Types of Hair Loss
CCCA: women of African descent
FFA: post-menopausal Caucasian women
LPP: middle-aged caucasian women
DLE: autoimmune condition, typically only affecting the skin
Hair loss (or alopecia) can be divided into two general categories: Non-Scarring and Scarring.
Non-scarring Hair Loss
There are several types of non-scarring hair loss. These types of hair loss are not typically permanent; however, if left untreated, these forms of alopecia can eventually lead to permanent loss.
Telogen Effluvium- The hair grows in three phases- 1)Anagen (growing) 2) Catagen (resting) 3) Telogen (Shedding). Normally, 85-90% of the scalp hair is in the anagen phase, 2-3% is in catagen, and 10-15% is in telogen. Therefore, we should normally shed 100-150 hairs daily. However, if a stressor occurs (ie thyroid abnormality, iron deficiency, hormonal changes, medication change, pregnancy, hospitalization, or serious illness), up to 4-6 months later, the hair cycle can shift so that 20-40% of the scalp hair sheds or enters the telogen effluvium. This is usually manifested as significant shedding and decreased overall thickness of the hair. This entity is typically temporary, with the hair shifting back to normal cycling 6-12 months after the inciting stressor has been resolved. Rarely, telogen effluvium can be ‘idiopathic’, meaning no cause is found and may be chronic.
Androgenetic alopecia- Male and Female Pattern Hair Loss are the most recognizable forms of hair loss. Without treatment, the hair loss can become permanent. This entity leads to progressive miniaturization of the hairs in the affected area with each hair cycle, until the hair can no longer grow back. The best treatment of androgenetic alopecia is preventative!! It is best to prevent or slow down the hair loss, than to wait until the hair loss becomes noticeable to the public. At that point, it is more difficult to achieve regrowth with medication and may warrant treatment with surgical hair restoration.
Alopecia Areata- This entity is a less common form of non-scarring alopecia. Alopecia areata is an autoimmune condition, in which the immune system attacks the bulb of the hair follicle, causing the hair to fall out. It can leave large completely bald circular patches or diffusely bald areas.
Traction alopecia- Traction alopecia is typically loss around the hairline caused by tight hairstyling practices, such as tight ponytails, braids, weaves, and dreads. The tight hairstyles cause tenderness and inflammation around the hair follicles. Without stopping the inciting problem and treating the hair loss, traction alopecia can eventually lead to permanent, scarring hair loss.
Scarring Hair Loss
There are several types of scarring hair loss. They are caused by inflammation around the hair follicles that eventually heal over with ‘fibrosis’ or scar. These entities can be treated if diagnosed early. The goal of treatment is to stop the progression of the inflammation to allow the hair to regrow. However, once the scarring has begun, it becomes difficult to achieve regrowth.
Lichen Planopilaris (LPP)- For unknown reasons, LPP is typically seen in middle-aged Caucasian women. It typically leads to tender, burning, and/or itchy areas in the front of the scalp with redness, scaling, and bumps around the affected hair follicles.
Frontal Fibrosing Alopecia (FFA)- FFA is considered to be a variant of LPP; however, it is more commonly seen in post-menopausal Caucasian women. These women experience gradual hairline recession and eyebrow loss.
Central Centrifugal Cicatricial Alopecia (CCCA)- For unknown reasons, CCCA affects predominantly women of African descent. It can be accompanied by traction alopecia and may be related to a history of tight hairstyling practices or pomade use. It starts with mild tenderness and hair loss on the crown of the scalp. It left untreated, it can be a chronic progressive condition, leading to cosmetically disfiguring balding.
Discoid Lupus Erythematosus (DLE)- DLE is an autoimmune condition that typically only affects the skin. However, rarely, these individuals can develop systemic lupus erythematosus. When DLE affects the scalp, it can cause reddish-purple or brown plaques with hair loss in the affected areas.