Retrograde alopecia is a form of hair loss characterized by the gradual thinning or recession of hair at the nape of the neck or the sides of the scalp.
Retrograde alopecia is a form of hair loss characterized by the gradual thinning or recession of hair at the nape of the neck or the sides of the scalp. These are places that usually aren’t significantly impacted by other types of hair loss.
There’s very little research on retrograde alopecia, but it appears to be associated with androgenetic alopecia (male pattern baldness).
What’s the difference between retrograde alopecia versus regular alopecia? Unlike traditional male pattern baldness, which is very common and often starts at the crown or temples, retrograde alopecia affects regions considered to have more resilient hair.
It often starts with subtle symptoms and, on the Norwood scale (a hair loss severity guide), it typically affects men at a 6 or 7 — the most severe stages.
Initially, retrograde alopecia symptoms are often slower to develop than other forms of male hair loss. If your hair looks or feels a little different lately, take notice of any of these early signs of retrograde alopecia:
Thinning hair at the base of the neck. Hair becomes sparse at the lower part of the scalp, near your hairline.
Hairline recession at the sides of the scalp. Your hairline may move upward on the sides, creating a higher boundary of hair growth.
Loss of density in affected areas. Hair in the impacted regions may appear less voluminous, with noticeable thinning over time as more fine hair grows and less normal hair grows.
Uniform or patchy progression. While retrograde alopecia progression may occur evenly, some individuals might experience patchy thinning at the nape or sides.
The exact causes of retrograde alopecia are not fully understood, but it’s believed to be linked to autoimmune responses, hormonal imbalances, age, and genetics.
Retrograde alopecia can be caused by several factors, some of which overlap with other types of hair loss. Like with any other condition, what causes retrograde alopecia for one person may not for another.
Here are some of the more common reasons why someone may develop this type of hair loss:
DHT is an androgen hormone that plays a key role in hair loss. It binds to receptors in scalp hair follicles, leading to reduced hair growth.
Men with a genetic sensitivity to DHT are more likely to experience retrograde alopecia, as the hormone affects follicles located even in less typical areas.
More research is needed, but not getting enough nutrients like iron, zinc, or biotin (true deficiency of which is rare) in your diet may compromise hair follicle health, weakening hair and contributing to certain types of alopecia and hair loss. Other research suggests an association between low levels of protein or vitamin D and hair thinning.
Nutritional imbalances can disrupt the hair growth cycle, making the base and sides of the scalp more vulnerable to thinning. This may be the result of either a diet that’s generally low in nutrients, problems absorbing those nutrients, or both.
If you regularly experience high physical or emotional stress, this can take a toll on many areas of your health, including your hair. Chronic stress triggers hormonal imbalances, such as elevated cortisol levels, which can disrupt the hair growth cycle and lead to hair shedding, called telogen effluvium.
When stress is ongoing and not well-managed, it can also worsen underlying conditions like androgen sensitivity or poor scalp health, increasing the risk of retrograde alopecia.
In some cases, retrograde alopecia may occur alongside an autoimmune disease, in which the body mistakenly attacks healthy cells. People with autoimmune disorders, such as lupus or alopecia areata, may be at higher risk for hair loss patterns resembling retrograde alopecia.
When retrograde alopecia is related to an autoimmune response, the body incorrectly targets healthy hair follicles, resulting in gradual thinning of hair.
Having a family history of hair loss increases the risk of retrograde alopecia in men. This genetic predisposition means you’re more sensitive to factors like DHT and the natural aging of hair follicles.
Men with genetic links to hair thinning or baldness are more likely to experience follicle weakening, including in areas like the base of the neck and sides of the scalp.
Certain factors may increase the likelihood of developing retrograde alopecia:
Family history of hair loss. If your family has a history of androgenetic alopecia, you have a higher risk of retrograde alopecia.
Age. It’s a fact of life that, as we get older, we’re more likely to notice thinning hair and recession, which may be due to retrograde alopecia.
How you style your hair. If you have long hair, pay attention to how you’re wearing it. Tighter hairstyles, like buns, ponytails, or tight braids, can stress your hair at the sides and nape of your neck, which may trigger traction alopecia.
How you care for your hair. Frequently using high-heat styling tools, being an aggressive comber, or exposing your hair to harsh chemicals can weaken it and trigger loss.
Existing scalp issues. Chronic conditions like dandruff, seborrheic dermatitis, or psoriasis can potentially weaken your hair follicles and contribute to hair loss.
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It can be hard to determine whether you have retrograde alopecia or another form of hair loss on your own. If you’re experiencing changes in your hair growth, it’s always best to speak with your healthcare provider, who may refer you to a dermatologist for a specialized exam.
Here are some of the things you might expect when pursuing a retrograde alopecia diagnosis:
Clinical exam. Your provider will perform a comprehensive physical exam to get a better idea of the pattern and extent of your hair loss, the condition of your scalp health, and any signs of inflammation or scarring. These details help differentiate retrograde alopecia from other hair loss types.
Photograph documentation. If you’ve been taking photos of your hair loss, bring them to show your provider. Documenting the progression can be helpful in monitoring changes before and after treatment.
Trichoscopy. Trichoscopy uses a handheld magnification tool (called a dermatoscope) to closely examine the scalp and hair. It evaluates follicle and scalp health and hair shaft abnormalities, providing insights into the progression of retrograde alopecia.
Hair pull test. This noninvasive test evaluates active hair shedding by gently pulling hair strands, helping test the fragility of hair and any potential disruptions in the normal hair growth cycle.
Hair density measurements. A provider may measure hair per square centimeter in order to quantify the severity of your hair loss and track treatment outcomes.
Biopsy. Your healthcare provider may take a scalp tissue sample (called a biopsy) to analyze follicular structure and rule out other conditions like scarring alopecia or autoimmune diseases.
Wondering how to stop retrograde alopecia? Treatment requires targeting existing symptoms with medications, laser therapy, and hair transplant, as well as addressing underlying symptoms. Early and appropriate treatments can help preserve and restore hair in affected areas.
Because retrograde alopecia is similar to androgenetic alopecia, the typical treatment options are similar. There may not be a retrograde alopecia cure, so managing existing symptoms and addressing underlying factors is often the best approach.
The following two medications are FDA-approved for the purpose of androgenetic alopecia, and may be used for retrograde alopecia as well.
Topical Minoxidil. Minoxidil encourages new hair growth by increasing blood flow to your hair follicles and pushing hairs into the growth phase of the hair growth cycle. Depending on your application preference, this medication is available topically as a liquid solution and a minoxidil foam.
Oral Finasteride. Oral finasteride (sold under the brand name Propecia®) reduces your body’s DHT production, which slows or stops the DHT-related damage that causes hair loss. Research of over 530 Japanese men with androgenetic alopecia found 91 percent experienced hair regrowth while taking finasteride. A 2021 study found topical finasteride also improved hair growth.
Low-level laser therapy or laser hair growth treatments may sound scary, but they can be effective and are safe for most people. These newer methods of treatment increase blood circulation and stimulate new hair growth, which may be helpful for managing retrograde alopecia.
Another option to treat retrograde alopecia is hair transplant surgery. It involves taking donor hair grafts from your scalp and implanting them in areas with hair loss or hair thinning.
There are two main surgical procedure options to help restore hair loss due to retrograde alopecia, which are considered to be equally effective:
Follicular Unit Extraction (FUE hair transplant). FUE involves extracting individual hair follicles from a donor area (usually the back of the scalp) and transplanting them to thinning or balding regions. For retrograde alopecia, FUE can restore hair density in affected areas like the base of the neck with minimal scarring and precise placement of follicles.
Follicular Unit Transplantation (FUT). FUT, also called the strip method, involves surgically removing a strip of scalp tissue from a donor area and dissecting it into individual follicular units for transplantation. This process may be used for retrograde alopecia to address severe hair loss, providing a larger number of grafts for restoration in one session.
It’s not always possible to prevent retrograde alopecia. Factors like age, autoimmune disorders, and genetics are out of your control. However, there are things you can try that may help slow the progression of your hair loss and maintain the hair you have based on what’s typically helpful for androgenetic alopecia:
Products containing ketoconazole or saw palmetto can be helpful in preventing further hair loss due to retrograde alopecia.
One 2023 trial found people with androgenetic alopecia who used a topical saw palmetto oil formulation for 16 weeks reduced hair loss by 22 percent and improved hair density by nearly eight percent.
Regular use of topical ketoconazole can also increase hair shaft diameter among people with androgenetic alopecia.
Optimizing your nutrition is a key aspect of your overall wellness and can help prevent many health conditions, including hair loss.
Get enough protein, iron, zinc, and vitamins that promote hair health by eating a variety of fruits, vegetables, nuts, seeds, whole grains, legumes, and lean proteins.
Avoid harsh chemicals, excessive heat styling, and tight hairstyles that can stress your hair follicles and promote further damage and loss.
It’s also important to practice good scalp hygiene. Keep your scalp clean and healthy with regular washing, and consider massage, which can help reduce inflammation and prevent worsened hair loss.
We can’t always avoid stress, but making stress-management practices a regular part of your lifestyle can help reduce its negative effects on your health (and your hair).
Try to incorporate mindfulness techniques, physical activity, spending time in nature, and other calming activities on a daily basis.
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