What is Retrograde Alopecia?
The hallmark of retrograde alopecia is its distinctive vertical thinning on the sides of the scalp and nape of the neck. This is why the condition is also commonly referred to as vertical alopecia.
Men are more likely than women to be affected by retrograde alopecia. The condition is common in male patients suffering from extensive androgenetic alopecia.
Retrograde alopecia differs from traditional male pattern hair loss, which typically starts at the crown or temples. Comparatively, the hair loss patterns of retrograde alopecia are reversed.
The question of “What is retrograde alopecia?” is still not sufficiently answered in some circles. In the paper on retrograde alopecia amongst Egyptian men, experts differed on whether retrograde alopecia should be viewed as part of male androgenetic alopecia or considered a distinct condition.
This ongoing discussion highlights the complexity of hair loss patterns and their causes.
Causes of Retrograde Alopecia
Understanding what causes retrograde alopecia helps you take control of your hair health.
While researchers are still unravelling the full picture, here is what we know about the causes of this condition so far.
Natural Body Changes
Our bodies are constantly adjusting to internal signals, including hormones that affect hair growth cycles. While these hormonal imbalances generally don’t impact the areas affected by common balding patterns, they may contribute to hair follicles’ sensitivity around the scalp’s edges.
Genetic Factors
Your genetic blueprint has a significant influence on hair health patterns. Family history often reveals a predisposition to specific types of hair thinning, particularly along the lower side of the scalp and the neckline regions.
External Influences
Tight hairstyles, scalp health issues, or ongoing irritation can cause weakened hair follicles over time. Patients predisposed to retrograde alopecia may be triggered by environmental factors such as pollutants and certain toxins.
Autoimmune Disorders
Sometimes, our body’s defence system mistakenly targets healthy hair follicles. This internal response can trigger the gradual thinning of hair. The resulting patchy hair loss is especially noticeable along the nape of the neck and sides of the scalp.
Symptoms of Retrograde Alopecia
Hair loss caused by retrograde alopecia is not as noticeable as standard male pattern baldness.
Individuals may find it challenging to recognise hair loss in the affected areas unless it is pointed out by someone else.
These are some common symptoms of retrograde hair loss:
Gradual onset
Retrograde alopecia is characterised by a slow regression to lower-density hair. This makes it difficult for those affected to notice early signs of the condition.
Thinning in atypical areas
In early retrograde alopecia stages, hair thinning can occur in the nape area and sides of the scalp, particularly above the ears. This may extend into the lateral temporal region. These atypical areas usually resist standard male pattern baldness.
Variations in hair density
Individuals with retrograde alopecia may observe significant differences in hair density within an affected area. There is often a sharp contrast between the thinner hair near the ears and the denser hair that grows on the top of the scalp.
Vertical advancement of hair loss
As indicated by its other name, vertical alopecia, this condition tends to progress vertically. The initial hair loss begins at the nape of the neck and gradually moves into the lower occipital zone. In rare cases, the condition reaches up to the occipital bone.
Higher density hair band
In select cases, one of the distinct symptoms of retrograde alopecia is a visible narrow band of higher-density hair.
Mostly stable hairline
While the frontal hairline may remain stable, affected areas can still display signs of vertical hair loss.
Diagnosing Retrograde Alopecia
Scalp examination
Hair pull test
Dermoscopy
Are you experiencing noticeable thinning hair or hair loss?
Book a consultation with Dr Bonaros for a comprehensive assessment and tailored treatment plan.
Scalp biopsy
Medical Treatments for Retrograde Alopecia
Only a medical professional can determine the most appropriate treatment for retrograde alopecia, as each case is unique.
However, the general treatment pathway is similar to that of androgenetic alopecia.
Here are some of the retrograde alopecia treatment options available:
Medications for Retrograde Alopecia
Disclaimer: This content is meant for informational purposes only and is not a substitute for professional medical advice. You should consult with a registered specialist before beginning any new treatment plan.
Topical treatments and oral medication options for retrograde alopecia include:
- Minoxidil: Originally developed as a blood pressure medication, minoxidil is used off-label for hair loss. The medication increases blood flow around the hair follicles, which promotes hair growth.
- Dutasteride: A generic brand of Avodart, dutasteride is an off-label treatment for male hair loss. This medication has a similar mechanism of action to finasteride.
- Finasteride: This oral medication works by inhibiting the production of dihydrotestosterone (DHT), the hormone primarily linked to male pattern hair loss.
- Anti-inflammatory medication: If your retrograde alopecia is linked to autoimmune reactions, anti-inflammatory medications are often the most effective approach. These treatments help inhibit the immune system’s attack on hair follicles.
Non-Surgical Treatments for Retrograde Alopecia
For individuals seeking alternatives to surgical hair restoration, several effective non-surgical interventions are available to treat retrograde alopecia.
- Low-level laser therapy: This is a non-invasive hair restoration procedure used to stimulate hair follicles. Low-level laser therapy works by boosting blood circulation, which, in turn, helps stimulate hair growth.
Platelet-Rich Plasma (PRP): This inpatient procedure is performed by injecting PRP into the scalp. The purpose is to reinforce existing follicles.
Viability of Retrograde Alopecia Hair Transplant Surgery
Hair transplantation is not always a viable treatment for this condition. Retrograde alopecia primarily affects the lower occipital zone, which is a traditional donor area for hair transplant surgery.
As a result, the availability of suitable donor hair may be limited, hindering the hair transplantation process.
FAQ
Retrograde Alopecia — FAQs
Is retrograde alopecia permanent?
There is no clear answer regarding the permanency of retrograde alopecia. While hereditary hair thinning and density reduction tend to progress if left untreated, there are several management options available. Medications such as minoxidil can increase the blood flow to hair follicles, promoting hair growth.
Non-surgical treatments can also help slow the progression of retrograde alopecia, and in select cases, hair transplant surgery may be an option — provided there is enough viable donor hair for transplantation.
What are the other forms of alopecia?
Other than retrograde alopecia, there are many conditions that can cause hair loss and thinning. Here are some other common hair loss conditions:
- Alopecia areata: An autoimmune condition causing hair loss in round or oval patches on the scalp or other hair-growing areas, such as the beard. Variations of alopecia areata include patchy alopecia areata, alopecia totalis, alopecia universalis, and diffuse alopecia areata. In alopecia totalis, there is complete hair loss within two years.
- Traction alopecia: Hair loss caused by prolonged hair follicle pulling, often due to tight hairstyles, relaxers or hair extensions.
- Persistent chemotherapy-induced Alopecia (pCIA): Prolonged hair loss lasting over six months following the end of chemotherapy.
- Androgenetic alopecia: Also called pattern hair loss, androgenetic alopecia affects men and women in distinct ways. In men, this hair loss follows a defined pattern, typically receding from the temples, while women experience overall thinning across the scalp without a noticeable recession.
- Central centrifugal cicatricial alopecia: A group of scarring hair loss conditions where hair follicles are destroyed and replaced with scar tissue. This leads to permanent hair loss. The symptoms begin at the centre of the scalp and gradually spread outward.
