Diagnosing alopecia is the most important step towards treatment.

Alopecia is the disease that consists in general or localised hair loss situated in the head or the body. The clinical picture of alopecia includes hair loss, skin lesions, and potentially scarring. Loss of hair takes place gradually. Usually, the area suffering from androgenetic alopecia shows thinning of hairs, which are largely in the telogen phase and with each new life cycle lose their growth dynamic, eventually getting deteriorated.

A long process of thinning and degeneration follows, called miniaturisation, until the hairs reach their final point of degeneration. The hair follicle disappears, and the remaining hairs look like a transparent, thin fluff (terminal hair, vellus hair).

It has major psychological and social impact on patients, as dense hair has always been an important beauty feature in both sexes

Types of Alopecia

androgenetic alopecia

Androgenetic Alopecia

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alopecia areata

Alopecia Areata

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diffuse alopecia

Diffuse Alopecia

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cicatricial alopecia

Cicatricial Alopecia

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Diagnosing Alopecia

alopecia diagnosis through pull test

Pull Test:

With this test, the doctor will gently pull the hair and then evaluate how many hairs are left in his/her hand. These hairs are then examined microscopically for the diagnosis of alopecia. This is the classical diagnostic method known as trichogram.


A scalp skin biopsy helps in the correct diagnosis, when there are issues with the differential diagnostic. It is particularly useful in cases with an unclear clinical picture, alopecia areata and cicatricial alopecia.

alopecia diagnosis through biopsy
alopecia diagnosis through trichogram


The classic trichogram gives conclusions about the number and the ratio of hairs that are in the anagen and in the telogen phase, thereby determining if the balance between the hair growth phases has changed. It can also show if there are dystrophic hairs that do not develop properly, and whether there are damages to the bulb or the hair shaft that cause the alopecia.


The most modern method of determining alopecia is the phototrichogram, with the use of a special digital microcamera. At Advanced Hair Clinics, we use the Follysis method for the evaluation of alopecia and the selection of the suitable treatment option. More specifically, using the special Follysis software, photos of the affected and the healthy areas are digitally analysed. The extent of the affected area, the number of follicles and the average number of hairs per follicle, as well as the hair shaft diameter are determined and compared with reference values from the healthy area of the scalp.

A decreased strand diameter is an early indication of development or progression of alopecia in the examined area. After diagnosing the type of alopecia, the clinic’s dermatologist and plastic surgeon jointly decide on the type of treatment. Advanced Hair Clinics is one of the most specialised alopecia treatment centres at a European level, and plastic surgeon Dr. Anastasios Vekris is one of the pioneers in the field of surgical restoration of alopecia.

alopecia diagnosis through phototrichogram

Alopecia - FAQs

Which are the causes?

The hair follicle consists of the follicle proper and the hair bulb, which creates the hair, its strain and the sebaceous gland. Any damage to the follicle or bulb can cause alopecia.

The growth cycle of hair consists of the Anagen phase (growth), the Catagen phase (transition) and the Telogen phase (shedding). Disturbance of any of these phases results in alopecia.

Normally 90-95% of the hairs are in the anagen phase and 5-10% in the telogen phase, and a loss of 50 to 100 hairs a day is normal. When the rate of loss increases over 100 hairs a day, alopecia can be observed. This is called telogen effluvium. This form of hair loss is common in iron deficiency anaemia and endocrine and metabolic diseases. Any disturbance of the anagen (growth) phase of the hair causes anagen alopecia. This form is observed during the use of chemotherapeutic substances and radiation for malignant diseases.

Which are the factors that evoke the development of Alopecia?

Surgery and childbirth can cause transient alopecia. Anxiety and stress, constant pulling of hair during brushing, and hair styling techniques can lead to traction alopecia. There are also cases of alopecia that have an autoimmune aetiology, such as pathological cicatricial alopecia in case of lichen planus, systemic lupus erythematosus, scleroderma, etc. Also, chronic use of certain medications, such as antidepressants, cortisone or hormonal preparations, can cause hair thinning, hair loss and eventually alopecia, which in most cases is reversible if the medication is discontinued. Alopecia is also due to:

  • Hereditary
  • Hormonal factors
  • Chronic inflammations
  • Diabetes
  • Fungal infections
  • Thyroid disease
  • Hypervitaminosis A
  • Iron deficiency
  • Poor diet

Which are the common types of Alopecia?

The most common form in men, in a percentage of more than 90%, is androgenetic alopecia (male pattern hair loss, commonly known as baldness), while in women, androgenetic alopecia is the cause in about 50% of cases. The most common form in children is alopecia areata (spot baldness) and traction alopecia, which is due to pulling the hairs and usually has psychological roots.

Localised traumatic alopecia, resulting from injuries, burns, accidents etc. is a quite frequent form of alopecia. Furthermore, there are frequent cases of traumatic alopecia resulted from a previous hair transplantation performed with the older hair restoration technique named Strip or FUT, as this technique always leaves a postoperative linear scar in the donor site in the occipital region of the head. Traumatic alopecia usually involves the scalp, but can also involve facial hair, especially the eyebrows and beard.

What is the clinical picture of Androgenetic Alopecia in men?

The pattern of androgenetic alopecia in men consists in thinning or complete lack of hair in the frontal, temporal and parietal regions, while the occipital area is spared. At a microscopic level, it has been found that the hair follicles in the constant hair growth zone do not have androgen receptors, making them less susceptible to the action of male hormones and the subsequent hair loss.

What is the clinical picture of Androgenetic Alopecia in women?

In women, the total lack of hair in a particular area is extremely rare compared to men, in whom it is extremely frequent. The continuing growth of hair in the occipital and lateral temporal regions, even in old age, is a feature that is observed worldwide and defines the so-called ‛constant hair growth zone’, which serves as a donor site for hair transplantation.

Androgenic alopecia in women shows a more diffuse form, normally with retention of the front hairline, hair thinning in the frontal and parietal regions, and hair growth that is maintained in the occipital region. It can be circumscribed (patchy), diffuse or total. It is also divided in cicatricial (scarring) and non-cicatricial (non-scarring).

How are the various types of Cicatricial Alopecia being classified?

Cicatricial (scarring)

  • Pathological cicatricial alopecia
  • Lichen planus
  • Systemic lupus erythematosus, scleroderma

Other auto-immune diseases

  • Neoplastic aetiology (basal-cell or squamous-cell carcinoma)
  • Inflammatory aetiology (bacterial, fungal or viral)
  • Congenital aetiology (ichthyosis, congenital absence of skin)

Traumatic cicatricial alopecia

  • From injury or burn
  • Damages after radiation

Postoperative scars

  • Scars resulted from previous hair transplantation performed with the FUT or Strip method

How are the various types of non-Cicatricial Alopecia being classified?

  • Normal alopecia
  • Alopecia areata (spot baldness)
  • Androgenetic alopecia (male pattern hair loss)
  • Alopecia induced by various harmful factors
    1. Diffuse alopecia, depending on the image of trichogram
      • Telogen alopecia or telogen effluvium
      • Dystrophic or anagen alopecia
      • Mixed alopecia
    2. Diffuse alopecia, depending on the harmful factor
      • Due to endocrinal disorders
      • Caused by medicinal and chemical substance
      • Caused by nutritional and metabolic disorders
      • Chronic diffuse alopecia
  • Traumatic alopecia
    • Trichotillomania
    • Traction alopecia
"The dermatologist and the plastic surgeon of the clinic, after having diagnosed the form of alopecia, jointly decide on the type of treatment that will be followed. Advanced Hair Clinics is, at European level, one of the most specialized centers for alopecia treatment and plastic surgeon Dr. Anastasios Vekris is one of the pioneers in the field of the surgical restoration of alopecia."

Dr. Anastasios Vekris, Plastic Surgeon
Scientific Director of Advanced Hair Clinics

doctor's bio
dr anastasios vekris quote on alopecia diagnosis and treatment

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