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Alopecia is a wider term for all kinds of hair loss, and affects a huge number of people in the UK.
The NHS estimates around half of men will experience some form of hair loss by the time they reach 50, with women most likely to experience hair loss after menopause, or even early menopause, at an age average of 52.
Not all hair loss is of concern though. We all regularly lose hair, with the American Academy of Dermatology explaining that losing between 50-100 hairs per day is considered normal – based on the average scalp containing 100,000 hair follicles.
But for some people, they will lose a lot more hair. And many will experience a type of alopecia, meaning the complete or partial absence of hair where it is normally meant to grow.
For women who experience this, hair loss or thinning most commonly occurs across the top of the head, so can be hard to hide. In these cases women often find the change in their appearance understandably distressing.
And it’s not just the hair on our head that can be affected; many people who suffer from alopecia will lose eyebrows, eyelashes and even arm or leg hair, too.
We spoke to Amy Johnson from charity Alopecia UK to help us answer some of the most commonly asked questions about hair loss.
Causes are as varying as the different types of alopecia out there. For instance, for many men who experience hair thinning – it’s usually because of hereditary genetics.
If hair loss isn’t hereditary, causes range from emotional and physical stress to severe dieting and strong medication, depending on the type of alopecia.
Alopecia Areata is a condition that Alopecia UK are most often contacted about, and dissimilarly to hair loss as a result of external factors, it is an autoimmune condition. It is not fully understood why some people develop the condition.
Amy discusses why it’s important to change people’s perceptions of the causes of alopecia. She explained, ‘The most common misconception about hair loss of any kind is that it’s simply caused by stress. It’s definitely not as simple as that.
‘In cases of alopecia areata, often labelled as “stress alopecia” by the media and some doctors, some individuals can link their first bald patch to a stressful event, but some cannot. Alopecia Areata can strike at any age and some have it occur at the time in their lives when they are most content.’
She then goes on to say: ‘When “stress” is discussed, we need to recognise that stress can be physical stresses on the body and not just emotional stress. Some believe their alopecia is triggered by infection, physical pain, hormonal imbalances etc.’ Before concluding that, ‘There needs to be more research into the causes and triggers, before we can be satisfied that we fully understand the cause of the condition.’
As with the causes, there are hugely varying symptoms depending on the type of alopecia. However, The Belgravia Centre in London shows male pattern baldness and female pattern hair loss as the most common conditions. In women this usually becomes apparent with hair thinning across the crown of the head. The hairline often isn’t affected, outside of the receding we all experience as we age.
For less common kinds of alopecia, signs and symptoms range from bald patches and hair thinning to scaly and itchy skin.
Does alopecia come with any other health complications?
Besides the physical symptoms of hair loss and the emotional issues surrounding changing appearances Amy also says, ‘As well as the psychological impact of alopecia, there are also some physical impacts. A lack of nasal hair can result in a dripping-tap nose – a continued irritation to many a person with alopecia and a lack of eyelashes can result in irritation to the eyes, as lashes provide a barrier to grit getting into the eyes.’
Alopecia Areata is one of the most common causes of hair loss or thinning, apart from heredity hair loss. It is estimated by The Belgravia Centre that it affects one person in every 100 and genetics play a role in one in five cases. Those suffering from Alopecia Areata often experience sudden, dramatic and recurring hair loss and it can affect men, women and children.
There are no completely successful treatments available for Alopecia Areata at the moment, but many people will see their hair grow back naturally after some time.
For both female and male pattern hair loss the treatment options are limited, and even those offered don’t have a hugely high success rate.
Minoxidil lotion is currently the most widely available treatment option for men and women who suffer from alopecia but it needs to be used for several months before any results may be seen, and even then the NHS estimate it will only help hair regrowth in one in every four women. Here are some of the most common treatments:
Topical (‘rub-on’) steroid
Steroid cream, gel, etc, may help hair re-growth, but does not work as well as steroid injections. It may be worth a try if you have bald patches that are not suitable for steroid injections, or if you are waiting to see a specialist to have steroid injections. If re-growth occurs it takes 3-6 months. There is no point continuing with this treatment if no re-growth occurs after six months.
This is rubbed into the bald patches and has been shown to promote hair re-growth in some cases. This is the same treatment that is used for the common male pattern baldness. It is not known how it works. The success rate is not high but may be worth a try. In particular, if you have more extensive bald patches that are not suitable for steroid injections, or if you are waiting to see a specialist for steroid injections.
Minoxidil is not available on the NHS. You need a private prescription and have to pay the full cost of the product, which makes it expensive. If it works, it usually takes 2-3 months of treatment for an initial response, and one year for a maximum response. There is no point continuing with this treatment if there is no improvement after one year.
Some people feel that combining a topical steroid with minoxidil gives a higher chance of hair re-growth than either treatment alone. However, there is little research evidence to prove this.
Injections of steroid into the bald patches of the scalp suppresses the local immune reaction that occurs in alopecia areata. This can then allow the hair follicles to function normally again and for hair to re-grow. This treatment may be an option for one or more small to medium sized bald patches. Steroid injections are thought to be the most effective treatment for patches of alopecia areata that are not too big. However, they do not work in every case.
This treatment is usually only done by a skin specialist and so you will usually need to be referred to hospital for it. Several injections (about 1 cm apart) are usually given at each session of treatment but the number is often limited by pain. Therefore, large bald areas are not suitable for steroid injections. Initial re-growth takes 1-2 months and injections are repeated every 4-6 weeks.
On the subject of treatment Amy talks about the variations in people’s reactions to different types, commenting: ‘Unfortunately there are no treatments guaranteed to work and what shows some results for one person may not for another. Also treatment options which are offered can vary considerably between dermatologists.’
How do you ‘manage’ alopecia symptoms?
Many people who experience alopecia will naturally feel stressed and anxious about their changing appearance. Amy says: ‘Coming to terms with alopecia is often about finding a way to “manage” the condition. Many turn to wigs, hats and scarves to cover their hair loss. Some are happier to embrace their baldness, and it’s worth remembering that people can still look great with hair loss. It’s about finding what works for you.
‘Our best advice would be to seek out others with alopecia for support. It’s easy to feel isolated with alopecia but there are plenty of people who know how you feel. Speaking to others can provide a great source of emotional support and practical advice. Alopecia UK has a number of local support groups listed in its website as well as an active Facebook group and online forum, too.’
She adds: ‘Some people really struggle to come to terms with their diagnosis and some never do. It can depend on the personality of the individual and the support network around them’.
If you’re experiencing hair loss or alopecia, and are worried, visit the NHS website or see your doctor who will be able to advise further.