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5 Commonly Asked Questions About Alopecia

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Plus one question you should always ask

Posted by Afton Metkowski, MD

For many people, losing all or part of their hair can be quite upsetting — especially if that loss is unexpected. The reason for this often bewildering change is a condition called alopecia.

Alopecia is not a diagnosis, but an umbrella term associated with about 15 types of hair loss. The various types of alopecia are categorized as either scarring, in which the hair follicles become permanently damaged, or nonscarring, in which the hair follicles remain intact but may not be growing hair.

It’s possible that one person can receive a diagnosis of more than one type of alopecia. Each type requires its own treatment, which may involve medications that are topical, injectable, or oral. Because some nonscarring types of alopecia can develop into a scarring condition, early intervention at the very first signs of hair loss is extremely important. With many types of alopecia, it is a race against time to get a proper diagnosis quickly, save the follicles you can save, treat whatever is treatable and get to the bottom of what’s causing the type of alopecia.

When people see me about their hair loss, they usually have many questions. Here are five of the most common ones:

1. If I’m experiencing hair loss, do I have alopecia?

The simple answer is “Yes.” When you make an appointment for hair loss, you’re telling me you have alopecia, which in Latin translates to “hair loss.”

A better question for patients to ask is, “What type of alopecia do I have?” People of any ethnicity can develop alopecia. However, in my dermatology practice, the majority of patients are Black women, who commonly develop these types of alopecia:

  • Central centrifugal cicatricial alopecia (CCCA) can be caused by many factors, including genetics. This scarring hair loss starts in the central area of the scalp with a little patch of hair loss or breakage, perhaps with some tenderness and itchiness. Over time, you’ll see hair loss spreading out from the center (or centrifugal) pattern. The word cicatricial comes from cicatrix, which means scarring. Even if a Black woman has never had braids or used a relaxer, they can still develop CCCA. Research suggests that some may be born with hair shafts containing a gene that causes the condition.
  • Traction alopecia occurs when chronic tension negatively affects the hair follicles. It usually occurs in women of African descent who have tightly coiled hair. Susceptible to traction alopecia are people who often wear tight ponytails, braids, or locks. Traction alopecia can lead to permanent hair loss but is preventable if diagnosed early. That’s why I love seeing children at the first sign of hair loss. At that time, I can recommend minor changes in habits and hair-styling practices that can reverse hair loss. Because people of color can damage their hair follicles if they’ve had cumulative years of creative styling that tugs on their hair, I offer this advice: Embrace your natural curls and avoid back-to-back high-tension hairstyles!
  • Telogen effluvium is hair loss caused by mental or physical stressors. If you’re under stress, you may notice clumps of hair falling out. It may be alarming, but it is reversible if the cause of the stress is treated. Stress-inducing factors can range from the loss of a relationship or loved one to COVID-19 or other medical conditions, such as having surgery, a baby, or fever.
  • Frontal fibrosing alopecia (FFA) is a hair loss condition causing your entire hairline to move backward. This scarring alopecia can also result in the loss of eyebrows and small, raised bumps on the face that look like pimples. If caught early, treatment can stop or slow progression.
  • Alopecia areata may have the most awareness. Jada Pinkett Smith acknowledged she has this type of alopecia. This is autoimmune-induced alopecia in which round or oval patches of hair loss may occur. It can also result in total loss of scalp hair or body hair.

2. Is my hair loss reversible?

It depends on the type of alopecia you have. As I’ve noted, some hair loss conditions, if caught early, are completely reversible. If you have inflammation around your hair follicles causing the hair not to grow, the hair follicles are still active and are not damaged. But if not treated, it can lead to irreversible alopecia.

Whenever hair loss occurs, see a dermatologist at once for a proper diagnosis. With early intervention, an alopecia condition does not have to become part of your life.

3. If I cut or shave all my hair off and start over, will it grow back?

Your hair is different from your hair follicles. So, if you cut off all your hair, you’re not going to regrow a full new head of hair in the areas where you experienced hair loss. The problems will still be there. I’m fully supportive of people cutting off their hair for personal reasons. Shaving your head, though, does not replace the need for further evaluation and treatment.

4. Is alopecia treatable?

Yes, it is treatable, but it depends on the stage of your particular type of alopecia. Again, seeing a dermatologist at the first signs of hair loss and getting a proper diagnosis is crucial.

5. Will the type of alopecia that I have put my children at risk for hair loss?

Some types of hair loss can be hereditary, but also some hair-styling habits leading to hair loss are passed down from generation to generation. We can change habits, but we cannot change genetics.

I realize that my patients feel vulnerable when I tell them they have a specific type of alopecia. That may be why so many ask, “How can you be sure I have alopecia?” But during my years of clinical experience, I’ve seen many types of alopecia. To pinpoint an alopecia diagnosis, I’ll examine their scalp with a specialized medical instrument and sometimes perform a scalp biopsy. Then, we’ll discuss treatments, which depend on the cause of someone’s alopecia.

If you’re experiencing hair loss, schedule a dermatologist appointment immediately to get a proper diagnosis of your type of alopecia. It may be the difference between losing your hair permanently and having a healthy head of hair.

You can make an appointment with a Temple Health dermatologist by calling 800-TEMPLE-MED (800-836-7536) or scheduling an appointment online.

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Afton Metkowski, MD

Dr. Metkowski is a board-certified dermatologist at Temple Health.

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