Alopecia: Types, Causes, Diagnosis and Treatment

What does alopecia look like?

Hair loss can affect the scalp, beard, eyebrows, eyelashes or other body areas. It may appear as thinning without bare skin, distinct patches, or a changing hairline. Hair breakage can also make an area look sparse even when the follicles are still producing hair.

These patterns help a clinician choose the next questions. They cannot establish a diagnosis on their own.

What you notice	Likely cause
Gradual thinning over crown	Androgenetic alopecia
Widening parting	Female pattern hair loss
Increased scalp shedding	Telogen effluvium
Smooth bald patches	Alopecia areata
Broken hairs, scaling	Fungal infection or traction
Shiny patches, pain	Possible scarring alopecia

Book a GP appointment if you are worried about new or worsening hair loss. Seek prompt assessment for painful inflammation, spreading redness, discharge or rapidly expanding bald areas. A child with patchy loss and scaling also needs medical assessment. Identifying the cause before buying treatment can avoid both delay and unnecessary expense.

Scarring and non-scarring alopecia

The follicle is the structure within the skin that produces a hair. In non-scarring alopecia, follicles are not destroyed by a scarring process, so regrowth may remain possible. This does not mean every non-scarring condition resolves spontaneously: hereditary thinning can progress over many years.

Scarring alopecia involves permanent damage to follicles. Conditions such as lichen planopilaris, frontal fibrosing alopecia and central centrifugal cicatricial alopecia belong to this group. Treatment aims primarily to control inflammation and protect remaining hair. Once a follicle has been replaced by scar tissue, medication cannot make it produce a new hair.

Do hair-loss scales identify the cause?

Scales describe appearance and extent. The Norwood scale records male pattern hair loss; the classic Ludwig scale has three grades of female pattern thinning. A diagram may help document changes, but it cannot tell whether a person also has an inflammatory scalp condition or a temporary shedding episode.

Why normal shedding is different from alopecia

Hair grows in cycles. Anagen is the growth phase, lasting years on the scalp. Catagen is a short transition, followed by telogen, a resting phase lasting months. The release of the old hair is also described separately as exogen. Different follicles move through these stages at different times.

Seeing some hair in a brush or shower is therefore normal. A commonly quoted range is around 50–100 hairs daily, but washing frequency and styling change how much you notice at once. A count from one wash cannot diagnose alopecia. Persistent changes in density, a widening parting or newly visible patches are more useful reasons to seek an assessment.

Our explanation of the hair growth cycle explores why shedding may appear months after a trigger and why visible recovery also takes time.

The main types of alopecia and their causes

Androgenetic alopecia: hereditary pattern hair loss

Androgenetic alopecia causes progressive changes in susceptible follicles, which produce finer, shorter hairs. In men, recession at the temples and thinning over the crown are common. The process reflects inherited susceptibility and androgen signalling, including the action of dihydrotestosterone, or DHT. It does not automatically mean that blood hormone levels are abnormal.

In women, thinning often appears as a widening central parting or reduced density over the top of the scalp. Its biology is more complex than a simple excess of testosterone. A clinician may investigate hormonal symptoms such as irregular periods or new excessive facial hair, rather than order the same hormone panel for everybody.

The separate guide to androgenetic alopecia covers its diagnosis and continuing treatment in more detail. The role of DHT in hair loss explains the hormone mechanism and what blocking it can realistically achieve.

Pregnancy, childbirth and menopause can coincide with changes in hair density, but they do not all cause the same condition. For example, shedding after childbirth is commonly telogen effluvium. A woman can also have pattern thinning and an additional temporary shedding episode at the same time.

Hair loss during medical treatment

Some cancer treatments damage rapidly growing hair cells and can cause anagen effluvium. The amount and timing of loss depend on the treatment. Regrowth is often possible afterwards, although its texture may change and recovery is not identical for everyone.

Other medicines can alter the hair cycle more gradually. Tell your prescribing clinician when shedding began and which medicines or supplements changed beforehand. Do not stop an essential treatment on your own. Your care team can discuss the likely cause, alternatives where appropriate and practical support such as wigs or suitable scalp cooling during some chemotherapy regimens.

Nutritional deficiencies and illness

Significant dietary restriction, rapid weight loss and certain deficiencies can contribute to shedding. Iron status may warrant investigation when the history suggests a problem; thyroid disease and other illnesses can also affect hair.

A balanced diet supports general health, but a supplement is not a universal alopecia treatment. Research reviewed by Almohanna and colleagues found important gaps in the evidence for routine supplementation. Testing and replacement should be guided by a suspected or confirmed deficiency. Taking several high-dose “hair” products can duplicate ingredients without addressing the cause.

Telogen effluvium: diffuse shedding after a trigger

Telogen effluvium occurs when more follicles than usual enter the resting phase, leading to increased shedding. It often starts about two to three months after a trigger, such as a significant illness, surgery, childbirth, marked dietary restriction or a stressful event. Sometimes no clear trigger is found.

Acute telogen effluvium lasts less than six months; shedding that persists longer is described as chronic. The timescale refers to the shedding episode, not a promise that full density returns within six months. Recovery may take longer because new hair needs time to grow visibly.

Management focuses on identifying and addressing relevant triggers, reviewing medicines and correcting established deficiencies. Ongoing shedding, scalp symptoms or an unclear pattern should prompt reassessment. A diagnosis of stress-related loss should not become a reason to overlook another condition.

Alopecia areata: autoimmune patchy hair loss

Alopecia areata develops when the immune system targets hair follicles. It commonly causes round or oval patches with relatively normal-looking skin. It can affect children and adults, and may involve the beard, eyebrows or eyelashes as well as the scalp. Some people also develop nail pitting or other nail changes.

Alopecia areata is not contagious. It can occur without a family history and is not caused by poor hair care. Some people have associated autoimmune or allergic conditions, but these are not present in every case.

The names describe the extent of loss: patchy alopecia areata affects limited areas; alopecia totalis affects all or almost all scalp hair; alopecia universalis involves extensive scalp and body hair loss. A small patch does not inevitably progress to total hair loss.

Regrowth is unpredictable. Hair may return spontaneously, sometimes initially pale, but further episodes can occur. Treatment decisions consider the extent and duration of loss, age, affected areas and the effect on daily life. For limited patches, a dermatologist may discuss topical or injected corticosteroids. Injections can cause discomfort and local skin thinning, so they require appropriate supervision.

For severe disease, specialist treatment has expanded. NICE recommends ritlecitinib as an option from age 12 under its prescribing conditions. Its July 2026 guidance also supports deuruxolitinib for eligible adults with severe alopecia areata. These medicines require individual assessment and monitoring; they are not treatments for ordinary hereditary thinning. Deuruxolitinib also requires CYP2C9 genotyping before treatment. Availability and assessment pathways should be discussed with the local dermatology service.

Traction, hair pulling and scalp disease

Repeated tension from a hairstyle can damage follicles. Traction alopecia may improve when pulling stops early, but longstanding damage can become permanent. The relevant issue is sustained tension, not a person’s ethnicity. Loosening a painful hairstyle and avoiding repeated pulling are practical first steps.

Trichotillomania is a separate condition involving recurrent hair pulling. It deserves a supportive clinical assessment rather than blame. Help addresses the pulling behaviour and its psychological context as well as the hair loss.

An itchy, scaly bald patch may instead indicate tinea capitis, a fungal infection that particularly affects children. It can spread between people or through contaminated items. Oral prescription antifungal treatment is usually needed; shampoo alone does not adequately treat infection within the hair.

Inflammatory conditions need their own assessment. Central centrifugal cicatricial alopecia is a scarring disorder, not simply another name for traction alopecia. Redness, burning, tenderness, scaling around follicles or loss of eyebrows alongside hairline recession should be discussed with a dermatologist. Some scarring disorders are less symptomatic, so absence of pain does not rule them out.

How is alopecia diagnosed?

Diagnosis starts with a history and examination, not a standard commercial test package. Expect questions about when the change started, where it began, family history, illnesses, pregnancy, diet, hair practices and medicines. Previous photographs can help show progression.

A clinician may use trichoscopy, which magnifies the scalp and hairs, and sometimes a gentle hair-pull test. Further investigations depend on the findings: selected blood tests for suspected deficiency or thyroid disease, fungal sampling for possible infection, or a scalp biopsy when scarring or diagnostic uncertainty needs clarification.

A genetic test is not required to diagnose every person with hair loss and does not replace examination. Some specific treatments have their own testing requirements, such as the CYP2C9 test before deuruxolitinib. That is a different purpose from determining which type of alopecia is present.

Before leaving the appointment, ask: What is the likely diagnosis? What is the treatment trying to achieve? When should we review the response? Also mention how hair loss affects confidence, relationships or work. Its emotional impact is a legitimate part of medical care.

Which alopecia treatments can help?

Treatment should match the diagnosis. An antifungal for an infection, an anti-inflammatory treatment for alopecia areata and a medicine for androgenetic alopecia act on different problems. There is no single “best treatment” for all three.

Hair care, oils and supplements

Gentle handling and avoiding excessive traction or damaging heat can reduce breakage. Oils may condition hair shafts, but conditioning is different from reversing follicular disease. Essential oils and kitchen mixtures can irritate the scalp or cause allergy. Stop a product that causes irritation and seek advice if symptoms persist.

A product being natural does not establish that it is effective or harmless. Supplements are most useful when they address a relevant deficiency. They should not postpone assessment of patchy, inflamed or progressive loss.

When might a hair transplant be appropriate?

A transplant moves existing follicles from a donor area to an area with reduced coverage. It does not create an unlimited supply of hair or treat every underlying cause of alopecia. Stable pattern hair loss with a suitable donor supply may be an indication. Active alopecia areata, active inflammatory scarring disease and unexplained shedding need medical assessment before surgery is considered.

For someone with an established diagnosis, a hair transplant assessment should examine donor quality, likely future loss, realistic coverage and the need for ongoing medical treatment. Some permanent scarred areas may be considered individually only after specialist assessment of disease stability.

With FUE hair transplantation, follicular units are removed individually using small punches. FUT removes a strip of scalp that is divided into grafts. FUE leaves small scars; FUT leaves a linear donor scar. Implantation methods and blade materials do not remove the risks of surgery or guarantee growth.

Local anaesthesia helps control discomfort during the procedure. Swelling, crusting, temporary shedding and recovery restrictions are possible afterwards. The clinic should provide written aftercare and explain when to contact the surgical team. A final cosmetic result takes months to assess.

Low-level light treatment

Low-level laser or light therapy has been studied mainly for androgenetic alopecia. Some trials report improved hair density, but devices, schedules and study quality vary. It is not a replacement for investigating sudden patches or scalp inflammation.

The proposed process is photobiomodulation, a response of cells to particular light exposure. Evidence for a device used in pattern hair loss does not establish that it improves every transplant result.

Light treatment may be considered as an adjunct in selected cases. The illustration shows a proposed combination with transplantation; it does not predict an individual patient’s regrowth.

Platelet-rich plasma and tissue micrografts

PRP involves taking blood, processing it to obtain a platelet-rich preparation and injecting it into the scalp. Research in pattern hair loss has reported encouraging findings, but preparation methods and treatment schedules are not standardised. It is not a proven cure for every type of alopecia.

Injections can cause pain, redness, bruising or bleeding, and infection is a procedural risk. Treatment requires a clinician’s assessment. PRP is not included in Body Expert’s standard hair transplant package; any proposed additional treatment should be specified separately in the personalised quote.

Tissue micrograft procedures use material taken from the patient’s own scalp and processed for reinjection. They should not be described as established hair cloning or as a guaranteed way to regenerate lost follicles. Studies of cell-based approaches remain heterogeneous, and suitability, evidence and risks need discussion before treatment.

Medicines for pattern hair loss

Medicines can slow progression or improve growth in some people with androgenetic alopecia. Response takes time, and continuing treatment is usually needed to maintain benefits. A useful review compares photographs taken in similar conditions and discusses both tolerability and the patient’s priorities.

Topical minoxidil is used for male and female pattern hair loss, according to the product’s indication. It can cause scalp irritation, unwanted hair growth outside the treated area and an initial increase in shedding. A pharmacist or clinician can advise on a suitable formulation. Follow the product leaflet; stop using it and seek medical advice if symptoms such as chest pain, palpitations, dizziness or swelling develop. Oral minoxidil is a separate prescription treatment with systemic risks and should not be substituted for a topical product without medical advice.

Finasteride 1 mg is an oral prescription treatment for male pattern hair loss. Discuss potential sexual and psychiatric adverse effects before starting it. The MHRA warns that sexual dysfunction may persist after stopping and advises patients taking finasteride 1 mg to stop and contact a healthcare professional promptly if depression or suicidal thoughts develop. Immediate danger requires emergency help.

Choosing treatment means weighing likely benefit, risks, the commitment involved and alternatives. Deciding against medication is also an option; the aim is an informed choice rather than a promise of complete regrowth.

Living with alopecia and planning follow-up

Wigs, hairpieces, scarves and cosmetic fibres are legitimate options, whether used temporarily, alongside treatment or long term. Ask your care team about local support and eligibility for an NHS wig. Alopecia UK offers information and ways to connect with other people affected by hair loss. Protect exposed scalp from sunlight with suitable headwear and sunscreen.

Scalp micropigmentation creates the appearance of small hair dots using tattoo pigment. It does not grow hair. Results, fading and possible removal vary; infection, pigment reactions and an unwanted appearance are risks to discuss with an appropriately trained practitioner.

Follow-up should answer whether the diagnosis still fits, whether loss is progressing and whether treatment remains worthwhile. Seek reassessment for new patches, scalp inflammation, unexpected side effects or a change from the original pattern. Regrowth can be slow, but a clear diagnosis and an agreed review plan make it easier to judge meaningful progress.

Sources

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