In plain language, alopecia is the absence or loss of hair where it should typically grow. While this may seem simple enough, understanding why alopecia happens, which hair loss treatment will work for you and managing the emotional toll of hair loss can be anything but easy.
Dr. Joel Schlessinger, board-certified dermatologist, Mohs surgeon and cosmetic surgeon explains,
“Hair loss is a widespread condition that can be temporary or permanent and shows up in various forms. Since there may be multiple causes behind the condition, finding one ‘smoking gun’ can often be challenging, but a board-certified dermatologist is the first place to start if you are looking for serious answers.”
If you’re seeing more hair strands than normal in the shower drain, a ponytail that wasn’t as full as it once was, or major patches of hair loss, our board-certified dermatologists at Schlessinger MD can help.
In this article, they break down the differences between two types of alopecia, non-scarring and scarring, highlighting recent findings by board-certified dermatologist, as well as Mohs surgeon and cosmetic surgeon, Dr. Daniel Schlessinger.
What is non-scarring alopecia?
Non-scarring alopecia is the most common form of hair loss, which is good news because this type of hair loss can be reversed in some cases. This is because the hair follicle remains intact, making it possible for hair to regrow. Non-scarring alopecia ranges from hair thinning to total hair loss and is caused by genetics, hormone levels, stress, infections and more.
Here are a few types of non-scarring alopecia:
Androgenetic alopecia
Also known as male or female pattern hair loss, androgenetic alopecia is hair loss due to increased androgen hormones, which are essential in both men and women. For this type, women might notice an increase in thinning around the crown or temples of the scalp, while men typically experience a receding hairline or thinning on the top of the head. Dr. Daniel Schlessinger notes, “Hair loss treatments, like platelet rich plasma (PRP) and minoxidil, may help with regrowth, but this type of hair loss will usually progress over time. ”
At-home devices like the FDA-cleared HairMax LaserBand 41 ComfortFlex Hair Growth Device are a great at-home tool for this type of hair loss. This device uses medical-grade lasers to precisely target the hair follicle, stimulating growth. Treatment time is just three minutes, three days a week and you can easily wear the device while you are working, relaxing or moving about your home.
Telogen effluvium
This type of hair shedding occurs as a side effect of significant illnesses or traumatic experiences but generally improves within six months of its worst point. Telogen effluvium can occur as a result of:
- Major life events such as a family death or car accident
- Dietary deficiencies
- Dramatic changes to the body due to weight loss medications like GLP-1s (Ozempic)
- Recurring COVID-19 infections
- High fevers
- Major surgeries
- Childbirth (typically occurs six months after the baby is born)
Supplements like the Viviscal Professional Hair Growth Program can be helpful for telogen effluvium. They are formulated with an AminoMar® marine complex, biotin, apple extract and vitamin C to support healthy hair growth and fortify weak hair strands, so you keep more of your existing hair. Hair systems, like the ReTress Hair Rejuvenation Kit, developed by board-certified dermatologist Dr. Candace Spann, can also help women slow hair loss and thinning while soothing a sensitive scalp.
Alopecia areata
This type of non-scarring alopecia affects 2% of the world’s population and has many triggers including stress and illnesses. Alopecia areata is a byproduct of when your body’s immune system mistakes healthy tissue for harmful tissue and attacks it, causing patchy or total loss of hair on the scalp (alopecia totalis) or the body (alopecia universalis). It can also show visible effects on the nails! Medications known as JAK inhibitors like Olumiant®, which was studied at Schlessinger MD, as well as corticosteroids and prescriptions like minoxidil are often used to treat alopecia areata. Counseling may be helpful if stress is a big contributor to your hair loss.
What is scarring alopecia?
Scarring alopecia is less common and occurs when hair follicles are permanently destroyed and replaced with scar tissue. Dr. Joel Schlessinger elaborates, “The main causes of scarring alopecia include inflammatory or auto-immune disorders, as well as burns to the skin, severe infections, tumors and other conditions.”
While there is no cure for scarring alopecia, if hair loss treatments are begun early you may be able to slow this type of hair loss. To diagnose this type of hair loss and determine the best treatment options for you, a scalp biopsy may be needed.
While there are many types of scarring alopecia, here are two of the most common:
Lichen planopilaris
Lichen planopilaris (LPP) is hair loss that occurs as a side effect of auto-immune responses which leads to scarring. This type of hair loss primarily affects adult women between the ages of forty and sixty, often occurring in patches and can include redness, pain, scaly skin and itchiness of the scalp.
Frontal fibrosing alopecia
Frontal fibrosing alopecia (FFA) is a form of LPP that involves hair loss in the front hairline and eyebrows. This type of scarring alopecia most commonly occurs in post-menopausal women and like LPP, may involve redness or scaling around the hair follicle as well as itching and burning sensations in your scalp.
While the exact causes of FFA are still being debated, Dr. Daniel Schlessinger has recently contributed to new research on the condition. One of his recently published studies shines light on a possible connection between FFA and the use of everyday hair care products.
Dr. Schlessinger elaborates, “Researchers have long wondered whether a form of hair loss called frontal fibrosing alopecia was due to allergic contact dermatitis, which also causes itchiness and redness in the skin. I was part of a research team that looked into this and found that many of these patients may be allergic to an ingredient called cetrimonium bromide, which is used in conditioners for its anti-frizz benefits.”
Getting to the bottom of your hair loss and back on the road to fuller, healthier hair is a journey. With thorough conversations, examinations and tailored lab work at Schlessinger MD, we can help determine the source of hair thinning or hair loss and develop the right treatment plan for you. You can schedule an appointment conveniently online with our board-certified dermatologists today.