If you have noticed hair thinning at the nape of your neck or above your ears, you might be affected by retrograde alopecia.
This unique form of hair loss affects many individuals — yet often goes unrecognised. While studies into retrograde alopecia causes are limited, there are treatment options to manage the condition.
Continue reading to learn more about retrograde alopecia, including its potential causes, symptoms, and treatment pathways.
Reviewed by Dr Epameinondas Bonaros
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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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.
In select cases, one of the distinct symptoms of retrograde alopecia is a visible narrow band of higher-density hair.
While the frontal hairline may remain stable, affected areas can still display signs of vertical hair loss.
To properly diagnose vertical thinning, a hair restoration specialist such as Dr Bonaros
will first consult the patient’s medical history. Diagnostic methods may include the following:
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:
Topical treatments and oral medication options for retrograde alopecia include:
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.
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.
Read MoreNoticing signs of developing retrograde alopecia or unexplained hair loss?
Get in touch with our hair loss clinic to receive a personalised treatment plan.
Read our answers to some frequently asked questions to learn more about retrograde alopecia.
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.
There is no universal hair loss treatment, which is why you need personalised care. Our mission is to provide honest, responsible and ethical advice tailored to each patient’s unique circumstances.
The Dr Bonaros hair transplant clinic delivers evidence-based expertise and solutions for diverse hair loss conditions. Our services range from treating retrograde alopecia and androgenetic alopecia to hair transplants and other hair loss treatments.
When you decide to come to our Glasgow clinic, you don’t just get a hair loss recovery programme — you also get to work with a team that does everything to ensure you have the best possible experience. Rest assured, you’re choosing the highest standard of hair loss care available with Dr Bonaros.
Understanding retrograde alopecia and its causes is the first step toward restoring your hair’s appearance. Book a consultation at our hair loss clinic now to regain your looks and confidence.