Alopecia: Evaluation and Treatment

Alopecia refers to hair loss. Hair loss can occur due to various diverse causes. These are related to disease processes, drug intake, or inherited predilection for hair loss.

Classification of Alopecia

• Cicatricial or Scarring Alopecia: This occurs from inflammatory disorders affecting the scalp and hair follicles. This usually results in permanent hair loss as the follicles get irreversibly damaged. Infections, surgery, cancers, and radiation therapy can cause scarring alopecia.
• Non-cicatricial or Non-scarring alopecia:  This form involves limited inflammation and the hair follicles are generally preserved. These forms can often be reversed with appropriate treatment. The most common causes are:
• Alopecia Areata: This is an autoimmune condition where the body’s immune system attacks the cells in the hair follicles. This can be associated with other autoimmune conditions. The individual experiences hair loss in patches. Total loss of hair is also possible (alopecia totalis)
• Pressure-induced alopecia: loss of hair occurring a few weeks after a period of prolonged pressure to an area of the scalp. This is noted to occur after prolonged immobilization for long surgeries under general anesthesia. The patients eventually recover their hair.
• Traction alopecia: This occurs due to pressure and tension at the hair follicles from tight hairstyles.
• Male pattern baldness or androgenic alopecia: This is the classic hair loss seen in men with aging.
• Trichotillomania or hair plucking: this is a behavioral disorder with a compulsion to repeatedly pluck their own hair.
• Skin diseases: Systemic Lupus erythematosus (SLE), psoriasis, atopic and contact dermatitis
• Drug-induced: Chemotherapy is the most common reason for complete hair loss.
• Structural Alopecia: This category comprises of several disorders in which the basic structure of the hair is compromised leading to fragile and brittle hair. These may be inherited or arise from improper hair care practice. The most common being from use of chemicals for hair processing and applying excessive heat to the hair.

Symptoms of Alopecia

The exact symptoms experienced differ based on the underlying condition. In general, the following features are noted:

• Hair loss from the scalp in excess of normal daily hair loss. Hair is noted on the pillow and in the shower in large quantities
• Itching of the scalp
• Patterned hair loss may be seen

Evaluation of Alopecia

• History and Physical Exam: the exact course of the hair loss, pattern of loss, and associated medical conditions, medications, and family history is asked for. The scalp is examined thoroughly to look at the pattern of loss and to examine the hair follicles.
• Trichoscopy or Dermoscopy: this is a method of examination of the hair and skin using a handheld magnifying lens.
• Microscopic examination of the hair: The hair shaft and roots are examined under a microscope
• Scalp biopsy: This can help in making a diagnosis when the underlying cause is uncertain
• Blood tests: These may be required to rule out autoimmune conditions associated with hair loss. Testosterone levels may be measured in case of androgenic alopecia

Treatment of Alopecia

The treatment provided depends on the underlying cause

• Alopecia Areata: Local and systemic steroids may be tired depending on the extent of the hair loss
• Androgenic Alopecia: androgen blocking agents are generally prescribed
• Behavioral and lifestyle modification may be needed for trichotillomania and hair loss from traction or harmful hair care practices.
• Using a wig to cover up fallen hair in case of permanent loss or during transient loss from chemotherapy.
• Hair transplantation and laser therapy are newer methods available to stimulate hair growth.

References:

• Hair loss | American Academy of Dermatology [Internet]. [cited 2018 May 30].
• Alopecia Areata | American Academy of Dermatology [Internet]. [cited 2018 May 30].