Nonscarring alopecia

Nonscarring alopecia

Description, Causes and Risk Factors:

Alternative Name: Noncicatricial alopecia.

Nonscarring alopecia refers to a situation where the hair shafts fall out, but the hair follicles are still alive. It is an autoimmune disease characterized by single or multiple areas of alopecia without inflammation. If it involves the whole of scalp then it is called alopecia totalis. If it involves the whole of body is called alopecia universalis.

The exact causes are unknown, but the consensus of opinion is that nonscarring alopecia is the result of acute physical and emotional stress in a sensitive individual. This is true in the majority of the cases. The condition is certainly not caused by microorganism, or virus. Medical causes of nonscarring alopecia may include tinea capitis, hypothyroidism, folliculitis decalvans, hyperthyroidism, etc.

Other cause may include:

    Failure of hair follicle production due to hormonal and genetic reasons, as in male pattern baldness.

  • Hair shaft abnormalities.

  • Abnormalities in hair cycling, as seen in telogen effluvium, anagen effluvium, loose anagen syndrome or generalized alopecia areata. Abnormalities of hair cycling occur usually following a prolonged illness, pregnancy, stress and nutritional deficiencies including anemia.

Types may include:

    Anagen effluvium: Causes by the agents that impair or disrupt the anagen cycle. Causes may include chemotherapeutic agents, poisoning (e.g., boric acid, mercury, thallium), and radiation.

  • Primary hair shaft abnormalities: Causes by trichorrhexis nodosa (easy hair breakage, genetic disorders, loose anagen hair syndrome, and overuse of hair dryers.

  • Telogen: Causes may include drugs (antimitotic chemotherapeutic agents, anticoagulants, retinoids, oral contraceptives, ACE inhibitors, ?-blockers, antithyroid drugs, anticonvulsants, heavy metals, vitamin A excess), endocrine problems, nutritional deficiencies, and physiological stress.

Risk factors for nonscarring alopecia may include:

    Emotional stress.

  • Family history of hair loss.

  • Male gender.

  • Poor diet.

  • Chemotherapy.

  • Pregnancy.


Symptoms may include:

    Hair loss

  • Itchy scalp.

  • Mild scaling of the skin on the scalp.

  • Mild redness of the skin on the scalp.


Close examination of the skin is enough to differentiate the scarring from non scarring alopecia. In scarring alopecia, there is absence of hair follicle opening and increased wrinkling of the involved skin. The skin surface is thin, shiny and dry. Underlying small blood vessels may be visible through the atrophic skin. Towards the periphery of the bald patch, hairs will be twisted because of the pull of the scar tissue.

Laboratory tests may include:

    Antinuclear antibodies.

  • Complete blood count.

  • DHEA (dehydroepiandrosterone) blood level

  • Free testosterone level.

  • T and B cell lymphocyte counts.

  • Thyroid profile.

Other tests to assess may include:

    Syphilis test.

  • Hair pull test.

  • Microscopic examination of the hair follicle.

  • KOH preparation.

Videodermoscopy (trichoscopy): Videodermoscopy of hair and scalp (trichoscopy) is gaining popularity as a valuable tool in differential diagnosis of hair loss. This method allows viewing of the hair and scalp at X20 to X160 magnifications. Structures which may be visualized by trichoscopy include hair shafts of different types: Vellus, terminal, micro-exclamation mark type, monilethrix, Netherton type, and pili annulati hairs. The number of hairs in one pilosebaceous unit may be assessed. It may be distinguished whether hair follicles are normal, empty, fibrotic, filled with hyperkeratotic plugs or containing cadaverized hair. Abnormalities of scalp skin color or structure which may be visualized by trichoscopy include honeycomb-type hyperpigmentation, perifollicular discoloration (hyperpigmentation), and scaling.


Alopecia that is caused by genetic inheritance such as male pattern baldness can easily be treated by drugs such as finasteride, Revivogen and some hair loss shampoos. Finasteride acts against the enzyme that converts testosterone into DHT (dihydrotestosterone). DHT is the compound that causes hair follicles to shrink thus causing some of them to die off resulting in hair thinning and eventual balding. DHT normally accumulates over the vertex and frontal part of the scalp thus the reason for the distinguishable male pattern baldness.

In the case of women, androgens can also cause hair loss, especially after pregnancy or when using some contraceptives. The ideal move will be to stop using the contraceptives and start to use hair treatment drugs such as minoxidil or Rogaine shampoo. This drug acts as a vasodilator as it dilates blood vessels that supply hair follicles thus increasing blood supply to hair follicles. This will boost hair growth as more nutrients and oxygen will be reaching active hair follicles.

In the case of alopecia caused by deficiencies of the diet, patients can be put under some controlled diet regime followed by vitamin and mineral supplements. Such patients will be encouraged to go on a diet that is rich in protein, low on carbohydrates and fats. Sea food will be the most ideal as it is rich in proteins, essential amino acids and vitamins which are required in hair follicle development and hair growth. Multivitamin tablets and syrups can also be taken. It is however advisable to take vitamins under the direction of a doctor as excess vitamin intake can cause vitamin toxicity which will result in further hair loss.

Diet and Nutrients supplements may include:

    Vitamin A: Healthy sebum and keratinisation.

  • Vitamin C: Antioxidant.

  • Vitamin E: Scalp circulation.

  • Biotin: Produces healthy keratin.

  • Inositol: Healthy hair follicle.

  • Niacin: Scalp circulation.

  • Vitamin B6, B12 & pantothenic acid: Prevent graying of hair and reduces hair loss.

  • Low Iron intake: Thinning of hair.

  • Zinc: Lowers DHT production.

  • Copper deficiency: Hair shaft abnormalities.

  • Essential fatty acids Regulates:

  • Green tea: Anti androgenic & antioxidants.

  • Saw palmetto: Lowers level of DHT.

In the case of alopecia caused by disease, drugs such as minoxidil and hair treatment drugs that contain ketoconazole. These two drugs can be combined as the two can work hand in hand. The minoxidil will boost hair growth by increasing the amount of fuel and oxygen reaching hair follicles, while the ketoconazole eliminates pathogens that want to take opportunity of a weakened immune system and cause hair loss. Another good way to treat this kind of alopecia that is caused by disease will be to use herbs. Herbs are very safe to use as they are different from drugs which have many side effects. Herbs are good at treating hair loss in the presence of a disease as some of the herbs can eliminate the toxins that are released by the pathogens causing disease.

Surgeries may include: Hair flap, hair transplant, scalp reduction, scalp lift, and tunnel grafts.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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