Types of alopecia: non-scarring

Non-scarring alopecias are those in which the hair follicles have not been permanently destroyed. In many cases, it is possible to regain some of the lost hair or control the progression of alopecia, depending on its cause, duration, and response to treatment.

1. Androgenetic alopecia

Androgenetic alopecia is the most common cause of hair loss in men and women. It is characterized by the progressive miniaturization of the hair, which becomes thinner and less dense. In men, it usually mainly affects the temples, frontal area, and crown. In women, reduced density is more commonly observed in the upper area of the scalp.

Treatment: Medical treatment may include minoxidil, finasteride, or dutasteride, depending on each patient’s characteristics and needs. Intradermal treatments, such as mesotherapy or platelet-rich plasma (PRP), may also be considered as complementary options, taking into account their indications and the available evidence. These treatments aim to slow the progression of alopecia and improve the characteristics of existing hair. When hair loss is advanced and the patient is a suitable candidate, a hair transplant may be considered to restore coverage in specific areas.

2. Areata alopecia 

Alopecia areata is an autoimmune disease that causes hair loss, generally in the form of round patches. It may affect the scalp and other areas of the body. Its course is variable: some patients recover their hair spontaneously, while others experience recurrent episodes or more extensive forms.

Treatment: Treatment depends on the extent and course of the condition. It may include topical or intralesional corticosteroids and, in certain cases, other immunomodulatory treatments. In more extensive forms, systemic treatments—including JAK inhibitors—may be considered according to each patient’s clinical indications and circumstances.

3. Telogen effluvium

Telogen effluvium is characterized by increased hair shedding due to a disruption of the hair growth cycle. It may occur after illnesses, surgical procedures, physical or emotional stress, hormonal changes, or certain nutritional imbalances.

Treatment: Treatment focuses on identifying and correcting the cause of the hair shedding. In certain patients, it may be necessary to address nutritional deficiencies or treat associated conditions. Recovery usually occurs gradually once the triggering factor has resolved. (Medical note: PRP should not be presented as a treatment with proven effectiveness for every case of telogen effluvium.)

4. Difusse alopecia

Diffuse alopecia is characterized by a generalized reduction in hair density, without being limited to a specific area of the scalp. It may be related to hormonal changes, nutritional deficiencies, illnesses, medications, or other causes.

Treatment: Establishing an accurate diagnosis is essential, as treatment depends on the underlying cause of hair loss. In some cases, correcting the cause may be sufficient. In others, medical treatment and follow-up appointments will be necessary to assess progress.

Types of alopecia: scarring

1. Frontal fibrosing alopecia

It is a form of scarring alopecia that mainly affects women, especially after menopause, although it can also occur in men and women of other ages. It is characterized by the progressive recession of the frontal hairline and may be accompanied by eyebrow hair loss.

Treatment: Its aim is to control inflammation and slow the progression of the condition. Depending on the patient’s characteristics, topical or intralesional corticosteroids and certain systemic treatments, such as hydroxychloroquine or 5-alpha-reductase inhibitors, may be used when indicated.

2. Discoid lupus erythematosus

It is a chronic inflammatory skin condition that can affect the scalp and cause permanent destruction of hair follicles. It may present with inflammatory patches, pigmentation changes, and hair loss.

Treatment: The aim is to control inflammation and prevent new lesions. It may include topical or intralesional corticosteroids, calcineurin inhibitors, and, in certain cases, systemic medications such as hydroxychloroquine.

3. Lichen planopilaris

It is an inflammatory condition that affects the hair follicles and may cause permanent scarring alopecia. In some patients, it causes itching, discomfort, or scalp redness, although it may also progress with few symptoms.

Treatment: Treatment is intended to control inflammation and prevent the progression of hair loss. It may include topical or intralesional corticosteroids and, depending on the activity and extent of the condition, other systemic treatments.

4. Folliculitis decalvans

It is a chronic inflammatory condition of the scalp that may cause the destruction of hair follicles. It is characterized by the appearance of pustules, inflammation, and areas of hair loss, which may progress to scarring alopecia.

Treatment: The aim is to reduce inflammation, control flare-ups, and prevent progression. It may include antibiotics and anti-inflammatory treatments and, in certain cases, isotretinoin, according to medical assessment.

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