A Discussion about Alopecia

Alopecia is an autoimmune-related skin disease that affects both males & females of all ages & ethnicities.

In some communities, little is known or understood regarding androgenetic alopecia commonly known as male pattern baldness (MPB), which accounts for 95% of hairloss in men.   66% of men will experience thinning hair by age 35 and around 85% of men will be affected by age 50.  The following is a brief description of the different types of alopecia suffered by a staggering and increasing number of men and women throughout the world.  

Hair_Follicle Areata is the most common form of alopecia, resulting in smallish patches of hairloss on the scalp or elsewhere on the body.  Usually it begins with one or more small round or oval smooth patches on the scalp, which may then continue to progress and expand to total scalp hairloss (referred to as Alopecia Totalis) or complete body hair loss (known as Alopecia Universalis) which may affect any hair-bearing part of the body.  An individual who has experienced any form of alopecia continuously for up to 2 years, is believed to have a particularly low chance of spontaneous re-growth and is less likely to be responsive to currently available therapies.

The prevalence of alopecia areata affects roughly 2% of the world population with a total of approximately 6.5 million affected individuals in the US alone.  This common skin disease is highly unpredictable and cyclical – meaning that hair may grow back or fall out again at any time – and the disease course is experienced differently by each person.  Genetic factors have been shown to directly influence the susceptibility and severity of alopecia areata sufferers.  The internationally accepted hairloss measure for men is the Hamilton Norwood Scale and for women, the Savin Scale is used. 

 Hamilton Ludwig scale for men and women respectively

More than 95% of occurring male hairloss is due to male-pattern baldness – a genetic trait that can be transferred from either parent.  In some cases, vitamin deficiencies and/or certain medications (such as too much vitamin A) may cause the hair to fall out.  Dramatic shedding of hair is known as telogen effluvium, and may be caused by illness or stress.  Hairloss not attributable to male-pattern baldness may often reverse itself in men.  The physical effects of hair loss can be traumatic, even devastating and may cause multi-levelled social isolation and/or psychological-related depression.

A number of treatment options are currently available.
These include: 

While there is currently no cure-all solution for male-pattern baldness, the incidence of hairloss may be slowed down with certain medications such as Corticosteroids (which act to suppress the immune system), Diphencyprone, Anthralin, with the most popular being Propecia, Rogaine and Minoxidil.  In some cases, new hair may even grow.  However, as soon as the medication is discontinued, hairloss returns.

Hair Transplant
Some 20% of male (compared to 12% of female) sufferers opt for the surgical route, whereby healthy hair from the sides and back of the head are harvested and moved to the thinning top.  Hair transplants can be very costly and may involve several procedures.  The related scarring and limited success rate should be taken into consideration before making this decision.

Scalp Micro-pigmentation
In short, scalp micro-pigmentation is the process of tattooing the scalp with tiny micro-dots in order to give the resemblance of stubble – a short buzz-cut appearance which looks best when any remaining hair is kept very short.  To the experienced practitioner, scalp micro-pigmentation is a simple procedure, it is relatively non-invasive and there is no down time.  A specialised pigment (not a standard tattoo ink) is matched to the existing hair colour (if any exists) or skin tone and a hairline is agreed upon based on where it used to be.  Hundreds of micro-dots are then added to the  scalp – focusing on the areas of thinning hair.  

Scalp pigmentation in progress PIC.001

The same process may be used to camouflage a variety of head scars.  Excellent numbing solutions are available, however, minimal pain is experienced as the pigment is placed at a very shallow depth underneath the skin.  While this can be a time-consuming procedure, it has  proven to be an excellent alternative – fast-growing in popularity.


photo 1


Another alternative and proven to be an effective solution to consider is a microneedling procedure.  When used together with very specific highly active and easily absorbed, safe protocols, the hair follicles are stimulated at the root level, frequently delivering dynamic results.  These before and 10 weeks after pics are proof of the efficacy and immense performance of this hair follicle stimulation method.

Women and Alopecia

Alopecia universalis client correction by Maija Butkovic (Croatia)
Alopecia universalis client correction by Marija Butkovic (Croatia)

It may surprise you to know that women make up a staggering 40% of hair loss sufferers.  Women are 53% more likely than men (26%) to seek medical intervention options.  While a large variety of specialized medications and treatments are available for both male and female alopecia sufferers, there are no conclusive studies proving effective long term relief for alopecia, which may negatively affect even highly visible parts of the body – including eyebrows and eyelashes.  

In some instances, women may experience the condition temporarily, for example during certain pregnancies, whilst experiencing hormone imbalances or following intense shock.  However, after treatment, hair growth will usually return to normal, providing there is no underlying medical cause which may have remained undiagnosed.  

The negative social implications have devastating effects on both the self-image and emotional wellbeing of this growing number of women.

Each and every case of alopecia needs to be treated on a unique and individual basis and I would encourage anyone suffering from alopecia to seek advice from an experienced professional in order to explore the treatment options most suitable to individual lifestyles.  Working in this field is as highly rewarding to the practitioner as it is to the would-be client in that it dramatically improves self-esteem, dignity and confidence – thereby effectively giving the client a new lease on life.

Article written by Gwendoline Johnston 

All work is subject to © copyright laws, all rights reserved. Material may not be used, copied or reproduced in any way without prior written consent.
  • The New England Journal of Medicine, April 2012 issue. 
  • Alopecia Areata – by Maria Hordinsky, MD
  • American Hairloss Association and Dr Paul J. McAndrews
  • Wikipedia
  • Belgravia Centre
  • Marija Butkovic (Coratia)

About the author: 

Gwendoline Johnston owns Permanent Makeup by Gwendoline and practices as a Permanent Make-up Specialist at her studios in Johannesburg.  Gwendoline attained her Masters Certification from the American Institute of Intradermal Cosmetics in October 2013.  She has kept fully up to date with ongoing study in the latest techniques and trends by obtaining over eighteen certificates  and diplomas both locally in South Africa and internationally – attending advanced permanent makeup training seminars, master classes, conferences and workshops.

Gwendoline’s vast experience attained over the past eighteen years, together with a thorough understanding of skin and colour, has placed her in the confident position to teach, advise and perform in all areas of advanced permanent make-up, including para-medical applications.  Permanent Makeup by Gwendoline is affiliated with local and international Plastic Surgeons, Dermatologists, Specialists and Medical Spa’s.

Throughout my career, I have remained committed to delivering excellence.  I have a deep passion for my craft and genuine care for my clients, which when teamed with the highest level of professionalism, my aim is to deliver unparalleled performance within the vibrant and ever-evolving world of permanent makeup.”

Landline:   (011) 704-3086

E-mail:     info@permanentmakeup.co.za or gwendoline@permanentmakeup.co.za

Website:  www.permanentmakeup.co.za

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