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Health condition · Clinically reviewed

Hair loss, pattern loss, alopecia areata and the modern UK treatment ladder.

Not one condition but many - genetic, autoimmune, reactive, traction, scarring or systemic. Getting the type right is what changes the outcome.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAD and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including topical and oral minoxidil, finasteride and MHRA-approved JAK inhibitors for alopecia areata.

Key facts

Hair loss at a glance.

The essentials, in plain English - the main types, what tests help and how modern UK treatment works.

  • What it is

    A broad group of conditions causing hair thinning or loss - from patterned genetic thinning to autoimmune, reactive, traction, scarring and psychiatric causes.

  • Most common form

    Androgenetic alopecia (pattern hair loss) affects roughly half of men by 50 and a significant share of women, especially post-menopause.

  • Autoimmune type

    Alopecia areata causes discrete patches and can progress to totalis or universalis - now treatable with MHRA-approved JAK inhibitors.

  • Reactive shedding

    Telogen effluvium follows a trigger (illness, delivery, weight loss, medication) and is usually reversible within 6 to 12 months.

  • Scarring alopecia

    Frontal fibrosing alopecia, lichen planopilaris and discoid lupus destroy follicles permanently - specialist review is urgent.

  • When to test

    Ferritin, thyroid function, FBC, vitamin D, zinc and (in women) androgens help exclude reversible drivers.

Why this guide matters

The right type, the right ladder.

Most hair-loss disappointment comes from using the wrong tool for the wrong type. Three points shape everything else on this page.

  • Diagnose before you treat

    Pattern loss, alopecia areata, telogen effluvium and scarring alopecia need very different plans - trichoscopy and targeted bloods pay off.

  • Give treatment time

    Topical and oral therapies for pattern loss and JAK inhibitors for alopecia areata all take months - judge them at 6 months, not 6 weeks.

  • Do not miss scarring alopecia

    Once a follicle is scarred it is gone. Loss of follicular openings, scalp pain or eyebrow loss needs urgent specialist review.

How the diagnosis is made

From first thinning to a clear plan.

The steps a UK GP, trichologist or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and pattern

    Onset, distribution, family history, medications, systemic symptoms and any recent trigger - the story usually points to the diagnosis.

  2. 02

    Assessing

    Scalp examination

    Look at pattern (bitemporal, vertex, diffuse, patchy or band-like), density and any signs of scarring or inflammation.

  3. 03

    Assessing

    Trichoscopy and pull test

    A dermatoscope shows exclamation-mark hairs in alopecia areata, miniaturisation in AGA and loss of follicular openings in scarring disease.

  4. 04

    Confirming

    Bloods for reversible drivers

    Ferritin, TFT, FBC, vitamin D, zinc and - in women with hormonal features - androgens, prolactin and screening for PCOS.

  5. 05

    Confirming

    Dermatology or trichology review

    Complex, scarring, refractory or psychologically distressing cases benefit from a specialist opinion.

  6. 06

    Planning

    Scalp biopsy when needed

    A 4 mm punch biopsy confirms scarring alopecia, atypical patterns and treatment-resistant disease.

  7. 07

    Planning

    Shared decision on treatment

    Once the type is clear, options are matched to severity, safety and personal goals - including cosmetic and psychological support.

Typical timeline: first consultation to settled plan within a few weeks.

Symptoms

What hair loss actually looks like.

The classic patterns of pattern loss, alopecia areata, frontal fibrosing alopecia and scarring disease - and the features that need urgent review.

  • Bitemporal recession

    Classic male pattern loss - receding hairline and vertex thinning driven by androgen sensitivity and genetics.

  • Diffuse crown thinning

    Female pattern loss - widening of the central parting with preservation of the frontal hairline (Ludwig pattern).

  • Well-defined patches

    Sudden smooth, round bald patches with exclamation-mark hairs at the edge - the hallmark of alopecia areata.

  • Frontotemporal band

    A recessed hairline with pale, atrophic skin and eyebrow loss - the signature of frontal fibrosing alopecia.

  • Loss of follicular openings

    Smooth, shiny scalp without visible follicles - a sign of scarring alopecia that needs urgent specialist review.

  • Increased shedding

    Handfuls of hair coming out in the shower or on the pillow - typical of telogen effluvium after a trigger.

  • Broken hairs in a pattern

    Short broken hairs along a parting or margin - suggests traction alopecia or trichotillomania (hair pulling).

  • Red flag - rapid or scarring loss

    Rapidly progressive loss, scarring, scalp pain, itching or systemic symptoms warrant same-week specialist review.

Treatment

How hair loss is treated in the UK.

Minoxidil and finasteride for pattern loss, intralesional steroid and JAK inhibitors for alopecia areata, hydroxychloroquine and anti-androgens for frontal fibrosing alopecia - and treatment of the underlying cause where one exists.

  • Topical minoxidil

    Minoxidil 5% (men) or 2 to 5% (women) twice daily - first-line for androgenetic alopecia. Judge success at 6 months.

  • Oral finasteride

    Finasteride 1 mg daily (men) - a 5-alpha-reductase inhibitor. Not for women of childbearing potential. Discuss sexual side effects.

  • Low-dose oral minoxidil

    Off-label oral minoxidil 0.25 to 5 mg daily - increasingly used under specialist supervision for pattern loss when topicals fail.

  • Intralesional steroid

    Triamcinolone injections into bald patches of alopecia areata - first-line for limited disease.

  • Topical immunotherapy

    Diphenylcyclopropenone (DPCP) applied in specialist clinics for extensive alopecia areata that has not responded to steroids.

  • JAK inhibitors

    Baricitinib (Olumiant) and ritlecitinib (Litfulo) - MHRA-approved for severe alopecia areata. Specialist-commissioned.

  • Hair transplant

    Follicular Unit Extraction (FUE) or Strip (FUT) - moves permanent follicles to thinning areas once medical therapy has stabilised loss.

  • Cosmetic and psychological

    Wigs, camouflage powders, scalp micropigmentation and support from Alopecia UK - as important as any medication.

Specialist clinics

Where medical and cosmetic options meet.

For advanced cases our hair loss clinic, JAK inhibitor alopecia clinic and FUE hair transplant service work alongside dermatology, trichology and psychology in one MDT.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or dermatologist knows your scalp and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Association of Dermatologists (BAD). Guidelines on androgenetic alopecia and alopecia areata.

  • NICE Technology Appraisal TA926 - baricitinib for severe alopecia areata.

  • MHRA. Approvals of baricitinib (2022) and ritlecitinib (2023) for alopecia areata.

  • European Dermatology Forum. S3 guideline on androgenetic alopecia.

  • Primary Care Dermatology Society (PCDS). Hair loss guidance for UK primary care.

Red flags

When hair loss needs urgent attention.

Most hair loss is manageable in primary care. These are the situations that are not - and where a specialist opinion is needed.

  • Scarring alopecia

    Loss of follicular openings, scalp pain, itching or burning suggests a scarring process - refer to dermatology within days, not months.

  • Rapidly progressive loss

    Sudden extensive loss over weeks - especially with systemic symptoms - needs urgent review to exclude autoimmune, endocrine or drug causes.

  • Frontal fibrosing alopecia

    A receding hairline with eyebrow loss in a woman is FFA until proven otherwise - early specialist input protects remaining hair.

  • Alopecia totalis or universalis

    Loss of all scalp or body hair carries a heavy psychological burden and is now treatable with JAK inhibitors under specialist care.

  • Psychological distress and body image

    Hair loss can trigger low mood, anxiety and social withdrawal - screen for it and offer support alongside medical treatment.

  • Trichotillomania

    Compulsive hair pulling needs a compassionate mental-health approach - referral to psychology or CBT is often more useful than any topical.

  • Suspected syphilis

    Patchy moth-eaten alopecia in a sexually active adult should prompt syphilis serology - it is a treatable and reversible cause.

  • New medication trigger

    Chemotherapy, anticoagulants, retinoids, antithyroid drugs and many others can cause shedding - review the medication list carefully.

  • Systemic clues

    Fatigue, weight change, menstrual disturbance or virilisation point to thyroid disease, PCOS or other endocrine causes.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - gentleness, patience, mind and the confidence to step up when needed.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits - kept up for months - do more than a heroic week that does not last.

  1. 01 Routine

    Be gentle with your hair

    Avoid tight styles, aggressive brushing and hot tools while you find a plan that works - traction adds to any other cause.

  2. 02 Patience

    Give treatment 6 months

    Minoxidil, finasteride and JAK inhibitors all take months to show benefit - judge them at 6 months, not 6 weeks.

  3. 03 Mind

    Look after the psychological side

    Hair loss is not vanity - it affects identity and mood. Support groups and, when needed, formal psychology help.

  4. 04 Escalate

    Know when to step up

    If topicals are not enough, oral options, injections and JAK inhibitors are available - ask about a specialist referral.

Frequently asked

Everything we get asked about hair loss.

Quick answers on minoxidil, finasteride, JAK inhibitors, hair transplants and when to seek help.

  • What is the most common cause of hair loss?

    Androgenetic alopecia (pattern hair loss) is by far the most common - affecting roughly half of men by 50 and a significant share of women, particularly after the menopause. It is driven by a genetic sensitivity of scalp follicles to androgens (DHT) and follows recognisable patterns.

  • Is hair loss reversible?

    It depends on the cause. Telogen effluvium (reactive shedding), iron or thyroid-related loss and traction alopecia are usually reversible if caught early. Androgenetic alopecia can be slowed and partially reversed with treatment. Scarring alopecia and long-standing pattern loss are not fully reversible - the aim is to preserve what remains.

  • Do minoxidil and finasteride actually work?

    Yes - both are supported by strong evidence in androgenetic alopecia. Topical minoxidil twice daily stabilises loss and produces modest regrowth in about two thirds of users. Finasteride 1 mg daily in men slows progression in around 90% and regrows hair in about half. Both need to be continued long-term to keep the benefit.

  • Are JAK inhibitors safe for alopecia areata?

    Baricitinib (Olumiant, MHRA-approved 2022) and ritlecitinib (Litfulo, MHRA-approved 2023) can produce dramatic regrowth in severe alopecia areata. They are dermatology-prescribed with baseline screening (bloods, TB, viral serology) and ongoing monitoring for infection, lipids and other side effects. NICE guidance TA926 sets out access criteria.

  • When should I ask for a specialist referral?

    When there is any suggestion of scarring (loss of follicles, pain, itch), rapid progression, eyebrow loss, extensive alopecia areata, treatment failure at 6 months, or significant psychological impact. Frontal fibrosing alopecia in particular benefits from early specialist input.

  • Is a hair transplant a cure?

    No - a transplant moves permanent follicles from the back of the scalp to thinning areas. It is best done once medical therapy has stabilised loss, so newly transplanted hair is not surrounded by continuing thinning. It works well for pattern loss but is not appropriate for active scarring or unstable alopecia areata.

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