Looking at alopecia areata and Propecia

In theory, this is relatively easy to identify because, as its popular name "spot baldness" suggests, the first stages of the conditions are usually the emergence of distinct bald areas. Since male pattern baldness begins to show a distinctive area of loss, the two conditions should be easy to distinguish. However, since both may be "symptomless", i.e. there are no accompanying indications of cause, men in the right age bracket should pause for a short period to ensure the spots do not grow into the characteristic M shape of the male pattern. So what exactly is alopecia areata?

You are likely to find hair falling out and forming distinct bald patches. The scalp will look and feel quite normal (although a very small number do report occasionally feeling a slight itchiness) and there are no obvious scars or other marks. Over time, the patches can expand and result in a completely bald head. In about 2% of all cases, hair is lost from the entire body. The face can often be made to look strange because, for example, bald patches can appear in a beard or moustache or the hairline forming the eyebrow may become broken during the early or middle stages of the disorder.

When hair is being lost in unpredictable areas on visible parts of the body, this produces difficult choices to preserve appearance. In the early stages, there are periods of loss followed by quite intense periods of regrowth. The timing of each period may vary between a few weeks and several months. It's therefore essential not to panic and rush to have some of the treatments on offer. For example, all suggestions of hair transplants should be resisted at the first signs of loss. If you are going to experience periods of loss and regrowth, paying for transplants could be a complete waste of money as different parts of the head might be affected sequentially. It is worth noting, however, that the regrown hair can be white and may only recover it color later on.

This means alopecia areata is not life threatening but it can make your life miserable. Making this worse is the lack of any consistently effective treatment. For the record, there are no scientifically reliable trials for any treatment and no evidence of success although there's some anecdotal evidence on the successful use of a 308-nm Excimer laser. It will be interesting to see whether these claims are taken as justifying a full clinical trial.

Putting this together, the word to the wise is to wait a short period if hair begins to fall at the front of the scalp. This could be the first signs of the characteristic shape forming or it could be one or more bare patches emerging. Obviously hair loss on areas of the scalp not usually part of the pattern should be ignored. Using Propecia is not going to help. It's not going to cause you any loss of effectiveness to wait a few weeks before beginning Propecia to confirm which variety of loss you have.