What is alopecia?

Alopecia means hair loss. There are different types of alopecia. Some types can cause you to lose hair from a single area. Other types can cause hair loss from several areas of your head, face or body.

Common types of alopecia include:

• male pattern hair loss
• female pattern hair loss
• alopecia areata
• telogen effluvium

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What causes alopecia?

Androgenetic alopecia

Androgenetic alopecia is the name for both male pattern hair loss and female pattern hair loss. It usually runs in families. It is caused by the effects of androgens (male hormones) on your hair follicles. Most of the time, hormone levels are normal.

Alopecia areata

Alopecia areata is an autoimmune disease that occurs when your immune system attacks your hair follicles. No one knows for sure what causes this, but it’s probably triggered by a combination of genetics and environmental factors. In some people, it might be triggered by extreme stress or anxiety.

Telogen effluvium

Telogen effluvium is where a shock to your body stops your hair growing temporarily. This can continue for a few months, and during this time more of your old hairs fall out than usual. Because it takes time before your new hairs grow, this causes temporary hair loss.

Triggers that can cause this include:

• childbirth
• fever
• surgery or trauma
• stress
• sudden weight loss
• health conditions such as hypothyroidism or lupus
• starting or stopping some medicines

Other causes

Other causes of hair loss include:

• medicines such as cancer treatments
• infections such as tinea
• skin diseases such as psoriasis
• pulling out your hair, which may be due to a mental health condition
• chemicals, bleach, heat from a hair dryer or brushing your hair too much
• traction alopecia — if your hair is under tension in a tight hairstyle

What are the symptoms of alopecia?

Alopecia areata

Alopecia areata usually leads to one or more circular patches of hair loss, usually on your head. Bald patches can get bigger quickly. The skin in these patches looks normal. You may have some white or broken hairs in the bald patches.

You may have an itchy or burning feeling in the area, but most people won’t feel any different to usual. You might have tiny pits in your nails.

The hair usually grows back, but it can take several months or even years. Sometimes your hair will fall out again and then grow back again, with alopecia coming and going. In some people, it may never grow back.

Occasionally, alopecia areata can be much more widespread. Alopecia totalis is when all the hair on your head falls out. Alopecia universalis is when all your hair falls out — on your head, face and body. It’s less likely that hair will grow back if there is more extensive hair loss.

Scarring alopecia

Some health conditions cause alopecia where the skin in the bald patches looks red, swollen, scaly or blistered. If it’s not treated early, it can lead to permanent scarring of the skin.

How is alopecia diagnosed?

Talk to your doctor if you’re worried about hair loss. Your doctor might refer you to a dermatologist. Often, they can diagnose what is causing your hair loss by asking about your symptoms and examining you.

If they are unsure about what’s causing your hair loss, they might take a sample of skin or hair to examine more closely. Your doctor might refer you for blood tests to rule out health conditions that may lead to hair loss.

How is alopecia treated?

Treatment of alopecia depends on what is causing it. You may have an underlying infection or health condition that can be treated. If it’s caused by a medicine, you may be able to stop taking it.

If you have androgenetic alopecia, you can take medicines to slow down hair loss.

There is no cure for alopecia areata, but there are many different treatments that might help, such as:

• strong cortisone creams or lotions
• cortisone injections into the bald patch
• a range of other topical medicines that a specialist dermatologist might prescribe
• phototherapy
• medicines to suppress your immune system (in more severe cases)

If you have smaller patches of alopecia areata that are likely to grow back, you might choose not to have any treatment.

Living with hair loss

Sometimes, treatments don’t work and you may need to learn to accept your hair loss. This may not be easy. For many people, hair loss can be upsetting and embarrassing and affects their  self-image, self-esteem or mental health. You might find it helpful to see a psychologist for counselling or to join a support group.

There are practical actions that a person living with alopecia can take. These include wearing a wig or hat, shaving your head (for example, if your remaining hair is very fine, broken or coming out in clumps), using hair products to add volume to your hair or getting eyebrow tattoos.

Where can I find help?

If you are finding it difficult to accept your hair loss, remember that you are not alone. There is help and advice available to you.

• The Australia Alopecia Areata Foundation provides helpful material as well as support groups.
• Beyond Blue can help you if you feel anxious or depressed. Call 1300 22 4636 anytime.