What is Alopecia?

Alopecia is a blanket term for any medical condition associated with hair loss. Though distressing, it’s not an uncommon condition. Most men and up to 50% of women will experience one type of alopecia or another in their lifetime.

Alopecia occurs for a host of reasons unconnected to your race, gender, or background. Some types of alopecia can cause balding while others simply result in a thinning of the hair. Some are permanent while others are temporary.

Whatever type of alopecia you might have, it’s never easy to handle. Our hair is closely linked to our self-esteem and confidence. The condition of our hair can affect our mood - why do you think we talk so much about “pulling our hair out” or “bad hair days”?

Alopecia describes a number of a complex conditions but understanding more about them can leave you in a better position to deal with them.

The Causes of Alopecia

While it’s not immediately understood what causes particular types of alopecia, the majority of hair loss happens when there’s a disruption to the hair growth cycle. Hair grows in a cycle of growth, rest and fall that repeats over your lifetime. Each hair is grown by an organ known as a follicle. Each follicle cycles through its stages of growth rest, fall and then rebirth/regeneration in its own time and out of sync with its neighbors. In this way you will have about 80-90% of hairs actively growing at any given time, and the remainder resting and regenerating. The asynchronous cycling is also the reason why you shed about 50-100 hairs a day, as resting hairs finally detach, usually pushed out of the scalp by a shiny new hair shaft growing in its place.

The Different Types of Alopecia

Androgenetic alopecia

This type of hair loss is also referred to as pattern hair loss and is by far the most common. About 50% of men under 50 and about 80% of men at 70 will have experienced this form of hair loss. Pattern hair loss is also very common in women, with more than 50% of women having mild hair loss as they age, while about 20-30% develop moderate to severe hair loss.

Pattern hair loss a very complex condition and can have a huge number of factors at play. Things such as genetics, hormones, lifestyle, aging and environmental factors can all contribute to pattern hair loss. In terms of genetics, a large number of genes may be involved as well, with the latest sophisticated analyses showing us that over 150 genes may be involved in early onset male hair loss alone. It is likely that many more genes are involved in slow onset hair loss in men and also hair loss in women.

The loss of hair is referred to as pattern hair loss for a reason: it follows a defined path that is predictable in most people. For men, pattern hair loss usually becomes visible at the temples, frontal area and over the crown. It can start presenting for men as early as the late teens or early twenties. Women experience androgenetic alopecia a little differently and while there are no clear bald patches or regional patterns of thinning, women will usually see diffuse hair loss at the frontal region and top of the head, which may be most visible at the center part or the temples.

The common factor seen in pattern hair loss, regardless of the genes or other factors in play, or the sex of the person, is a change in the hair growth cycle, specifically premature shortening of the growth phase of the cycle. When the follicles prematurely regress, shortening the growth phase, there is more hair falling, more hair resting, and a transition towards follicular miniaturization, where the follicles only produce fine baby hairs called vellus hairs. Preventing this shortening, for example by blocking the key initiator of regression FGF5, is a key aspect of treating androgenetic alopecia.

Involutional alopecia

This type of hair loss, also known as senescent alopecia, is simply age-related hair loss. this form of hair loss is seen as a gradual thinning with age. Follicles are very active organs that work very hard to produce hair. Like in our skin, the process of hair growth simply doesn’t work as well as we get older, and the follicles lose their ability to produce high quality hair shafts. Follicles are very active organs. With the exception of the gut lining, the follicle cells divide faster than almost any other cell in the body. The rapid growth and cell division in the follicles results in the production of a lot of free radical molecules in the follicles and scalp. When we are young our bodies produce special antioxidant molecules to mop these up, but as we get older this becomes less effective, leading to damage to cells and proteins, resulting in low level inflammation. The combination of tired hair follicles and age-related inflammatory processes results in the production of finer, less substantial hairs and a disruption of the hair cycle, shortening its growth phase. With a short growth phase there are more follicles resting and falling at any given time, resulting in reduced hair density.

Alopecia areata and autoimmune alopecia

Usually a temporary condition, alopecia areata presents as patchy hair loss or clumps of hair falling out, usually in a circular pattern. It can start suddenly and may lead to total scalp hair loss (called alopecia totalis) or complete body hair loss (alopecia universalis).

Alopecia areata is likely caused by an overactive immune system that mistakes hair follicles for foreign bodies and attacks them. Hair usually returns within a few years for some 90% of people with the condition. Treatment with topical or systemic steroids may be required, so if you think this is happening to you, you shouléd see a doctor.

Telogen effluvium

With this condition, large numbers of hair follicles stop growing and enter the rest phase at the same time, causing shedding and thinning over the scalp. It’s often induced by extreme stress, illness, dietary changes, and particularly after childbirth. Telogen effluvium can result in some hair cycle dysfunction that may need a little help to restore but is usually temporary and fully reversible.

Anagen effluvium

If your body undergoes harsh, system wide insult, such as with cancer chemotherapy or poisoning, it may cause the sudden and rapid shedding of anagen hair follicles. The result is diffuse or even total hair loss. The hair loss seen with chemotherapy occurs because chemotherapy drugs target rapidly dividing cells. Cancer cells divide rapidly, but so do hair follicle cells and the gut lining, so the chemotherapy kills off hair as a side effect.

Anagen effluvium is usually totally reversible. Once the poison or medication is removed from your body, the follicles will regenerate. Due to the massive impact of the chemotherapy, the hair may grow back patch or with hair cycle changes. In these cases, a little help in restoring the hair cycle can help revive the follicles.

Traction alopecia

Physical stress or tension on your hair can lead to follicle damage. Each follicle is connected to a small muscle called the arrector pili. Too much tension on the hair can cause this muscle to detach from the follicle. When this happens, the follicle can be damaged and lose its ability to regenerate. Hairstyles such as tight ponytails, pigtails, dreadlocks, hair weaving, braiding, and cornrows put pressure on your hair follicles, and if the pressure is kept up for long periods, follicles may die.

Treatments for Alopecia

Multiple studies have shown that blocking the important hair cycle regulatory protein FGF5 can help keep your hair in the growth phase for longer. FGF5 is the key signal that initiates the transition out of growth and into regression. After regression, hair rests, then falls. FGF5 only has one job in the body, and it is the only molecule that does that job. By blocking it, hair remains in the growth phase longer, helping restore the hair cycle to its natural length. All forms of common hair loss are characterized by a shortened growth phase so blocking the molecule that stops and shortens the growth phase is a strong strategy to take the fight to the follicles.

After years of research, évolis® has pioneered anti-aging and hair loss treatments using unique FGF5-inhibitor technology. Our hair products contain an original botanical blend that will strengthen your hair, accelerate hair growth, reduce hair loss, and extend the hair life cycle.

About the Author


Dr Dominic Burg
PhD, Chief Scientist

Dr Dominic Burg is a biochemist and systems biologist with expertise in hair and scalp biology, particularly hair cycle signalling. An accomplished science communicator with a career spanning academic research and the private sector, Dr Burg is the Chief Scientist for pioneering hair and scalp health leaders évolis.


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