What are different types of alopecia (hair loss)?
Hair loss is divided into two main types, scarring and non-scarring.
Scarring alopecia occurs through inflammation and leads to destruction and scarring of the hair follicles. Once a hair follicle is destroyed as a result of scarring alopecia, it will not recover.
On the other hand, non-scarring alopecia is defined as hair loss without the development of scarring. In many cases, if intervention occurs early enough, the hair follicle can recover and regrow hair. Non-scarring types of alopecia include androgenic alopecia (patterned hair loss occurring through the aging process), alopecia areata, telogen effluvium, and anagen effluvium.
Why do people develop androgenic alopecia (patterned hair loss)?
Over 30% of men over age 30 and 50% of men over age 50 will experience patterned hair loss (androgenic alopecia). It is also a frequent cause of increased shedding and hair density reduction (hair loss) in women. Over 160 genes (inherited from mom and dad) are involved in the process of androgenic alopecia. It is often thought that “balding” comes from a mother’s father, for example, but the truth is that many genes are involved in this process. Besides genetic inheritance, androgenic alopecia is also potentially related to how much emotional and physical stress an individual is experiencing. For example, lack of sleep, excessive alcohol use, tobacco use, poor diet, exposure to pollution and harmful chemicals can promote hair loss. Lastly, in certain cases, nutritional deficiencies, such as low vitamin D, zinc, or iron, are also implicated in hair loss.
A consultation with your dermatologist is the first step to determine what kind of alopecia you may be experiencing, whether any lab testing is required, and treatment options are available to you.
What are common labs used to test patients with alopecia?
Iron studies, thyroid function tests, zinc and vitamin D levels
Will a skin biopsy be required to check for the type of alopecia?
For scarring alopecia, it is very common to obtain a biopsy to help determine the proper diagnosis. For non-scarring alopecia, a skin biopsy is often not necessary. However, there are situations when differentiating between various types of alopecia can be difficult on direct examination alone, and in this case a skin biopsy can be very helpful to secure the proper diagnosis.
What are the treatment options for scarring alopecia?
Scarring alopecia is divided into lymphocytic and neutrophilic causes of alopecia.
Lymphocytic causes include lupus erythematosus, central centrifugal cicatricial alopecia, lichen plano-pilaris. In general anti-inflammatory treatments, such as steroids, plaquenil, and immunosuppressant medications can be helpful treatments. Neutrophilic causes of alopecia include folliculitis decalvans and dissecting cellulitis. Often antibiotics or retinoid (isotretinoin) therapy are useful treatments.
Androgenic Alopecia (Patterned hair loss)
The FDA-approved therapies for patterned hair loss (“balding”) include minoxidil and finasteride.
Minoxidil is available as an over-the-counter treatment that is applied directly to the scalp. Originally developed to lower blood pressure, minoxidil was shown to improve hair growth as well. Minoxidil is available as a 2% and 5% topical application (either in a foam or a liquid). Some also advocate the use of low dose oral minoxidil in the treatment of alopecia (oral treatment of alopecia with minoxidil is an FDA off-label therapy).
Finasteride blocks 5-alpha reductase, thus lowering the concentration of DHT (dihydrotestosterone, the more potent form of testosterone). DHT is thought to trigger hair follicle miniaturization and shorten the growth phase (anagen phase) of the hair follicle. Finasteride is now available as a generic (non-branded) therapy and is a relatively low-cost option for the treatment of alopecia. Dutasteride, the more potent blocker of 5-alpha reductase, is also available as a non-FDA approved therapy for hair loss.
Alternative treatments for alopecia include low-level light therapy and PRP injection.
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