There are many reasons why hair loss occurs, from hormones to natural aging and genetics. If you notice bald spots about the size of a coin or are losing a lot of hair when you brush, however, it is probably alopecia — a medical condition that affects 6.8 million Americans.

Alopecia is a common autoimmune disorder that causes the hair to fall out in clumps and areas of baldness to develop. These spots generally start out small with only a few patches on the head. But over time they can connect and, in severe cases, affect the entire scalp.

“Some forms of alopecia occur gradually, while others may become apparent over days or weeks,” explains Alessandra Haskin, MD, dermatologist at Summit Health. “Pain, burning, itchiness, and flakes can signal active inflammation in the scalp, which can also lead to hair loss.”

The condition affects people of all ages and usually comes and goes. When alopecia is active, it is usually referred to as a flare-up, but if it stays away for a period of time, it is known as remission. Alopecia does not cause you to feel physically sick, but the spots may itch or become irritated.

“Having your hair and scalp examined in a timely manner by a board-certified dermatologist who specializes in hair loss is important to confirm the exact cause of alopecia,” explains Dr. Haskin. “This can allow us to tailor a patient-specific treatment plan and address hair and scalp concerns before they worsen.”

Types of Alopecia

The three different types of alopecia vary in severity. They include:

• Alopecia areata - A handful of bald patches appear on the head.
• Alopecia totalis - All the hair on the scalp falls out.
• Alopecia universalis - Hair throughout the entire body is lost, including eyebrows and eyelashes. This may be permanent.

How Hair Loss Occurs

There are about 100,000 hairs on our head. Like the skin, hair growth is a cycle — it falls out and then regrows. The average person loses about 100 hairs every day. In alopecia, this hair loss accelerates significantly.

Hair follicles are tiny structures on the top layer of the skin that hold the strands in place and stimulate growth. Like other autoimmune diseases, in alopecia the body attacks its own healthy cells in the hair follicles. When they become damaged, the hair begins to fall out faster than they can be replaced.

The Stress Factor

It is alarming and upsetting when you suddenly start losing hair. Alopecia, understandably, can cause severe emotional distress in both men and women. There is no cure, and the condition is often chronic.

Individuals with alopecia have high rates of anxiety and depression. Sometimes these bald spots begin in childhood during a particularly vulnerable time when appearance can have a significant impact on self-esteem.

“Hair is an important part of our physical identity and individual expression,” says Dr. Haskin. “Hair loss has been shown to influence symptoms of depression and anxiety and can disrupt the lives of many who experience it. The first step in avoiding this is to seek help from a dermatologist when signs of hair loss begin.”

Patients often ask Dr. Haskin if stress can cause alopecia. “Different types of stress can influence hair loss,” she explains. “Telogen effluvium is a common type of alopecia that often occurs temporarily after bodily stressors such as illness, surgery, pregnancy, or even periods of emotional distress.”

Treatments for Alopecia

There is no cure for alopecia, but there are several treatments. The type of therapy your dermatologist recommends will depend on your age and how extensive the hair loss has become. Since the immune system is overactive in alopecia, most of the treatments work by reducing inflammation and suppressing the overactive immune system.

“Depending on the type of alopecia, treatment can consist of medications such as topical steroids, prescription strength shampoos, oral medications, or injections,” says Dr. Haskin. “Most forms of alopecia can be managed to limit the amount of hair loss.”

• Topical ​​Corticosteroids - This cream is applied directly to the scalp to help decrease inflammation and hair loss.
• Topical Minoxidil - This solution is applied on the bald spots to stimulate mild hair loss. Minoxidil is generally used in conjunction with oral or injectable steroids.
• Corticosteroid Injections - These shots, which are administered into the bald patches about every 3 to 6 months, are highly effective in stimulating hair growth.
• Oral Corticosteroids - A prolonged dose of corticosteroids can reduce inflammation and reactivate hair growth.
• Contact Immunotherapy - These potent drugs are used when there is widespread hair loss. A chemical is applied to the scalp each week that suppresses the immune system and prevents it from attacking the hair follicles.
• Oral Immunotherapy - In severe cases, immunosuppressants like Methotrexate can also be taken daily in pill form.

Treatments may take time to become effective. A wig or scalp prosthetic can help hide the hair loss while you are waiting for it to grow back and make you feel more confident.

If you suspect hair loss, schedule an appointment with a dermatologist who can best diagnose your condition and set you up on the best hair loss treatment plan. Dr. Haskin is available to see patients at our 18 W 18th Street New York City office.