Human beings have been losing their hair since the dawn of our species. For some, it’s a slow and gradual process, and for others, it disappears at a rate of knots (yes, that's a hair pun, and no, we are not ashamed). Sometimes it’s a rapidly receding hairline, sometimes it’s that ever-growing halo making its mark on your crown, and sometimes it’s little patches here and there with seemingly no pattern whatsoever. Those unfamiliar with hair loss might assume these are all various manifestations of the same disease process, but in reality, there are multiple different causes for the loss of your lid. It’s important that you understand what kind of hair loss you may have, and how it should be treated.
Hair loss disorders are generally divided into two broad categories - scarring and nonscarring alopecias. Nonscarring alopecias make up most of the cases of hair loss that are seen in clinical practice and include some of the more usual suspects like male pattern hair loss, alopecia areata and telogen effluvium. These disorders are usually treatable, and the resulting hair loss is (to an extent) reversible. Below we’ll explore some of the more common types of hair loss and how to spot them.
Androgenic Alopecia (AGA)/Male Pattern Hair Loss (MPHL)
This is the most common type of hair loss, affecting approximately 90% of men who present with hair loss. While women may also experience AGA, known as female pattern hair loss (FPHL), it disproportionately affects men. This type of hair loss causes the classic M-shaped receding hairline, thinning at the crown or the infamous horseshoe pattern, which most people are familiar with. The age that this type of hair loss begins varies widely, with some experiencing hair loss as early as their teens while others only begin losing their hair well into middle age. The underlying cause of this type of hair loss is related to the effects of dihydrotestosterone (DHT) on the hair follicle as well as multiple inflammatory pathways resulting in disruption of the hair growth cycle and miniaturisation of the hair follicles, ultimately causing one’s hair to thin and eventually fall out. Various medications have been developed to treat androgenic alopecia, with minoxidil and finasteride being the only two FDA-approved treatments currently available amongst myriad other treatments ranging from rigorously tested and scientifically backed solutions to pseudoscientific snake oils and supplements.
Alopecia Areata (AA)
Alopecia areata classically causes one or more bald spots (or lesions) to appear, usually in the size and shape of a small coin. While the exact cause has not been determined, it is believed that it arises as a result of an autoimmune mechanism, where the body’s immune system launches an (unprovoked) attack on the hair follicles in a certain patch of hair. It is not very common, with less than 1% of the population being affected. There is no cure for the disease but using steroid injections into the lesions or topically applied steroid creams may help to speed up hair regrowth.
Telogen Effluvium (TE)
This condition is caused by a disruption of the normal hair growth cycle whereby more than 10% of your hair follicles are in the telogen phase, which means that a lopsided amount of your hair follicles is dormant or resting. The cause of TE is poorly understood but can often be explained by body trauma or stressors, which include things like poor nutrition and eating disorders, giving birth, having undergone an operation, significant emotional distress, various acute and chronic illnesses, and certain drug use. Various prescription and non-prescription treatments have been evaluated for use in TE, but usually, management of the underlying condition will result in normalization of the hair cycle and hair regrowth will occur over a few months following the initial hair loss episode.
Anagen Effluvium (AE)
This disease is similar in its mechanism to TE in that it occurs as a result of a disruption of the normal hair cycle, in this case specifically during the anagen phase of the cycle. It has classically been described in patients with cancer receiving certain chemotherapeutic agents and in radiation therapy to the head or scalp.
Traction Alopecia (TA)
Traction alopecia is a type of mechanical alopecia where the mechanism of hair loss is due to external forces acting on the hair, rather than an underlying disease process. This is quite a common form of hair loss, usually resulting from a primary pulling force being applied to the hair. It is seen in both men and women who wear their hair in tight ponytails, braids or other hairstyles that require traction on the hair to create the style. This continuous traction results in the hair being prematurely pulled from the follicles and the hair loss usually only lasts as long as it takes new hair to grow in its place. Various types of headgear and chemical treatments can also result in traction alopecia.
Trying to figure out what type of hair loss you are experiencing may not be such an easy task. While the cause could be environmental, lifestyle choice, or genetic – taking early and proactive action is likely to improve your chances of successful treatment. We encourage you to talk to a doctor to help identify the cause of your hair loss and choose an appropriate treatment method!