Understanding Alopecia: Types, Causes & Treatment Options

What Is Alopecia?

Alopecia is the medical term for hair loss, encompassing many different conditions that cause hair thinning or baldness. It can affect the scalp or any hair-bearing area of the body, and it ranges from mild thinning to complete hair loss. Alopecia is not a single disease — it is a symptom with many possible causes, and effective treatment depends entirely on identifying the specific type.

Hair loss affects approximately 50% of men by age 50 and 40% of women by age 50. Despite its prevalence, hair loss can cause significant psychological distress, affecting self-image, confidence, and quality of life. Understanding the type and cause of your hair loss is the first step toward effective treatment.

Cuba's dermatology team classifies alopecia into scarring (cicatricial) and non-scarring types, as this distinction fundamentally affects treatment options — non-scarring alopecia, where follicles remain alive, can respond to follicle-stimulating treatments like Piloactive, while scarring alopecia, where follicles are destroyed, cannot.

Non-Scarring Alopecia Types

Non-scarring alopecia types are those where the hair follicle remains intact and has the potential to regrow hair. These are the most common forms and the most responsive to treatment:

• Androgenetic alopecia (pattern hair loss) — The most common type, affecting both men and women. Caused by a genetic sensitivity of hair follicles to dihydrotestosterone (DHT), a hormone derived from testosterone. In men, it causes a receding hairline and thinning at the crown. In women, it causes diffuse thinning over the top of the scalp while the hairline is usually maintained.

• Alopecia areata — An autoimmune condition where the immune system attacks hair follicles, causing sudden, round or patchy hair loss. Can affect the scalp (alopecia areata), the entire scalp (alopecia totalis), or the entire body (alopecia universalis). Often triggered by stress, illness, or genetic predisposition. Hair may regrow spontaneously but can also recur.

• Telogen effluvium — A diffuse shedding of hair that occurs 2-3 months after a trigger event such as severe stress, illness, surgery, childbirth, rapid weight loss, or medication changes. The trigger causes a large number of hairs to enter the resting (telogen) phase simultaneously. Usually self-limiting once the trigger resolves.

• Traction alopecia — Hair loss caused by repeated tension on hair from tight hairstyles (braids, ponytails, extensions). If caught early, removing the tension allows regrowth. Long-term traction can permanently damage follicles.

• Anagen effluvium — Sudden hair loss during the growth (anagen) phase, typically caused by chemotherapy or radiation therapy. Hair usually regrows after treatment ends.

Scarring (Cicatricial) Alopecia

Scarring alopecia is less common but more serious. In these conditions, inflammation destroys hair follicles and replaces them with scar tissue, making regrowth impossible:

• Lichen planopilaris — An inflammatory condition causing perifollicular redness, itching, and progressive hair loss, often at the crown and frontal scalp. • Frontal fibrosing alopecia — A variant of lichen planopilaris causing a receding hairline, primarily in postmenopausal women. • Discoid lupus erythematosus — An autoimmune condition that can cause scarring hair loss on the scalp. • Folliculitis decalvans — A bacterial infection causing inflammatory pustules and scarring hair loss.

Scarring alopecia requires early diagnosis and treatment to halt follicle destruction before permanent loss occurs. Once follicles are scarred, no treatment — including Piloactive — can regrow hair, because the follicles no longer exist. Treatment focuses on stopping the inflammatory process and preserving remaining follicles.

This is why Cuba's dermatologists perform trichoscopy and, when necessary, scalp biopsy during the initial assessment — to distinguish scarring from non-scarring alopecia and determine whether follicle-stimulating treatments like Piloactive are appropriate.

Treatment Options: Conventional vs. Cuban Approach

Treatment options for alopecia vary by type:

Conventional treatments: • Minoxidil (Rogaine) — A topical vasodilator that prolongs the anagen phase. Available over the counter. Works for androgenetic alopecia and some other types. Must be used indefinitely to maintain results. • Finasteride (Propecia) — An oral medication that blocks DHT production. Effective for male androgenetic alopecia. Not suitable for women of childbearing age. Must be used indefinitely. • Corticosteroid injections — Used for alopecia areata to suppress the autoimmune attack on follicles. • Hair transplantation — Surgical redistribution of hair follicles from the back of the scalp to thinning areas. Most effective for androgenetic alopecia with stable donor hair. • Platelet-rich plasma (PRP) — Injection of concentrated platelets from the patient's own blood into the scalp to deliver growth factors.

Cuba's approach with Piloactive: • Biological, multi-pathway stimulation — Placental extract delivers multiple growth factors (EGF, FGF, IGF-1) that stimulate follicles through several mechanisms simultaneously, rather than targeting a single pathway. • Non-hormonal — Piloactive does not involve hormonal manipulation, making it suitable for patients who cannot or prefer not to use finasteride. • Gentle for long-term use — Without the side effects of long-term minoxidil or finasteride use, Piloactive can be used for extended periods. • Complementary — Can be used alongside conventional treatments for a multi-modal approach.

Cuba's dermatologists evaluate each patient's alopecia type, medical history, and treatment goals to design the most appropriate individualized plan — which may include Piloactive alone or in combination with other therapies.