Understanding Different Types of Alopecia: A Comprehensive Guide

Hair loss is more common than many people realize. Over 3 million Canadian men are affected by some form of hair loss. Male pattern baldness affects up to 50% of men, and four out of five men experience some degree of balding by age 70. Additionally, up to 40% of Canadian women experience thinning hair by age 50.

While accepting hair loss can be challenging, understanding the different types of alopecia and their underlying causes is an important first step. This knowledge can help you have informed conversations with healthcare providers about your specific situation.

Before exploring options with a healthcare professional, learn about the various types of alopecia to better understand your condition.

Androgenetic Alopecia (Male and Female Pattern Hair Loss)

Androgenetic alopecia is a gradual condition that often begins affecting men after puberty. It can occur in both males and females, where it is known as male pattern baldness and female pattern baldness respectively.

This type of alopecia causes progressive hair thinning and eventual hair loss, typically starting at the hairline and moving backward. This pattern often creates an "M" shape at the temples, while the circular area on the back of the head—called the vertex or crown—also experiences thinning.

Key Characteristics

• Progressive and gradual
• Genetic predisposition
• Hormone-related (associated with dihydrotestosterone or DHT)
• Follows predictable patterns
• Affects both men and women, though patterns differ

Understanding the Mechanism

Androgenetic alopecia is associated with the hormone dihydrotestosterone (DHT), an androgen that can cause hair follicles to shrink over time. This process, called miniaturization, leads to progressively shorter and finer hair until follicles eventually stop producing visible hair.

Because this condition is progressive and often has a genetic component, early consultation with a healthcare provider can be valuable for understanding your individual situation and discussing personalized approaches.

Alopecia Areata (Autoimmune Hair Loss)

Unlike pattern baldness, which often has a hereditary link, alopecia areata can develop spontaneously at any age. It is an autoimmune condition in which the body's immune system mistakenly attacks hair follicles. This results in patchy hair loss that can appear anywhere on the scalp or body.

Key Characteristics

• Sudden onset with round or oval patches of hair loss
• Can affect the scalp, beard, eyebrows, or other areas
• Unpredictable progression—may remain limited or become more extensive
• Hair may regrow spontaneously in some cases
• Associated with other autoimmune conditions in some individuals

Types of Alopecia Areata

Alopecia Areata (patchy): Limited to one or more coin-sized patches

Alopecia Totalis: Complete loss of scalp hair

Alopecia Universalis: Loss of all body hair, including eyebrows and eyelashes

Because alopecia areata involves the immune system, seeking medical evaluation when you first notice symptoms is important for proper diagnosis and to rule out other conditions.

Telogen Effluvium (Stress-Related Hair Loss)

The telogen phase is the resting stage of the hair growth cycle when follicles are dormant. In telogen effluvium, a larger-than-normal number of hair follicles enter this resting phase simultaneously, leading to excessive shedding several months later.

Key Characteristics

• Diffuse thinning across the entire scalp (rather than specific patterns)
• Sudden onset, typically 2-3 months after a triggering event
• Temporary in most cases
• Does not cause complete baldness

Common Triggers

• Physical or emotional stress
• Illness or high fever
• Surgery or major medical events
• Significant weight loss
• Hormonal changes
• Nutritional deficiencies (iron, zinc, protein)
• Certain medications

Telogen effluvium is generally temporary and often resolves once the underlying trigger is addressed. However, chronic or recurring episodes warrant medical evaluation to identify and address underlying causes.

Traction Alopecia (Mechanical Hair Loss)

Traction alopecia occurs when constant tension is placed on hair follicles, typically from tight hairstyles such as ponytails, braids, buns, or hair extensions. The repeated pulling gradually damages follicles, leading to hair loss, particularly along the hairline and temples.

Key Characteristics

• Gradual hair loss at areas of tension
• Often affects the frontal hairline and temples
• May cause scalp tenderness or discomfort
• Preventable and potentially reversible if caught early
• Can lead to permanent hair loss if prolonged

Warning Signs

• Scalp tenderness when hair is styled
• Small bumps on the scalp
• Redness or inflammation
• Receding hairline, particularly at the temples
• Broken hairs along the hairline

The key to addressing traction alopecia is recognizing the signs early and modifying styling habits. Avoiding tight hairstyles and reducing tension on the hair can prevent further damage. If the condition has progressed significantly, consulting a healthcare provider or dermatologist is recommended.

Cicatricial Alopecia (Scarring Alopecia)

Cicatricial alopecia, also known as scarring alopecia, refers to a group of rare disorders that destroy hair follicles and replace them with scar tissue, resulting in permanent hair loss. Unlike other forms of alopecia, the hair loss in this condition is irreversible in affected areas.

Key Characteristics

• Permanent destruction of hair follicles
• Smooth, shiny patches of scarred skin
• Hair does not regrow in scarred areas
• Can be primary (follicle-targeted) or secondary (due to external factors)

Types

Primary Cicatricial Alopecia: The hair follicle itself is the target of inflammation or an autoimmune response. Examples include:

• Lichen planopilaris
• Frontal fibrosing alopecia
• Central centrifugal cicatricial alopecia
• Discoid lupus erythematosus

Secondary Cicatricial Alopecia: Scarring occurs due to external factors that damage the scalp, such as:

• Burns or trauma
• Severe infections
• Radiation therapy
• Tumors
• Prolonged traction alopecia

Symptoms

• Burning, itching, or pain in affected areas
• Redness and inflammation
• Scabbing or crusting
• Loss of follicle openings (smooth, shiny appearance)
• Progressive hair loss in patches

Because cicatricial alopecia causes permanent follicle destruction, early medical evaluation is crucial when symptoms first appear. A dermatologist or hair loss specialist can perform a scalp biopsy to confirm diagnosis and identify the specific type.

Hair Shaft Abnormalities

Structural defects in the hair shaft itself can cause fragile hair that breaks easily, leading to the appearance of hair loss. These abnormalities can be congenital (present from birth) or acquired through damage.

Common Hair Shaft Disorders

Trichorrhexis Nodosa: The most common hair shaft disorder, characterized by weak points along the hair shaft that cause breakage. Often results from chemical damage (bleach, relaxers) or physical trauma (heat styling, harsh brushing).

Loose Anagen Syndrome: A condition where hair shafts are not properly anchored in the follicle, causing them to fall out easily with minimal trauma. Most common in young children with blonde or light-colored hair.

Monilethrix: A rare inherited condition causing beaded or fragile hair that breaks easily.

Diagnosis and Evaluation

Hair shaft abnormalities require examination by a dermatologist or trichologist (hair specialist). Diagnosis typically involves:

• Visual examination with magnification
• Microscopic analysis of hair samples
• Evaluation of underlying conditions (thyroid disorders, nutritional deficiencies)

Addressing underlying health issues and avoiding further damage to the hair shaft are important considerations. A healthcare provider can help identify contributing factors and provide guidance on hair care practices.

When to Seek Medical Evaluation

While some hair loss is temporary and resolves on its own, certain signs warrant prompt medical attention:

• Sudden or rapid hair loss
• Patchy or unusual patterns of hair loss
• Scalp pain, burning, or itching
• Scaling, redness, or other skin changes on the scalp
• Hair loss accompanied by other symptoms (fatigue, weight changes, skin changes)
• Hair loss that affects your quality of life or emotional well-being

A healthcare provider can perform a thorough evaluation, including:

• Medical history review
• Physical examination of the scalp
• Laboratory tests (blood work, hormone levels, nutritional assessment)
• Scalp biopsy (if scarring or unusual patterns are present)

Understanding Your Hair Loss Journey

Experiencing hair loss can be emotionally challenging and may impact self-esteem and confidence. It's important to remember that:

• Hair loss affects millions of people and you are not alone
• Many types of hair loss have identifiable causes
• Early evaluation can help determine the type and cause
• Understanding your specific condition is the first step
• Support is available through healthcare providers and support groups

At Phoenix, we understand the personal nature of hair loss concerns. Our digital healthcare platform provides private assessments with licensed Canadian physicians who can evaluate your individual situation and discuss your options.

Our platform makes it convenient to complete an online health questionnaire and connect with healthcare providers from the comfort of your home, with free follow-ups available.

References

• Alopecia - Canadian Dermatology Association
• Androgenetic Alopecia - National Library of Medicine
• Primary cicatricial alopecia: diagnosis and treatment - PMC
• Postpartum Hair Loss - Cleveland Clinic