Retrograde alopecia is a less common and aggressive form of hair loss that researchers still don’t fully understand. Many believe it’s a type of androgenetic alopecia, which happens when the body reacts strongly to certain sex hormones.

Yet unlike male-pattern hair loss and female-pattern hair loss, which begin near the top of the head, retrograde alopecia starts at the base of the head and works its way up vertically. For this reason, it’s also known as reverse-pattern hair loss.

Any family history of hair loss may indicate you have a genetic predisposition for developing this condition. Lifestyle choices can also raise your risk. Even your stress levels can influence retrograde alopecia. Because it’s such an aggressive form of hair loss, early diagnosis is key. An early diagnosis can help your dermatologist create a treatment plan to slow or stabilize your hair loss.

Here’s what you need to know about retrograde alopecia, including how it’s diagnosed and treated.

What Is Reverse-Pattern Hair Loss?

Retrograde alopecia is a type of hair loss that starts at the nape of the neck or the base of the head, where hair begins to grow. As it progresses, it moves upward in a vertical pattern. Sometimes referred to as vertical alopecia, this form of hair loss can move all the way up the back of the head or even progress to the top of the scalp.

Scientists believe reverse-pattern hair loss may be a form of androgenetic alopecia, a genetic condition linked to a hormonal imbalance and a strong response to androgens. Androgens are sex hormones that include testosterone and dihydrotestosterone (DHT).

People with androgenetic alopecia are more susceptible to retrograde alopecia. In fact, one study of 1,000 people with androgenetic alopecia found that 5 percent also had retrograde alopecia. The researchers also discovered that the more severe the person’s androgenetic alopecia, the more likely they were to experience retrograde alopecia.

However, this type of alopecia is different from other types of androgenetic hair loss like male- and female-pattern hair loss. For instance, male-pattern hair loss starts above the temples and can affect both the top of the head and its perimeter. Female-pattern hair loss can cause significant hair thinning on the top of the scalp but rarely causes baldness.

What Causes Retrograde Alopecia?

While retrograde alopecia isn’t well researched, scientists believe that those with the condition tend to have finer hair follicles than those without the condition. Likewise, people with a family history of the condition are more likely to develop it as well, especially because it involves genetic and hereditary influences.

Another possible trigger for retrograde alopecia includes hormonal imbalances, such as changes in testosterone or thyroid hormone levels. Side effects of certain medications and stress can also trigger this type of hair loss, while nutritional deficiencies and improper grooming habits can make it worse.

Lichen planopilaris, an autoimmune disease, may also increase your risk of retrograde alopecia. In lichen planopilaris, your immune system overreacts and produces inflammation around your hair follicles, eventually destroying them. Once this happens, you can develop scarring alopecia and experience permanent hair loss.

However, if your dermatologist or another healthcare provider identifies a risk of retrograde alopecia, they may be able to develop a more effective treatment plan. They may even be able to prevent hair loss.

How Retrograde Alopecia Is Diagnosed

If you’re starting to show signs of retrograde alopecia, a board-certified dermatologist can help make a diagnosis. This evaluation often begins with a physical examination and an overview of your medical history and family history of hair loss. They may also ask you about your lifestyle and diet.

Then they may assess the extent of your hair loss using a tool called a dermoscopy. This tool helps them evaluate your scalp by providing a magnified view of the affected areas so they can determine the extent of your hair thinning and hair loss. They may also perform a hair density test, which helps them determine how much hair has been lost.

When a more definitive diagnosis is needed or if you’ve been considering hair transplant surgery, your dermatologist may recommend a scalp biopsy. This procedure involves taking a small sample of your scalp tissue, which can be evaluated under a microscope. Not only can this biopsy help doctors identify inflammation and structural changes in your hair follicles, but it may also suggest the underlying cause of your condition. Plus, if you have retrograde alopecia, hair transplants may not be an effective option.

Your healthcare provider can use this information to create a more effective treatment plan. This is important because retrograde alopecia can be a more aggressive form of hair loss than other types. For example, traction alopecia may be reversed if it’s treated early, before scarring starts. With alopecia areata, treatment may help hair grow back. Retrograde alopecia is often harder to treat, so early diagnosis is important to help slow or stabilize hair loss.

Treatment Options for Retrograde Alopecia

Treating retrograde alopecia focuses on slowing your hair loss and encouraging hair growth. Consequently, your treatment plan may include a combination of medications, therapies, and lifestyle changes. Here are some possible treatments you may be offered if you’re diagnosed with retrograde alopecia.

Medications

Frequently, dermatologists will recommend minoxidil to treat hair loss. This remedy boosts blood flow around your hair follicles, which may help slow hair loss while promoting thicker, fuller hair. Another option is finasteride, which helps reduce the hormone DHT. And like minoxidil, it also promotes thicker, fuller hair. Corticosteroids can also be used to slow hair loss, especially if your doctor suspects you have an autoimmune disease. These medications may be prescribed to be taken orally, injected, or applied topically to reduce inflammation.

Procedures

Platelet-rich plasma (PRP) therapy is another option to improve your hair’s density. This therapy involves injecting platelets from your blood plasma into your scalp in order to boost the health of your hair follicles.

Low-level laser therapy is another option for boosting hair follicle health. This therapy involves using light to stimulate cell function.

Lifestyle Changes

If you believe you have retrograde alopecia, consider eating a balanced diet that is rich in leafy greens, nuts, eggs, and other nutrient-rich foods. A healthy diet will help boost the strength of your hair follicles and support your treatment plan. Likewise, managing your stress levels and exercising consistently may improve your overall health as well as your hair health. Finally, be gentle with your hair. Avoid wearing tight hairstyles, use a wide-tooth comb instead of a brush on wet hair, and limit the use of heat-styling tools like hair dryers.

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If you have been diagnosed with retrograde alopecia, which treatment options have you found most helpful and why? Let others know in the comments below.