A Guide to Understanding Alopecia

September 2024

by Dr. Ashley Cauthen

Hair loss can be a challenging experience, but understanding the different types of alopecia can help you manage your condition effectively. Whether you’re losing hair or just curious about hair loss, we’re here to break it down in a way that’s easy to digest.

What’s the Deal with Alopecia?

Alopecia is a fancy term for hair loss, and it comes in two main flavors: scarring and non-scarring. Think of it like the difference between a permanent marker (scarring) and a washable marker (non-scarring). Let’s dive into the most common examples of each type.

Scarring Alopecia: The “Permanent Marker” of Hair Loss

Scarring alopecia involves hair loss where the hair follicles are permanently harmed and replaced with scar tissue. It’s like when your toddler finds a sharpie and scribbles on your leather couch. No amount of cleaner or elbow grease is going to completely reverse that damage.

Types of Scarring Alopecia

-Lichen Planopilaris (LPP) and Frontal Fibrosing Alopecia (FFA

• Cause: Your immune system goes rogue and attacks your hair follicles.
• Treatment: Think of treatments as trying to negotiate peace with your immune system. Steroid creams and injections are the diplomats, while topical immunotherapy is the mediator. Often times we have to get creative with various off-label oral medications.  All of these help to calm inflammation and manage symptoms.
• Outcome: While treatment can help manage symptoms and slow progression, hair regrowth is limited.

-Discoid Lupus Erythematosus (DLE)

• Cause: Autoimmune disease that causes skin lesions, including on your scalp.
• Treatment: Sunscreen is your best friend here—sunlight is like the ultimate frenemy. Topical corticosteroids and antimalarial drugs like hydroxychloroquine help keep things under control.
• Outcome: With proper care, you can manage symptoms and prevent new lesions, but some scarring will be permanent.

-Central Centrifugal Cicatricial Alopecia (CCCA)

• Cause: Chronic inflammation, often seen in African American women.
• Treatment: Anti-inflammatory treatments are the mainstay, along with corticosteroids (topical and intralesionally).
• Outcome: Catch it early, and you might slow down the hair loss. Full regrowth is not guaranteed, but managing inflammation can help.

Non-Scarring Alopecia: The “Washable Marker” of Hair Loss

Non-scarring alopecia means the hair follicles are still in business, and there’s a chance for regrowth if you address the underlying issue. It’s like a washable marker—you’ve got a shot at a fresh start!

Types of Non-Scarring Alopecia

-Androgenetic Alopecia

• Cause: Genetics and hormones are in cahoots, causing hair to thin. Think of it as the classic “family heirloom” of hair loss.
• Treatment: Minoxidil (topical and/or oral) and finasteride/dutasteride or Spironolactone (women specifically) are your trusty sidekicks. Hair transplant surgery can also offer a more permanent solution. Although not confirmed by himself, Elon Musk most likely had a hair transplant to treat this type of alopecia.
• Outcome: Treatments will slow down hair loss and likely regrow some hair, but don’t expect a full makeover once ‘balding’ has already started. If this type of hair loss runs in your family and you notice thinning hair, outcomes are best if treatment is started in your 20-30s.

-Alopecia Areata

• Cause: Your immune system is at fault again. It decides to go rogue and attack your hair follicles. It’s like having an overzealous security guard for your hair. However, it is shooting with a BB gun, vs a machine gun like with LPP, and doesn’t cause permanent damage.
• Treatment: Corticosteroids (topical, oral and intralesional) and topical immunotherapy are the main players. Newer treatments like JAK inhibitors are also on the field.
• Outcome: Many people see regrowth with proper treatment (sometimes even spontaneously) but it can be unpredictable.
• Fun fact: this is the type of alopecia Jada Pinkett Smith has

-Telogen Effluvium

• Cause: Stress, illness, or a nutritional mishap triggers a temporary hair shedding phase. It’s like your hair’s way of throwing a tantrum. And you will notice!! Oftentimes, this type of hair loss comes out of nowhere and will clog shower drains.
• Treatment: Address the root cause (stress, illness, or diet). Hair usually bounces back once things stabilize. Shedding typically lasts for 3-6 months. Don’t be (too) alarmed though, you will never lose more than 50% of your hair with this type of alopecia.
• Outcome: Hair typically regrows once the underlying issue is resolved, but it may take a few months to see full recovery.

-Traction Alopecia

• Cause: Tight hairstyles are the culprit here. Think of it as your hair saying, “Hey, ease up on the ponytail or braids!”
• Treatment: Loosen up those hairstyles and switch to gentler hair care practices. Protective products can also help.
• Outcome: Hair can often regrow if the tension is removed early enough; however, prolonged cases might lead to permanent damage.

Conclusion

Hair loss can feel like a rollercoaster ride, but understanding the differences between scarring and non-scarring alopecia can help you navigate the twists and turns. Scarring alopecia often requires more intensive management with a focus on controlling inflammation and symptoms. Non-scarring alopecia usually offers a better chance for regrowth if the underlying cause is addressed.

Remember, whether you’re dealing with the “permanent marker” or the “washable marker” of hair loss, you’re not alone. There are treatments and strategies to help manage your condition and keep your hair journey as positive as possible. Your favorite Dermatology office is just the place to get a proper diagnosis and customized treatment plan.