Types of Alopecia

What types of alopecia exist nowadays?

Hair loss can cause great uncertainty for many people; however, it's important to know that not all hair loss is permanent, nor are all types of alopecia treated the same way. To help understand what is happening to the hair, it's crucial to classify types of alopecia most common in order to analyze their clinical symptoms, effects on the hair, and the actual medical solutions we apply in our practice.

Androgenetic Alopecia (common baldness)

Androgenetic alopecia, or common baldness, is the most frequent cause of hair loss, affecting most men and a high percentage of women. Its origin is hormonal, and its predisposition is genetic because the hormone DHT (dihydrotestosterone) binds to androgen receptors, causing changes in the hair follicle. This hormone causes the miniaturization and progressive weakening of hair, producing increasingly finer hairs until these hair follicles end up resembling fine down or even disappear over time.

• How to identify androgenetic alopecia or common baldness?

Identifying androgenetic alopecia or common baldness is relatively simple, as in the early stages a lack of hair density is noticeable, with hair becoming increasingly thin and weak. In men, hair begins to thin at the temples and crown, while in women, androgenetic alopecia manifests as a loss of density along the part, which widens as it progresses.

• Can a hair transplant be performed on someone with androgenetic alopecia?

Absolutely, androgenetic alopecia is the ideal type of hair loss for a hair transplant. By preserving the healthiest hair on the back and sides of the head (this is the area we use as a donor since it is much more resistant to DHT), the hair transplanted using the FUE technique will be much thicker, healthier, and have low sensitivity to DHT, making a hair transplant possible.

• What hair treatments are available for androgenetic alopecia?

At our clinic, we always prescribe pharmacological treatment to stabilize the alopecia and improve the health of the existing hair. 5-alpha reductase inhibitors and minoxidil treatment are currently the most effective and scientifically supported treatments for androgenetic alopecia. Hair mesotherapy with the aforementioned medications and PRP hair therapy have also demonstrated remarkable effectiveness.

Diffuse Patterned Hair Loss (DPA)

Diffuse patterned hair loss (DPA) is a variant of androgenetic alopecia. The difference in this case is that the hair doesn't fall out in specific areas, such as the temples or crown, but rather thins across the entire top of the head. This type of alopecia is characterized by a progressive and generalized loss of hair density across the scalp, which can make it much more difficult to detect in its early stages.

• How to identify diffuse patterned hair loss (DPA)?

If you suffer from DPA or patterned hair loss, you will notice a generalized loss of volume on the top of your head. When you look in the mirror or under bright light, the hair will appear thinner evenly, while the sides and back of your head will look much better and retain their volume.

• Can a hair transplant be performed on someone with diffuse pattern hair loss (DPA)?

A hair transplant can be performed on someone with diffuse pattern hair loss, but it requires more intensive medication for prior stabilization. With a safe and strong donor area, a hair transplant is possible to repopulate the affected areas and increase the density of existing hair, provided that hair loss is well controlled medically.

• What hair treatments are available for DPA?

Hair treatments for diffuse pattern hair loss (DPA) are generally the same as those used for common alopecia. Among the most commonly used are minoxidil, finasteride, and dutasteride, as these act as DHT inhibitors, as well as hair biostimulation and PRP (platelet-rich plasma) treatments.

Diffuse Non-Pattern Alopecia (DUPA)

Unlike the previous type, diffuse non-pattern alopecia, or DUPA, affects the hair on the entire head equally, including the sides and back of the neck. The miniaturization and hair loss process in this type of alopecia affects all areas equally. DUPA progresses gradually, potentially affecting donor areas typically used for hair transplantation, and limiting the options for hair transplantation in some patients.

• How to identify diffuse non-pattern alopecia (DUPA)?

In diffuse non-pattern alopecia, the hair becomes extremely thin, short, and brittle across the entire head in those affected. Initially, you may notice that the hair at the nape of the neck or above the ears is thinning and losing strength. This can be a sign of DUPA alopecia and should be treated as soon as possible to prevent its progression.

• Is a hair transplant possible with DUPA alopecia?

In these cases, a hair transplant is not recommended because the donor areas at the back of the head are also affected by this type of alopecia. This means that in these cases, there is no "donor area" with healthy follicles.

• What hair treatments are available for DUPA alopecia?

Medical support treatments for diffuse alopecia without a pattern (DUPA) have a 100% pharmacological approach and are designed for long-term use (systemic medications and in-clinic infiltration therapies) in order to halt the progression of the disease or DUPA and maintain existing hair, preventing further progression or slowing its effects on the hair.

Acute Telogen Effluvium

Acute telogen effluvium is not a permanent condition, but rather a temporary disruption of the hair growth cycle. It is caused by a stressful or traumatic event that forces hundreds of hairs to suddenly enter the shedding phase known as the telogen phase. As a result, sudden and diffuse hair loss occurs across the scalp, generally caused by episodes of intense stress, surgical procedures, fever, infections, hormonal changes, restrictive diets, or nutritional deficiencies, among other factors.

• How to identify acute telogen effluvium in hair?

Acute telogen effluvium is characterized by a sudden and massive hair loss (hair falls out in clumps in the shower or while brushing). It typically appears two to three months after a clear trigger, such as childbirth, a high fever infection (like COVID-19), major surgery, or a severe stressful event that causes this type of hair loss.

• Can a hair transplant be performed with acute telogen effluvium?

In these cases, it is not necessary, as acute telogen effluvium is a reversible and temporary hair loss process. In these situations, the hair follicle remains alive, and the hair will regrow on its own once the body regains its internal balance.

• What hair treatments are available for acute telogen effluvium?

To treat acute telogen effluvium, we recommend consulting with our trichology experts to identify the cause and make a differential diagnosis, as this is essential for a swift recovery. Furthermore, in cases of acute telogen effluvium, hair mesotherapy is a very helpful treatment.

Chronic Telogen Effluvium

In contrast, chronic telogen effluvium occurs when the massive and diffuse hair loss characteristic of acute effluvium does not stop and lasts for more than 6 months, sometimes extending for years. In this type of alopecia, the hair prematurely enters its telogen phase, resulting in generalized hair loss. This causes persistent hair loss that can lead to a progressive decrease in hair density, which, unlike acute telogen effluvium, does not usually resolve in a short period of time.

• How to identify chronic telogen effluvium in hair?

The loss of volume is constant and prolonged in people who suffer from chronic telogen effluvium. This type of hair loss is usually caused by internal problems that persist over time, so it's advisable to request a general blood test to look for any deficiencies that may explain or worsen the condition. A severe iron deficiency (low ferritin), a decrease in B vitamins, zinc, or other thyroid disorders or unregulated hormonal imbalances can be the cause.

• Can a hair transplant be performed with chronic telogen effluvium?

In these cases, it's not initially recommended since the underlying cause must first be identified and a medical solution applied to this disruption in the hair growth cycle. A hair transplant on an unstable scalp, such as that experienced by patients with chronic telogen effluvium, will not be successful, and its results may be compromised by this instability and the continued hair loss.

• What hair treatments are available for chronic telogen effluvium?

First, a complete blood test will help determine the origin of this condition and identify its underlying causes. Subsequently, once the causes are known, there are complementary hair treatments with PRP (Platelet-Rich Plasma) injections to nourish and strengthen the follicles exhausted and affected by chronic telogen effluvium.

Alopecia Areata

Finally, alopecia areata is an autoimmune condition caused by overstimulation of the immune system (often exacerbated by stress), in which the body's defenses attack the hair follicle, causing inflammation that interrupts hair growth and leads to hair loss. In this type of alopecia, hair loss usually manifests as one or more bald patches, although in other cases, alopecia areata can affect much larger areas of the scalp.

• How to identify alopecia areata on the scalp?

The appearance of alopecia areata on the scalp is usually much more sudden and visual. This manifests itself in the form of round or oval patches that are completely bald and characterized by smoother skin. This alopecia can appear in an isolated form or show multiple conditions on the head or beard.

• Can a hair transplant be performed with alopecia areata?

For alopecia areata it is not recommended in the most active phase of the condition. Being an inflammatory disease, the immune system would also attack the transplanted hair in patients suffering from alopecia areata. In these cases, surgery is only considered in very specific cases where the plaque is completely inactive and healed after a few years of follow-up.

• What hair treatments are there for alopecia areata?

As for the most effective treatments for alopecia areata, microinjections with local corticosteroids in the plaque and immunomodulators to stop the attack of the defenses and reactivate natural growth are the most effective treatments for alopecia areata. Thanks to them, we can control inflammation, promote the recovery of affected follicles and stimulate hair growth.

Classification of types of alopecia in women and men

Alopecia is defined as a total or partial loss of hair and hair follicles, a condition that can affect both men and women and can be due to different causes. To do this, classifying the different types of alopecia according to their origin, evolution or hair loss pattern allows us to better understand this hair loss, establish a much more precise diagnosis, as well as offer an appropriate treatment for each case. Therefore, and as we will see below, knowing the types of alopecia in women and men is of vital importance since it allows us to identify the different characteristics for each of them, as well as know their causes, symptoms and different treatment options.

Types of alopecia in women or female and treatments

Alopecia in women or female hair loss is a very serious problem that worries many women around the world. Unlike men, the types of alopecia in women usually have a series of very specific characteristics that differentiate them and for which an accurate diagnosis and treatment is required. Regarding the types of female alopecia and treatments, we find the following:

• Female androgenic alopecia: Female androgenic alopecia is usually the most common type of alopecia in women and the one that raises the most concern. This is usually related to hormonal or genetic factors, producing a gradual thinning of the hair follicles or hair. Its treatment includes the use of minoxidil, a medication that in most cases helps stop androgenetic alopecia, as well as other treatments that we also perform in our clinic such as hair biostimulation or hair mesotherapy.
• Telogen effluvium in women: On the other hand, female telogen effluvium is another type of alopecia that we see the most in women. This causes alopecia or temporary hair loss. It usually occurs after an episode of certain stress such as pregnancy, illness or weight loss. In telogen effluvium in women we also see diffuse loss on the scalp. In this case, a preventive hair diagnosis and finding or identifying the underlying causes of this episode of stress will pave the way for the recovery of our hair.
• Female alopecia areata: In the case of women, female alopecia areata is due to a possible autoimmune disease that affects the hair follicles. In this type of alopecia, hairless areas on the head with a rounded shape and unpredictable evolution are easily identified. The best treatment for this is to provide corticosteroids and complementary treatments in the affected areas such as immunotherapy or the use of topical treatments that help to gradually reduce these conditions on the scalp of women.

Types of alopecia in men and their treatments

Alopecia in men or male hair loss is usually much more common in different parts of the world, especially in our country Spain, where we have one of the highest percentages of alopecia. Generally, the types of male alopecia tend to manifest in a much more progressive and evident way than in women, affecting the different areas of the hair according to the types of alopecia in men that we find:

• Male androgenic alopecia: It is one of the main causes of alopecia in men and the one that usually affects the largest number of men. It can begin to manifest itself from adolescence onwards and is related to the hormone DHT, or dihydrotestosterone. The treatments indicated to reduce the effects of this type of alopecia primarily aim to lower the body's DHT levels, such as the use of finasteride, one of the most effective medications for this purpose, or topical minoxidil, which helps stimulate the growth of hair follicles.
• Scarring alopecia in men: A less common type of male pattern baldness, but present among many men who suffer from hair loss. Scarring alopecia is related to the irreversible destruction of hair follicles as a result of inflammatory processes, burns, or scalp diseases. This causes permanent hair loss, but in many cases, its effects can be reduced with the use of corticosteroid or immunosuppressant medications, as well as the possibility of a hair transplant in affected areas.
• Male pattern baldness (Alopecia areata): This type of hair loss is similar to female pattern baldness and is characterized by the appearance of localized bald patches with a similar appearance. This is a consequence of an autoimmune disease or episodes of stress, the progression of which can vary from patient to patient. Therefore, treatment will depend on the severity of the individual's condition, although corticosteroids and immunotherapy treatments are often used to help regrow lost hair.

  In summary, both types of hair loss in women and types of hair loss in men have different characteristics, causes, and progression patterns that require a personalized study and diagnosis for each specific case. Therefore, identifying the possible causes for each type of hair loss in women and men is essential to determining the most appropriate hair treatment to combat each type of alopecia, taking into account the individual needs and characteristics of each patient.