A guide to hair loss

AliPecia

Where the hair goes tells you a lot about why it is going.

Hair loss comes in more than ten distinct forms, and they need different treatments. This guide shows what each one looks like, what may drive it, what treats it and how strong the evidence is. The aim is to help you ask better questions at your appointments, so you get the right diagnosis and the right treatment sooner, and to help you look after your head as well as your hair.

This guide cannot diagnose you. Take what you learn here to a GP or dermatologist, and ask for a referral or a biopsy if something doesn't add up.

Male pattern

Alopecia areata

Frontal fibrosing

Telogen effluvium

HairHair lossInflammationViewed from above, face at the top

My story

Four diagnoses before the right one

I started noticing hair loss on my head when I was around 17. At first I was devastated. Like a lot of people, I went straight for the hair loss medicines and spent a long time chasing treatments.

Along the way I was given three different diagnoses. First androgenetic alopecia, ordinary pattern hair loss. Then seborrhoeic dermatitis. Then alopecia areata.

The treatments weren't working. Then my beard and eyebrows began falling out too, and I knew something else was going on. I started reading about every type of hair loss I could find, and that is how I came across lichen planopilaris. It matched what I was seeing. I took that to my dermatologist and a biopsy was finally done. It confirmed LPP.

I am certain that if I had not educated myself, the biopsy would never have happened. With a scarring alopecia, that delay is not just frustrating. Every month of the wrong treatment is hair that does not come back.

That is why AliPecia exists: to give you the knowledge to recognise what might be happening, ask the right questions, and push for the right test when something does not add up.

Ali

Around age 17Hair loss starts on my scalp
~~Start~~
1
Androgenetic alopeciaPattern hair loss
~~Not it~~
2
Seborrhoeic dermatitisInflamed, flaky scalp
~~Not it~~
3
Alopecia areataAutoimmune patchy loss
~~Not it~~
Beard and eyebrows goTreatments aren't working, and the loss spreads
~~Turning point~~
4
Lichen planopilarisScarring alopecia, found through my own research
Biopsy confirmed

The lesson for you: diagnoses made by eye can miss scarring alopecias, because redness and scale look like dandruff and patchy loss looks like alopecia areata. If treatment isn't working, or the label doesn't fit your symptoms, ask directly: "Could this be a scarring alopecia, and would a biopsy rule it out?"

Step two

The different types

The most important split is whether the follicle survives. In non-scarring types it does, so regrowth is possible. In scarring types it is destroyed, so the aim is to stop the loss early.

A
The bulge holds the stem cells.Scarring types (FFA, LPP, CCCA) attack here. Once the stem cells are gone the follicle becomes scar tissue and cannot regrow.
B
The bulb makes the hair.Alopecia areata attacks here. The hair falls out, but the stem cells above survive, so the follicle can restart.
C
The whole follicle can shrink.In pattern loss, DHT makes follicles smaller with each cycle until hairs are fine and short. Treat early while follicles are still there.
D
The hair cycle can be knocked off course.In telogen effluvium, a shock pushes many follicles into the resting phase at once. They shed together 2 to 3 months later, then restart.

Evidence labels: StrongSeveral good trials or guideline-backed ModerateSome trials or consistent studies EmergingSmall or early studies WeakCase reports, theory or association

Non-scarring

Follicles survive. Regrowth is possible.

Male pattern hair loss

Androgenetic alopecia (AGA)

Non-scarring

Temples and crown

What it looks like

Hairline recedes at the temples into an M shape.
Thinning spot on the crown that slowly widens.
Hairs get finer and shorter before they disappear (miniaturisation).
Measured on the Norwood scale, stages 1 to 7.

Clues that point here

Slow, over years. Scalp looks normal: no redness, no scale, no itch. Often runs in the family. The back and sides usually stay full.

How it gets confirmed

Usually diagnosed by eye. Trichoscopy (a magnified scalp camera) shows hairs of very different thicknesses side by side.

Treatments

Minoxidil 5% foam or liquidStrong
Finasteride 1 mg tabletStrong
Low-dose oral minoxidilModerate
Dutasteride (off-label in the UK)Moderate
Topical finasteride sprayModerate
PRP injectionsEmerging
Hair transplant, once loss is stableStrong

See clinical photos on DermNet ↗

Female pattern hair loss

Androgenetic alopecia in women (FPHL)

Non-scarring

Widening central parting

What it looks like

Parting gets wider, often in a 'Christmas tree' shape towards the front.
Front hairline usually stays put.
Ponytail gets thinner.
Measured on the Ludwig or Sinclair scale.

Clues that point here

Gradual, often after menopause or pregnancy, but can start in the 20s. Scalp looks normal. Can coexist with shedding from low iron or thyroid problems.

How it gets confirmed

Trichoscopy shows mixed hair thickness at the parting. Bloods worth asking for: ferritin, thyroid function, and hormones if periods are irregular or there is acne or excess facial hair.

Treatments

Minoxidil 5% foam or 2% liquidStrong
Low-dose oral minoxidilModerate
Spironolactone (off-label)Moderate
Correcting low iron if presentModerate
Finasteride or dutasteride, only with no chance of pregnancyEmerging
PRP injectionsEmerging

See clinical photos on DermNet ↗

Retrograde alopecia

Thinning from the nape upwards

Non-scarring

Nape and lower back of the scalp

What it looks like

Thinning starts at the nape of the neck and moves upward.
Can affect the back and sides, the area normally spared in pattern loss.
Often seen alongside advanced male pattern loss.

Clues that point here

Slow and diffuse, with no bald patches and a normal-looking scalp. If loss at the back comes as a smooth band or patches, think of the ophiasis form of alopecia areata instead.

How it gets confirmed

Not a separate diagnosis in most dermatology guidelines. The term is mainly used by hair transplant surgeons, because it shrinks the safe donor area that transplants depend on.

Treatments

Same medicines as male or female pattern lossModerate
PRP injectionsEmerging
Transplant often unsuitable; surgeons may use beard or body hairWeak

Alopecia areata

Autoimmune patchy hair loss (AA)

Non-scarring

Patchy

Ophiasis band

Totalis

What it looks like

Round or oval patches that are completely smooth.
'Exclamation mark' hairs at the edges: short hairs that narrow towards the root.
Ophiasis: a band along the back and sides.
Totalis: whole scalp. Universalis: scalp, brows, lashes and body.
Severity measured by the SALT score, 0 to 100% of scalp.

Clues that point here

Appears over days or weeks, often noticed by a barber or hairdresser. Skin looks normal, sometimes slightly pink. Beard, eyebrows or eyelashes can be involved. Nail pitting is common. Regrowth may come in white at first.

How it gets confirmed

Usually clear by eye and trichoscopy (yellow dots, exclamation mark hairs). Ask about a thyroid check, because thyroid autoimmunity is more common with AA.

Treatments

Waiting: many small patches regrow within a yearModerate
Steroid injections into patchesModerate
Potent steroid creams, foams or lotionsModerate
Contact immunotherapy (DPCP)Moderate
JAK inhibitor tablets for severe AAStrong
Minoxidil as an add-onWeak

See clinical photos on DermNet ↗

Telogen effluvium

Diffuse shedding after a trigger (TE)

Non-scarring

Even thinning everywhere

What it looks like

Lots of hairs shed from all over the scalp: on the pillow, in the shower drain.
Shed hairs have a small white bulb at the root.
Overall volume drops but there are no bald patches.

Clues that point here

Starts 2 to 3 months after a trigger: fever or COVID, childbirth, surgery, crash dieting, major stress, low iron, thyroid problems, or starting or stopping some medicines (including the pill). Normal shedding is roughly 50 to 100 hairs a day.

How it gets confirmed

A gentle pull test brings out several hairs. Bloods for ferritin, thyroid and vitamin D help find a trigger. Shedding lasting over 6 months is called chronic TE and may unmask pattern loss underneath.

Treatments

Find and remove the triggerStrong
Correct iron or other deficiencyModerate
Usually recovers in 6 to 9 monthsModerate
Minoxidil to speed regrowthEmerging

See clinical photos on DermNet ↗

Traction alopecia

Hair loss from pulling hairstyles

Non-scarring

Edges and temples

What it looks like

Thinning along the edges, temples and above the ears.
'Fringe sign': a row of short fine hairs left along the very edge.
Small bumps or tenderness around tight braids, weaves or ponytails.

Clues that point here

Matches where the hair is pulled hardest. Reversible early on, but years of tension can scar follicles permanently.

How it gets confirmed

History of tight styles, extensions or wigs glued at the hairline. Biopsy only if it looks scarred.

Treatments

Loosen styles and change the tension pointsStrong
Steroid creams or injections if inflamedModerate
Minoxidil once tension stopsEmerging

See clinical photos on DermNet ↗

Trichotillomania

Hair-pulling disorder

Non-scarring

Irregular patches

What it looks like

Patches with odd, irregular edges.
Broken hairs at many different lengths, never fully smooth.
Often on the side of the dominant hand, the crown, brows or lashes.

Clues that point here

An urge to pull, often during stress, boredom or concentration, sometimes without noticing. It is a body-focused repetitive behaviour, not a choice or a sign of weakness.

How it gets confirmed

Trichoscopy shows broken and coiled hairs. It can look like alopecia areata, so a dermatologist's view helps.

Treatments

Habit reversal training (a form of CBT)Moderate
N-acetylcysteine supplementEmerging

See clinical photos on DermNet ↗

Scarring

Follicles are destroyed. Act early to protect what remains.

Frontal fibrosing alopecia

FFA, a form of lichen planopilaris

Scarring

Receding band at the front

What it looks like

Front and side hairline recedes in a band, leaving smooth pale skin.
Eyebrows thin or vanish, often before the scalp.
'Lonely hairs' left stranded in the bare band.
Redness and fine scale around hairs at the new hairline.
Small skin-coloured bumps on the face in some people.

Clues that point here

Slow, over months to years. Mostly women after menopause, but rising in younger women and in men. Itch or burning is common. The bare skin is shiny with no visible pores.

How it gets confirmed

Trichoscopy shows lost follicle openings with redness and scale around remaining hairs. A scalp biopsy confirms it. Ask for one if your hairline is receding with eyebrow loss.

Treatments

Dutasteride or finasteride to stabiliseModerate
Steroid injections at the hairlineModerate
Hydroxychloroquine or doxycyclineEmerging
Pioglitazone, low-dose naltrexone, JAK inhibitorsEmerging
Calcineurin creams (tacrolimus, pimecrolimus)Emerging

See clinical photos on DermNet ↗

Clinical photos

The hairline has moved back, leaving smooth, shiny skin with no visible pores. A few 'lonely hairs' are stranded in the bare band. Image: DermNet

Redness and fine scale around each hair at the hairline (perifollicular erythema). This is a sign the disease is active. Image: DermNet

Eyebrow loss (madarosis). It often starts before the scalp hairline changes, so it is an important early clue. Image: DermNet

Lichen planopilaris

LPP

Scarring

Inflamed patches, often crown

What it looks like

Patches on the crown or top of the head.
Redness and scale wrapped around each remaining hair.
Bare centres become shiny and smooth.
Itch, burning or tenderness.

Clues that point here

Symptoms often come before visible loss. Often misdiagnosed: the scale and itch get mistaken for seborrhoeic dermatitis, the patches for alopecia areata, and thinning for pattern loss, which it can also coexist with.

How it gets confirmed

Biopsy confirms it. Trichoscopy shows redness and scale around follicles.

Treatments

Potent steroid creams and injectionsModerate
HydroxychloroquineEmerging
Mycophenolate or ciclosporin for active diseaseEmerging
Pioglitazone, JAK inhibitorsEmerging

See clinical photos on DermNet ↗

Central centrifugal cicatricial alopecia

CCCA

Scarring

Crown, spreading outwards

What it looks like

Starts in the middle of the crown and spreads outward in a circle.
Shiny skin with fewer follicle openings.
Sometimes tender, itchy or bumpy.

Clues that point here

Mostly affects women of African descent. Linked to genetics (variants in the PADI3 gene) and possibly heat or chemical styling. Often mistaken for pattern loss.

How it gets confirmed

Biopsy confirms it. Early diagnosis matters because the lost follicles do not come back.

Treatments

Steroid creams and injectionsModerate
DoxycyclineEmerging
Gentler styling and less heatEmerging
Minoxidil for remaining folliclesEmerging

See clinical photos on DermNet ↗

Step three

What might be causing it

Some links are well proven. Others are popular online but thin on evidence. Each one is labelled so you can see the difference.

Genes and hormones (DHT)

Strong

Linked to: Male and female pattern loss

Follicles on the top of the head inherit a sensitivity to DHT, a hormone made from testosterone. Over many hair cycles DHT shrinks those follicles until they make only fine hairs. This is why blocking DHT (finasteride, dutasteride) works.

Autoimmunity

Strong

Linked to: Alopecia areata

Follicles normally hide from the immune system, a protection called immune privilege. In AA that protection breaks down and T cells attack the bulb, driven by interferon-gamma signals that pass through the JAK pathway. The stem cells higher up survive, which is why regrowth is possible and why JAK inhibitors work.

Thyroid disease, including Hashimoto's

Strong

Linked to: Alopecia areata; also shedding (TE)

The link is real but it is an association, not proof that the thyroid causes AA. People with one autoimmune condition are more likely to have another. In a study of 33,401 people with AA, Hashimoto's affected 6.9% compared with 4.3% of matched controls. A pooled analysis of 17 studies found the odds of thyroid autoimmunity were around 3.7 times higher. Separately, an under- or overactive thyroid can itself cause diffuse shedding. Worth asking for TSH and thyroid antibodies (TPO).

Chronic scalp inflammation

Strong

Linked to: Scarring types; possibly pattern loss

In FFA, LPP and CCCA, inflammation around the follicle is the disease: it targets the bulge stem cells, and once they go the follicle turns to scar. Mild inflammation around follicles is also seen in pattern loss biopsies, though its role there is less clear. Dandruff and psoriasis rarely cause permanent loss, but heavy scratching and inflammation can increase shedding.

Gluten and coeliac disease

Weak

Linked to: Alopecia areata

Coeliac disease and AA share some genetic risk, and there are case reports of regrowth after going gluten-free in people who had coeliac disease. There are also reports where a gluten-free diet did not help. No trial shows that cutting gluten helps AA in people without coeliac disease. If you suspect coeliac, get the blood test (tTG antibodies) first, while still eating gluten, because cutting it out early makes the test unreliable.

High-sugar diets

Weak

Linked to: Alopecia areata

There is no good evidence that sugar causes or worsens AA. A strict or crash diet carries its own risk: rapid weight loss and low protein, iron or zinc are well-known triggers of telogen effluvium. If you change your diet, do it in a way that keeps you well fed.

Low iron, vitamin D or zinc

Moderate

Linked to: Shedding; female pattern loss; AA

Low ferritin and low vitamin D are more common in people with hair loss. Correcting a real deficiency makes sense. Taking supplements when levels are normal has not been shown to help, and too much vitamin A or selenium can cause hair loss.

Stress

Moderate

Linked to: Telogen effluvium; AA flares

Major stress is a well-established trigger for shedding 2 to 3 months later. Many people with AA notice flares after stressful periods. In animal studies, stress signals activate mast cells around follicles, which release inflammatory chemicals.

Going deeper

What is known about frontal fibrosing alopecia

FFA was first described in 1994 and has become much more common since. Researchers think it needs a genetic tendency plus a trigger from the environment.

Genes Strong

A 2019 genome-wide study of over 1,000 women found four risk regions. The strongest, the immune gene variant HLA-B*07:02, raised risk about five-fold. Another sits in CYP1B1, an enzyme that breaks down oestrogen, which may help explain why FFA mostly affects women.

Immune attack on stem cells Moderate

Immune cells gather around the bulge, protective signals there drop, and interferon-gamma rises. This collapse of immune privilege lets the immune system target the stem cells.

Stem cells turning to scar Moderate

Under attack, bulge stem cells switch into scar-forming cells, a process called epithelial-mesenchymal transition. Loss of PPAR-gamma, a switch that controls fat metabolism in the follicle, is linked to this scarring in animal studies. That is why pioglitazone, which activates PPAR-gamma, is being tried.

Mast cells Emerging

Mast cells release inflammatory chemicals around follicles under stress, mostly shown in mouse studies. This may feed inflammation in FFA and LPP, but it is not proven in people. Research has not established a link between FFA and mast cell activation syndrome (MCAS) as a condition.

Skin products and sunscreen Weak

A case-control study found FFA more common in people using some leave-on facial products, while sunscreen use showed no link in that study. These are associations, not proof of cause.

Hormones Weak

Most cases follow menopause, but studies have not found consistent hormone abnormalities, and FFA also occurs in men and younger women.

Step four

Treatment toolbox

The main options across all types, with evidence strength and how you would get them in the UK. Off-label means a doctor can prescribe it, but it is not licensed for hair loss.

Treatment	Used for	Evidence	How you get it (UK)	Know before you start
Minoxidil (foam or liquid)	Male and female pattern loss; add-on for AA	Strong	Over the counter	Extra shedding in the first 2 months is normal. Judge it at 6 to 12 months. Gains fade within months of stopping.
Low-dose oral minoxidil	Pattern loss, chronic TE	Moderate	Private prescription, off-label	Can cause facial and body hair growth, ankle swelling or a fast heartbeat. Needs a prescriber who monitors you.
Finasteride 1 mg	Male pattern loss; sometimes FFA	Strong	Private prescription; not funded by the NHS for hair	Blocks DHT, the hormone that shrinks follicles. The MHRA requires a patient alert card about possible mood changes and sexual side effects. Not for anyone who could become pregnant.
Dutasteride	Male pattern loss (off-label), FFA	Moderate	Private, off-label	Blocks DHT more strongly than finasteride and stays in the body for months. In FFA, a 2024 pooled analysis of 7 studies found about 6 in 10 people stabilised.
Spironolactone	Female pattern loss	Moderate	Dermatologist, off-label	Needs reliable contraception. Blood pressure and potassium are checked.
JAK inhibitor tablets	Severe alopecia areata	Strong	NHS via a dermatologist: ritlecitinib (age 12+) and deuruxolitinib (adults). Baricitinib is licensed but not NHS-funded	They calm the immune signals attacking the follicle. In trials roughly a quarter to a third of people regained 80% or more of scalp hair within 6 to 9 months. Hair often falls again after stopping. Regular blood tests are needed.
Steroid injections	AA patches, FFA, LPP, CCCA, traction	Moderate	Dermatologist	Given every 4 to 6 weeks. Can leave small temporary dents in the skin.
Steroid creams, foams and lotions	AA, inflamed scarring types	Moderate	GP or dermatologist	Good for calming inflammation. Long use thins the skin, so follow the plan you are given.
Contact immunotherapy (DPCP)	Extensive AA	Moderate	Specialist hospital clinics	A chemical painted on weekly causes a mild rash that redirects the immune system. Takes months.
Hydroxychloroquine	FFA, LPP	Emerging	Dermatologist	An immune-calming tablet borrowed from lupus treatment. Needs eye checks over time.
PRP (platelet-rich plasma)	Pattern loss; sometimes AA	Emerging	Private clinics, paid per session	Your own blood is spun and injected into the scalp. A 2024 analysis of 13 trials found about 28 more hairs per cm² than placebo, but the results varied widely and certainty was low.
Red light or laser devices	Pattern loss	Emerging	Home devices	Modest effects in trials; quality varies a lot between devices.
Hair transplant	Stable pattern loss	Strong	Private surgery	Needs a stable donor area at the back, which retrograde loss can undermine. Not suitable while AA or a scarring alopecia is active.
Habit reversal training	Trichotillomania	Moderate	NHS Talking Therapies, psychologists	Learns your pulling triggers and builds a competing response.

NHS status: ritlecitinib was recommended by NICE in 2024 and deuruxolitinib in July 2026 for severe alopecia areata. NICE did not recommend baricitinib in 2023. Hair loss medicines for pattern loss are not funded by the NHS.

Step five

When treatment isn't working

Treatments fail more often than adverts suggest. Before giving up, work through these in order.

Check you gave it long enough
Minoxidil and finasteride take 6 to 12 months to judge. JAK inhibitors can take 6 to 12 months. Steroid injections need about 3 months.
Recheck the diagnosis
A treatment failing is a reason to look again. Pattern loss and FFA, or AA and shedding, can happen together. A biopsy can settle it.
Combine treatments
Many specialists combine approaches, such as minoxidil with finasteride, or injections with tablets, rather than relying on one.
Look for a clinical trial
New treatments for AA and scarring alopecias are in trials. Search the UK's Be Part of Research service or ClinicalTrials.gov.
Consider surgery or tattooing
Hair transplants suit stable pattern loss. Scalp micropigmentation tattoos tiny dots that look like shaved stubble and works with any type once it is stable.
Choose to stop treating
Deciding to stop is a valid choice, not a failure. Many people find freedom in wigs, a shaved head, or simply going without.

Avoid

JAK inhibitors bought online without a prescriber. They need blood tests and monitoring for infection, cholesterol and clot risk.
Products promising regrowth for every type of hair loss. Nothing works for all of them.
Very restrictive diets without medical advice. They can trigger more shedding.

The part that matters most

Looking after your mind

Feeling devastated by hair loss is a normal response to a real loss.

Anxiety and low mood are more common in people with alopecia. Hair is tied to identity, attractiveness and how others read us, so losing it can feel like grief. That reaction deserves care, not dismissal.

Limit the checking

Constant mirror checks, hair counting and photo comparisons feed anxiety. Pick one fixed time a month for photos and leave it there.

Talk to people who get it

Alopecia UK runs free support groups across the UK and online. Meeting others who have been through it often helps more than anything else.

Separate treating from accepting

You can pursue treatment and still work on being at peace with how you look today. Acceptance does not mean giving up.

Get talking therapy

CBT can help with appearance anxiety and with hair pulling. In England you can refer yourself to NHS Talking Therapies without seeing a GP.

If you are struggling right now

Samaritans, free and open 24 hours: 116 123.
NHS 111 for urgent mental health support, or 999 in an emergency.
Alopecia UK for support groups, a helpline and information.

Options, not obligations

Cosmetics and coverage

For confidence on your own terms. Try things in low-stakes settings first.

Eyebrows

Brow transfers: temporary tattoo stickers made from real brow photos. Last 2 to 5 days, waterproof versions available.
Pencils, powders and pomades: cheapest to learn with. Hair-stroke pens look most natural.
Microblading: semi-permanent, lasting 1 to 2 years. Ask for an artist experienced with alopecia, and wait until loss is stable.
Brow wigs: real or synthetic hair on a lace strip, glued on.

Lashes

Strip or magnetic lashes: magnetic ones avoid glue but need some natural lashes or eyeliner to grip.
Lash glue: patch test first. Latex-free glue for sensitive skin.

Other routes

Scalp micropigmentation: tattooed dots that look like stubble. Suits men with a shaved look, or adds density for anyone thinning.
Hair fibres: keratin fibres that cling to existing thin hair. Good for pattern loss, not bare patches.
Headwear: scarves, wraps and hats, including sports-friendly options.
Going bare: plenty of people find this the most freeing option of all.

NHS wigs (England)

A doctor can refer you for a wig on prescription. Free for under-16s, 16 to 18-year-olds in full-time education, hospital inpatients, people on certain benefits and HC2 certificate holders. Otherwise:

Stock synthetic wig£80.15

Partial human hair wig£212.35

Full bespoke human hair wig£310.55

Current charges on nhs.uk ↗

Wigs and hair systems, explained

A wig or men's hair system is three choices: the base it is built on, the hair knotted into it, and whether it is stock or custom. Then you choose how to attach it. Here is what each term means.

1 · The base

The base is the thin layer that sits on your scalp. It decides how natural the hairline looks, how cool it feels, and how long the unit lasts.

Base	What it is	Look	Feel	Typical lifespan	Best for
Swiss lace	Very fine, soft mesh. Each hair is hand-knotted through it.	Most invisible hairline when glued down	Softest and most breathable	2 to 3 months	Hot climates, gym-goers, people who prioritise realism over durability
French lace	A slightly thicker, stronger mesh than Swiss lace.	Very natural, slightly less fine than Swiss	Breathable, still soft	4 to 6 months	The best all-rounder for most first-time lace wearers
Thin skin (poly / PU)	A thin polyurethane film, from 0.03 mm to 0.08 mm. Hair is injected or looped in.	Looks like scalp. Gives a sharp, clean hairline	Smooth but hot, as air can't pass through	Ultra-thin: shortest. 0.08 mm: about 4 to 6 months	Easy to clean and tape, so good for beginners and colder climates
Monofilament (mono)	A tougher mesh with square holes, usually with a poly edge.	Natural from a distance, less fine up close	Firmer, a bit stiffer	The longest of the mesh bases	Heavy-density units, and people who want durability over invisibility
Silk top	Hair is knotted under a layer of silk, so no knots show.	The most realistic parting and crown	Very soft, slightly warmer	About 8 to 12 months	Women's wigs where a visible parting matters
Hybrid	Lace at the front, with poly around the edges or back.	Lace realism at the hairline	Breathable on top	Longer than full lace	Combining an invisible front hairline with easy taping at the back

Women's wigs also describe how the cap is built. A lace front has lace only along the front hairline. A full lace wig has lace throughout, so it can be parted anywhere and worn up. Hand-tied caps move most like real hair. A vacuum or silicone base is moulded to your head and stays on by suction without adhesive, which suits total hair loss.

2 · The hair

Synthetic

Man-made fibre. Holds its style after washing, keeps its colour, and costs much less. Standard fibre melts under heat tools. Heat-friendly synthetic tolerates low heat. Frizzes over time where it rubs on collars, usually within 4 to 6 months of daily wear.

Remy human hair

Every strand keeps its cuticle, the outer scaly layer, and all run root to tip in the same direction. That stops tangling, so it stays smooth and shiny for longer. Remy is a sorting method, not a certified quality grade, so ask what processing it has had.

Non-Remy human hair

Collected without keeping strands aligned, so the cuticle is stripped with acid and coated in silicone to stop tangling. It looks great when new but often tangles and dulls once the coating washes out.

Virgin or raw

Hair never dyed, bleached or permed. Holds up best to colouring and styling. No legal standard defines either term, so these are seller claims.

Indian hair

The world's most common source of human hair. Medium thickness with a natural slight wave, and it blends well with many hair types. Usually dark, so lighter shades have been bleached.

Chinese and other Asian hair

Thick, strong and very straight. Durable, but heavier and shinier than most European hair. Often heavily processed to change its texture.

European hair

Finer and naturally lighter in colour, so it needs less bleaching. The rarest and most expensive. Best match for fine, light hair.

Brazilian, Peruvian, Malaysian

Mostly marketing labels for a texture, such as thick, glossy or wavy, rather than proof of where the hair came from. Judge it by feel, cuticle and processing, not the country name.

3 · Stock or custom

Stock (pre-made)

Off the shelf in standard sizes. Men's systems usually come as an 8 × 10 inch base trimmed to fit.
Often pre-cut and pre-styled, so it looks finished out of the box. Many are sold uncut and need a stylist to cut them into your hair.
Available within days and much cheaper.
Fit and colour are close rather than exact.
Good for a first unit, to learn what you like before spending more.

Custom (made to order)

Built from a head template: a mould of the area to cover, made by wrapping the head in cling film and tape and drawing the hairline on it. Some makers use plaster moulds.
You choose the base, hair type, colour from a hair sample, curl, density and hairline shape.
Takes roughly 6 to 12 weeks to make, and costs more.
Fits exactly, which helps it stay secure and look natural.
Once you have a unit you like, makers can duplicate it from the original or the template.

4 · Attaching it, and other words you'll see

TapeDouble-sided strips around the edge. Easy to take off daily or weekly. Best on poly edges.

Liquid adhesiveGlue painted on the scalp. Strongest hold, lasting 2 to 4 weeks, but needs proper removal.

ClipsSnap onto existing hair. For toppers and people with some hair left.

Vacuum fitSuction from a moulded base, no adhesive. Only works on a fully bare scalp.

DensityHow much hair is on the base, often 80% to 130%. Lighter at the hairline looks more natural.

KnotsSingle knots at the hairline look most real. Bleached knots hide the dots where hair meets the lace.

TopperA partial piece for the crown or parting. Suits thinning rather than bare patches.

MaintenanceUnits need cleaning and refitting every 1 to 4 weeks. Many wearers rotate two units so one is always ready.

Questions to ask a supplier

What is the base made of, and how long does it usually last with daily wear?
Is the hair Remy, and has it been bleached or coloured?
Can I see or feel a hair sample before ordering?
Do you fit and cut it, or will I need my own stylist?
And ask your dermatologist, not the supplier: is adhesive safe on my scalp if it is inflamed?

Where this comes from

AliPecia

Four diagnoses before the right one

Reading your own hair loss

What shape is the loss?

Weeks, or years?

Does the bare skin look normal?

Eyebrows, lashes, beard, body?

Itch, burning or tenderness?

Worth reading first

Getting an accurate diagnosis

See a doctor soon if

The different types

Non-scarring

What it looks like

Clues that point here

How it gets confirmed

Treatments

What it looks like

Clues that point here

How it gets confirmed

Treatments

What it looks like

Clues that point here

How it gets confirmed

Treatments

What it looks like

Clues that point here

How it gets confirmed

Treatments

What it looks like

Clues that point here

How it gets confirmed

Treatments

What it looks like

Clues that point here

How it gets confirmed

Treatments

What it looks like

Clues that point here

How it gets confirmed

Treatments

Scarring

What it looks like

Clues that point here

How it gets confirmed

Treatments

Clinical photos

What it looks like

Clues that point here

How it gets confirmed

Treatments

What it looks like

Clues that point here

How it gets confirmed

Treatments

What might be causing it

Genes and hormones (DHT)

Autoimmunity

Thyroid disease, including Hashimoto's

Chronic scalp inflammation

Gluten and coeliac disease

High-sugar diets

Low iron, vitamin D or zinc

Stress

What is known about frontal fibrosing alopecia

Genes Strong

Immune attack on stem cells Moderate

Stem cells turning to scar Moderate

Mast cells Emerging

Skin products and sunscreen Weak

Hormones Weak

Treatment toolbox

When treatment isn't working

Avoid

Looking after your mind

Limit the checking

Talk to people who get it

Separate treating from accepting

Get talking therapy

If you are struggling right now