Causes of Alopecia

List of causes of Alopecia

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Alopecia) that could possibly cause Alopecia includes:

• Severe illness
• Severe emotional stress
• Certain hormonal disorders
• Menopause

Causes of Alopecia (Diseases Database):

The follow list shows some of the possible medical causes of Alopecia that are listed by the Diseases Database:

• Vasculitis
• Vitamin H deficiency
• Mitoxantrone
• Acrokeratosis paraneoplastica of Bazex
• Ablepharon-macrostomia syndrome
• Vitamin A
• Tribavirin
• Hallermann-Streiff syndrome (HSS)
• Schopf-Schulz-Passarge syndrome
• Rosselli-Gulienetti syndrome
• Erythroderma
• Vitamin D dependent rickets type 2a
• Lepromatous leprosy
• Alopecia mucinosa
• Valproic acid
• Proguanil
• Amiodarone
• Haemochromatosis
• Combined oral contraceptive pill
• Iron deficiency
• Danazol
• Secondary syphilis
• Vincristine
• Selenium
• Heparin
• Total congenital alopecia
• Cantu syndrome
• Irinotecan
• Cidofovir
• Gestrinone
• Biotinidase deficiency
• Vogt-Koyanagi-Harada syndrome
• Holocarboxylase synthase deficiency
• Chagas' disease
• Psoriasis
• Systemic lupus erythematosus
• Myositis ossificans progressiva
• Monilethrix
• Albendazole
• Hypopituitarism
• Marie Unna hereditary hypotrichosis
• Canada-Cronkhite syndrome
• Dermatopathia pigmentosa reticularis
• Werner's syndrome
• Autoimmune adrenalitis
• Hypothyroidism
• Papular atrichia
• Hutchinson-Gilford progeria syndrome
• Incontinentia pigmenti
• Cutaneous T cell lymphoma
• Hypotrichosis simplex
• Orofaciodigital syndrome type 1
• Leflunomide
• Atopic dermatitis
• Keratosis follicularis spinulosa decalvans cum ophiasi
• Topotecan
• Keratosis pilaris
• Parry-Romberg syndrome
• Trichotillomania
• Dubowitz syndrome
• Proximal myotonic myopathy
• Tinea capitis
• Adrenal cortex insufficiency
• Hidrotic ectodermal dysplasia
• Clomifene
• Traction alopecia
• Eflornithine
• Tuberculoid leprosy
• Interferon alpha
• Pseudoprogeria syndrome
• Zinc deficiency
• Alopecia areata

Alopecia as a symptom:

Conditions listing Alopecia as a symptom may also be potential underlying causes of Alopecia. Our database lists the following as having Alopecia as a symptom of that condition:

• Ablepharon macrostomia syndrome
• Acrodermatitis Enteropathica
• Alopecia congenita keratosis palmoplantaris
• Alopecia, anosmia, deafness, hypogonadism syndrome
• Alopecia, epilepsy, oligophrenia syndrome of Moynahan
• Alopecia-contractures-dwarfism-mental retardation
• Amyloidosis
• APECED Syndrome
• Argentinean hemorrhagic fever
• Biotinidase deficiency
• Bolivian hemorrhagic fever
• Chemical poisoning - Thallium
• Chromosome 12p tetrasomy syndrome
• Clouston syndrome
• Dyskeratosis Congenita
• Dystrophic epidermolysis bullosa
• Ectrodactyly-ectodermal dysplasia-cleft lip/cleft palate
• Eosinophilia-myalgia syndrome
• Epidermolysis bullosa, generalized atrophic benign
• Follicular hamartoma - alopecia - cystic fibrosis
• Fungal infections
• Harlequin type ichthyosis
• Hay-Wells Syndrome
• Hay-Wells syndrome, recessive type
• Hutchinson Gilford Syndrome
• Hypoadrenocorticism - hypoparathyroidism - moniliasis
• Hypoparathyroidism familial isolated
• Ichthyosis - alopecia - eclabion - ectropion - mental retardation
• Ichthyosis congenita, Harlequin fetus type
• Ichthyosis congenita, harlequin type
• Ichthyosis follicularis-atrichia-photophobia syndrome
• Ichthyosis vulgaris, sex-linked, recessive
• Kuster-Majewski-Hammerstein syndrome
• Mandibuloacral dysplasia
• Mandibuloacral dysplasia with type A lipodystrophy
• Microcephalic osteodysplastic primordial dwarfism, type 3
• Neuroectodermal endocrine syndrome
• Oliver-McFarlane syndrome
• PARC syndrome
• Patel-Bixler syndrome
• Poikiloderma of Rothmund-Thomson
• Polydactyly alopecia seborrheic dermatitis
• Polyendocrine deficiency syndrome type 2
• Porphyria, congenital erythropoietic
• Progeria
• Progeria short stature pigmented nevi
• Rapp-Hodgkin syndrome
• Retention of tears - ectrodactyly - ectodermal dysplasia - strange hair, skin and teeth
• Sabouraud syndrome
• Satoyoshi syndrome
• Senter syndrome
• Sezary syndrome
• Systemic lupus erythematoses
• Sézary syndrome
• Thallium poisoning
• Trichoscyphodysplasia
• Ulerythema ophryogenesis
• Vogt-Koyanagi-Harada Syndrome
• Vohwinkel syndrome
• Whitaker syndrome
• Zinc deficiency

Medications or substances causing Alopecia:

The following drugs, medications, substances or toxins are some of the possible causes of Alopecia as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

• Certain drugs
• Certain poisons
• Doxorubicin Hydrochloride
• Adriamycin PFS
• Adriamycin RDF
• more drugs...»

See full list of 28 medications causing Alopecia

Medical news summaries relating to Alopecia:

The following medical news items are relevant to causes of Alopecia:

• Hair loss is common in females too
• More news »

Related information on causes of Alopecia:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Alopecia may be found in:

• Medications that may cause Alopecia
• Hidden causes of Alopecia

Causes of Alopecia: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Alopecia.

Alopecia: Differential Diagnosis
(In a Page: Signs and Symptoms)

Non-scarring alopecia

• Acne keloidalis
  –Hypertrophic scars are characteristic
  –Often in black men at the nape of the neck
  after a chronic papulopustular eruption
• Pseudopelade of Brocq
  –Primary or end stage of inflammatory diseases (e.g., lichen planus, SLE)
  –Presents with smooth, shiny, hairless scalp patches with absent hair follicles

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Alopecia: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Non-scarring alopecia

• Inflammatory/infectious disorders: Tinea capitis (Trichophyton tonsurans, Microsporum canis), kerion

• Alopecia areata
  –Sudden localized loss of hair in round/oval patches; associated with Scotch plaid nails (transverse and longitudinal pitting rows) in 10–20% of the cases, and with autoimmune disorders
  –Ophiasis alopecia starts the posterior occiput; extends anteriorly, bilaterally
  –Other forms show loss of all scalp hair (alopecia totalis) or body hair (alopecia universalis)

• Trauma: Traction (trichotillomania, tight braiding, ponytails), pressure (prolonged bed rest, especially in infants [occiput])
• Telogen effluvium: Partial alopecia noted 3 months after a stressful event; reversible; rarely involves more than 50% of the hair
• Anagen effluvium: Sudden loss of the growing hairs (80% of the scalp), resulting from the interruption of the anagen phase of the hair cycle; follows chemotherapy (folic acid and purine antagonists, alkylating agents, alkaloids), irradiation, or intoxication (lead, thallium, arsenic, bismuth, coumadin)
• Hair shaft anomalies (moniletrix, trichothiodystrophy, pili torti)
• Seborrheic dermatitis
• Thyroid disease
• Male-pattern alopecia (in both sexes)
• Congenital triangular alopecia
  Scarring alopecia (cicatricial)
• Dermatologic disorders and syndromes: Lichen planus, SLE, acrodermatitis enteropathica, sarcoidosis, scleroderma (localized/systemic), keratosis pilaris, folliculitis decalvans
• Infectious (prolonged scalp infections, tuberculosis, syphilis, herpes zoster)
• Physical trauma (chronic irradiation, trichotillomania, thermic/caustic burns)
• Developmental defects (aplasia cutis) and genetic syndromes (Hallerman-Streiff, Treacher Collins, Marie-Unna hypotrichosis, trisomy 13, etc.)

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Alopecia: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The most common form of nonscarring alopecia is male-pattern alopecia, which appears to be related to androgen levels and to aging. Genetic predisposition commonly influences the time of onset, degree of baldness, speed with which it spreads, and pattern of hair loss. Women may experience diffuse thinning over the top of the scalp.

Other forms of nonscarring alopecia include:

❑ physiologic alopecia (usually temporary): sudden hair loss in infants, loss of straight hairline in adolescents, and diffuse hair loss after childbirth

❑ alopecia areata (idiopathic form): generally reversible and self-limiting; occurs most frequently in young and middle-age adults of both sexes (See Alopecia areata.)

❑ trichotillomania: compulsive pulling out of one’s own hair; most common in children

❑ traction alopecia: localized areas of hair loss due to chronic use of tight braids (such as cornrows) or other hair styles. This condition may also result in scarring alopecia.

Predisposing factors of nonscarring alopecia also include radiation, many types of drug therapies and drug reactions, bacterial and fungal infections, psoriasis, seborrhea, and endocrine disorders, such as thyroid, parathyroid, and pituitary dysfunctions.

Scarring alopecia causes irreversible hair loss. It may result from physical or chemical trauma and chronic tension on a hair shaft, as occurs in braiding. Diseases that produce alopecia include destructive skin tumors, granulomas, lupus erythematosus, scleroderma, follicular lichen planus, and severe fungal, bacterial, or viral infections, such as kerion, folliculitis, or herpes simplex.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Alopecia [Hair loss]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Alopecia areata

Alopecia areata is usually marked by well-circumscribed patches of nonscarring hair loss on the scalp without skin changes. Occasionally, the patches also appear on the beard, axillae, pubic area, arms, legs, or the entire body (alopecia universalis). “Exclamation point” hairs—loose hairs with rough, brushlike tips on narrow, less-pigmented shafts—typically border expanding patches of alopecia. Although this disorder is recurrent, hair growth usually returns after several months. In about 20% of patients, alopecia areata also causes horizontal or vertical nail pitting.

Arsenic poisoning

Most common in chronic poisoning, alopecia is diffuse and mainly affects the scalp. Related signs and symptoms include muscle weakness and wasting, areflexia, partial or total vision loss, and bronze skin.

Arterial insufficiency

Patchy alopecia occurs in arterial insufficiency, typically on the lower extremities, and is accompanied by thin, shiny, atrophic skin and thickened nails. The skin turns pale when the patient’s legs are elevated and dusky when they’re dependent. Associated findings include weak or absent peripheral pulses, cool extremities, paresthesia, leg ulcers, and intermittent claudication.

Burns

Full-thickness or third-degree burns completely destroy the dermis and epidermis, leaving translucent, charred, or ulcerated skin. Scarring or keloid formation associated with these burns causes permanent alopecia.

Cutaneous T-cell lymphoma

More common in older patients, cutaneous T-cell lymphoma may be associated with alopecia mucinosa in its first, or premycotic, stage. Scattered papules or plaques may occur on clothed areas, such as breasts and buttocks, or a zebralike pattern of scaly erythema may form on the trunk. Alopecia may persist through the plaque and tumor stages.

Dissecting cellulitis of the scalp

Resulting from skin infection, dissecting cellulitis of the scalp is characterized by small nodules that eventually rupture and drain. Keloid formation during healing causes permanent alopecia.

Exfoliative dermatitis

Exfoliative dermatitis is a transient disorder in which loss of scalp and body hair is preceded by several weeks of generalized scaling and erythema. Nail loss commonly occurs along with pruritus, malaise, fever, weight loss, lymphadenopathy, and gynecomastia.

Fungal infections

Tinea capitis (scalp ringworm), the most common fungal infection, produces irregular balding areas, scaling, and erythematous lesions. As these lesions enlarge, their centers heal, causing the classic ring-shaped appearance. Surrounding the balding areas are broken scalp hairs. When they break off at the scalp surface, hairs resemble black dots. Other findings include pruritus and thick, whitish nails.

Hodgkin’s disease

Permanent alopecia may occur if the lymphoma infiltrates the scalp. It’s accompanied by edema, pruritus, and hyperpigmentation. Associated signs vary with the degree and location of lymphadenopathy.

Hypopituitarism

In adults, hypopituitarism varies greatly, depending on its severity and the number of deficient hormones. Gonadotropin deficiency in the female causes sparse or absent pubic and axillary hair accompanied by infertility, amenorrhea, and breast atrophy. A similar deficiency in the male decreases facial and body hair and causes infertility, decreased libido, impotence, poor muscle development, and undersized testes, penis, and prostate gland. A human growth hormone deficiency at an early age may cause short stature. Deficiency of thyroid-stimulating hormone produces signs of hypothyroidism; deficiency of corticotropin produces signs of adrenocortical insufficiency.

Hypothyroidism

In hypothyroidism, the hair on the face, scalp, and genitalia thins and becomes dull, coarse, and brittle. Most characteristic, though, is loss of the outer third of the eyebrows. Typically, alopecia is preceded by fatigue, constipation, cold intolerance, and weight gain. Other signs and symptoms include dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; thick, brittle nails; slow mental function; bradycardia; menorrhagia; and myalgia.

Lichen planus

Occasionally, lichen planus disorder produces patchy hair loss on the scalp with skin inflammation. Angular, flat, purple papules typically develop on the lower back, genitalia, arms, and lower legs. Related findings include pruritus and nail changes, ranging from grooves to nail loss. Scarring alopecia may develop with scalp skin atrophy.

Lupus erythematosus

Hair loss is a chief complaint in patients with either discoid or systemic lupus. Hair tends to become brittle and may fall out in patches; short, broken hairs (known as lupus hairs) commonly appear above the forehead. Both types of lupus are characterized by raised, red, scaling plaques with follicular plugging, telangiectasia, and central atrophy. Facial plaques typically assume a distinctive butterfly pattern.

In systemic lupus, however, the rash may vary in severity from malar erythema to discoid lesions. Unlike discoid lupus, systemic lupus affects multiple body systems. It may produce photosensitivity, weight loss, fatigue, lymphadenopathy, arthritis, emotional lability, and other signs and symptoms.

Myotonic dystrophy

Premature baldness characterizes the adult form of this muscular dystrophy. However, myotonia—the inability to normally relax a muscle after its contraction—is its primary sign. Associated signs include muscle wasting and cataracts.

Protein deficiency

Protein deficiency produces brittle, fine, dry, and thinning hair and, occasionally, changes in its pigment. Characteristic muscle wasting may be accompanied by edema, hepatomegaly, apathy, irritability, anorexia, diarrhea, and dry, flaky skin.

Sarcoidosis

Sarcoidosis may produce scarring alopecia if it infiltrates the scalp. Accompanied by various lesions on the face and the oral and nasal mucosa, it may also produce fever, weight loss, fatigue, lymphadenopathy, substernal pain, cough, shortness of breath, visual muscle weakness, arthralgia, myalgia, and cranial nerve palsies.

Scleroderma (progressive systemic sclerosis)

A late sign in scleroderma, permanent alopecia is accompanied by thickening and tightening of the skin, especially on the arms and hands. The skin appears taut and shiny and loses its pigment. Other findings include dysphagia, dyspepsia, abdominal pain, altered bowel habits, cough, dyspnea, and signs of renal failure.

Seborrheic dermatitis

Erupting in areas with many sebaceous glands and in skin folds, seborrheic dermatitis may produce hair loss on the scalp. Alopecia begins at the vertex and frontal areas and may spread to other scalp areas. The patient’s skin is reddened and dry with branlike scales that flake off easily. Pruritus is common.

Skin metastasis

Occasionally, cancer from an internal site, such as the lung, metastasizes to the skin, causing scarring alopecia that may develop slowly along with scalp induration and atrophy. Related findings include weight loss, fever, altered bowel habits, abdominal pain, and lymphadenopathy.

Syphilis, secondary

This sexually transmitted disease produces temporary, patchy hair loss that gives the scalp and beard a “moth-eaten” appearance. It also produces loss of eyelashes and eyebrows and a pruritic rash. Associated signs and symptoms include slight fever, weight loss, sore throat, malaise, anorexia, lymphadenopathy, nausea, vomiting, headache, a maculopapular rash, and condyloma latum.

Thyrotoxicosis

Diffuse hair loss, possibly accentuated at the temples, occursin this disorder. Hair becomes fine, soft, and friable. The skin becomes uniformly flushed and thickened, marked by red, raised, pruritic patches. Characteristically, this disorder produces fine tremors, nervousness, an enlarged thyroid, sweating, heat intolerance, amenorrhea, palpitations, weight loss despite increased appetite, diarrhea, and possibly exophthalmos.

Other causes

Drugs

Chemotherapeutic agents—such as bleomycin, cyclophosphamide, dactinomycin, daunorubicin, doxorubicin, fluorouracil, and methotrexate—may cause patchy, reversible alopecia a few weeks after administration. Hair loss is usually limited to the scalp, but with long-term chemotherapy, it may also affect the axillae, arms, legs, face, and pubic area. New hair—which may differ in thickness, texture, and color from the patient’s original hair—may begin to grow after the drug is discontinued or between successive treatments.

Other common drugs may cause diffuse hair loss on the scalp a few weeks after administration. These include allopurinol, antithyroid drugs, beta-adrenergic blockers, carbamazepine, colchicine, gentamicin, heparin, hormonal contraceptives, indomethacin, lithium, trimethadione, valproic acid, excessive doses of vitamin A, and warfarin. Hair growth usually resumes when these drugs are discontinued.

Radiation therapy

Like certain drugs, radiation therapy produces temporary reversible hair loss a few weeks after exposure. Because X-rays damage hair follicles at the site of therapy, head or scalp X-rays cause the most obvious hair loss.

Thallium poisoning

Thallium poisoning produces diffuse but temporary hair loss on the scalp. Nausea and vomiting are also common. In acute poisoning, the patient may experience arm and leg pain, bilateral ptosis, ataxia, fever, nasal congestion, conjunctival injection, and abdominal pain. In chronic poisoning, he may experience translucent, thin, and shiny skin and signs of renal damage such as oliguria.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Alopecia/Hirsutism: Differential Overview
(Field Guide to Bedside Diagnosis)

Alopecia

❑ Androgenetic

❑ Telogen effluvium

❑ Drugs/hair loss

❑ Anagen effluvium

❑ Alopecia areata

❑ Tinea capitis

❑ Traction

❑ Hypothyroidism

❑ Seborrheic dermatitis

❑ Discoid lupus

❑ Systemic lupus erythematosus

❑ Lichen planus

❑ Scleroderma

❑ Dietary deficiency

❑ Trichotillomania

❑ Syphilis

Hirsutism

❑ Idiopathic hirsutism

❑ Drugs/hair growth

❑ Hypertrichosis

❑ Hyperprolactinemia

❑ Polycystic ovary syndrome

❑ Cushing syndrome

❑ Adrenal tumor

❑ Ovarian tumor

❑ Ovarian hyperthecosis

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Alopecia: Causes
(Handbook of Diseases)

The most common form of nonscarring alopecia is male pattern alopecia, which appears to be related to androgen levels and to aging. Genetic predisposition commonly influences the time of onset, degree of baldness, speed with which it spreads, and pattern of hair loss. Women may experience a similar disorder, called androgenetic alopecia, characterized by diffuse thinning over the top of the scalp.

Other forms of nonscarring alopecia include: