Types of Alopecia and Overlap in their Causes

Alopecia can strike anyone for any variety of reasons.  Even newborn babies can be born with this condition.  There are five most common types of hair loss, several other types of alopecia exist, the first five being the most common ones:

  • The most common form of baldness is a progressive hair thinning condition, so called Androgenic alopecia or male pattern baldness (MPB).
  • Female pattern baldness. The equivalent of MPB, and often is related to Polycystic Ovarian Syndrome (PCOS), malnutrition or wheat/gluten intolerance.
  • Alopecia areata, involves the loss of some of the hair from the head, Those with alopecia areata have scattered bald spots all over the head, or one large bald spot confined to one section of the head. It is known as “spot baldness”, it can result in hair loss ranging from just one location (Alopecia areata monolocularis) to every hair on the entire body (Alopecia areata universalis). Alopecia areata, is typically associated with sudden hair loss, sometimes related to trauma, or illness, stress, abusive hair styling such as tight braids and pony tails, wigs, hairpieces or chemicals used on the hair. Alopecia areata is an autoimmune disorder. *4
  • Alopecia totalis, involves the loss of all of the head hair, typically be characterized by the complete loss of hair on the head.  The shedding of normal hair will usually occur over a certain amount of time. The sufferers of alopecia totalis will sometime have a small amount of soft Lanugo hair left over after the normal hair has completely fallen out. *7
  • Alopecia universalis, which involves the loss of all of the hair from the head and the body, from the top of the head to the legs and feet including eye brows.  Alopecia universalis is the rarest condition of the five most common forms of alopecia. It is thought that alopecial universalis is an autoimmune condition. *5

The following are are thought of as being less common, these can be confused as female/male pattern baldness:

Traction alopecia is most commonly found in people with ponytails or cornrows who pull on their hair with excessive force.

Trichotillomania is the loss of hair caused by compulsive pulling and bending of the hairs. It tends to occur more in children than in adults. In this condition the hairs are not absent from the scalp but are broken. Where they break near the scalp they cause typical, short, “exclamation mark” hairs.

Worrisome hair loss often follows childbirth without causing actual baldness. In this situation, the hair is actually thicker during pregnancy due to increased circulating oestrogens. After the baby is born, the estrogen levels fall back to normal pre-pregnancy levels and the additional hair foliage drops out. A similar situation occurs in women taking the fertility-stimulating drug clomiphene.

Iron deficiency hair loss is a common cause of thinning of the hair, though frank baldness is not usually seen.

Infections-related hair loss. Some mycotic infections can cause massive hair loss.[4]

Hypothyroidism hair loss.  Typically frontal, and is particularly associated with thinning of the outer third of the eyebrows (syphilis also can cause loss of the outer third of the eyebrows)

Hyperthyroidism hair loss. This  is parietal rather than frontal.

Congenital triangular alopecia – It is a triangular, or oval in some cases, shaped patch of hair loss in the temple area of the scalp that occurs mostly in young children. The affected area mainly contains vellus hair follicles or no hair follicles at all, but it does not expand. Its causes are unknown and although it is a permanent condition, it does not have any other effect on the affected individuals. *3

Telogen effluvium. Traumas such as chemotherapy, childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium *1. Hair follicles in the growing phase are affected by chemotherapy while this treatment targets dividing cancer cells. Therefore, almost 90% of hairs fall out soon after chemotherapy starts. *2

Alopecia mucinosa (also known as “Follicular mucinosis,” “Mucinosis follicularis,”, “Pinkus’ follicular mucinosis,”[1]  and “Pinkus’ follicular mucinosis–benign primary form”) generally presents, but not exclusively, as erythematous plaques or flat patches without hair primarily on the scalp and face. This can also present on the body as a follicular mucinosis and may represent a systemic disease.*8

Radiation to the scalp, as happens when radiotherapy is applied to the head for the treatment of certain cancers there, can cause baldness of the irradiated areas.

Alopecia Ophiasis. A form of alopecia areata characterized by the loss of hair in the shape of a wave at the circumference of the head. It gets its name from “ophis”, which is the Greek word for snake, because of the apparent similarity to a snake-shape and the pattern of hair loss. The term “sisaipho” is used to characterize the inverse pattern. Sisaipho is the reverse spelling of ophiasis.[4] It is also called “ophiasis inversus”. Ophiasis has got poor prognostic significance. *9

Malnutrition hair loss, one example is hair loss due to biotin deficiency.  Malnutrition may be due to a bad diet or to lack of absorption.

Temporary hair loss can occur in areas where sebaceous cysts are present for considerable duration; normally one to several weeks in length.

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Noncicatricial Alopecia. Is a nonscarring form of hair loss, thought to be caused by Alopecia areata, Anagen effluvium,  Androgenetic alopecia, Dermatopathia pigmentosa reticularis, Telogen effluvium, Trichotillomania (Trichotillosis) *7

Localized or diffuse hair loss may also occur in cicatricial alopecia (lupus erythematosus, lichen plano pilaris, folliculitis decalvans, central centrifugal cicatricial alopecia, postmenopausal frontal fibrosing alopecia, etc.). Tumours and skin outgrowths also induce localized baldness (sebaceous nevus, basal cell carcinoma, squamous cell carcinoma).

Comment:

Many factors cause hair loss of all types, the above lists some of the most common causes of hair loss in general. When one is fighting any type of hair loss (say MPB as an example) it is beneficial to consider all the possible causes. In other words, if you have been diagnosed as having male/female androgenic alopecia do not just think of androgens and DHT, do consider all the other causes of hair loss as they often do contribute, trigger and exacerbates what we call male/female patterned baldness or as some incorrectly call it androgenic alopecia.

I believe there is an overlap in the causes of hair loss and the different types of hair loss.

Some sources:

*1 – Nnoruka E, Nnoruka N (October 2005). “Hair loss: is there a relationship with hair care practices in Nigeria?”. Int J Dermatol 44 (Suppl 1): 13–7. doi:10.1111/j.1365-4632.2005.02801.x. PMID 16187950.

*2- Pappas P, Kauffman C, Perfect J, Johnson P, McKinsey D, Bamberger D, Hamill R, Sharkey P, Chapman S, Sobel J (1995). “Alopecia associated with fluconazole therapy.”. Ann Intern Med 123 (5): 354–7. PMID 7625624.

*3 – “Congenital triangular alopecia”. http://www.keratin.com/af/af005.shtml. Retrieved 2010-06-29.

*4 – Alopecia areata on wikipedia

*5 – Alopecia universalis on wikipedia

*6 – Alopecia totalis on wikipedia

*7 – Noncicatricial alopecia on wikipedia

*8 – Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.  -and -  Freedberg, et al. (2003). Fitzpatrick’s Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.  – and -  James, William D.; Berger, Timothy G.; et al. (2006). Andrews’ Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.  – and – Folliculitis, follicular mucinosis, and papular mucinosis as a presentation of chronic myelomonocytic leukemia. Rashid R, Hymes S. Dermatol Online J. 2009 May 15;15(5):16.

*9 – Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.  – and -  “DermaCase”. http://www.cfpc.ca/cfp/2006/Aug/vol52-aug-clinical-dermacase.asp. Retrieved 2007-12-03.  – and – “Definition: ophiasis from Online Medical Dictionary”. http://cancerweb.ncl.ac.uk/cgi-bin/omd?ophiasis. Retrieved 2007-12-03.   – and – “eMedicine – Alopecia Areata : Article by Chantal Bolduc, MD, FRCPC”. http://www.emedicine.com/derm/topic14.htm. Retrieved 2007-12-03. – and – Muñoz-Pèrez MA, Camacho FM (1999). “Sisaipho. Why ophiasis inversus?”. Pediatr Dermatol 16 (1): 76. doi:10.1046/j.1525-1470.1999.016001076.x. PMID 10028012. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0736-8046&date=1999&volume=16&issue=1&spage=76

Last Edited: 1/3/2011






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