Learn About Alopecia Areata

This form of irregular hair loss – on the scalp and sometimes elsewhere on the body – has incomplete understanding and treatment. But some can be reversed.

It might help anyone with a new diagnosis of alopecia areata to know they’re not alone. Approximately 5 million Americans suffer from the condition of patchy or complete hairloss that falls outside the definition of pattern baldness and, unfortunately, outside the effectiveness of most common hair loss treatments.

While it can take several forms – simple coin-size patches of hair loss in the scalp, complete loss of hair on the scalp (alopecia totalis), a total loss of hair on the head and body (alopecia universalis), and some combinations of the above to varying degrees – alopecia areata is believed to be caused by an autoimmune disorder. This occurs when the body’s immune system attacks a healthy body part (in this case, hair follicles) as it would a foreign and harmful invader (such as a virus). The cause is probably a combination of genetics and environmental factors, although variances between individuals make a definitive, scientifically valid finding elusive.

Alopecia areata is more psychologically damaging than physically disabling in most instances. Bare scalp and other areas need to be protected from the elements (sun, cold), but its aesthetic effect is what most patients seek to address.

What is known about alopecia areata is that it can sometimes be reversed. For some, it happens once and reverses itself. For others, it can become a permanent condition. The factors that are somewhat predictive of a positive outcome (less hair loss, reversal of alopecia areata) are adult (vs. childhood) onset of the condition; minimal loss in general; absence of changes to fingernails (associated with advanced cases); absence of strong family history; and absence of multiple autoimmune conditions. Simply having alopecia areata is not necessarily an indication of another, larger health challenge.

As one might expect, treatment for the condition varies by the type and extent of it, and by individuals. The good news is that while the hair follicles are attacked in a case of mistaken identity (that hair follicles are foreign invaders), so to speak, those follicles do not go away. They can be rejuvenated by time or treatment – not always, but often. Here are some options:

Medical topical treatments – While the common medical hair loss treatment Minoxidil will not be effective in the short term, some patients with mild alopecia areata experience regrowth if applied for a year or longer. It is available without a prescription. Surprisingly, an irritation of the affected skin areas with the use of Anthralin or diphencyprone can also work, however the effect may take many months to be realized, if at all. Corticosteroid creams decrease follicular inflammation and can work in some patients.

Medicines (taken internally) – As with most internally taken medications, there is always a risk of serious side effects (high blood pressure, kidney and liver damage, lymphoma). That said, cortisone and immunosuppressants have proven effective in some cases.

Medicine (injections) – Micro-injections of steroids in the affected areas, repeated every one to two months, have proven effective in some patients. 

Medical phototherapy – Also called light therapy and photochemotherapy, used in combination with orally-taken psoralens, offer some restoration of hair growth.

There is a great deal of interest in “natural” treatments for balancing the human immune system, which is off-balance in the case of alopecia areata. These include various teas, aromatherapy, probiotics, the application of essential oils and onion juice, and anti-inflammatory diets. None are tested by the FDA and none have clinical documentation of efficacy. Suffice it to say that much more research and data need to be compiled to identify the specific causes and treatments for alopecia areata. With millions of people having some degree of it, expect that research will tell us more in the years ahead.

Learn About Traction Alopecia: Prevention and Treatment

Hair loss due to grooming techniques – tight hair braiding and ponytails in particular – might be frustrating. A change of style is the best preventative.

While the vast majority of individuals who experience alopecia – that’s hair loss of the involuntary kind – do so because of a genetic predisposition, at least one type of follicular demise is due to behaviors. Therefore, individuals must keep an eye on prevention, because hair loss solutions for this particular condition can be tricky business.

It’s called traction alopecia. It’s largely due to pulling the hair tightly, as in a ponytail or braiding, and thus affects women much more than men. But it plays no favorites with gender under certain circumstances: there are at least two examples of hair practices due to religious observances that can also lead to traction alopecia. One is with men of the Sikh religion, whose turbans conceal the uncut hair that characterizes their faith, which they sometimes pull tight with clips; the other is religions that forbid women from cutting their hair, in which case very long locks are heavy enough (with particularly thick hair) that gravity tugs on the hair roots.

A third cause of traction alopecia can be sports headgear, such as helmets of various types worn by skiers, snowboarders, bicyclists and motorcyclists. But that is under extreme use, and generally is accompanied by unchecked infections.

Who is most affected by traction alopecia?

African American women most commonly experience this condition because certain styling techniques within the culture, such as braiding and cornrows, involve tight tugging of the hair. Compounding it in individuals of any race and gender is the use of harsh chemicals to relax or otherwise condition the hair in certain ways. A related, chemically induced version of hair loss is central cicatricle centrifugal alopecia, also affecting primarily women of African descent.

Additionally, the use of hair weaves – sometimes used to conceal hair loss – that involve braiding a hairpiece into growing hair can tug on the roots, leading to traction alopecia.

The reversibility of this type of hair loss is considered a matter of timing and severity. Particularly where chemicals compound the physical tugging of the hair, the loss is more likely to be permanent.

Prevention and treatment of traction alopecia

The ways to halt or prevent this type of hair loss is a list of dos and don’ts:

DO change your hairstyle such that the tugging is occasional and not continuous, wrap your head in place of hair rollers while sleeping, choose a satin wig cap if you wear wigs, and wear weaves and extensions for only short periods of time.

DON’T pull hair tightly with ponytails, use chemical relaxers, use thinner braids (thicker braids tend to be pulled less tightly), use high heat settings in hair dryers or while ironing hair flat.

As for treatment of apparent hair loss due to traction alopecia, visiting a dermatologist is the smartest first step. A medical examination might involve taking a biopsy to determine if there is or is not another cause to the hair loss. If an infection is identified – which might itself lead to hair loss – your doctor can prescribe antibiotics, topical steroids or antifungal shampoos to correct for that.

Ultimately, over-the-counter treatments (minoxidil or biotin supplements) might be prescribed if your doctor determines that regrowth from traction alopecia is possible. If it’s too late for treatment, a referral to a more-than-competent studio that specializes in women’s hair loss solutions is advisable.

Male Pattern Baldness and Heredity

There are many myths around the causes of androgenic alopecia – male pattern baldness – but science is finally isolating the likely genetic basis of hair loss.

Before men go looking among the available hair loss solutions for men – hair transplant surgery, hair systems, laser hair therapy and more – it’s vital to have a good understanding about the types of hair loss that occur and why they occur. Not all hair loss treatments work for all men.

So let’s be clear about something from the start. Everyone, male and female, over the age of 18 sees hair in the shower drain catcher every morning. That’s because even the healthiest, thickest head of hair sheds up to 100 shafts per day. But those hairs are replaced with new hair. This is why about a third of the adult population of men, and a larger percentage of women, have a full head of hair well into their adult and even senior years.

The problems happen when those lost hairs aren’t replaced – what ultimately happens to about two-thirds of men, some younger than others. Androgenic alopecia, the type of hair loss commonly referred to as “male pattern baldness,” is just that: when the replacement hairs to those lost in the shower dwindles, with weaker, thinner hairs growing from the follicles (follicles are the roots of hair, what lies below the surface of the skin of the scalp). The follicles do not disappear but they lack the ability to grow strong hair without interventions, such as the use of pharmaceuticals (Propecia and minoxidil, for example).

The reason for this diminishing of hair growth is multifactorial. Poor health habits may contribute to premature hair loss, and there are multiple reasons for other types of alopecia, including infections and physical factors such as tight hair weaves (a problem most common among women of African heritage where such styles are favored).

That said, genetic factors – long suspected as contributors to hair loss – are increasingly considered as primary causes of hair loss. A study published in 2017 in PLoS Genetics (“Genetic prediction of male pattern baldness, Hagenaars, Hill, Marioni, et al.; the publication is a peer reviewed scientific journal), which looked at 52,000 participants (all Caucasian men, between the ages of 40 and 69). It found “over two hundred independent, novel genetic correlates of male pattern baldness,” concluded the study authors. The study, which looked at men who participate in the UK Biobank, which has a total of 500,000 people who contribute blood, urine and saliva samples along with detailed self-reported information and agreements to have their health followed over time. The sheer depth of data in the Biobank lends credence to the baldness gene study.

Perhaps greater awareness of these genetic causes will diminish common myths over what leads to male pattern baldness. Those include: it comes from the mother’s genes (partially true, but the father’s genes show a strong correlation as well), it’s just a part of aging (it’s common for hair loss to become prominent among 20-year-olds), hats and helmets tug on follicles to cause hair loss (only if coupled with poor hygiene that leads to scalp infections), and it’s due to poor diet (only rapid losses and gains in weight, sometimes called yo-yo dieting, are connected to weight loss), and that emotional trauma causes hair loss (only if it was going to be lost anyway). So while much hair loss is due to genetic destiny, take heart. It’s not your fault – and you’re hardly alone.

Introduce Yourself (Example Post)

This is an example post, originally published as part of Blogging University. Enroll in one of our ten programs, and start your blog right.

You’re going to publish a post today. Don’t worry about how your blog looks. Don’t worry if you haven’t given it a name yet, or you’re feeling overwhelmed. Just click the “New Post” button, and tell us why you’re here.

Why do this?

  • Because it gives new readers context. What are you about? Why should they read your blog?
  • Because it will help you focus you own ideas about your blog and what you’d like to do with it.

The post can be short or long, a personal intro to your life or a bloggy mission statement, a manifesto for the future or a simple outline of your the types of things you hope to publish.

To help you get started, here are a few questions:

  • Why are you blogging publicly, rather than keeping a personal journal?
  • What topics do you think you’ll write about?
  • Who would you love to connect with via your blog?
  • If you blog successfully throughout the next year, what would you hope to have accomplished?

You’re not locked into any of this; one of the wonderful things about blogs is how they constantly evolve as we learn, grow, and interact with one another — but it’s good to know where and why you started, and articulating your goals may just give you a few other post ideas.

Can’t think how to get started? Just write the first thing that pops into your head. Anne Lamott, author of a book on writing we love, says that you need to give yourself permission to write a “crappy first draft”. Anne makes a great point — just start writing, and worry about editing it later.

When you’re ready to publish, give your post three to five tags that describe your blog’s focus — writing, photography, fiction, parenting, food, cars, movies, sports, whatever. These tags will help others who care about your topics find you in the Reader. Make sure one of the tags is “zerotohero,” so other new bloggers can find you, too.

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