The first finding of alopecia kind usually begins with the establishment of alopecia as either a scarring (cicatricial) alopecia or alopecia nonscarring. Nonscarring alopecia tend to have preserved follicular ostia. No clinically apparent inflammation is noted most of the presentations, but histological inflammation may be present. The most common nonscarring alopecia include alopecia areata and telogen effluvium.
Scarring alopecia have loss of follicular ostia or atrophy. Clinical inflammation is often, but not always present. Histological inflammation are present. Ultimately, histological confirmation is the best method to confirm the presence of fibrosis / scarring process hair follicles.
Many types of alopecia are biphasic. For example, androgenic alopecia ultimately resulting in loss of ostia, and therefore may be represented as a scarring alopecia.
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Bald patches establish on the scalp, beard, and possibly eyebrows. Eyelashes may fall out as well. This is thought to be an autoimmune disease, where the immune system aggressions the hair follicles and leads to hair loss on the scalp and other parts of the body. However, the hair follicles are alive so there is potential for hair to regrow when the underlying problem has resolved. Growth may occur even without medication and even after many years. In most cases hair shedding only happens in a few places, leaving a few bare patches. In some cases though, the disease can advance to total loss of hair from the head (alopecia areata totalis) or complete loss of hair on the head, face and body (alopecia areata universalis).
Tinea capitis is hair fall due to fungal infection of the scalp. This is easily treated with antifungal medicines.
Telogen effluvium is temporary hair loss, which can occur after a serious illness, major surgery or emotional or physical stress.
Anagen effluvium is hair loss due to treatment with chemotherapy medicines. These medicines target rapidly dividing cells, so affects the actively growing hair cells. Hair grows back after the treatment is finished. This type of hair fall also appears with radiation therapy but it is localized to the area of treatment. So if treatment is in the hip area you will lose hair in that area but not the hair on your head.
Traction alopecia certain hairstyles such as when you pull on your hair tightly can cause scarring of the hair follicles. If pulling is stopped before scarring to the scalp then your hair will grow back normally. Nervous habits such as continual hair pulling or scalp rubbing can also cause scarring and ultimately permanent hair loss. Excessive shampooing and blow-drying can also cause hair loss.
Cicatricial or Scarring alopecia
Cicatricial or Scarring alopecia hair loss occurs when inflammation damages and scars the hair follicle and replaces it with scar tissue. The inflammation that destroys the follicle is under the skin surface so affected areas of the scalp may show little signs of inflammation. It is not known what triggers or causes this inflammation. If the inflammation destroys the stem cells and sebaceous glands, then hair loss is permanent.
Trichotillomania is a psychological condition where the individual has strong urges to pull out their own hair.
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