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Male and Female-Pattern Baldness

Male-pattern baldness is the most common type of hair loss. As well as affecting men, it can sometimes affect women (female-pattern baldness). It can be particularly difficult for both men and women to cope with. Male-pattern baldness follows a pattern of a receding hairline, followed by thinning of the hair on the crown and temples. During female-pattern baldness, hair usually only thins on top of the head. Male- and female-pattern baldness is also called androgenic or androgenetic alopecia. Male-pattern baldness is a condition that runs in families, but it is not clear if this is the case with female-pattern baldness.

Alopecia areata

Alopecia areata is patches of baldness that may come and go. It can occur at any age, but mostly affects teenagers and young adults. Six out of 10 people affected develop their first bald patch before they are 20 years old. Alopecia areata is thought to be caused by a problem with the immune system (the body's natural defence against infection and illness). It is also believed that some people's genes make them more susceptible to alopecia areata, as one in five people with the condition have a family history of the condition. In many cases the hair grows back after about a year.

Scarring alopecia

Scarring alopecia, also known as cicatricial alopecia, is hair loss that can occur as a result of complications from another condition. In this type of alopecia, the hair follicle (the small hole in your skin that an individual hair grows out of) is completely destroyed. This means your hair will not grow back.
Conditions that can cause scarring alopecia include lichen planus (an itchy rash affecting many areas of the body) and discoid lupus (a mild form of lupus affecting the skin, causing scaly marks and hair loss).

Anagen effluvium

Anagen effluvium is widespread hair loss that can affect your scalp, face and body. One of the most common causes of this type of hair loss is the cancer treatment chemotherapy.
It may be possible to reduce hair loss from chemotherapy by wearing a special cap that keeps the scalp cool. However, scalp cooling is not always effective and not widely available.
In most cases, hair loss in anagen effluvium is temporary. Your hair should start to grow back a few months after chemotherapy has stopped.

Telogen effluvium

Telogen effluvium is a common type of alopecia where there is widespread thinning of the hair, rather than specific bald patches. Hair is shed from the scalp, usually as a reaction to stress or medication. This type of hair loss tends to improve without treatment after a few months.
Read more about the symptoms of hair loss and the causes of hair loss.

How is hair loss treated?

More common types of hair loss, such as male-pattern baldness, do not need treatment because they are a natural part of ageing and do not pose a risk to your health. However, any type of hair loss can be distressing, so you should see your GP if you are worried about it. Your GP should be able to diagnose your type of hair loss by examining your hair, and they can also discuss possible treatments with you. It is advisable to visit your GP before you try a private consultant dermatologist (skin care specialist).

If you wish to seek treatment for male-pattern baldness for cosmetic reasons. However, these treatments are not effective for everyone and only work for as long as they are continued. These treatments are also not available on the NHS and can be expensive. Alopecia areata is usually treated with steroid injections, although it is sometimes possible to use a steroid cream, gel or ointment. A treatment called immunotherapy may also be used. This involves stimulating hair growth by causing an intentional allergic reaction in the affected areas of skin. If you have significant hair loss of any type, you may decide to wear a wig. Wigs are available on the NHS, but you may have to pay for one unless you qualify for help with charges. There are also some surgical options for hair loss, including a hair transplant and artificial hair implants.
Read more about diagnosing hair loss and treating hair loss.

Emotional issues

Hair loss can be difficult to come to terms with. The hair on your head can be a defining part of your identity. It reflects the image you have of yourself and how you want others to see you. If you start to lose your hair, it can feel as if you are losing part of your identity. This can affect your self-confidence and sometimes lead to depression. Speak to your GP if you are finding it difficult to deal with your hair loss. They may suggest counselling, which is a type of talking therapy where you can discuss your issues with a trained therapist. You may benefit from joining a support group or speaking to other people in the same situation – for example, through online forums. A number of charities, such as Alopecia UK, have support groups and online forums where you can talk to others who are experiencing hair loss.

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SCARRING ALOPECIA

Scarring alopecia, also known as cicatricial alopecia, refers to a collection of hair loss disorders that may be diagnosed in up to 3% of hair loss patients. It occurs worldwide in otherwise healthy men and women of all ages.

Each specific diagnosis within this category is fairly rare, but some examples include dissecting cellulitis, eosinophilic pustular folliculitis, follicular degeneration syndrome (previously called "hot comb" alopecia), folliculitis decalvans, lichen planopilaris, and pseudopelade of Brocq, to name a few. Scarring alopecia may also be part of a much larger condition such as chronic lupus erythematosus, where many organs of the body can be affected.

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Understanding Hair Loss

Although you can't reverse natural balding, you can protect your hair from damage that may eventually lead to hair thinning.  Many people put tremendous stress on their hair. Hair dryers, hot curlers, hair dyes, permanent and hair straightening products, and chemical-laden cosmetics may cause dry, brittle, and thinning hair.  To prevent hair damage that may cause hair loss, follow these tips: Go natural: Leave your hair its natural color and texture. If that is not an option for you...

Read the Understanding Hair Loss

While there are many forms of scarring alopecia, the common theme is a potentially permanent and irreversible destruction of hair follicles and their replacement with scar tissue.

Most forms of scarring alopecia first occur as small patches of hair loss that may expand with time. In some cases the hair loss is gradual, without noticeable symptoms, and may go unnoticed for a long time. In other instances, the hair loss is associated with severe itching, burning, and pain, and is rapidly progressive.

The scarring alopecia patches usually look a little different from alopecia areata in that the edges of the bald patches look more "ragged." The destruction of the hair follicle occurs below the skin surface so there may not be much to actually see on the scalp skin surface other than patchy hair loss. Affected areas may be smooth and clean, or may have redness, scaling, increased or decreased pigmentation, or may have raised blisters with fluids or pus coming from the affected area.

These visual indicators may help with diagnosis, but it is difficult to diagnose a scarring alopecia just from the pattern of the hair loss and the nature of the scalp skin. Often when scarring alopecia is suspected, one or more skin biopsies are done to confirm the diagnosis and help identify the particular form of scarring alopecia. A small biopsy of 2 to 4 mm in diameter is taken and examined under a microscope. A pathologist or dermatologist will look for destruction of the hair follicles, scar tissue deep in the skin, and the presence and location of inflammation in relation to the hair follicles.

Often, the early stages of a scarring alopecia will have inflammatory cells around the hair follicles, which, many researchers believe, induces the destruction of the hair follicles and development of scar tissue. However, there is some argument about this among dermatologists, as sometimes a biopsy from a scarring alopecia-affected individual shows very little inflammation.

Scarring alopecia almost always burns out. The bald patches stop expanding and any inflammation, itching, burning, or pain goes away. In this end stage, another skin biopsy usually shows no inflammation around hair follicles. Bald areas usually have no more hair follicles. 

Sometimes, though, hair follicles, at least those at the periphery of a bald patch, are not completely destroyed and they can regrow, but often all that is left are just a few longitudinal scars deep in the skin to show where the hair follicles once were.