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In order to correctly treat clients with alopecia, it is important to understand that alopecia itself comes in many different forms. The most common types you will encounter are alopecia areata and alopecia totalis, however other strains like traction alopecia and scarring alopecia are also seen from time to time.

Alopecia areata is very common and is manifested as patchy hair loss. These patches are usually round and can affect a single area, or multiple areas at the same time.

The condition is highly unpredictable. Patches can grow larger, reduce in size and even change position. The condition can go away, then come back again. Most people with alopecia areata suffer over a long period of time. Those with a history of the condition are more likely to develop the symptoms again later on in life.

Aggressive alopecia areata can further develop and cause the loss of all head hair including eyebrows, eyelashes and facial hair. At this stage the condition is described as alopecia totalis (below right).


Alopecia-related hair loss happens when the immune system mistakes hair follicles for foreign bodies, and subsequently attacks them. Despite many years of research, it is not yet known why this happens.


The implementation of scalp micropigmentation is ultimately the same as with any other client, however planning the clients treatment requires additional considerations.For clients with alopecia areata, the key question is how aggressively your client is experiencing the condition. If the client has just a small area that is affected, and they have never experienced alopecia before (or at least no more severely than at present), then treating the area in isolation is a possibility.

If however the clients patches are sporadic in nature, frequently change shape, size or position or is regularly recurrent, the advice should usually be to treat the entire head, including the full back and sides. This way, any variation in the clients symptoms will be catered for in advance. A technician should usually follow the clients existing hairline around the entire head, and after shaving the hair down, add sufficient density to provide an illusion of hair regardless of whether or not their real hair is lost.

For clients with alopecia totalis, the entire ‘shape’ of their head hair must be recreated, although the procedure itself is the same from a technical standpoint as any other procedure. It is strongly recommended that you reference multiple examples of ear lines, neck lines, temples, sideburns, and hairlines. If possible it would be helpful to refer to old photographs of the client showing them with a full head of hair.


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