What is Alopecia and how is it treated?

9 min

Alopecia is a generic term for all hair loss on the body, particularly head hair. Extensive and long-term hair loss can be a source of considerable worry and insecurity for patients, and this condition affects men as well as women (in which case it is called “female alopecia”). Read this article to find out all the key facts about alopecia: the various causes of hair loss, symptoms to look out for and treatments that can potentially slow down hair loss and promote regrowth.

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What is alopecia?

Alopecia is a medical condition characterised by partial or total hair (or body hair) loss, which can affect the scalp as well as other parts of the body. The term is derived from the Greek word “alopex” meaning “fox”, in reference to the large amount of fur this canine sheds every spring.

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Article on female alopecia

Scarring vs. non-scarring alopecia

Alopecia can be classified into two main categories: scarring and non-scarring alopecia. Understanding how to distinguish between these two conditions is essential to determine the best possible treatment plan.

What is scarring alopecia?

In cases of scarring alopecia, the hair follicles are permanently destroyed, often due to inflammation or skin trauma. A variety of factors can cause this form of alopecia, including inflammatory skin diseases such as systemic lupus erythematosus, scleroderma, folliculitis decalvans, or severe burns.

What is non-scarring alopecia?

Unlike scarring alopecia, non-scarring alopecia is often reversible. It has a variety of causes, including genetic factors, hormonal changes or autoimmune disorders such as systemic lupus erythematosus, autoimmune polyglandular syndrome or Hashimoto’s thyroiditis.

How is alopecia classified according to its degree of severity?

To fully understand alopecia, an accurate assessment of its severity must be performed, using classification tools such as the Hamilton-Norwood scale for male alopecia and the Ludwig scale for female alopecia. These scales play an important role in making a diagnosis, and are used by healthcare professionals to categorise hair loss into specific stages - ranging from mild to advanced - and then offer a suitable treatment.

The Hamilton-Norwood scale for male alopecia

The Hamilton-Norwood scale is the classification method currently used to assess the severity of alopecia in men. It helps determine the stage of hair loss, ranging from mild to severe. In the milder stages, hair may be receding around the temples, while in the more advanced stages, the top of the head may also be affected by baldness. This scale provides a visual basis for understanding the progression of male hair loss.

The Ludwig scale for female alopecia

The Ludwig scale has been specifically designed to assess female alopecia. It provides a detailed definition of the different stages of female hair loss: the mildest form can be characterised by diffuse thinning of the hair, while in the most advanced cases, there is more marked hair loss on the top of the head.

What are the causes of alopecia?

Alopecia is caused by a variety of factors, which all affect hair follicle health in a specific way. These include hormones, drug treatments and even hair styling habits.

Androgenetic alopecia

Also known as “baldness”, androgenetic alopecia is closely linked to genetic and hormonal factors. It manifests differently in men and women, with the hair follicles becoming increasingly sensitive to androgen hormones, and dihydrotestosterone (DHT) in particular.

Medical treatments

Certain medications can cause temporary hair loss. This is particularly true of:

Blood thinners;
Vitamin A derivatives (retinoids);
Antidepressants;
The contraceptive pill;
Drugs for high blood pressure;
Immunosuppressants;
Antithyroid drugs;
Gout medication (colchicine)
Epilepsy medication (trimethadione and sodium valproate).

The hair recovery process depends on the type and duration of treatment.

How does chemotherapy affect hair loss?

The cytotoxic agents used to treat cancer have significant side effects, including hair and body hair loss. Hair loss generally occurs two to three weeks after starting treatment and is temporary in most cases.

According to the website of the Gustave Roussy Centre, Europe’s leading cancer centre, placing a cold cap on the patient’s head during chemotherapy treatment may help prevent alopecia caused by anti-cancer drugs.

Traction alopecia

Wearing very tight hairstyles (braids, ponytail, bun, etc.) or extensions, or frequently using accessories that pull on the hair can lead to a form of alopecia known as “traction” alopecia. This puts excess pressure on the roots and thus weakens and eventually pulls out the hair, most often around the temples and forehead.

Scalp infections

Some scalp infections can cause severe inflammation, damaging the hair follicles and potentially leading to alopecia. This is the case with:

Ringworm;
Impetigo;
Seborrhoeic dermatitis;
Cellulitis of the scalp.

Most of these infectious diseases can be treated with appropriate medication (antifungal drugs, antibiotics etc.). Once the infectious agent has been eliminated, hair may start to grow back, although some areas of the scalp may be permanently damaged.

What are the first signs of alopecia?

The first signs of alopecia may vary depending on the type of hair loss.

Some of the most important signs to look out for include:

Excessive hair loss;
Thinning hair;
Areas on the scalp where hair is sparse;
Itchy scalp.

When should you see a doctor about alopecia?

If symptoms persist (or get worse), you should book an appointment with a healthcare professional, and, more specifically, a dermatologist, who will be able to make an accurate diagnosis. Depending on the doctor’s diagnosis, you may be prescribed treatment to prevent hair loss and promote regrowth.

How is alopecia diagnosed?

According to the French Society of Dermatology’s website, a dermatologist can perform several analyses to diagnose alopecia:

Clinical examination to assess hair loss;

Microscopic analysis of an area of the scalp to determine the general health of the hair follicles (trichogram);
Monitoring symptoms by taking photos at regular intervals;
Scalp biopsy;
Blood tests;
Assessment of the patient’s medical, family and hormonal history;
Traction test to assess hair strength.

By using a combination of these analyses, the doctor can obtain an overall picture of the situation, identify the underlying cause of alopecia and then propose a personalised treatment protocol.

How is alopecia treated?

There are a number of therapeutic options available to treat alopecia, ranging from medical treatments to surgery, or the wearing of a medical wig. Depending on the doctor’s recommendations, a combination of certain treatments may be used to optimise the chance of hair regrowth, as well as to improve the patient’s quality of life.

Medical treatments for alopecia

Minoxidil is a topical medication that promotes hair growth and can be used by both men and women.
Finasteride blocks the effects of certain hormones responsible for hair loss. It is prohibited for use by women and professional athletes.
Corticosteroids can be applied locally to reduce inflammation and stimulate regrowth.

Surgical treatments for alopecia

Surgical treatments for alopecia aim to restore hair density by implanting new hair follicles in the affected areas. Two main techniques are widely used: hair transplants and the strip harvesting technique, both of which must be performed by a specialist surgeon.

Follicular extraction hair transplant

Hair transplants are becoming increasingly popular among men affected by baldness (also known as “androgenetic alopecia”), despite the high price, long recovery time and results that are not guaranteed.

The patient’s head is completely shaved, and then individual hair follicles are extracted one by one from their scalp using a motorised or manual harvesting device, while under local anaesthetic to relieve any pain. The extracted follicles are then sorted into grafts and implanted into the recipient areas, according to a natural pattern to obtain the most uniform result possible. The final results can be assessed approximately one year after the surgical procedure, which gives the transplanted hair enough time to fully grow.

Strip harvesting

A different technique but with similar results, strip harvesting involves cutting a strip of scalp from the donor area (most often the temporal area), from which grafts are then taken. The grafts are then sorted and implanted one by one. A higher number of grafts can be harvested in a single session compared to an extraction hair transplant, but the scarring can be noticeable in patients with short hair.

Dietary supplements

While eating a varied and balanced diet is still the best way to maintain healthy hair, dietary supplements can also be beneficial in cases where nutritional deficiencies have been detected via a blood test. The most effective essential nutrients for hair loss are:

Biotin
Vitamin B
Vitamin D
Zinc
Iron
Omegas 3 and 6

What is the best haircare routine to prevent hair loss?

To halt the progression of alopecia and promote regrowth, adopting an anti-hair loss routine is recommended. In addition to using a special shampoo, which gently cleanses the hair while stimulating the scalp, you should apply a no-rinse lotion to the roots on a daily basis. This can help to increase hair density, strengthen fragile hair and promote regrowth.

How to cope with alopecia

Alopecia can be a particularly difficult experience for the men, women, adults and children with this condition. In addition to regularly seeing a dermatologist, to obtain a diagnosis in the first instance and then to monitor progress after following the treatment(s) prescribed by the doctor, psychological support from a healthcare professional may also help patients to regain their self-confidence. Associations, such as La Tresse, run discussion and support groups that provide a caring space for patients suffering from hair loss.

Hair supplements

Opting to take a hair supplement can mitigate the effects of alopecia and help patients to lead as normal a life as possible. Depending on your needs and budget, this may involve wearing a wig or a custom-made prosthesis. With the variety of styles, colours and textures available, people affected by alopecia can obtain a look that reflects their identity. From long, wavy hair to trendy short styles, a vast range of options is available.

GOOD TO KNOW

In France, according to the Health Insurance website, people with alopecia may be entitled to a reimbursement of 100% for their wig or accessories to help conceal hair loss, subject to a medical prescription.