What is alopecia?

In recent months, Jada Pinkett Smith has been open about her decision to shave her head after being diagnosed with alopecia.

However, online searches related to the medical condition skyrocketed again after her husband Will Smith sensationally slapped presenter Chris Rock at the 2022 Academy Awards on Sunday night for making a joke which compared Jada's look to that of the movie character G.I. Jane, who also has a bald head.

So, what exactly is alopecia? Essentially, the term relates to the reduction and loss of hair.

"Alopecia can be a diffuse process or occur in localised areas on the scalp or other areas of the body," explained Dr Adam Friedmann, consultant dermatologist at Stratum Clinics. "It can occur slowly over many years, or be rapidly progressive, occurring over days or weeks."

What are the causes?

Alopecia is an autoimmune disease, meaning that the cells in the immune system have attacked the follicles - causing the hair to fall out.

"There are many causes for alopecia. They can broadly be grouped into three categories: internal deficiencies, scalp disease or 'other' causes. The most important distinction is whether scarring is a feature or not, because this will dictate how successful treatment can be," the expert shared.

Scarring alopecia refers to when hair follicles become inflamed and are replaced with scar tissue on the skin on the scalp. Examples include traction/traumatic alopecia, which is often related to continuous braiding or certain hairstyles, and lichen planopilaris, an inflammatory scalp condition.

"For this reason, when hair loss has occurred, there is no potential for the hair to recover in those areas," noted Dr Friedmann.

Non-scarring alopecia is when there is little irritation or inflammation, but hair loss can be significant. Hair loss here can either appear in patches or be spread throughout the hair.

"Androgenic or genetic alopecia is the most common type of hair loss in men and women, and relates to small, round patches of baldness on the scalp, although hair elsewhere such as the beard, eyebrows, eyelashes can also be affected," he continued.

What should you look out for?

Hair loss can happen for many reasons and progress in a variety of patterns.

"You may have noticed a patch of baldness that has begun to grow or a receding hairline at your temples or forehead. Or, you may have noticed an increase in hairs on your pillow or clothes, indicating that you are shedding hairs at an increased rate, even if there is no visible thinning of the hair," noted Dr Friedmann.

Treatment

The key to treatment is establishing if the condition is scarring or not. If it is scarring, it is important to switch off the process as quickly as possible to prevent progression, as scarred areas will not regrow. Non-scarring alopecia can recover fully with treatment but may gradually progress over time.

"Diagnosis involves a consultation, a full scalp examination, and blood testing to establish if there is a deficiency or hormonal problem," he added. "If scalp disease is present or a diagnosis is not straightforward, a scalp biopsy might be undertaken to examine the process at a microscopic level."