Alopecia – Symptoms, Treatments, Clinical Trial Findings and More

Keywords: Alopecia Symptoms, Hair loss Causes

Quick Links:

• What is Alopecia?
  • Male Pattern Baldness
  • Female Pattern Baldness
  • Alopecia Areata
• Symptoms of Alopecia
• When to see a doctor
• Causes of Alopecia
• Clinical Treatments of Alopecia
  • Male or Female Pattern Baldness
  • Alopecia Areata
  • Other treatments
• MedBuzz Clinical Trial Findings

What is Alopecia?

Alopecia (or hair loss) is a condition that causes people to lose hair from the head, face or body. The most common types of alopecia are:

• Male pattern baldness (or androgenetic alopecia in males)
• Female pattern baldness (or androgenetic alopecia in females)
• Alopecia areata

Alopecia can be temporary or permanent. It can happen to anyone, though it is more common in men. Alopecia can be left untreated or simply covered up, otherwise, patients can undergo treatments to prevent further loss or restore hair growth. People who experience hair loss should speak to their doctor about ruling out other causes e.g. thyroid problems, cancers, medications.

Male pattern baldness (MPB)

Male pattern baldness is the most common type of hair loss in men. It is caused by a change in hair growth cycles. Either due to hormonal changes or genetic predisposition, the growth cycle gets weaker and weaker, especially with age, until the hair follicle shrinks so much that no new hair grows. 

Classic signs of MPB occurring is a receding hairline – hair moving back on the forehead – or thinning of the hair – this can start in a horseshoe shape on the top of the head or thinning of the whole head of hair. More than 50% of all men over the age of 50 will experience some type of male pattern baldness.

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Female pattern baldness (FPB)

About one-third of all women experience hair loss at some point in their lives. Hair loss in women tends to begin along the parting line working its way outwards, and a general thinning of the hair radiating from the top of the head. It’s rarer for women to become completely or partially bald from FPB. 

There are a number of causes for FPB including some medical conditions, stress or medications. Additionally, it can be a result of greater sensitivity to hormones but more research needs to go into understanding causes of FPB further.

Alopecia areata

Alopecia areata is an autoimmune disorder that causes temporary hair loss on the head or body, often quickly and in clumps. It is characterised by non-scarring hair loss in one or multiple areas of the scalp, face or body. Alopecia areata is caused by a genetic predisposition and an environmental trigger such as stress. The hair usually grows back but it can take many months. 

Other less common types of alopecia include:

• Alopecia areata totalis: total loss of on your head
• Alopecia areata universalis: total loss of hair on your body. 
• Diffuse alopecia areata: a sudden, non-patchy thinning of your hair
• Ophiasis alopecia areata: hair loss in band shapes around the sides and back of your head.

Note: Telogen effluvium is a form of hair loss that happens after stressful events or a traumatic event, that is different from alopecia areata, or other types of alopecia.

Symptoms of Alopecia

Hair loss can happen in many different ways, on any part of your body. Here are the most common types of scalp hair loss:

• Gradual thinning from the top of the head: The most common type of hair loss, commonly affecting people as they age. Men often see it first as a receding hairline, and in a horseshoe shape on the top of their head. Women experience it first from their center part, radiating outwards.
• Bald or circular patches: Occurring in circular patches on the scalp, facial hair or on the rest of the body.
• Sudden shedding of hair: This is most often noticed whilst showering or brushing hair, but can often cause overall thinning of the hair. This type is usually temporary and caused by emotional or physical stress.
• Full-body hair loss: Usually as a side effect of treatments such as cancer treatment.
• Patches of scaling: When this is spread over the scalp, it is usually a sign of ringworm and is usually accompanied by broken hair, redness, swelling and/or oozing.

When to see a doctor

If you notice sudden hair loss, or you’re distressed by gradual hair loss over time, speak to your doctor about your choices. The earlier the better when it comes to hair loss and recovery treatment. 

It is also good to see a doctor as you notice it, so they can rule out any other more severe illnesses.

Causes of Alopecia

Around 50-100 strands of hair is lost every day, and usually, it isn’t noticeable. Hair loss starts to become noticeable when the lost hair comes out in clumps or isn’t replaced. There are a number of suspected causes of hair loss or alopecia.

• Genetic predisposition or hereditary: Aging causes this type of hair loss. Some people are more likely to start losing their hair as they age. Usually, if you can see this in your parents or grandparents, there is a higher chance of you also experiencing some hair loss. This condition is female pattern baldness and male pattern baldness and is a gradual loss.
• Hormonal changes: This can sometimes relate to the above condition with changing hormones as you age. Other hormonal changes can include pregnancy, childbirth menopause, increased stress, hormonal treatments, or thyroid problems.
• Medical conditions: Some conditions such as alopecia areata, an immune system related issue, can cause hair loss.
• Medications or supplements: Medications to certain illnesses such as cancer, arthritis, depression, heart, gout or high blood pressure can cause hair loss.
• Radiation: Radiation therapy to the head might cause the hair to fall out and grow back differently to before.
• Certain hair treatments or hairstyles: Hair treatments that involve high temperatures, pulling, or chemicals that damage hair (e.g. peroxide) can cause the hair to thin. Hairstyles that involve pulling the hair e.g. pigtails or cornrows or can cause hair loss around the hairline. This is called traction alopecia.

Risk Factors of Alopecia

Those who are more at risk of developing alopecia is varied, but a number of factors can play a part in your chances of losing hair. These include: 

• A family history of hair loss
• Age
• Significant weight changes
• Medical conditions
• Malnutrition or poor general health
• High levels of stress

Clinical Treatments for Alopecia

Male & female pattern baldness

There are some useful treatments for male or female pattern baldness, causing a slow or reversal of hair loss, that range from topical or injection to more invasive treatments like transplants or implants. These treatments aren’t a cure, so you need to continue with them to avoid losing hair again.

• Minoxidil (Rogaine): Minoxidil or Rogaine comes in a number of forms, like foams, liquids or hair washes, and can be purchased without a prescription. It is most effective when taken 1-2 times per day, and you can expect to see results from about 6 months from starting the routine. Side effects include hair growth on hands or other parts of the face and some scalp irritation. Speak to your doctor about how you can use it for your condition. 
• Finasteride (Propecia): Taken as a daily pill, this drug is a prescription for men and many see an improvement in the thickness or regrowth of hair within the first 6 months. Poorer results have been shown in men over 60, and some rarer side effects include a loss of sex drive and function and an increased risk of prostate cancer. The drug is potentially harmful to pregnant or soon to be pregnant women.
• Hair transplant: This involves the relocation of healthy hair from a non-affected part of the head by a dermatologist or cosmetic surgeon, onto the bald or affected area. Though hospitalisation isn’t required, it’s quite a serious treatment. Sedation medicine will be given, and side effects include bleeding, bruising, swelling and infection in some cases. This is not a solution to hereditary hair loss such as male/female pattern baldness as the condition will still progress after surgery.
• Laser therapy: Some low-level laser treatments have shown to improve hair thickness and density, but more studies are needed to show long-term side effects.
• Certain styling products: Purchased at hair salons, hairdressers can suggest products that increase volume, or make the thinning less noticeable. 

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Alopecia areata

Currently, there is no cure for alopecia areata. Treatments for this condition are focused on patients regrowing their hair quicker. These treatments include:

• Corticosteroids: An anti-inflammatory drug for autoimmune diseases, usually taken as an injection into the scalp or areas of hair loss. It suppresses the immune system to stop your body from attacking the hair cells.  Alternatively, it can be applied topically on the area. Results usually take a number of months to show. 
• Topical immunotherapy: When there are repeated or large amounts of hair loss, topical immunotherapy is used on the area to produce an allergic reaction. This reaction causes a rash that causes the hair to grow back.
• Minoxidil (Rogaine): A treatment for male pattern baldness, Minoxidil can also be used for alopecia areata. Results usually take a number of months to show, if at all.

Other treatments for Alopecia

Though most types of alopecia are non-preventable, there are some steps you can take to slow the process of hair thinning and minimise hair breakage that gives a thin look. These include:

• Avoid detangling without a detangler brush: Additionally, brushing out knots with a conditioner or liquid detangler will limit the amount of breakage.
• Avoid harsh hair treatments or hairstyles: Hot rollers, straighteners or curlers shouldn’t be used often. Additionally, hot oil treatments and chemical dyes should be used with extreme care and shouldn’t be done often. Avoid pulling the hair back in tight ponytails or hairstyles, and limit the usage of rubber bands or brains in styles.
• Ask your doctor about your medication side effects: Some medications can cause hair loss in rare cases, so it’s best to speak to your doctor if you’ve suddenly experienced hair loss on your current medication. If you’re undertaking chemotherapy, ask your doctor about cooling caps that might reduce the amount of hair loss on your head.
• Supplement your diet: There are a number of nutritional supplements that can support healthy skin, nails, and hair. You might be deficient in some vitamins that could make a difference in your hair. Ask your doctor for supplements they would recommend.
• Avoid long hours unprotected in the sun: Too much ultraviolet light can cause thinning hair. With thinner hair, you are at a higher risk of melanoma (skin cancer) developing on your head with more light passing through to your scalp.
• Avoid smoking: Links have been found between smoking and baldness.

MedBuzz Clinical Trial Findings:

We do the research so you can be better informed!

There are a number of active trials around the world on hair loss and alopecia areata. The following trial findings provide a better understanding of alopecia, how it happens, and the best ways to treat it. 

• Minoxidil dosage: In a clinical trial in 2002, researchers found that 5% topical minoxidil was more effective than 2% topical minoxidil and placebo in increasing hair growth in men with male pattern baldness. With the increased dosage, there were some side effects such as irritation and itchiness. 
• Platelet-rich plasma (PRP): In a clinical trial in 2018, researchers tested the effectiveness of a series of subdermal (head) PRP injections over 6 months for patients with alopecia. Participants demonstrated “significant” increases in hair count from baseline to 6 months, with more successful patients receiving more frequent injections over the 6 month period.
• Decreased tissue iron stores: In a clinical trial in 2003, subjects’ tissue iron stores in their body with alopecia areata, androgenic alopecia and alopecia totalis/universalis were compared to those with normal hair or no hair loss. They found that tissue iron stores in androgenetic were “significantly” lower than those without hair loss.
• Finasteride: In studies of men with male pattern baldness, researchers found men with low levels of testicular androgens, or low levels of dihydrotestosterone were more likely to exhibit symptoms of male pattern baldness. Finasterid is a type 2-selective 5αR inhibitor that demonstrated some improvements in scalp hair growth, in men only.
• Baricitinib: In a clinical trial of 1 patient, doctors observed a ‘striking improvement’ of their alopecia areata condition after 1 year of daily dose treatment taken via pill.
• Oral ruxolitinib: In a clinical trial in 2016 of 12 patients with alopecia areata, 75% demonstrated “remarkable response” after 6 months of treatment, with an additional decrease in inflammatory markers and an improvement of hair-specific markers. 

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Sources:
HealthDirect.gov
MedicalNewsToday.com
HealthLine.com
Health.Harvard.edu
Mayoclinic.org
Dermcoll.edu
Feature image: MedicalExpress.com