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Alopecia Hair Loss - Alopecia Areata (Alopecia Totalis, Alopecia Universalis) - Causes, Symptoms And Treatment

Alternate names : Alopecia Totalis, Alopecia Universalis

Alopecia, the partial or complete loss of hair, most commonly occurs on the scale as well as bearded areas, eye brows and eyelashes. Hair loss else where on the body is less common and less conspicuous. In the non scarring form of this disorder (noncicatricial alopecia), the hair follicle can generally re grow hair. However, scarring alopecia usually destroys the hair follicle making hair loss irreversible. Both men and women lose hair density as they age, but in different patterns- male-pattern baldness and female- pattern baldness.

Male-pattern baldness is characterized by a gradual recession of the hairline by form an "M" shape and is caused by hormones and genetic predisposition. The existing hair may be finer and may not grow as long as it formerly did. The hair at the crown also begins to thin, and eventually the top point of the hairline "M" meet the thinned crown, leaving a horse
shoe pattern of hair around the sides of the head. Unlike the gradual recession of the hairline in male-pattern baldness female-pattern baldness is an overall thinning that maintains the normal hairline.

Causes of alopecia hair loss

The most common form of non scarring alopecia in men and women is and regenetic alopecia, which is hair loss mediated by a chemical known as dihydrotestosterone (DHT). This hair loss appears to be related to androgen levels and to aging. Genetic predispositions commonly influences time of predisposition commonly influences time of onset degree of baldness, speed with which it spreads, and pattern of hair loss.

Hormones, aging, and genetic predisposition cause female-pattern baldness, which may be more noticeable after a woman reaches menopause. Estrogen in a woman's body counteracts the small amount of testosterone that's converted to DHT. After menopause, a woman no longer has the estrogen to counteract the conversion of DHT. Other reasons for alopecia in women include:

  • temporary shedding of hair (telogen effluvium), which is more common in women.
  • breaking of hair from such things as styling treatments and twisting and pulling of hair.
  • patchy areas of hair loss (alopecia areata), an immune disorder causing temporary hair loss.
  • some medications (such as chemotherapy)
  • certain skin diseases.

Other forms of non scarring alopecia include:

  • physiologic alopecia (usually temporary) - sudden hair loss in infants, loss of straight hairline in adolescents and diffuse hair loss after childbirth
  • alopecia areata (idiopathic form)generally reversible and self-limiting; occurs most commonly in young and middle-age adults of both sexes.

Predisposing factors of non scarring alopecia also include radiation, many types of drug therapies and drug reactions, bacterial and fungal infections, psoriasis, seborrhea, and endocrine disorders, such as thyroid, parathyroid, and pituitary dysfunctions.

Scarring alopecia causes irreversible hair loss. It may result from physical or chemical trauma or chronic tension on a hair shaft, as occurs in braiding. Diseases that produce alopecia include destructive skin tumors; granulomas; lupus erythematosus; scleroderma; follicular lichen planus; and severe fungal, bacterial, or viral infections, such as kerion, folliculitis, or herpes simplex. Hair loss in patches, diffuse shedding of hair, breaking of hair shafts, or hair loss associated with redness, scaling, pain, or rapid progression could be caused by these or other underlying conditions.

Signs and symptoms

In androgenetic alopecia, hair loss is gradual and usuallY affects the thinner, shorter, and less pigmented hair of the frontal and parietal portions the scalp. In women, hair loss is generally more diffuse and mainly affects the top of the scalp; completely bald areas are uncommon but may occur, Also, the frontal hairline is maintained. However, hair loss of female pattern baldness is permanent.

Alopecia areata affects small patches of the scalp, but may also occur as alopecia totalis, which involves the entire scalp, or as alopecia universalis, which involves the entire body. Although mild erythema may occur initially, affected areas of scalp or skin appear normal. "Exclamation point" hairs (loose hairs with dark, rough brush like tips on narrow, less pigmented shafts) occur at the periphery or new patches. Re growth initially appears as fine, white, dry hair, which is replaced by normal hair.


Physical examination alone is usually sufficient to confirm the diagnosis of alopecia. Diagnosis, however, must also identity any underlying disorder.

Treatment For Alopecia Areata

Topical application of minoxidil, a peripheral vasodilator more typically used ,is an oral antihypertensive, is the preferred treatment of androgenetic alopecia. It's the only FDA-approved treatment for hair loss in women. It's available over the counter and is applied twice daily to the scalp. It may take at least 4 months for results to be seen and must be used continuously. any Interruption in treatment will cause extra hair to be lost. Minoxidil has been shown to bc effective in only 10% to 40% of users.

In alopecia areata, minoxidil is more effective, although treatment is commonly unnecessary because spontaneous re growth is common. Intralesional corticosteroid injections are beneficial for small patches and may produce re growth in 4 to 6 weeks. Anthralin, topical cydosporine, oral inosiplex, and topical nitrogen mustard have all been used in treating alopecia areata. Hair loss that persists for more than 1 year has a poor prognosis for re growth.

In the obsessive-compulsive disorder trichotillomania (pulling of one's own hair), an occlusive dressing may promote normal hair growth simply by preventing the patient from hair pulling. Clomipramine may be effective for short-term treatment. Treatment of other types of alopecia varies according to the underlying cause.

Special considerations

  • Reassure a woman with female pattern alopecia that it doesn't lead to total baldness. Most forms of female pattern baldness are mild. Suggest that she wear a wig.
  • If the patient has alopeda areata, explain the disorder and reassure her that complete regrowth is possible.
  • There's no known prevention for female-pattern baldness. Provide the woman with emotional support as female-pattern baldness may affect self-esteem and cause psychological stress and anxiety due to changes in her appearance.

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