Changes in androgen levels, thyroid disorders, polycystic ovaries, and other endocrine conditions can affect hair growth.
Especially in women, hair loss may be associated with cycles of hormonal fluctuations.
Alopecia: Types, Causes, Symptoms and Modern Treatments
Alopecia is the medical term used to describe hair loss on the scalp or other areas of the body.
In general, hair shedding is a normal phenomenon to some extent. However, when it becomes excessive or persistent, it may indicate an underlying condition. In such cases, alopecia may be related to genetic, hormonal, autoimmune, or environmental factors.
In terms of its characteristics, alopecia can be temporary or permanent and can affect men, women, or children of any age.
There are different types of alopecia (androgenetic, alopecia areata, diffuse, scarring), each characterized by a different mechanism of onset, clinical presentation, and progression.
For this reason, early and accurate diagnosis by a specialist is crucial for selecting the appropriate treatment and preventing permanent damage to the hair follicles.
Alopecia is the medical term used to describe hair loss on the scalp or other areas of the body.
In general, hair shedding is a normal phenomenon to some extent. However, when it becomes excessive or persistent, it may indicate an underlying condition. In such cases, alopecia may be related to genetic, hormonal, autoimmune, or environmental factors.
In terms of its characteristics, alopecia can be temporary or permanent and can affect men, women, or children of any age.
There are different types of alopecia (androgenetic, alopecia areata, diffuse, scarring), each characterized by a different mechanism of onset, clinical presentation, and progression.
For this reason, early and accurate diagnosis by a specialist is crucial for selecting the appropriate treatment and preventing permanent damage to the hair follicles.
What is alopecia?
The term alopecia refers to hair loss from the scalp or other areas of the body, occurring at a rate or extent that exceeds normal limits.
When hair loss exceeds 50–100 hairs per day or is accompanied by thinning, reduced density, or clearly defined bald patches, the condition is classified as alopecia.
Temporary vs Permanent Alopecia
Alopecia is categorized as temporary or permanent, depending on whether the damage to the hair follicles is reversible.
- In temporary alopecia, the follicles remain alive and hair growth can return, with or without treatment.
- In permanent alopecia, the follicles are destroyed and hair loss is irreversible.
What is alopecia?
The term alopecia refers to hair loss from the scalp or other areas of the body, occurring at a rate or extent that exceeds normal limits.
When hair loss exceeds 50–100 hairs per day or is accompanied by thinning, reduced density, or clearly defined bald patches, the condition is classified as alopecia.
Temporary vs Permanent Alopecia
Alopecia is categorized as temporary or permanent, depending on whether the damage to the hair follicles is reversible.
- In temporary alopecia, the follicles remain alive and hair growth can return, with or without treatment.
- In permanent alopecia, the follicles are destroyed and hair loss is irreversible.
Alopecia types
Alopecia appears in various forms, each with different causes, characteristics, and prognosis. Proper classification is crucial for selecting the appropriate treatment approach.
Androgenetic Alopecia
Androgenetic alopecia is the most common form of hair loss in both men and women. It is caused by a combination of genetic predisposition and the hormonal effect of androgens on the hair follicles.
In men, it is characterized by progressive thinning at the temples and the crown. In women, it presents as diffuse thinning without recession of the hairline. Its progression is gradual, and early intervention is necessary to slow down hair loss.
Alopecia Areata
This is an autoimmune form of alopecia in which the immune system attacks the hair follicles, leading to sudden and localized hair loss. It typically appears as round or oval bald patches, mainly on the scalp.
Its course is unpredictable—hair may regrow spontaneously in some cases, while in others it may progress to more extensive forms. Early diagnosis and the initiation of immunomodulatory therapy increase the chances of regrowth.
Diffuse Alopecia
Diffuse alopecia is characterized by generalized thinning across the entire scalp, without clearly defined bald areas. It is often linked to temporary conditions such as physical or emotional stress, hormonal changes (e.g., postpartum), poor nutrition, or certain medications.
It does not cause complete baldness, but diagnosis requires careful clinical assessment and laboratory testing. It is usually reversible once the underlying cause is addressed.
Scarring Alopecia
Scarring alopecia includes a group of rare disorders that cause permanent destruction of hair follicles and their replacement by scar tissue. It is often accompanied by inflammatory symptoms such as redness, burning, or itching, and may gradually progress.
Αν δεν αντιμετωπιστεί έγκαιρα, η τριχόπτωση είναι μη αναστρέψιμη. Η θεραπεία στοχεύει στην αναστολή της φλεγμονής και στην πρόληψη της περαιτέρω βλάβης.
Causes of alopecia
Alopecia can result from a variety of factors that directly or indirectly affect the normal function of the hair follicles. Understanding the underlying cause is essential for proper diagnosis and targeted treatment.
Genetical predisposition
Heredity is the most common factor in the development of alopecia. Individuals with a family history of hair loss have an increased likelihood of experiencing the condition.
Hormonal imbalances
Autoimmune diseases
In certain forms of alopecia, the immune system mistakenly attacks the hair follicles.
The causes of this dysfunction remain largely unclear, but it is often associated with other autoimmune disorders.
Harmful habits
Frequent use of heat-styling tools, chemical products, tight hairstyles, or extensions places continuous tension on the hair follicles.
This can lead to traction alopecia, which over time may become irreversible.
Stress
Acute or chronic stress can disrupt the hair growth cycle and lead to telogen effluvium, a temporary but intense form of diffuse hair shedding.
Hair loss usually begins 2–3 months after the stressful event that triggered the condition.
Medical treatments
Certain medications, such as chemotherapy agents, antidepressants, anticoagulants, and antihypertensives, may cause temporary or permanent hair loss.
Similar effects may also occur with treatments such as radiation therapy.
Nutritional deficiencies
Insufficient intake of iron, zinc, vitamin D, and proteins can affect the normal growth of hair.
In many cases, hair loss is the first visible sign of an underlying nutritional deficiency.
Skin diseases
Skin conditions such as dermatophytosis (fungal infection), seborrheic or psoriatic dermatitis, as well as bacterial or viral infections, can cause localized or generalized hair loss.
Alopecia symptoms
Alopecia presents with different symptoms depending on the type, cause, and stage of the condition. Early recognition of the first signs is crucial for preventing progression and choosing the right treatment approach.
- Visible thinning or patchy hair loss
Progressive reduction in hair density, mainly at the crown or temples. Appearance of circular or irregular bald patches. - Sudden hair shedding
- Significant hair loss over a short period, especially after stress, childbirth, or illness. Commonly noticed during washing or brushing.
- Hair thinning and weakening
Hair strands become finer and more fragile, losing their normal structure. - Itching, redness, or burning sensation
Signs of inflammation often associated with scarring alopecia or skin conditions. Dermatological evaluation is required to rule out infection or autoimmune disease. - Loss of eyebrows, eyelashes, or body hair
A characteristic symptom of specific forms of alopecia, often accompanied by reduced hair growth in other areas of the body.
How to diagnose alopecia?
Diagnosing alopecia requires a structured and multi-level approach. The goal is to accurately identify the type of hair loss and any potential underlying causes.
Below are the key diagnostic steps:
1 – Medical history and clinical examination
The physician records the duration and progression of the hair loss, the location of the affected areas, the presence of accompanying symptoms (such as itching, redness, or pain), as well as any recent risk factors (stress, medications, illnesses, hormonal changes).
A thorough clinical examination of the scalp follows.
2 – Trichoscopy & hair loss tests
Trichoscopy (or digital dermatoscopy) is an essential diagnostic tool that allows the analysis of hair follicle morphology, the detection of inflammatory or scarring lesions, and the differential diagnosis between different types of alopecia.
It is a painless examination performed using a specialized microscope or camera.
The pull test is performed by gently pulling a small bundle of hair to assess how easily the hairs detach, while the trichogram analyzes the percentage of hairs in each phase of their growth cycle (anagen, catagen, telogen). These tests provide valuable information about the nature of the hair loss and help identify the type of alopecia.
3 – Blood and hormonal testing
Depending on the examination findings, laboratory tests may be requested to measure markers such as ferritin, thyroid hormones, vitamin D, zinc, estrogens, androgens, or prolactin.
These tests help identify systemic factors that may be impairing normal hair growth.
4 – Scalp biopsy (in selected cases)
In more complex or unclear cases, a small sample of the scalp skin may be required.
The biopsy is examined histologically and helps diagnose rarer forms of alopecia (e.g., scarring alopecia, autoimmune conditions).
Alopecia treatment options
The management of alopecia depends on its type, cause, and extent, and includes both pharmaceutical and interventional options.
Today, there are effective treatments that aim either to stabilize hair loss or to stimulate natural hair growth. The choice of the appropriate therapeutic approach is personalized, based on an accurate diagnosis and the individual needs of each patient.
Minoxidil
Topical or oral. Enhances blood flow to the follicles and stimulates new hair growth.
Finasteride
Inhibits the action of DHT, slowing down hair loss (in men).
Autologous mesotherapy
Injection of growth factors derived from the patient’s own blood, aiming to rejuvenate the follicles.
Heterolegous mesotherapy
Local injection of vitamins, amino acids, and nutrients to strengthen hair growth.
Corticosteroids
They suppress inflammation in autoimmune forms of alopecia, such as alopecia areata.
Microneedling
Mechanical stimulation of the scalp with microneedling to enhance hair regeneration.
Low-level laser therapy (LLLT)
Use of low-level laser therapy (LLLT) to stimulate cellular activity and increase hair density.
Hair transplant
Aims to restore hair growth in areas of the scalp where thinning or hair loss is present.
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