Retrograde Alopecia

Retrograde alopecia is a type of alopecia in which hair loss occurs in a reverse fashion. This involves hair loss migrating up from the lower region of the neck called the nape and either side of the scalp above the ears, where hairs continue to regress. Retrograde alopecia is not widely known, but it is still prevalent in the general community, affecting mostly people with hereditary hair loss conditions.

What is retrograde alopecia?

Retrograde alopecia is also known as vertical alopecia because hair loss starts to occur from the bottom of the neck and comes up in a northward fashion. This typically affects the occipital region of the scalp, which is the traditional donor area (the zone used to obtain hair follicles for the transplant).

Retrograde alopecia tends to progress slowly, thinning and reducing hair density, which takes several months or years until receding hair is noticeable. Although it affects both men and women, retrograde alopecia is likely considered as a sub-type of male pattern hair loss, affecting patients to varying degrees.

Alopecia is a broad spectrum term that encompasses a total of 6 types, including retrograde alopecia, which follows as:

• Alopecia areata: In this type, the immune system mistakenly attacks its own hair follicles, causing patchy hair loss or sudden hair thinning called diffuse alopecia when no patchy hair loss occurs
• Androgenic alopecia: This genetic condition affects both men and women. In men, it is referred to as male patterned hair loss (MPHL). It usually begins after hitting puberty or in the early twenties. In women, it is called female patterned hair loss (FPHL) usually noticeable by the age of 40
• Alopecia barbae: An autoimmune disorder in which the immune system damages hair follicles
• Alopecia totalis: An advanced form of alopecia areata that is characterised by complete hair loss from the scalp
• Traction alopecia: Occurs due to tight hairstyles such as ponytails, braids, or hair extensions, causing trauma to hair follicles, eventually leading to hair loss

Symptoms of retrograde alopecia

Symptoms of retrograde alopecia may include:

• Receding hairline
• Hair loss above the ears and also in areas from behind (creating an arch)
• Red patches on the scalp
• Large patches grow into bald spots
• Rough hair
• Slow hair regrowth
• Losing hair in a short time
• Grey/white hair
• Gradual hair thinning

Causes of retrograde alopecia?

Researchers and medical practitioners are unable to pinpoint the exact cause of retrograde alopecia. Biologically, a natural hair cycle consists of four key phases called anagen, catagen, telogen, and exogen, which together process stages of hair growth, fall out, and regeneration. Normally, people lose 50–100 hairs each day as a part of the natural process. However, if the cycle is disrupted, this may cause hair to fall out more rapidly than it is regenerated. Hair loss may be linked to an individual’s genetics, although there are other medical and behavioural aspects that may interrupt the hair cycle. 

One study indicated thyroid disorders such as hyperthyroidism, hypothyroidism, and parathyroid may cause hair loss. Since thyroid hormones are essential in the development of hair follicles, any imbalance may impair hair quality.¹

Another study showed the inflammatory genes CASP7 and TNF (tumour necrosis factor) are overexpressed in alopecia patients.²

Other major causes include:

• Family history
• Weight loss
• Bacterial or fungal infection
• Iron and zinc deficiency
• High-stress levels—seen in telogen effluvium (accelerated hair loss)
• Tempting urge to pull hair from the scalp (Trichotillomania)
• Cancer
• Exposing scalp to heavy chemicals
• Hormonal changes
• Chemotherapy
• Postmenopause
• Medications

Can retrograde alopecia be prevented?

Retrograde alopecia is progressive and may cause permanent hair damage. Treatment may be required if someone has skin disease on the scalp or has acquired the condition through their family. However, if caught early, retrograde alopecia can possibly be reversed by following the right steps to improve microcirculation:

• To reduce hair strain, avoid tight hairstyles such as high ponytails
• Massaging the scalp on a regular basis could ease stress and allow more oxygen supply to the hair follicles
• Avoiding chemicals, dyes, and straightening irons can cause breakage and weaken the hair shaft
• Following a healthy lifestyle and using gentle hair care could help to prevent damage to the hair follicles

Treatments

Although there is no cure for retrograde alopecia, several treatments and medications can help to prevent the condition.

Medications such as minoxidil and finasteride work well to slow down balding and stimulate hair growth. For those experiencing early balding signs, oral or topical minoxidil is prescribed to prevent receding hairlines since minoxidil shortens the telogen (resting phase) and activates growth through increasing anagen phase length. Hence, promoting effective hair regrowth. Sometimes, blocker therapy with Dutasteride is considered appropriate for treatment.

The health of the hair may be improved by including healthy vital elements in the diet. Leafy vegetables, vitamin A-rich foods, and supplements all support healthy hair.

Hair transplants are usually avoided because retrograde alopecia affects the permanent donor area, so hair follicles cannot be obtained for the procedure. Other preferred options may include:

• Low-level laser therapy
• Platelet-rich plasma therapy (PRP)
• Emotional counselling

Summary

Retrograde alopecia or vertical alopecia can cause progressive hair damage in a reverse fashion. It can be a permanent or temporary condition because there is no way to predict the outcome. However, early intervention followed by the right treatment steps, lifestyle changes, and adding essential nutrients to the diet could help to prevent the condition. Hair loss can be multifactorial. It is necessary to balance thyroid hormones, reduce emotional stress, add dietary supplements, and use gentle hair care to maximise the maintenance of hair growth.