Alopecia (Hair Loss)

Alopecia is the medical term for hair loss, ranging from small, isolated patches to complete loss of scalp or body hair. It is not a single disease but a group of conditions with different causes and patterns, the three most common being androgenetic alopecia (genetic, pattern hair loss), alopecia areata (an autoimmune condition causing patchy hair loss), and telogen effluvium (temporary, diffuse shedding triggered by stress, illness, or hormonal change). Hair loss related to hairstyling practices, particularly traction alopecia from tight braiding, weaves, or extensions, is also common and largely preventable. The impact of alopecia is not purely physical: hair carries significant cultural and personal identity value, and hair loss, at any age, can cause considerable psychological distress.

Presentation depends on the underlying type: Androgenetic (pattern) hair loss: • Gradual thinning on the crown or a receding hairline in men • Diffuse thinning, often most noticeable at the centre parting, in women Alopecia areata: • Sudden appearance of one or more well-defined, smooth, round patches of hair loss, usually on the scalp but sometimes affecting eyebrows, eyelashes, or beard • Occasionally progresses to total scalp hair loss (alopecia totalis) or total body hair loss (alopecia universalis) Telogen effluvium: • Diffuse, generalised thinning across the whole scalp, typically noticed as excessive shedding when washing or brushing, occurring two to three months after a triggering event Traction alopecia: • Gradual thinning and hairline recession, particularly at the temples and along the hairline, in areas subjected to repeated tension from tight hairstyles

• Genetics: androgenetic alopecia is driven by genetic sensitivity of hair follicles to androgens, causing progressive follicle miniaturisation over time • Autoimmune attack: in alopecia areata, the immune system mistakenly attacks hair follicles, halting hair growth • Hormonal changes: pregnancy, postpartum period, thyroid disorders, and PCOS can all trigger hair thinning or shedding • Physical or emotional stress and acute illness: can push a large proportion of hair follicles into a resting phase simultaneously, causing telogen effluvium two to three months later • Nutritional deficiencies: iron deficiency and, less commonly, deficiencies in zinc, biotin, or protein can contribute to hair thinning • Certain medications: including some chemotherapy drugs, retinoids, and anticoagulants • Traction: chronic tension on hair follicles from tight braids, weaves, extensions, or ponytails worn consistently over years

• Family history of pattern hair loss or alopecia areata • Underlying hormonal conditions such as PCOS or thyroid disease • Recent significant illness, surgery, major stress, or childbirth • Iron deficiency or other nutritional deficiency • Frequent use of tight braiding, weaves, or chemical relaxers over long periods • Personal or family history of other autoimmune conditions, for alopecia areata specifically

• Significant psychological impact, including reduced self-esteem, social anxiety, and depression • Permanent hair loss (scarring alopecia) if traction alopecia or certain inflammatory scalp conditions are not addressed before follicles are irreversibly damaged • Progression from patchy to total hair loss in a minority of alopecia areata cases

Prevention depends on the cause: • Genetic and autoimmune forms of hair loss (androgenetic alopecia, alopecia areata) cannot be prevented, but early treatment can slow progression and, in alopecia areata, sometimes stimulate regrowth • Traction alopecia is largely preventable: avoid excessively tight braids, weaves, or ponytails, alternate hairstyles regularly, and give the scalp rest periods without tension • Correcting underlying iron deficiency, thyroid disease, or other nutritional gaps can resolve or improve telogen effluvium • Gentle hair care, avoiding harsh chemical treatments and excessive heat styling, supports overall hair health