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Alopecia: Everything you need to know

What is alopecia?

Alopecia is an umbrella term for hair loss anywhere on the body, which can be permanent or temporary. It can affect anyone regardless of gender, ethnicity or age. Hair can grow back on its own or with treatment. The condition is said to affect 1 person in every 100 in the UK.

What are the different types of Alopecia?

Alopecia Areata

Alopecia Areata Scalp Sussex Trichology

Alopecia Areata (AA) is an auto-immune condition whose symptoms can be seen anywhere on the body, from the eyebrows to your limbs. When a microscopic invader enters your body, your body tries to protect you by releasing T-cell lymphocytes to raise the red flags of inflammation which include redness and itchiness. Sometimes, your body mistakenly attacks your hair follicles with T-cells but your hair follicles continue to live. This condition usually presents as bald spots and the size can vary from small to medium.

AA may develop into Alopecia Areata Totalis (AT) if the hair loss patches are located on the scalp and spread from there.

If Alopecia Areata covers the entire body and scalp then it has developed into Alopecia Universalis (AU).

Hair loss caused by AA, AT and AU may be temporary or permanent. In fact, you may experience sudden hair recovery both with or without treatment if the hair follicles are still intact and are able to regrow your hair. However, particularly because of the autoimmune element, there is still the possibility that you will experience permanent baldness with AA, AT or AU.

Androgenic Alopecia

Androgenic Alopecia (AGA) is also known as male and female pattern baldness on the scalp. This condition is caused by an increase of the androgen hormone Dihydrotestosterone (DHT). Testosterone in men and Dehydroepiandrosterone in women is converted to DHT by 5AR (enzyme). When too much DHT is attached to receptors on the hair follicles, they tend to miniaturise and lose their hair growth support. This condition may be hereditary.

Men tend to show AGA as a resigning hairline in the shape “W”, whereas women tend to show it by excessive thinning of the hair.

Sufferers of pattern balding should be wary of an increase of DHT as it is known to be related to other conditions such as prostate cancer, enlarged prostate and a slower healing of the skin. 

Telogen Effluvium (TE) and Anagen Effluvium (AE)

Both Anagen and Telogen Effluvium refer to the initial (active hair growth) and last (natural shedding of hair) stage of the hair growth cycle respectively. 

Hair loss under AE, also commonly referred to as chemotherapy-induced alopecia, is a disorder during which the cell division to produce new hair is obstructed by toxins, medication, radiation, chemotherapy and infection. Such activity causes the hair breakage and may lead to complete baldness if the hair bulb is affected. 

On the other hand, baldness caused by Telogen Effluvium is when a premature hair (anagen phase) moves straight to telogen (or resting phase) where the hair falls out. The shedding increases from 10% in normal heads to more than 30% in affected heads meaning that the hair loses its overall volume. It is likely to happen after a big change or trauma to the body such as childbirth, new medication, illness and hormonal changes. Telogen Effluvium can also be brought on by extreme stress.

Cicatricial Alopecia (CA)

This type of alopecia is a synonym of Scarring Alopecia, where inflammation permanently damages the upper part of your hair follicles. CA has many sub-types which are usually found on people with afro hair, especially ones that have been relaxing their hair for years. CA can also be caused by wearing your hair in very tight hairstyles or the extra tension of wigs/weaves on relaxed hair. Some of these subtypes can become genetic. 

When under strain from relaxer or tight braids, your body tries to protect itself from harm by causing inflammation, which in the case of scarring alopecia destroys and replaces your hair follicles with scar tissue. As a result, the hair follicle would no longer be viable. The condition may be non-symptomatic or you can also experience erythema, severe itchiness, discomfort, varied pigmentation, blisters with pus or fluid, strong burning and pain.

Central Centrifugal Cicatricial Alopecia (CCCA)

Scalp suffering from Central centrifugal cicatricial alopecia (CCCA)

CCCA, which used to be called “chemically induced scarring alopecia”, is a progressive, chronic inflammatory disorder of the hair follicle. It is common amongst black women, especially those who excessively stress their afro hair with weaves, tight hairstyles or those who have been using relaxers for years. It can occur suddenly after years of using relaxers with (seemingly) no problems. It most commonly appears on the crown of the head, in a symmetric centrifugal pattern. It may occur along with papules, pustules, severe itching and sensitivity.

Frontal Fibrosing Alopecia (FFA)

Frontal Fibrosing Alopecia (FFA) scalp

FFA usually occurs to postmenopausal black women. It is characterised by excessive development of keratin in your hair follicles, redness around the follicle, hypopigmented/hyperpigmented scarring, absence of the hair opening (due to external scarring) or progressional recession of the hairline from the front to the temporal lobes. Also, it can develop on the eyebrows, eyelashes and axillary and pubic areas.

Traction Alopecia (TA)

Traction Alopecia scalp

Traction Alopecia is caused by the tight, constant pulling of your hair because of common hair styling practises which affect specific sites both on afro and relaxed hair. For instance, if you wear your hair in tight “protective” styles then it’s more likely for you to develop TA along your hairline until the area above/around your ears. If you glue or stitch weaves, extensions or weft directly on your scalp or your hair net is not protective enough, then you are most likely to develop TA around the crown of your head in a pattern known as a “horseshoe.” 

If you consistently keep your hair in styles that place tension on it, then you are likely to develop TA. TA is characterised by scarring of the hair follicles.

How to treat Alopecia?

The first thing to do is remove the cause of the damage. Stop using any harsh chemicals such as relaxers, texturisers and dyes. Avoid braids, weaves, wigs and hair extensions and keep your hair and scalp from excessive strain.

Natural materials with high polyphenolic content, such as peppermint oil or lemongrass oil, can help with the nonscarring alopecia as they contain anti-inflammatory and antioxidants agents. You can mix a few drops of one of these essential oils in a carrier oil, such as olive oil, coconut oil and massage it into your hair for 5 minutes. Thorough rinsing should be followed to decrease the chances of irritation with the essential oils.

Our scalp oil Soothe contains lemongrass and olive oil, our founders created it to treat their own traction alopecia caused by years of relaxers, tight braids and weaves. Massaging this into the scalp twice a day, morning and night, will stimulate blood flow to the scalp due to the lavender oil and other essential oils. This will help to encourage new hair growth, provided the follicles are still intact. After two weeks of daily massage you should see around a quarter inch of new growth.

This method should be used in the case where the alopecia you are diagnosed with is reversible, meaning that the hair follicles are still intact and well-connected to your hair bulb.

However, if your alopecia (both symptoms and underlying cause) is not treated in time to reverse the damage, there are other options for you. 

The treatments available for AA and AGA are oral Finasteride and topical Minoxidil. They work by blocking the protein receptor 5AR whose job is to convert testosterone to DHT. Therefore, these agents stabilise/decrease the levels of DHT in the bloodstream that will reach the hair follicles. Topical/oral corticosteroids can help with hair growth as they "suppress the T-cell-mediated immune attack on the hair follicle." The size and strength of the hair follicles are reversed back to normal after topical or oral use. The new hair growth will likely differ in quality to the old hair but the results can be a dramatic improvement.

For both AE and TE, the hair can recover within months of removing or treating the initiator of this “side effect”, but can be also treated cosmetically. TE can be treated with topical antioxidants and 5AR inhibitors to promote hair growth. 

For scarring alopecia, the hair that was lost cannot be regained. The treatments are for future prevention and preserve your hair growth. If you are diagnosed with central centrifugal cicatricial alopecia, you should immediately stop any hair care routine that may pose a risk to your hair growth, including tight hair styles and perming. If the hair is not restored, then, you can use topical steroids or intralesional injections which work by minimising inflammation and irritation. 

Frontal fibrosing alopecia can be treated with steroids such as Hydroxychloroquine and Mycophenolate or Calcineurin inhibitors which deactivate the T-cells that your body sends for the inflammation to occur. 

Traction alopecia is a non-scarring type of alopecia but can progress to a scarring one, meaning that the hair follicles aren’t “alive”. First thing you should do is minimise the trauma/tension your hair follicles experience when you have “protective” styles on. You should also communicate to your hairdresser if they are pulling too much, or if you see a white tag. That’s your hair follicle. If you pull out your hair follicle too many times, then you slim down the changes of its natural regeneration.

In the meantime, try to give yourself, your head and hair time to “heal” every time you get your hair done whether it’s the hair styles your put your hair in or the chemicals that you use on it.

Remember that your scalp and hair continuously recall the tension (no matter the size of your braids/twists) unless you give them ample time to forget.

Acute Traction Alopecia can be treated with anti-inflammatory ingredients. On the other hand, Chronic traction alopecia, where the hair follicles are scarred, is more difficult to treat with medical/cosmetic therapies. In such a case, hair transplantation is recommended. 

Hair transplantation is one of the most effective treatments for restoring hair. With a rate of success between 10-80% and can be done in two different ways. Follicular Unit Transplantation involves cutting a piece of you skin that has viable hair follicles. The surgeon then cuts this piece into smaller ones and stitches them in.

The second way is Follicular Unit Extraction. This hair transplantation method involves viable hair follicles being incisioned in hundreds or thousands, depending on the magnitude of the hair loss. The surgeon cuts tiny holes in the bald spot(s). The hairs themselves are then being gently implanted into these spots. It may take several months for a full transplantation depending on the healing rate of the “new” hair. 

Another way of dealing with Alopecia is getting a Scalp Reduction Surgery. This surgical method involving the removal of the bald area. The skin with the hair is stretched to close the gap and is stitched in place.

Final words of advice on Alopecia

Hair loss can sometimes be hard to notice, but there are a few warning signs that you should always get checked out. According to London based trichologist (hair and scalp expert) Ebuni Ajiduah, you should see a doctor or trichologist if you experience:

  • Sudden hair loss (a bald patch or much more shedding than usual)
  • Tender/sore scalp (severe burning or itching that doesn’t go away)
  • Increase in shedding for a prolonged period of time

A second Trichologist, Stephanie Sey, adds that if you experience an "unexplained reduction in density," you should seek medical help. 

At Afrocenchix we recommend seeking help if you suffer from scalp and hair problems as they can be a sign of something more serious. Conditions such as anaemia, hyperthyroidism and lupus are common in the black community and hair loss can be an early warning sign.

For trichological help with severe hair and scalp problems, contact these trichologists who specialise in Afro hair:

Stephanie Sey, who you can book an appointment with using this form or Ebuni Ajiduah, who is bookable through her website.

Other articles:

5 Reasons Your Hair is Breaking

How do you reduce constant shedding and get your hair to grow?

How to Choose the Best Afro Hair Products For You

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