Signs and Symptoms of Alopecia

Alopecia is a group of conditions characterized by partial or complete hair loss. In most cases, the main symptom of alopecia is gradual hair loss.

Rare forms of alopecia lead to distinct patterns of hair loss as well as other unique symptoms. Hair loss can occur on the scalp, eyebrows, eyelashes, and other regions of the body. When the immune system plays a role in the disease—such as with alopecia areata—it can cause burning or discomfort on the scalp in rare cases.

Speak with your healthcare provider or a dermatologist (a doctor who specializes in skin, hair, and nail conditions) if you are experiencing hair loss. They can provide a diagnosis and treatment regimen.

Common Symptoms

There are a few common symptoms across different forms of alopecia, including:

• Gradual thinning of the hair on your head
• A growing bald spot
• Receding hairline
• Hair falling out in patches or strips 

Symptoms by Type of Alopecia

Some symptoms can vary depending on the type of alopecia you have. There are two major categories of alopecia: non-scarring and scarring.

Scarring alopecia damages the hair follicle (the skin pore where your hair grows from) and leads to permanent hair loss. With non-scarring alopecia, the hair follicle is not permanently damaged and the hair can grow back.

Non-scarring types of alopecia include:

• Androgenetic alopecia
• Alopecia areata
  
• Telogen effluvium
• Traction alopecia
• Trichotillomania

Scarring types of alopecia include:

• Lichen planopilaris (LP)
• Frontal fibrosing alopecia (FFA)
• Central centrifugal centripital alopecia (CCCA)

What's more, some types of alopecia can be associated with infections. These can either be non-scarring or scarring, depending on the type of fungal infection.

Androgenetic Alopecia

The most common type of alopecia is androgenetic alopecia, a genetic condition. It can occur in anyone regardless of sex assigned at birth, though symptoms can vary across sexes. As a result, the condition is more commonly called male-pattern hair loss or female-pattern hair loss, depending on the person.

Male-pattern hair loss can include:

• Hair follicles appear shrunken
• Hairline recedes from the forehead in an M shape
• A bald patch in the middle of the scalp (the vertex) grows

Female-pattern hair loss can include:

• Hair thinning near the front of the scalp and in the ponytail
• Widening hair partition in the middle of the scalp
• Thinning or hair loss that occurs after menopause

Alopecia Areata

Alopecia areata is an autoimmune condition in which the immune system attacks the hair follicles. Signs of this alopecia include:

• Hair loss in the scalp, eyebrows, eyelashes, beard, nose, and pubic hair
• Red or brittle nails
• Short, thin hairs visible on the scalp
• A patchy or band-like pattern of hair loss
• A burning or stinging feeling before sudden hair loss
• Yellow and black dots on the scalp 

Telogen Effluvium

Telogen effluvium is a more common form of alopecia. It is specific to the scalp (instead of the whole body) and is characterized by excessive shedding. It usually happens after intense emotional or physical trauma. It can also occur after a fever, pregnancy, or surgery, or from nutritional deficiencies, infection, weight loss, or hypothyroidism (a thyroid condition). Signs of telogen effluvium can include:

• Hair falling in spread-out areas (increased diffuse shedding)
• Sudden, dramatic hair loss
• Shedding of white bulb hair (hair that has the white bulb at the end that was in the scalp without a gel-like covering)
• Dry hair that is easy to pluck
• Changes in hair color, such as turning from dark brown to red (only in the case of severe protein malnutrition, such as kwashiorkor)

Telogen effluvium is almost always temporary. However, hair regrowth can take time and require consistent care.

Traction Alopecia

Traction alopecia occurs when hair follicles are damaged by repeated pulling, such as from tight hairstyles. Some symptoms include:

• Pimples and pustules on the scalp
• Hair that becomes shorter and thinner
• Scaly and itchy skin near hair follicles
• Pain or soreness of the scalp
• Redness of the skin

Trichotillomania

This form of alopecia is a type of mental health condition characterized by hair pulling. Signs and symptoms include:

• A compulsion to pluck out hair from the scalp and other body regions such as the eyebrows, legs, arms, or pubic area
• A repeated effort to cut down on hair-pulling behavior
• Hair pulling causes distress or impairment that negatively impacts a person’s life
• No symptoms characteristic of other forms of alopecia
  

Lichen planopilaris (LP)

Lichen planopilaris is a type of inflammatory alopecia that can cause scarring of the hair follicles and gradual hair loss. Symptoms include:

• Redness around the hair follicle (perifollicular erythema)
• Rough, raised bumps of the hair follicles (follicular hyperkeratosis) due to excess keratin (a hair and skin protein)
• Itching, sensitivity, or burning on the scalp
• Permanent hair loss due to scarring of the hair follicle

A healthcare provider can prescribe treatments that may help slow gradual hair loss.

Frontal Fibrosing Alopecia (FFA)

Frontal fibrosing alopecia is a variant type of LP that is characterized by hair loss at the front and sides of the scalp. It can cause scarring of the hair follicles and prevent hair from growing back. If you have FFA, you may experience:

• Noticeable hair loss on the scalp, face, arms, legs, or pubic area
• Thinning or loss of hairs from the edges of the eyebrows
• Rash near the hairline
• Scalp itching or pain
• Bumps on the face or skin

It is possible to stop the progression of FFA with early diagnosis and treatment. Talk to your healthcare provider if you are experiencing symptoms of FFA.

Central Centrifugal Cicatricial Alopecia (CCCA)

Central centrifugal cicatricial alopecia is a type of hair loss that starts at the center of the scalp and can lead to scarring of the hair follicles. The bald spot can get larger with time and scarring can cause permanent hair loss. The cause of CCCA is not known, but your healthcare provider can prescribe treatments to help with hair regrowth and prevent scarring and permanent damage.

Alopecia Associated With Infection

Different fungal infections of the scalp may cause alopecia. These may include ringworm (a common fungal infection) or piedra (another type of fungal infection that occurs in the hair cells). Skin conditions can also cause this type of alopecia, including folliculitis (inflammation of the hair follicles) and seborrheic dermatitis (a condition that causes scaly, oily skin).

If you have alopecia associated with infection, you may experience:

• Burning or itching of the scalp
• Scaly skin near bald patches
• Open sores or blisters on the scalp
  

When to See a Healthcare Provider

Alopecia can affect people of any age. You can talk to a healthcare provider about how to manage symptoms and treatments, depending on your condition—especially if your hair loss is sudden or occurs in your 20s or earlier. You may also speak with a doctor or dermatologist if you have:

• An unusual pattern of hair loss
• Pain and itching of the skin, especially on your scalp
• Red or scaly scalp
• Acne, facial hair, or changes to your menstrual cycle
• Bald spots on the beard or eyebrows
• Weight gain, muscle weakness, or fatigue
• Cold sensitivity
• Visible scalp infections
• Emotional or physical stress that affects your self-esteem or mental health