Lauren Kelly Many people have heard of alopecia and know it has something to do with hair loss. But there is a lot more to it than that. There are several types of alopecia, and they affect people differently based on age, sex, race, ethnicity, and genes. Learning about alopecia matters because it affects many people. For example, one common type, called androgenetic alopecia or pattern baldness, affects about half of all people at some point in their lives. Another type, called alopecia areata, currently affects about 700,000 people in the United States. It happens more often in Asian Americans and people of multiple races.
To learn more, we talked with Dr. Alexis Stephens, a board-certified dermatologist and founder of Parkland Dermatology & Cosmetic Surgery in Coral Springs, Florida.
What is alopecia?
Dr. Stephens explains that “alopecia is just the medical word for hair loss.” She also notes that “it’s not one disease,” as it covers many different conditions. These include common pattern baldness, rarer autoimmune types like alopecia areata (where the body’s immune system attacks the hair follicles), and scarring types that permanently destroy the follicles where hair grows.
What early signs of hair loss should people watch for?
Some early signs are easy to brush off as “normal.” But Dr. Stephens says these are worth getting checked, especially if they last more than 2-3 months:
- A sore, itchy, burning, or bumpy scalp, even before you notice hair loss
- A part line that looks wider or more “see-through” under bright light
- Noticeably more hair in the shower drain or on your pillow, for several weeks in a row
- Small, round, smooth bald patches (not flaky or itchy), often easy to miss on the back of the head
- Hair that breaks in the middle of the strand, instead of falling out from the root
What’s the difference between scarring and non-scarring alopecia?
Dr. Stephens notes that, with non-scarring alopecia, “the hair follicle is still alive; it’s just not growing hair well.” This includes pattern hair loss, alopecia areata, and hair loss caused by stress or illness. With non-scarring, she says, “hair can grow back, sometimes even without treatment.”
With scarring alopecia, “swelling and irritation (inflammation) destroy the follicle and replace it with scar tissue.” This includes central cicatricial alopecia (CCCA), lichen planopilaris, discoid lupus, and folliculitis decalvans. Dr. Stephens says, “Once scarring happens, the goal is no longer to regrow hair; it’s to stop the inflammation before more hair is lost.”
This difference changes how urgent treatment is, and what the treatment goals should be.
Why does catching it early matter so much? What happens during a doctor’s visit?
Dr. Stephens says with scarring alopecia, “lost follicles are gone for good. So time really matters.” During a visit, a dermatologist will usually:
- Ask about your health history, including your timeline of symptoms, family history, stress, illness, medicines, and hairstyling habits
- Look closely at your scalp with a special magnifying tool (called a dermatoscope) to check the hair follicles, hair thickness, and signs of inflammation.
- Do a gentle “pull test” to see how easily hairs come out
- Order bloodwork if an autoimmune, hormone, or nutrition-related cause is suspected
A skin sample (biopsy) may be needed if the diagnosis isn’t clear, or if scarring is suspected. Dr. Stephens explains that “it’s the only sure way to know if follicles are being permanently damaged, and why.”
Can alopecia be prevented?
Dr. Stephens cautions that “for most types, it’s more about catching it early and managing it well than preventing it.” But a few things can help:
- Genetic pattern hair loss: Starting treatment early (like minoxidil or finasteride) can help preserve more hair. It won’t stop genetics, but it can slow things down.
- Traction alopecia (hair loss from tight hairstyles, extensions, or glued-on wigs): This type is largely preventable by easing up on tension on the hair and scalp.
- General scalp and hair health: Eating a balanced diet, avoiding harsh chemical treatments, and managing health conditions like thyroid disease or low iron can all help.
- Autoimmune and scarring types: There’s no proven way to prevent these. The focus is on early treatment to limit damage.
Hair loss can be emotionally hard. How can people cope, and how can loved ones help?
Hair loss can affect how people see themselves and their self-esteem. Dr. Stephens stresses, “that’s a real reaction, not vanity,” and offers a few pieces of advice to help patients.
- Naming what’s happening and having a clear, realistic plan. This takes away some of the fear of not knowing.
- Connecting with others going through the same thing, through support groups like the National Alopecia Areata Foundation. This can help people feel less alone.
For friends and family who want to help, Dr. Stephens says:
- Don’t brush it off with comments like “it’s just hair”
- Listen, and avoid advising about cures they didn’t ask for
- Offer practical support, like coming along to doctor’s appointments
If someone notices hair thinning right now, what should they do first?
Dr. Stephens stresses the importance of seeing a dermatologist, not the internet or a hair-loss product ad. She says, “The type of hair loss determines the treatment, and guessing wrong wastes the time that matters most, especially if it turns out to be a scarring type.”
Is there anything else you’d want people to know?
As a final reminder, Dr. Stephens reflects that “hair loss is often a visible clue that something else is going on in the body, like thyroid problems, low iron, autoimmune disease, or even major stress. Alopecia isn’t just a cosmetic issue. Sometimes it’s the first sign that leads to a bigger health check-up.”
To learn more about alopecia and other skin or hair conditions, visit the Skin of Color Society.
Resources
30 Interesting Hair Loss statistics- National Council on Aging (NCOA)
Alopecia Areata- National Alopecia Areata Foundation
Prevalence of Alopecia Areata across Races and Ethnicities- National Alopecia Areata Foundation