What is alopecia? Causes, types and treatment

Short answer: Alopecia is the medical umbrella term for hair loss and encompasses several forms, each with different causes. In men, androgenetic alopecia is the most common; it is hereditary and hormone-related; other forms, such as alopecia areata, require a completely different treatment.

You may notice that your hair is becoming thinner, or perhaps you suddenly discover a bald patch. ‘Alopecia’ is then the term you’re likely to come across, but this term by no means covers just a single condition. The most common form in men develops gradually and is hereditary; other forms occur suddenly or have a completely different cause, such as an overactive immune system. This article explains exactly what alopecia is, what types there are, how to distinguish between them, and which treatment is appropriate for each form.

What exactly is alopecia?

Alopecia means hair loss or baldness and is a general term, not a diagnosis in itself. This term covers several conditions, each of which has its own cause and its own treatment strategy. Androgenetic alopecia is by far the most common form in men: a hereditary, hormone-related form of hair loss that progresses gradually. Alopecia areata is an autoimmune reaction in which the immune system attacks the body’s own hair follicles, leading to patchy bald spots.

Scarring alopecia, also known as cicatricial alopecia, occurs when the hair follicles themselves are permanently damaged, for example by inflammation, trauma or a skin condition, causing hair growth in that area to cease permanently. There are also lesser-known forms such as telogen effluvium, a temporary form of hair loss that can occur following stress, illness or a traumatic event. Crucially, the cause determines which treatment is effective: a remedy that works well for one form may have no effect whatsoever on another.

Androgenetic alopecia: the most common form in men

Androgenetic alopecia occurs when dihydrotestosterone (DHT) causes sensitive hair follicles to gradually miniaturise. This happens via the enzyme 5-alpha-reductase, which converts testosterone into DHT, and primarily affects men with a genetic predisposition to it. Research into the mechanism of male pattern hair loss shows that this miniaturisation follows a consistent, predictable pattern, which is represented on the Norwood scale from stage 1 to 7. Hair loss usually begins at the hairline, with characteristic receding areas, and at the crown. This form is progressive but is readily treatable, particularly in the early stages 1 to 4. It is precisely this form that the treatment of androgenetic alopecia at Fellos focuses on, using finasteride, dutasteride and minoxidil. Would you like to find out more about how this form develops? Read more about the causes of hair loss.

Alopecia areata: a different condition with a different treatment approach

Alopecia areata is an autoimmune condition and – unlike androgenetic alopecia – has nothing to do with DHT or heredity. The immune system attacks healthy hair follicles, resulting in sudden, round, sharply defined bald patches, usually on the scalp, but sometimes also in the beard or on the eyebrows. A recent review shows that alopecia areata affects around 2 per cent of people at some point in their lives and can occur at any age, including in young men. The course of the condition is unpredictable: it may resolve on its own, but it may also recur.

Important to note: finasteride, dutasteride and minoxidil are not intended for the treatment of alopecia areata and have neither been studied nor approved for this purpose. These treatments act on DHT or blood circulation, but not on the autoimmune process that attacks the hair follicles in alopecia areata. The treatment of alopecia areata, for example with corticosteroids or immunotherapy, does not fall within Fellos’ scope of services. If you suspect this condition – characterised by sudden, circular bald patches – you should consult your GP or a dermatologist.

Recognising symptoms: How do you know which form you have?

The way in which hair loss develops often reveals which form is involved. Androgenetic alopecia progresses gradually, begins at the hairline or parting, always leaves the hairline at the back of the head intact, and is not accompanied by itching or inflammation. Alopecia areata, on the other hand, occurs suddenly, with round or oval bald patches and a sharply defined edge, sometimes accompanied by itching or a tingling sensation, and can also affect the nails, causing small indentations. In the case of scarring alopecia, the skin in the bald patch often looks different: shiny, reddened or inflamed, and no hair grows back in that area. Are you unsure which type you have? A doctor can often determine this quickly through a physical examination.

When should you see a doctor?

Always consult your GP or a dermatologist if you experience sudden or patchy hair loss, if you have itching, pain or redness of the scalp, or if hair loss occurs in unusual places such as the eyebrows, beard or body hair. Rapidly progressing baldness or uncertainty about the cause are also reasons to make an appointment. According to Thuisarts.nl, a medical assessment is always the safest first step when in doubt, especially as treatment varies completely depending on the type of condition. An incorrect assessment will cost you time and, in some cases, may also result in the loss of hair follicles that cannot regenerate.

How does Fellos help with androgenetic alopecia?

Fellos focuses exclusively on androgenetic alopecia and not on other forms of hair loss. Following an initial online consultation, a Dutch doctor will assess your situation and confirm whether it is indeed androgenetic alopecia. Based on this, a personalised treatment plan is drawn up, usually involving finasteride and/or minoxidil, and, if these prove insufficient, dutasteride may be prescribed for off-label use where necessary. Studies into the effectiveness of these treatment options show that results are usually visible after 3 to 6 months, with maximum results achieved after approximately 24 months of consistent use. Would you like to know which treatment is best suited to your situation? Find out more about the difference between finasteride and dutasteride. Fellos’ treatment is expressly unsuitable and not intended for alopecia areata or scarring alopecia.

The correct diagnosis is the first step

Alopecia is not a single condition: the specific form determines which treatment is effective. In cases of hereditary hair loss, known as androgenetic alopecia, Fellos can intervene in good time using tried-and-tested medication and medical supervision, ideally as early as the initial Norwood stages. For other forms of hair loss, such as alopecia areata or scarring alopecia, a correct diagnosis by a doctor is the first and most important step before any treatment is considered.