Alopecia is a medical condition which results in the loss of hair. There are many different types, the most common being male pattern baldness (Androgenetic Alopecia) which is the thinning of the hair. This condition is caused by male hormones (androgens), and is usually caused by inherited genetic tendencies. It affects 50% of the male population and follows a typical pattern of a receding hairline at the front and temples, sometimes with a patch on the crown. The receding pattern can progress in waves until eventually only a semi-circle of hair is left around the back and sides of the head. It can also affect females, though this is more often seen as a general thinning of the hair in later years¹ rather than a receding hairline, and is much less prevalent.

However there are other types of Alopecia which can affect anyone, anytime at any age; even children, and psychologically this is much more difficult for a person to accept, especially if the onset and progression is fast.

Alopecia in its many other forms is one of many known auto-immune diseases. Despite assertions that these may be caused by stress, the most that can be proven so far is that stress may be the trigger for the onset of the condition. Stress, however, is not the only possible precondition. So, if Alopecia is present, it is vital to see your doctor for a medical check-up which includes blood tests. Other underlying conditions may include very treatable endocrine (hormonal) disruptions such as diabetes or thyroid imbalances and even nutritional deficiencies

The body's own immune system makes white blood cells whose job it is to attack diseased cells in the body. In this case they malfunction and turn on the body itself, attacking the healthy and rapidly growing cells in the hair follicles that make the hair, believing them to be foreign bodies. The affected hair follicles diminish and as a result slow down hair production. However, new cells produced do not seem to be targeted, so the follicle always has the potential to re-grow hair. Treatments are often based on stimulating the follicles back into action.

Main Types of Alopecia

Alopecia Areata

Patches of hair are lost usually from the scalp but it can also manifest as bald patches on the body. This can range from one or two small patches, about the size of coins, which may grow back after a period of months, to many more and much larger patches, with no sign of regrowth. In these cases the individuals often decide it is best to shave their remaining hair from their scalp and go completely bald. In some cases Areata progresses to Alopecia Universalis or Alopecia Totalis (see below).

Alopecia Barbae

This affects the facial hair, so is usually only apparent in men², and results in bald patches amongst the normal beard growth.

Alopecia Totalis

All the head hair is lost; this may or may not also affect the eyebrows, and other areas of body hair.

Alopecia Universalis

Total loss of all body hair, including eyebrows and lashes, and pubic hair.

Alopecia Mucinosa

This type of Alopecia is very rare. It results in slightly scaly bald patches in which the hair follicles are more prominent than usual.

Traction Alopecia

This is not an auto-immune disease but is caused by ill-fitting wigs, badly fitted hair extensions, or tight ponytail-type hairstyles. This is often temporary and once the 'traction' element has been removed, normal growth should return. However, in some cases it can be permanent³.

Treatments

On diagnosis by a doctor it is important to first of all ensure that relevant blood tests are completed to check if the problem is to do with a thyroid condition, or if there are any other underlying auto-immune conditions requiring treatment. The next step is referral to a dermatologist who may be able to recommend various treatments.

Although there are a lot of different treatments, there is currently (as in 2006) no known cure. The treatments may alleviate the symptoms, and in some cases may result in total re-growth, but there is no pattern to which treatment may be more effective for each individual case, nor if any re-growth is permanent or temporary. Often in the less severe cases the hair will grow back after a period of time with no treatment necessary.

Topical Creams and Applications

• Steroid creams are the most common first treatment prescribed. These creams are applied directly to the area of hair loss.
• Dithranol is an ointment that is applied to the scalp. It is thick and sticky and aims to irritate the scalp to stimulate the follicles. It can cause burning and staining, but need only be left on the scalp for short periods at a time.
• Diphenylcyclopropenone (DCPC) is a chemical applied in increasing strengths over several weeks until the skin develops eczema. The stimulation of the eczema on the follicles can cause the hair to re-grow.
• Retin A and Minoxidil. Retin A is a gel and is rubbed onto the area of hair loss. It can be used on its own or in combination with topical Minoxidil, which slows down hair loss. It has been successful in stimulating hair growth in some cases of Alopecia Areata.
• Anthralin is an irritant applied to the scalp to cause an allergic reaction. While the body is dealing with the irritant the follicles seem to get distracted enough to allow the hair to start re-growing.

Other Treatments

• Injections of corticosteroid(steroids) are administered directly into and around the bald areas of the scalp.
• PUVA treatment involves taking a light sensitive drug and then a short exposure to ultraviolet light. The skin burns, but the idea is that the body's immune system is so distracted into repairing skin tissue that it allows the hair to grow.
• UVB Similar to PUVA, this is like using a sunbed but involves standing in a cubicle of ultraviolet lights for an increasing amount of time.
• Oral steroids. These can be prescribed for - and are much more powerful than - local injections into the skin, so are generally used in the case of more extensive hair loss.

Coping Tactics

Those with Alopecia which is not (yet) responding to treatments often resort to coping tactics to disguise their hair loss or to help them to live with their new appearance.

Hair Re-styling

Comb-overs or moving the parting, maybe a zigzag parting, are the first steps in hiding that first bald patch. Windy days can be a challenge, though. For women the wearing of hair slides, clips or other hair ornaments to clip existing hair over the patch can help. If the patches get more obvious hair extensions may help to give more body to the hair in order to help in the cover-up. Use of shampoos and products which add extra body can help as well.

Masking

To mask the paleness of the nude patch showing through, the scalp can be 'coloured in' by using an eyebrow pencil or a coloured masking cream available specially for this job⁴. There are also products available which can spray on to existing hair give the appearance of a thicker head of hair.

Wigs, Hairpieces and Headgear

Sometimes the Alopecia has progressed too far to be hidden by re-styling. In these cases the Alopecian can have a choice of baring all and going out au naturel, wearing a hat, cap or bandana, or buying a professional wig or hairpiece. In the UK in some cases these may be partially funded by the health service. Wigs these days are very natural looking but do need to be styled from new to suit the wearer.

Eyebrows and Lashes

Eyebrow pencils can be used to draw in lost eyebrows until they grow back. If they are permanently lost it is possible to have them tattooed on. Stick-on brows and lashes are also available.

Effects of Alopecia

Although Alopecia is not debilitating as a condition, it can cause deep and painful psychological problems. In our society, especially among the young and among females, being bald is against the norm and runs counter to people's self-image. Building up self-esteem and confidence is not something often offered by the health service and individuals will need to find help and support from family and friends, and support groups. Many prefer to keep their condition secret and attempt to hide their condition often not even admitting to close friends that they have Alopecia. The trauma of this disease cannot be under-emphasised, with some people losing a full and thick head of hair completely within a matter of a few weeks or months, and having to quickly come to terms with a new and permanent appearance.

Famous Alopecians

There are many famous people who have the condition and some who have had it but have now recovered. Among these are:

• Gail Porter - who in 2005 lost all her hair in a matter of weeks

• Patrick Stewart - lost his hair as a teenager. Now he 'Baldly' goes trekking around the universe

• Matt Lucas - Star of Little Britain

• Duncan Goodhew - Famous Olympic swimmer who lost his hair as a result of falling from a tree as child.

• Princess Caroline of Monaco - lost her hair in 1995 but now has re-growth and is now recovered⁵.

• Christopher Reeve - Had Alopecia Areata and had treatment of steroid injections every three months into his bald patches while playing the part of Superman.