Types of alopecia: why the diagnosis comes first

Alopecia is the medical term for hair loss. It does not refer to one single disease. Pattern loss, alopecia areata, traction and scarring conditions can look different, behave differently and need different treatment. Identifying the cause comes before deciding whether surgery is appropriate.

Pattern hair loss

Androgenetic alopecia is also called pattern hair loss. Affected follicles gradually produce finer, shorter hairs. Common patterns include recession and crown thinning in men and thinning over the top of the scalp in women, although appearances vary.

The Norwood scale and Ludwig scale describe patterns and severity. They do not establish the diagnosis by themselves or provide an exact transplant graft count.

Medical treatment can help some people. Surgery may be considered where the diagnosis, donor supply and future plan are suitable. It does not stop all loss of surrounding native hair.

Alopecia areata, totalis and universalis

Alopecia areata is an autoimmune condition that can cause patches of hair loss on the scalp or elsewhere. Alopecia totalis describes loss of all scalp hair; universalis describes extensive loss of scalp and body hair. They are forms of the same disease spectrum, not separate stages everyone will pass through.

Hair can regrow, but the course varies and episodes can recur. The British Association of Dermatologists' alopecia areata leaflet explains assessment and treatment. A transplant is not usually suitable for alopecia areata because moving follicles does not address the underlying immune process.

Telogen effluvium

Telogen effluvium is increased shedding that can follow illness, childbirth, marked weight loss or another trigger. The shedding may begin months after the event. It can also occur alongside pattern loss.

Our telogen effluvium guide explains the timeline and reasons to seek assessment. Persistent diffuse shedding should not automatically be treated as a need for vitamins or transplantation.

Traction alopecia

Repeated pulling from tight hairstyles can damage hairs and follicles. Early changes may improve when the tension stops, but long-standing damage can become permanent. Pain from a style is a reason to change it, not something that must be tolerated for the style to hold.

The BAD traction alopecia information explains the condition. Treatment depends on the extent of damage and whether inflammation or scarring is present.

Scarring alopecia

Scarring alopecias are conditions in which inflammation can destroy follicles and replace them with scar tissue. Hair cannot regrow from a destroyed follicle. Early specialist assessment matters because treatment aims to control the process and protect remaining hair.

Examples include central centrifugal cicatricial alopecia and frontal fibrosing alopecia. The BAD CCCA leaflet explains one pattern that often begins around the crown. Transplant suitability, if considered at all, requires specialist assessment of disease activity and donor hair.

Describe the location, but do not mistake it for a diagnosis

“Occipital hair loss” means hair loss at the back of the scalp. It describes a location rather than one specific disease. Similarly, a patch at the temple can have several causes. Age, history, symptoms and examination determine what the description means medically.

Seek advice for sudden patches, progressive thinning, pain, itching or visible scalp changes. The NHS hair-loss page gives general guidance on getting help.