The moment made an impression on everyone who was watching the 94th annual Academy Awards ceremony: Will Smith, nominated for Best Actor for his role in King Richard, approaching the Oscars stage to strike Chris Rock after the comedian made a joke about Jada Pinkett Smith’s shaved head. The slap heard round the world, many are calling it. But the incident also spawned a larger conversation about an important topic—alopecia, or hair loss.
Pinkett Smith has been open about the pressures of aging in Hollywood and her battle with alopecia, but Rock’s joke clearly struck a nerve with her husband, who, in spite of their up-and-down relationship, rushed to her defense. Once the dust settled, many began to wonder, What exactly is alopecia? Ahead, top experts explain more about the condition, what causes it, who is most likely to be affected, and the treatments available.
What is alopecia?
“Alopecia is a very broad medical term that simply means someone has hair loss,” says Helena Kuhn, MD, assistant professor of dermatology and clinician educator at the Warren Alpert Medical School of Brown University. “Saying someone has alopecia is like saying someone has cancer—what type of cancer?” In fact, there are several different kinds of alopecia, and understanding the nuances among them, particularly when it comes to treatment, is critical, Kuhn adds. “In fact, there are more than 10 different types and even more subtypes of alopecia,” notes Isfahan Chambers-Harris, PhD, a trichologist and founder of Allodia Haircare.
These are the most common types of alopecia
- Androgenic alopecia: This is the most prevalent form. “Up to 95 percent of people experiencing hair loss suffer from androgenic alopecia,” says Craig Ziering, MD, a board-certified dermatologist, hair restoration specialist, and transplant surgeon. You’ve probably heard it called male or female pattern hair loss or baldness. In women, it manifests as thinning at the part; in men, as receding from the front or at the temples and at the top of the head.
- Alopecia areata: This is another common type and what many people think of when they hear the word alopecia, Kuhn points out. (It’s also what Pinkett Smith suffers from.) “The hair falls out in bizarre patterns, making the disease somewhat disfiguring,” she says. There are four subtypes of this alopecia, adds Chambers-Harris, who notes that it can vary from circular bald patches on the scalp to complete hair loss on the entire body.
- Telogen effluvium: This is stress-related hair shedding, characterized by sudden, extreme hair loss after a stressful event. It bears mentioning that some hair loss or shedding is normal for everyone. Ziering says most of us lose anywhere from 50 to 150 hairs per day, likely without giving it much thought. But in the case of telogen effluvium, this increases dramatically, and typically starts three months after an emotional or physical stressor, adds Kuhn. Those who experience Covid-19-related hair shedding are thought to suffer from telogen effluvium.
- Traction alopecia: Unlike some of the other forms, which are caused by factors largely out of our control (more on those in a minute), traction alopecia is directly related to how we wear our hair. High-tension styles, such as weaves and braid, cause trauma to the follicles, leading to thinning and balding around the front of the hairline and around the temples, explains Chambers-Harris.
- Central centrifugal cicatricial alopecia: Most often referred to as CCCA, Chambers-Harris notes this is one of the more prevalent forms of scarring alopecia, meaning it destroys the follicles and the hair usually can’t grow back. “CCAA is characterized by permanent hair loss that starts centrally on the crown and extends outward,” adds Kuhn.
So what causes alopecia?
Short answer: It depends on the type of alopecia in question. Androgenic alopecia has a hormonal component; it’s caused by an excessive number of androgens that minimize the hair follicle and cause thinning, explains Chambers-Harris. However, genetics and age also play a role. Alopecia areata is an autoimmune disease. “Immune cells become confused and see the hair follicles as foreign and dangerous, attacking them and causing hair to fall out,” explains Kuhn, who notes that what sets this off is still unknown.
And, as mentioned, telogen effluvium is triggered by emotional or physical stress. “It shocks the follicles into entering the resting, or telogen, phase of the hair growth cycle, resulting in hair loss,” says Ziering. Finally, physical damage to the hair follicle causes traction alopecia, while the CACC is multi-factorial, a combination of genetics and harsh hair practices.
By the age of 50, nearly 85 percent of men and 40 percent of women are experiencing some type of hair loss.
How prevalent is alopecia—and whom does it affect?
This, again, depends on the specifics of the situation, but alopecia affects all genders, ages, and races. According to the Cleveland Clinic, androgenic alopecia affects 80 million Americans and alopecia areata affects up to 6.8 million. For a little more context, “By the age of 50, nearly 85 percent of men and 40 percent of women are experiencing some type of hair loss,” notes Ziering. And while alopecia certainly isn’t race-specific, there are particular types that are much more prevalent in African American women than in any other group. To that point…
What’s the connection between race and alopecia?
The Jada Pinkett Smith situation elicited both conversations about hair loss and how it affects African American women specifically. Indeed, there are some direct connections. “Approximately 50 percent of black women report hair loss over their lifetime,” says Kuhn, who adds that CCCA is the most common type for this group. (Harsh haircare practices likely play a role.) In a study conducted at Brown University by Eunyoung Cho, MD, reseachers found the lifetime incidence of alopecia areata to be significantly greater in Black and Hispanic females as compared to white females, and traction alopecia is also more common in African American and Latinx populations, says Kuhn, due to high-tension hairstyles, such as braids and weaves.
What are the best treatments for alopecia?
You have to know what type of alopecia you’re dealing with to figure out the best possible treatment. For example, telogen effluvium typically resolves on its own. “Once the stressor is removed or resolved, the shedding will eventually stop, usually after three to six months, and hair will regrow,” says Kuhn. Treatments for male and female pattern hair loss run the gamut from everything from drugs such as finasteride and minoxidil—both in oral and topical form—to PRP injections to laser therapy to hair transplantation, says Ziering. Alopecia areata typically requires the use of topical and oral steroids, though both Chambers-Harris and Kuhn note that a new class of medications known as JAK inhibitors is very promising and will hopefully be available to patients soon. CCCA treatments range from topical steroids to oral medications.
Even though there are many nuances among the causes and treatments for all these varying types of alopecia, there are a few universal constants. First and foremost, early detection of any kind of alopecia is key to increasing the likelihood that treatments will work, advises Chambers-Harris. Implementing good hair practices—avoiding those high-tension hair styles, minimizing chemical treatments, using gentle products—is always a good idea, she adds. And finally, all the things that are generally good for us—stress reduction, a healthy diet, a regular exercise routine—can also play a role in fighting hair loss and maintaining hair and scalp health, says Ziering.