🧑‍⚕️ Alopecia refers to hair loss from the scalp or body, classified into scarring (permanent follicle destruction) and non-scarring (potentially reversible). Causes range from genetics to autoimmune disease, drugs, stress, and infections. Recognising the type is essential for correct management.

🗂️ Types of Alopecia

Type of Alopecia	Description	Causes	Common Symptoms
Androgenetic Alopecia (Pattern Baldness)	Most common form. Gradual, progressive thinning.	🧬 Genetic + 💡 Dihydrotestosterone (DHT) mediated.	Men: Receding temples, crown loss. Women: Diffuse thinning over crown with preserved frontal hairline.
Alopecia Areata	Autoimmune; patchy hair loss.	Immune attack on follicles.	Round bald patches, “exclamation mark hairs”, nail pitting. Severe forms: totalis (scalp) or universalis (body).
Telogen Effluvium	Transient shedding due to hair cycle shift.	Stress, illness, postpartum, medications.	Diffuse shedding, clumps of hair in shower/comb. Non-scarring, self-limiting.
Traction Alopecia	Hair loss from chronic tension.	Tight hairstyles, braids, extensions.	Hairline recession, broken hairs. Reversible if early; scarring if chronic.
Scarring Alopecia (Cicatricial)	Permanent follicle destruction with fibrosis.	Lupus, lichen planopilaris, burns, radiotherapy, severe infections.	Shiny scalp, loss of follicular openings, erythema, scaling. 🚩 Needs urgent specialist referral.
Non-Scarring Alopecia	Follicles intact; regrowth possible.	Endocrine disorders, nutritional deficiency, drugs, ageing.	Patchy or diffuse shedding, potential regrowth with cause removal.

⚠️ Causes of Alopecia

🧬 Genetic predisposition.
🛡️ Autoimmune disease (alopecia areata, lupus).
🔄 Hormonal imbalances (thyroid disease, PCOS, menopause).
💊 Medications (chemotherapy, anticoagulants, lithium, beta-blockers).
🥗 Nutritional deficiencies (iron, vitamin D, zinc).
😥 Stress or illness.
🦠 Infections (e.g. tinea capitis).
✂️ Trauma / traction.
🧴 Inflammatory dermatoses (eczema, psoriasis).

🔎 Symptoms of Alopecia

Gradual or sudden hair loss (scalp/body).
Patchy bald spots or diffuse thinning.
Sudden shedding in handfuls.
Shiny scarred scalp (scarring alopecia).
Scalp pruritus, tenderness, or burning.
Exclamation-mark hairs (alopecia areata).
Nail pitting with autoimmune alopecia.

🧪 Diagnosis of Alopecia

History & Exam: Pattern, onset, triggers, drug history.
Blood tests: TFTs, ferritin, vitamin D, autoimmune screen.
Scalp biopsy: If diagnosis uncertain (esp. scarring).
Trichoscopy: Dermoscopic features (yellow dots in alopecia areata, absence of follicular openings in scarring).

💊 Treatment Options

Medications:
- Minoxidil (topical) – first-line for pattern baldness.
- Finasteride (oral, men only).
- Corticosteroids (topical/intralesional for areata).
- Immunotherapy (e.g. diphencyprone for resistant areata).
Procedures:
- Hair transplantation (androgenetic alopecia).
- Platelet-rich plasma (PRP) therapy.
- Scalp micropigmentation.
Lifestyle:
- Gentle hair care, avoid traction hairstyles.
- Balanced diet, manage stress.
Alternative:
- Rosemary oil, acupuncture (limited evidence).

📌 Summary & Exam Pearls

Divide into scarring (irreversible) vs non-scarring (reversible).
Androgenetic alopecia: DHT-mediated, crown/temples in men, diffuse crown in women.
Alopecia areata: Autoimmune, exclamation mark hairs, nail pitting, can progress to totalis/universalis.
Telogen effluvium: Diffuse shedding after stress, pregnancy, or illness.
Red flag: Scarring alopecia = urgent dermatology referral.

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Alopecia