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Skin Issues

Expert Assessment for Hair Loss and Alopecia

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Skin Issues

Hair Loss Assessment & Treatment in Leeds

Alopecia is the absence or loss of hair in an area it is expected to be present. The condition can be temporary or permanent, localised or diffuse and affects males and females of all age groups. It can affect any hair-bearing surface, but it most commonly affects the scalp, beard or, less frequently, the eyebrows or eyelashes. The condition is relatively common, affecting roughly 1 in 1000 patients, with an estimated lifetime incidence risk of about 2%. The condition can occur for a variety of reasons, including genetics, pregnancy, hormonal changes, autoimmune conditions, infections, medications and localised trauma.Sources: Alopecia – StatPearls – NCBI Bookshelf (opens in a new tab); Definition | Background information | Alopecia areata | CKS | NICE (opens in a new tab); Prevalence | Background information | Alopecia areata | CKS | NICE (opens in a new tab)

There are various types of hair loss, broadly categorised into non-scarring (the vast majority of hair loss cases) and scarring (cicatricial) alopecia.

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  • Non-scarring alopecia is often reversible with the right care and adjustments to lifestyle and/or health. There is a broad subtype of non-scarring alopecia, including androgenetic alopecia (male and female pattern baldness), alopecia areata (autoimmune), telogen effluvium (stress-related hair shedding), anagen effluvium, traction alopecia, trichotillomania (hair-pulling disorder) and alopecia syphilitica. It is beyond the scope of this patient information context to discuss these individually, but more information regarding the specific types can be found in the source below.Source: Alopecia – StatPearls – NCBI Bookshelf (opens in a new tab)
  • Scarring alopecia is irreversible. The hair follicles are destroyed, leading to permanent hair loss. This kind of alopecia is typically brought on by inflammation of the scalp due to infections or autoimmune diseases. Conditions that can cause scarring alopecia include lichen planopilaris (LPP), central centrifugal cicatricial alopecia (CCCA), discoid lupus erythematosus and folliculitis decalvans.Source: Alopecia – StatPearls – NCBI Bookshelf (opens in a new tab)

Differentiating between these two categories of alopecia early is important, as it influences prognosis and treatment options.

The diagnosis of scarring vs non-scarring alopecia is based on a combination of the patient’s clinical features, medical history and occasionally a scalp biopsy. The pattern of hair loss and the scalp condition under dermoscopy/trichoscopy (pattern of follicular, vascular and inflammatory changes) help distinguish between the two categories of alopecia.Source: The dermatoscope in the hair clinic: Trichoscopy of scarring and nonscarring alopecia – PubMed (opens in a new tab)

Occasionally a scalp biopsy is required to confirm a diagnosis, and a blood test may be suggested to rule out underlying autoimmune diseases, hormonal imbalances or nutritional deficiencies that can all contribute to hair loss.

Management varies depending on the type of alopecia as well as the underlying cause.

Non-scarring alopecia

The goal of treatment for non-scarring hair loss is to reverse the cause and promote healthy hair growth. Common treatment options include:

  • Minoxidil: A topical treatment option used to treat hair loss in both men and women. Minoxidil encourages hair growth by increasing blood flow to the hair follicle, which delivers more oxygen and nutrients to stimulate growth.Source: Minoxidil: a comprehensive review – PubMed (opens in a new tab)
  • Finasteride: Often used to treat androgenetic alopecia in men and works by preventing the hormone testosterone from being converted to dihydrotestosterone (DHT). DHT damages the hair follicles and causes them to shrink and eventually stop growing.Source: Finasteride – StatPearls – NCBI Bookshelf (opens in a new tab)
  • Corticosteroids: Both topical and intralesional injections (triamcinolone) can be used for patients affected by alopecia areata to promote hair growth.
  • Janus Kinase (JAK) Inhibitor (baricitinib): May be considered for severe cases of alopecia areata that have not responded to other treatment options.Source: Overview | Baricitinib for treating severe alopecia areata | Guidance | NICE (opens in a new tab)
  • Lifestyle changes, stress management or addressing hormonal imbalances may be helpful in certain patients with alopecia.

Scarring alopecia

Treatment is focused on preventing further damage to the hair follicles and subsequent hair loss. There are no specific treatment guidelines for scarring alopecia, but treatment options, often based on expert consensus, may include:

Psychological support is a critical component in the comprehensive management for all patients with alopecia, due to the high prevalence of anxiety and depression associated with the disease. Setting and managing expectations from the outset is important when dealing with patients with scarring alopecia.Source: Integrating Psychological Support and Topical Therapy for the Effective Management of Stress-Induced Alopecia Areata: A Case Report – PMC (opens in a new tab)

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    I would like to recommend Dr K Bhatti - Consultant Dermatologist, he left no stone unturned all my 5 months of upset and stress over my skin condition was worth every penny of the consultancy fee so if your worried about a skin complaint, i have a longish wait to go but all my extra worry has gone as Dr Bhatti listens, very helpful cannot thankyou enough

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