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What causes alopecia? Diagnosis, prevention, and treatment

Medically reviewed by Chad Shaffer, MD
Physician
Updated Oct. 27, 2023  •  Published Apr. 10, 2023
Fact Checked
Alopecia causes

Overview: What is alopecia?

Everyone knows about hair loss. Most people think of hair loss as something that happens to men or senior citizens. However, alopecia describes any sort of hair loss, not just the familiar types of scalp hair loss, such as a receding hairline. As everyone knows, hair can get thinner on the head. It can also thin or fall out on the eyebrows, eyelashes, and anywhere else hair grows on the body. There are all kinds of ways to lose body hair. It could thin gradually (alopecia) or fall out in clumps (effluvium). It might fall out in a certain pattern, like male pattern baldness, or it might thin in patches. Or the whole body can lose hair, a condition called alopecia universalis. Alopecia could be a temporary problem, like hair loss caused by cancer chemotherapy or stress. Once the cause is eliminated, the hair grows back. Sometimes hair loss is more or less permanent. It depends on the cause.

Key takeaways:

  • Alopecia is a common health condition that can affect anyone, regardless of age, sex, race, or ethnicity. 

  • Alopecia is caused by sensitivity to male hormones, age, infections, drug effects, stress, autoimmune disorders, poor nutrition, chronic illness, hormone disorders, injuries, and simply pulling the hair out.

  • Risk factors for alopecia include male sex, age, family history of hair loss, steroid use, exposure to infections, chronic illness, hair styling, and stress.

  • Symptoms of alopecia include bald patches, patterned or general hair thinning, or hair falling out in clumps.

  • Alopecia is typically self-diagnosable but usually requires a medical diagnosis to determine the cause and appropriate treatment.

  • Alopecia generally does not require treatment, but some types of alopecia should be treated. Alopecia may or may not resolve with treatments in variable timelines.

  • Treatment of alopecia may include treating the underlying cause, hair regrowth medications, corticosteroids, or immunosuppressants. Read more about alopecia treatments here.

  • Alopecia is sometimes preventable, but the most common forms of hair loss—male pattern baldness and female pattern baldness—are not.

  • Use coupons for alopecia treatments, like minoxidil, finasteride, and dutasteride, to save up to 80%.

What causes alopecia?

Hair loss can be the result of a number of unrelated causes. These include:

  • Male pattern baldness (androgenetic alopecia)

  • Female pattern baldness

  • Infections, particularly fungal infections

  • Cancer

  • Chemotherapy

  • Drug side effects

  • Autoimmune conditions including scalp psoriasis and lupus

  • Alopecia areata (an autoimmune reaction in which the immune system attacks hair follicles)

  • Trauma

  • Physical or emotional stress

  • Hair styling and hair products

  • Excessive hair brushing or shampooing

  • Tight hair styling (traction alopecia)

  • Excessive scalp scratching

  • Compulsive hair pulling (trichotillomania)

  • Severe chronic illness

  • Major surgery

  • Childbirth

  • Thyroid disease (underactive thyroid)

  • Crash dieting or poor nutrition

  • Trauma

  • Burns

  • Chemical damage to the skin

RELATED: Why is my hair falling out? Learn the causes of hair loss

Risk factors for alopecia

Since there are so many causes of alopecia, there are numerous risk factors. The most significant risk factors for male pattern baldness include:

The risk factors for developing infections that cause hair loss include:

  • Sharing of hats, brushes, or other objects

  • Living in a warm or humid environment

Other risk factors for hair loss include:

RELATED: 6 surprising ways stress can affect your body

Is alopecia serious? When to see a doctor

Hair loss is not a serious medical condition. However, consider two things. First, it may be a sign of a medical problem like infection, psoriasis, poor nutrition, or anxiety. Second, no matter what the cause, hair loss can be devastating and significantly reduce self-image and quality of life. Is alopecia serious? Yes, if you think it is.

In that case, talk to a healthcare professional. In some cases, hair loss can be reversed or at least stopped if caught early enough. In other cases, there may be treatments to partially restore hair loss. 

How is alopecia diagnosed?

Alopecia is not an illness. As a symptom, it’s often hard to miss. A healthcare provider has two concerns: what is the nature of the hair loss and what is causing it. Most of the diagnostic work will consist of a physical examination and medical history. The clinician is looking for answers to these questions:

  • Where is hair being lost?

  • Is there patchy hair loss (focal alopecia), patterned hair loss, or just general thinning?

  • Is the problem hairlessness (alopecia) or is hair falling out every day (effluvium)?

  • Is there any scarring or skin problems?

  • How long has this been going on?

  • Are there other symptoms?

  • Is there a family history of hair loss?

  • What medications are being taken?

  • Are there other medical conditions? Injuries? Surgery?

The physical examination will not only focus on the places where hair is thinning but also a complete exam of the skin may be conducted. The clinician may perform a hair-pulling test to determine at what growth phase the hair is having problems. A tug test or card test will help spot any breaks in the hair. 

Further tests are conducted only if there are signs of an underlying medical condition. Blood tests are normally done, but a scalp punch biopsy may be used in some cases. 

Is alopecia hereditary?

For many types of hair loss, genetics is a prime contributor to the problem. This is particularly true of male pattern baldness in men and female pattern baldness in women. In these cases, family members with hair thinning or bald spots are a good indicator of potential hair loss in other family members. It’s also the reason for hair loss due to autoimmune disorders, alopecia areata, and a rare genetic disorder called hypotrichosis, which typically results in total hair loss by early adulthood. 

Is alopecia curable?

Some types of alopecia are usually completely reversible, such as hair loss due to chemotherapy, drug side effects, or some cases of alopecia areata. All or most of the hair will grow back. Other types of alopecia can be slowed or partly remedied with some hair regrowth. Unfortunately, some types of hair loss are permanent if the hair follicles are permanently damaged. Pulling hair, traction alopecia, alopecia areata, infections, or some autoimmune diseases can result in permanent hair loss.

So what will a doctor or dermatologist do to help with the problem? 

RELATED: Does finasteride work for women?

How to prevent alopecia

Many types of hair loss can be prevented. Other types can be helped but not fully prevented. Here are a few tips:

  • Avoid traumatizing the scalp such as scratching or sunburn

  • Wear your hair loosely and avoid tight hairstyles such as buns, ponytails, braids, or cornrows

  • Use gentle chemicals on the scalp like gentle shampoos and conditioners

  • Do not use harsh chemicals at home to change the color of your hair, straighten hair, or perm hair—have these done by a professional hair stylist

  • Avoid curling irons 

  • Use the lowest heat setting on hair dryers

  • Use a gentle brush and don’t overbrush your hair

  • Don’t play with your hair or pull on it

  • Eat a healthy diet

  • Consider taking dietary supplements

  • When losing weight, lose weight gradually

  • Learn to manage stress and practice relaxation techniques

RELATED: How to take biotin for hair growth

Most importantly, hair loss is often preventable

Yes, hereditary hair loss can be destiny. 50% of men and 30% of women will eventually see their hair thin out as they age. However, many cases of hair loss can be prevented or at least slowed down through a healthy diet, smart hair care, stress management, and other precautions. In particular, our culture bombards us with hair care products, hair styling products, and hairstyles that are genuinely bad for our hair, no matter how good they make us look. If your hair matters to you, take care of it in the same way as your eyes, your heart, your blood, your liver, or any other part of your body that matters to you.

FAQs about alopecia causes

What causes alopecia in women?

Women experience hair loss for the same reasons men do. That includes hair thinning due to age and male hormones. That being said, women are more likely to wear hairstyles that pull on the hair, such as buns and braids, which could pull hair out and even damage the hair follicles. They are also more likely to use harsh chemicals, high heat, or hairstyling techniques that can damage hair or hair follicles.

What causes traction alopecia?

Pulling on hair can eventually pull it out. While some people compulsively pull at their hair, many hairstyles can also put steady pressure on the hair and eventually pull it out. Pulling hair out this way can permanently damage the hair follicle. In that case, the hair cannot grow back. Healthcare professionals call this type of hair loss traction alopecia. Hair loss due to traction alopecia is completely preventable by avoiding wearing tight hairstyles such as buns, ponytails, braids, pigtails, or cornrows.

What causes scarring alopecia

Scarring alopecia is permanent hair loss due to the destruction of the hair follicles. Once destroyed, the follicles are replaced by scar tissue which is unable to grow new hair. The most common causes are infections, like severe fungal infections, and autoimmune disorders, such as lupus. However, any kind of skin trauma including burns and chemical damage can cause scarring alopecia.

What’s next? Additional resources for people with alopecia

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Chad Shaffer, MD
Physician

Chad Shaffer, MD, earned his medical doctorate from Penn State University and completed a combined Internal Medicine and Pediatrics residency at the University of Pittsburgh Medical Center and Children’s Hospital of Pittsburgh. He is board certified by the American Board of Internal Medicine and the American Board of Pediatrics. He has provided full-service primary care to all ages for over 15 years, building a practice from start up to over 3,000 patients. His passion is educating patients on their health and treatment, so they can make well-informed decisions.

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