Alopecia Hair Loss - Treatment, Symptoms and Cause of Alopecia

The two major forms of alopecia are scarring and nonscarring. In scarring alopecia there is associated fibrosis, inflammation, and loss of hair follicles. A smooth scalp with a decreased number of follicular openings is usually observed clinically, but in some cases the changes are seen only in biopsy specimens from the affected areas. In nonscarring alopecia the hair shafts are gone, but the hair follicles are preserved, explaining the reversible nature of nonscarring alopecia.

Cause of Alopecia

Primary cutaneous disorders are the most common causes of nonscarring alopecia and they include telogen effluvium, androgenetic alopecia, alopecia areata, tinea capitis, and traumatic alopecia. In women with androgenetic alopecia, an elevation in circulating levels of androgens may be seen as a result of ovarian or adrenal gland dysfunction. When there are signs of virilization, such as a deepened voice and enlarged clitoris, the possibility of an ovarian or adrenal gland tumor should be considered.

Exposure to various drugs can also cause diffuse hair loss, usually by inducing a telogen effluvium. An exception is the anagen effluvium observed with antimitotic agents such as daunorubicin. Alopecia is a side effect of the following drugs: warfarin, heparin, propylthiouracil, carbimazole, vitamin A, isotretinoin, acetretin, lithium, beta blockers, colchicine, and amphetamines. Fortunately, spontaneous regrowth usually follows discontinuation of the offending agent.

Less commonly, nonscarring alopecia is associated with lupus erythematosus and secondary syphilis. In systemic lupus there are two forms of alopecia¾one is scarring secondary to discoid lesions (see below) and the other is nonscarring. The latter form may be diffuse and involve the entire scalp, or it may localized to the frontal scalp and result in multiple short hairs ("lupus hairs"). Scattered, poorly circumscribed patches of alopecia with a "moth-eaten" appearance are a manifestation of the secondary stage of syphilis. Diffuse thinning of the hair is also associated with hypothyroidism, hyperthyroidism, and HIV infection.

Scarring alopecia is more frequently the result of a primary cutaneous disorder such as lichen planus, folliculitis decalvans, cutaneous lupus, or linear scleroderma (morphea) than it is a sign of systemic disease. Although the scarring lesions of discoid lupus can be seen in patients with systemic lupus, in the majority of cases the disease process is limited to the skin. Less common causes of scarring alopecia include sarcoidosis and cutaneous metastases.

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