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Alopecia

Overview

Alopecia is a condition in which excessive hair loss occurs from any part of the body. This condition can occur with aging, although an autoimmune condition causes alopecia in most cases. The most apparent hair loss occurs in your scalp region, but other parts of your body can also be affected. Some cases of alopecia can have spontaneous recovery on their own and require no specific treatment. In other cases, hair loss may be permanent, and cosmetic repair options may be considered to restore your regular hair volume.

Causes

Alopecia can occur due to an autoimmune condition in which your immune cells attack your hair follicles, leading to excessive shedding of hair and reduced hair growth. The medical term for this condition is known as alopecia areata. It has a strong genetic component. Another major cause of alopecia can be stress. Long periods of stress persisting for a few months can also lead to irregular hair loss. This stress not only occurs as a psychological condition but can also result from high fever, systemic infection, traumatic injury, major surgery, childbirth, etc.
Some medications may also cause alopecia as a side effect. These medications include anti-depressants, beta-blockers, NSAIDs, anticoagulants, retinoids, etc. Use of these medications, along with other factors, can flare up the symptoms of alopecia. Alopecia can also be caused by certain diseases such as anemia, syphilis, hypo or hyperthyroidism, ringworm disease, systemic lupus erythematosus, etc. Fluctuations in hormonal levels are another contributing factor. Other minor factors include excessive shampooing, rough combing, blow-drying hair, cold, dry weather, etc.

Types

Alopecia is divided into two major types: scarring and non-scarring alopecia.
Scarring alopecia is less common and occurs due to accumulation of mucus in hair follicles, infiltration of hair follicles by cancerous cells, a severe form of ringworm disease, systemic lupus erythematosus, sarcoidosis, and radiation therapy.
Non-scarring alopecia is the more common type that occurs due to multiple factors. The most common subtype of this is alopecia areata, resulting from an autoimmune condition. Other causes may include chemotherapy, aging, burns, traction, hypo or hyperthyroidism, etc.

Risk Factors And Epidemiology

Stress and changes in hormonal levels are major risk factors for alopecia. Short-term stress does not have a noticeable effect on hair loss, but persistent, long-term stress can increase the risk of excessive hair loss. It can be related to psychological issues and other systemic conditions that can alter the normal levels of hormones, such as menstruation, pregnancy, thyroid issues, high fever, etc. Certain individuals have a family history of alopecia that can carry on from generation to generation. If you have a weak immune system, you are at risk of developing viral or fungal infections that may lead to hair loss. Patients undergoing chemotherapy or radiotherapy are also at high risk. The use of certain medications, such as beta-blockers, antidepressants, anticonvulsants, etc., can also increase the risk of alopecia.
Alopecia has affected over 6 million people in the United States. It may present at any age, depending on its underlying factors. Males have a higher tendency to develop alopecia. The condition is known as androgenetic alopecia and occurs in individuals over 40 years.

Signs And Sypmtoms

Signs and symptoms of alopecia may vary depending on its underlying cause. Androgenetic alopecia can begin from the crown of the head and progresses as the person ages. Alopecia areata presents with hair loss that occurs in patches. It is most prominent on the scalp but can occur elsewhere on the body. Hair loss caused by stress or changes in hormonal levels is not localized and can affect the whole scalp at once. Hair loss in these cases can be noticed by combing hair or brushing it with fingers. Hair loss due to underlying systemic conditions can present with other associated symptoms such as fever, itchiness, redness, dry skin, etc.

Diagnosis

Diagnosis of alopecia begins with obtaining medical history and clinical examination of the affected regions. History will include questions regarding onset, duration, pattern, the severity of symptoms, and other possible preceding factors such as stress or medications. Clinical examination reveals the location of hair loss and other associated symptoms. A hair pull test may be performed to indicate active hair loss. Trichoscopy is a better technique to visualize skin and hair follicles under magnification. It is done by the use of a dermoscope. Your doctor may request specific lab tests such as autoantibody tests, thyroid function tests, CBC, etc., to determine the underlying cause. A biopsy is a choice of diagnostic techniques in particular cases which reveal detailed information about skin cells and hair follicles. Radiographic imaging techniques are usually not required in the diagnosis of alopecia. 

Differential Diagnosis

Since alopecia itself is a symptom of an underlying disease or skin condition, it is necessary to differentiate among possible causes based on history, presenting symptoms, and specific diagnostic tests. 

Treatment

Treatment of alopecia is based on the underlying cause. Mild cases of alopecia may not require any treatment as the condition recovers by itself in most cases. Moderate to severe hair loss involves the use of medications or surgical intervention. Topical corticosteroids are used in cases of alopecia areata. Androgenetic alopecia can be reduced by using topical or oral medications that facilitate hair growth and balance hormonal levels. Fungal infections require the use of topical or oral antifungal medications. Dietary changes are also recommended if necessary. Severe cases of alopecia may need hair transplantation or laser therapy to improve this condition.

Finasteride and minoxidil are common medications prescribed for androgenetic alopecia. Corticosteroids include fluocinonide, clobetasol etc. are prescribed for alopecia areata. Antifungals such as ketoconazole are given in case of a fungal infection. 

Prognosis

Mild to moderate hair loss can recover by itself or by prescribed medications. Severe hair loss may be managed to some extent, but complete recovery of hair volume is difficult. 

Prevention

Alopecia can be prevented to some degree by maintaining proper hygiene, taking care of scalp and hair, avoiding excessive shampooing, maintaining a balanced diet, and drinking plenty of water to prevent dry skin. Tight hairstyles such as high ponytails and heat treatments such as straightening, blow-drying, curling, etc., should be limited as well. 

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