Alopecia (Hair Loss)

What is alopecia?

Alopecia is a general term for hair loss. There are many causes of hair loss, and treatment depends on the type involved. Some forms are driven by genetics and hormones, while others are related to inflammation, stress, illness, medications, hairstyling practices, or immune-system activity.

Because hair loss is not one single disease, an accurate diagnosis is one of the most important parts of treatment.

What are common types of alopecia?

Common causes of hair loss include:

• Androgenetic alopecia, also called pattern hair loss

• Alopecia areata, an autoimmune form of hair loss that often causes patchy hair loss

• Alopecia totalis, which means loss of all hair on the scalp

• Alopecia universalis, which means loss of hair on the scalp and elsewhere on the body

• Telogen effluvium, often triggered by illness, stress, or major physiologic change

• Traction alopecia from chronic tension on the hair

• Scarring forms of alopecia that can permanently damage hair follicles

What causes alopecia?

The causes of alopecia are diverse and may include:

• Hormonal changes, as seen in male or female pattern baldness

• Fungal infections affecting the scalp

• Certain medications, including chemotherapy drugs

• Endocrine disorders such as thyroid or pituitary abnormalities

• Autoimmune conditions, notably alopecia areata

• Hair follicles stuck in the shedding phase

• Trichotillomania, a condition characterized by compulsive hair-pulling

• Harmful hair treatments like chemical straighteners, hot combs, and waxes

• Emotional or physical stress

• In some instances, the cause may remain unidentified

What are the symptoms of alopecia?

Symptoms vary by cause and may include:

• Gradual thinning over the scalp

• Patchy bald areas

• Widening of the part

• Increased shedding in the shower or when brushing

• Redness, itching, burning, or scale in inflammatory types of hair loss

In alopecia areata, hair loss often begins as round or oval patches on the scalp or beard area, but it can become more extensive in some patients.

How is alopecia treated?

Treatment depends entirely on the diagnosis.

Examples of common treatments used in dermatology include:

• Topical or oral minoxidil

• Finasteride in appropriate patients

• Evaluation and correction of contributing triggers when relevant

For alopecia areata, treatment often depends on how much hair loss is present. For more limited patchy alopecia areata, common options may include:

• Corticosteroid injections into affected areas

• Topical corticosteroids

• Anthralin

• Minoxidil as an adjunct in some cases

For more extensive alopecia areata, including alopecia totalis and alopecia universalis, treatment may include:

• Topical immunotherapy

• Oral or other systemic immune-directed medications in selected cases

• Oral JAK inhibitors, which are now an important treatment option for many patients with more severe disease

FDA-approved JAK inhibitor options for severe alopecia areata now include:

• Baricitinib (Olumiant) for adults

• Deuruxolitinib (Leqselvi) for adults

• Ritlecitinib (Litfulo) for adults and adolescents age 12 and older with extensive alopecia areata

Because different causes of hair loss can look similar, treatment should be guided by the specific diagnosis rather than by symptoms alone. In alopecia areata, treatment can help regrow hair, but relapses can still happen over time.

When should I seek evaluation for hair loss?

It is reasonable to seek evaluation when hair loss is increasing, patchy, associated with scalp symptoms, or causing concern. Earlier evaluation can be especially important when an inflammatory or scarring process is possible.

For further information on over-the-counter treatments, please refer to our hair loss recommendation sheet.