Alopecia

Alopecia is a general term for hair loss and can affect any part of the body. The loss of hair may be temporary or permanent and due to such factors as genetics, hormonal changes, medical conditions, or the aging process. Furthermore, people can experience hair loss in a variety of ways depending on the condition that caused it. Hair loss can appear as a receding hairline, thinning hair all over the head, small patches of hair loss on the scalp, or loss of hair on the scalp and the rest of the body. Certain types of alopecia are more prevalent in the African American population including central centrifugal cicatricial alopecia (CCCA), alopecia areata, and discoid lupus erythematosus (Raffi et al, 2019; Mayo Clinic, 2024; Lee et al, 2020; Cleveland Clinic, 2021).

Types of Alopecia

The two main categories of alopecia are scarring and non-scarring. The difference between the two is whether the hair follicles are destroyed. In non-scarring alopecia, the hair follicles are preserved, so the loss of hair is temporary and may grow back. With scarring alopecia, the hair follicles are irreversibly destroyed, leading to permanent hair loss. Scarring alopecia can be caused by inflammation, trauma, or infection (Al Aboud et al, 2024; Cleveland Clinic, 2023).

            Non-Scarring: Alopecia Areata is a type of non-scarring alopecia in which the immune cells attack the hair follicles resulting in hair loss. The condition causes the hair to fall out in round patches on the scalp. However, this type of alopecia may affect eyelashes, eyebrows, and beards. In addition to hair loss, other symptoms can include nails that develop ridges that run the length of the nail, that feel rough like sandpaper, or become brittle (Yale Medicine, 2024; Cleveland Clinic, 2023).

Scarring: CCCA and discoid lupus erythematosus are two types of scarring alopecia. CCCA is most prevalent among middle aged African American females; however, medical research has not established an exact cause of the condition. With CCCA, the hair loss begins in the center of the crown and subsequently extends outward in a circular pattern. Other symptoms include tiny bumps on the scalp prior to a significant hair loss, as well as, itching, burning, pain, and tenderness on the scalp. Discoid lupus erythematosus or chronic cutaneous lupus erythematosus (CCLE) is an autoimmune disorder that manifests as round, coin-shaped sores on the scalp and face. These lesions don’t usually cause pain or feel itchy. However, if these lesions form scars on the scalp, then it may lead to permanent hair loss (American Academy of Dermatology Association, 2022; Cleveland Clinic, 2021).

Diagnosis

A board-certified dermatologist is best able to help you determine the type of alopecia you have. Your physician will evaluate your medical history and conduct a physical exam to observe the location and pattern of hair loss. The medical professional also will examine the hair follicle opening to determine if there are visible indicators of inflammation.

Your health care professional may also conduct a pull test to assess the extent of the shedding process. A skin biopsy can be used to confirm the presence of scarring, especially in challenging cases where a physical exam alone may not be sufficient. The physician may order blood tests to determine if there are other medical conditions contributing to the hair loss (Cleveland Clinic, 2023; Mayo Clinic, 2024).

Treatment

            Topical: Shampoos (e.g. rogain), corticosteroid creams, and immunotherapy- a type of treatment in which a physician applies chemicals on the skin to keep the immune cells from attacking the hair follicle.

            Corticosteroid injections: These are medications injected directly into the affected area by a qualified physician. Treatments occur in 4 to 6 week intervals.

            Oral Medications: Many of these medications work as immunosuppressants.  Drugs such as Barcitinib, Deuruxolitinib, and Ritlecitinib work by reducing inflammation so that hair can grow.

            Hair Transplant Surgery: Hair replacement or hair restoration is a procedure that moves hair from one part of your scalp where the hair is thickest to the other part of the scalp that is affected with baldness or thinning. This procedure is ideally for patients who have unsuccessfully tried other treatments. In addition, this surgery is not for patients who have scarring alopecia since the scar tissue may prevent the transferred hair from growing (Cleveland Clinic, 2023; American Academy of Dermatology Association, 2023).

Summary

Alopecia is a general term for hair loss. CCCA, alopecia areata, and discoid lupus erythema, are types of hair loss common among African Americans. Alopecia areata is a non-scarring type of hair loss in which treatment attempts to manage hair loss or stimulate hair growth.  However, CCA and discoid lupus erythema are scarring conditions in which the hair loss is likely permanent. Treatments aim to reduce inflammation and irritation.

References

Al Aboud AM, Syed HA, Zito PM. Alopecia. [Updated 2024 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538178/

American Academy of Dermatology Association (2024, August 22). Hair loss types: Alopecia areata diagnosis and treatment. https://www.aad.org/public/diseases/hair-loss/types/alopecia/treatment

American Academy of Dermatology Association (2022 September 23). Lupus and Your Skin: Causes. https://www.aad.org/public/diseases/a-z/lupus-causes

Clevland Clinic (2021, August 26). Hair Loss. https://my.clevelandclinic.org/health/diseases/21753-hair-loss

Cleveland Clinic (2023, January 06). Scarring Alopecia. https://my.clevelandclinic.org/health/diseases/24582-scarring-alopecia

Cleveland Clinic (2021, September 13). Discoid Lupus. https://my.clevelandclinic.org/health/diseases/21808-discoid-lupus#symptoms-and-causes

Cleveland Clinic (2021, April 30). Hair Transplant. https://my.clevelandclinic.org/health/treatments/21519-hair-transplant

Lee, H., Jung, S. J., Patel, A. B., Thompson, J. M., Qureshi, A., & Cho, E. (2020). Racial characteristics of alopecia areata in the United States. Journal of the American Academy of Dermatology, 83(4), 1064–1070. https://doi.org/10.1016/j.jaad.2019.06.1300

Mayo Clinic (2024, January 19). Hair Loss. https://www.mayoclinic.org/diseases-conditions/hair-loss/diagnosis-treatment/drc-20372932

Raffi, J., Suresh, R., & Agbai, O. (2019). Clinical recognition and management of alopecia in women of color. International journal of women's dermatology, 5(5), 314–319. https://doi.org/10.1016/j.ijwd.2019.08.005

Yale Medicine (2024). Alopecia Areata. https://www.yalemedicine.org/conditions/alopecia-areata 

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