Alopecia & Hair Loss

Alopecia is the medical term for hair loss. It can range from a few small bald patches to total loss of all body hair. The NHS describes several main types that people commonly experience in the UK:^[1]NHS

• Alopecia areata — an autoimmune condition where the immune system attacks hair follicles, causing patchy hair loss. It can progress to total scalp hair loss (alopecia totalis) or total body hair loss (alopecia universalis).
• Androgenetic alopecia — the most common form, often called male-pattern or female-pattern baldness. It is hereditary and linked to hormones called androgens.
• Telogen effluvium — widespread thinning of hair, often triggered by illness, stress, childbirth, medication or crash dieting. It is usually temporary and hair regrows within months.
• Scarring (cicatricial) alopecias — rare conditions where hair follicles are permanently destroyed. Early dermatology referral is essential to prevent permanent loss.
• Traction alopecia — hair loss caused by repeated pulling or tension on the hair, often from tight hairstyles, extensions or chemical treatments.

Adapted from NHS and British Association of Dermatologists guidance.^[1]NHS[3]BAD

Alopecia areata affects approximately 1 in 50 people in the UK at some point in their lifetime. It can start at any age, though it often begins in childhood or young adulthood. Around 8 million women in the UK experience some form of hair loss, and approximately 1 in 4 men notice hair loss by age 25. By age 50, roughly 50% of men have noticeable thinning.^{[2]Alopecia UK[1]NHS}

Hair loss is not just a cosmetic issue. Research consistently shows that it significantly affects self-esteem, body image, social confidence and mental health — particularly for women and young people, but also for men who may feel pressured to hide it.

The causes vary depending on the type of hair loss:

• Autoimmune — alopecia areata is an autoimmune disease. People with a family history of autoimmune conditions (thyroid disease, type 1 diabetes, vitiligo) may be at higher risk.
• Genetics — androgenetic alopecia is hereditary; genes from both parents play a role.
• Hormonal changes — pregnancy, menopause, polycystic ovary syndrome (PCOS) and thyroid disorders can all trigger hair loss.
• Stress and illness — physical or emotional stress can push hair follicles into a resting phase, causing telogen effluvium. Covid-19 infection has also been linked to temporary hair loss in some people.
• Nutritional deficiencies — low iron, vitamin D, zinc or protein can contribute to hair shedding.
• Medications — chemotherapy, anticoagulants, some antidepressants, acne medications (isotretinoin) and beta-blockers can cause hair loss.
• Infection and skin conditions — scalp ringworm, psoriasis, eczema and severe seborrheic dermatitis can damage hair follicles.

Adapted from NHS, Alopecia UK and BAD.^{[1]NHS[2]Alopecia UK[3]BAD}

You should see a GP if you notice sudden or patchy hair loss, or more hair loss than usual when brushing or washing. The GP will examine your scalp, ask about your medical history and family history, and may order blood tests to rule out thyroid problems, iron deficiency or other underlying conditions.^[1]NHS

If the diagnosis is unclear or the hair loss is severe, the GP may refer you to a dermatologist — a specialist in skin and hair conditions. In some cases, a small scalp biopsy may be needed to confirm the diagnosis, especially for scarring alopecias where early treatment is critical to prevent permanent loss.

For children, rapid patchy hair loss should always be checked by a GP to rule out tinea capitis (scalp ringworm), which is treatable with antifungal medication.

Treatment depends on the type and severity of hair loss. There is no universal cure, but many options can slow loss, promote regrowth, or help people manage the condition effectively.

Alopecia areata

• Corticosteroid injections — injected into the bald patches by a dermatologist; often the first treatment for small patches. Regrowth usually begins within 4–6 weeks.
• Topical corticosteroids — creams or lotions applied to the scalp; less effective than injections but easier to use for widespread patches.
• Topical immunotherapy (DPCP) — a specialist treatment that deliberately triggers a mild allergic reaction on the scalp to stimulate hair regrowth. Only available in specialist centres.
• JAK inhibitors — newer medicines such as ritlecitinib (LITFULO) have been approved by NICE for severe alopecia areata in patients aged 12 and over. These are available through highly specialised NHS services.^{[4]NICE HST33}

Androgenetic (pattern) hair loss

• Minoxidil — a topical lotion or foam available over the counter or on prescription. It can slow hair loss and stimulate some regrowth, but needs to be used continuously to maintain results.^[8]NHS
• Finasteride — a prescription tablet for men that blocks the hormone linked to hair loss. Not suitable for women, especially those who are or may become pregnant.
• Dutasteride — sometimes prescribed off-label for men when finasteride is insufficient.

General measures

• Treating underlying causes — correcting iron deficiency, thyroid disorders or other medical problems can stop or reverse associated hair loss.
• Gentle hair care — avoid tight hairstyles, harsh chemicals, heat treatments and vigorous brushing that can worsen traction or breakage.
• Scalp micropigmentation, hair fibres and camouflage — non-medical options that can improve appearance while awaiting treatment or regrowth.
• Hair transplantation — a private option for stable pattern baldness, not suitable for active alopecia areata.

Adapted from NHS, Alopecia UK, BAD and NICE guidance.^{[1]NHS[2]Alopecia UK[3]BAD[7]British Skin Foundation}

For many people, the emotional impact of hair loss is harder than the physical one. Alopecia UK emphasises that there is no right or wrong way to cope — some people wear wigs or head coverings, others embrace their hair loss openly, and many move between both approaches over time.^{[5]Alopecia UK}

NHS wigs and fabric supports: If you have permanent hair loss, you are entitled to an NHS wig prescription. For temporary hair loss, you may get a wig at a subsidised rate. The exact cost depends on your local NHS trust. You can ask your GP or dermatologist for a referral to a wig fitting service. NHS wigs are made from synthetic or real human hair.^{[6]NHS England}

Private options: Many people choose to buy wigs privately for a wider range of styles, colours and cap constructions. The VAT exemption for medical wigs applies to those with alopecia areata, totalis and universalis — look for suppliers who offer VAT-free medical wigs with a GP letter or certificate.

Psychological support: Counselling, CBT and peer support can help with anxiety, depression, social withdrawal and body-image issues. Alopecia UK runs a telephone peer support network, online forums, local support groups and an annual conference. The charity also provides free resources for schools, employers and healthcare professionals.

• Protect your scalp — hair loss makes the scalp more vulnerable to sunburn, cold and irritation. Use SPF on exposed scalp, and wear hats or soft head coverings in extreme weather.
• Choose gentle products — fragrance-free, hypoallergenic shampoos and conditioners are less likely to irritate a sensitive scalp.
• Be cautious with supplements — biotin and other hair supplements are heavily marketed but evidence is limited. A balanced diet with adequate protein, iron and vitamin D is more important. Ask your GP before taking high-dose supplements.
• Manage stress — stress can worsen alopecia areata and telogen effluvium. Relaxation techniques, regular exercise, good sleep and talking therapy can all help.
• Keep a symptom diary — tracking flare-ups, triggers and treatments can help you and your dermatologist find patterns and adjust management.
• Connect with others — peer support from people who truly understand hair loss can be invaluable. Alopecia UK, Instagram communities and local groups offer connection without judgment.