinned or absent. In men, the sideburns and facial hair may be involved.
- Patient pearls: Explain to patients that therapies may stop or slow progression but generally do not lead to hair regrowth. Concomitant androgenic alopecia is common and can be treated.
Traction alopecia
Traction alopecia is a condition of the scalp secondary to trauma of the hair shaft. The hair shaft is weakened by various hair grooming practices including frequent tight braiding, use of elastic bands and tight rollers, tight ponytails, decorative cornrows, and excessive brushing or heat at the roots. Chemically relaxed hair with these styles is more susceptible.
- Patient pearls: Discourage hairstyles that place tension on the hair. Traction alopecia can be reversed with early treatment using medications. Permanent hair loss can result, however, if the condition is not treated or trauma to the hair shaft persists.
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