Blog entry by Rcgp Learning
Alopecia is a general term for hair loss. However, there are different types depending on the severity and underlying cause of the hair loss. Alopecia areata is a non-scarring hair loss, which results in a small, round patch of baldness on the scalp. It can also affect hair across the body, such as facial hair, body hair, eyebrows and eyelashes. For some people, larger areas can be affected, such as the whole scalp (alopecia totalis) or the whole scalp and body (alopecia universalis)².
Alopecia Awareness Month takes place in September and aims to raise awareness of alopecia and the impact it has on those it affects. It is estimated that the lifetime prevalence of alopecia areata in the UK is 1.7%, with both men and women affected¹. Patients with concerns about hair loss symptoms are likely to visit their GP initially, so it is useful to have some understanding of alopecia and the different ways it can present.
Alopecia areata is an autoimmune condition which occurs when T-lymphocytes attack the hair bulb. There is a genetic predisposition in some families and it can also be associated with other autoimmune conditions, such as thyroiditis, lupus erythematosus, vitiligo and psoriasis¹. Unfortunately, there is no known cure and hair regrowth cannot be guaranteed. The chances of the hair growing back depends on the amount that is lost in the first place. People with small bald patches may experience full regrowth within a year, whereas people who lose half of their hair may not make a full recovery².
Another cause of alopecia is androgenetic alopecia, which can affect men or women and for which there is a genetic link. Treatments for this include antiandrogens and hair transplants, which are not usually available on the NHS.
Telogen effluvium is another common form of alopecia. It occurs when hair follicles move from the anagen phase to the telogen phase too early. Around 85% of scalp hairs are in the anagen phase, which means that the hair grows by 0.5-1.5cm a month and lasts in the scalp around three-five years. Telogen is when the hair follicle is approaching the end of its lifecycle. The hair is fully keratinized and the follicle is dormant, lasting in the scalp around two-three months¹.
The normal hair cycle is illustrated in the diagram below:
Acute telogen effluvium can happen suddenly and generally comes on about three months after a trigger. Common triggers include childbirth, severe trauma or illness, a stressful or major life event, rapid weight loss, severe skin problems affecting the scalp or a new medication¹’³. Patients may notice large numbers of hairs on their pillow, hairbrush or in the plughole. In most cases, hair growth returns to normal within a few months¹. If the hair loss carries on for more than six months, this could suggest chronic telogen effluvium. It is more common in women and is linked to female pattern hair loss, thyroid disease and iron and vitamin D deficiencies¹.
The RCGP has recently developed an eLearning course with Alopecia UK, with the aim of increasing GPs’ knowledge of hair loss conditions. You can access the Alopecia eLearning course here. The course is FREE to access and gives you at least 0.5 CPD Credits upon completion. For more information on hair loss conditions, you can also visit the Alopecia UK website here.
¹ Royal College of General Practitioners. Alopecia eLearning course. [Internet]. Available from: https://elearning.rcgp.org.uk/course/view.php?id=283
² British Association of Dermatologists. Alopecia Areata Patient Information Leaflet. [Internet]. Available from: http://www.bad.org.uk/for-the-public/patient-information-leaflets/alopecia-areata
³ British Association of Dermatologists. Telogen Effluvium (a type of hair loss) Patient Information Leaflet. [Internet]. Available from: http://www.bad.org.uk/for-the-public/patient-information-leaflets/telogen-effluvium