Is this retrograde hair loss?

Question

Balding on nape and sides are thin

Anna Chacon, MD, FAAD · Answer

Based on the photos you provided, the thinning and recession you are experiencing along the nape and sides of your scalp do not appear typical for retrograde alopecia (also called ophiasis pattern alopecia areata) or the classic pattern of androgenetic alopecia (male pattern baldness), which usually affects the temples, crown, and frontal hairline first.

Instead, this pattern of thinning and loss can be seen in a few different conditions:

Mechanical or Traction Alopecia – If you often tie your hair tightly, wear helmets, or have styles that create tension on the nape and sides, this can lead to localized hair loss over time.

Short Anagen Syndrome or Loose Anagen Syndrome – Less commonly, these can present with breakage or diffuse thinning in certain scalp regions.

Scarring Alopecias (e.g., Folliculitis Decalvans, Lichen Planopilaris) – These can occasionally start on the nape and lead to patchy hair loss with signs of inflammation (redness, scaling, pustules).

Ophiasis Pattern Alopecia Areata – This autoimmune hair loss can create a band-like loss along the lower scalp margin, though typically you would also notice smooth bare patches.

If you see any of the following, you should consider having an in-person evaluation with a dermatologist:

Redness, scaling, or pustules in the affected area

Tenderness, itching, or burning

Rapid progression of hair loss over weeks

Scarring or shiny smooth skin where hair was previously growing

In the meantime:

Avoid tight hairstyles or tension on the area

Be gentle with hair grooming

Monitor for progression or other symptoms

If the thinning continues or worsens, a dermatologist can perform a closer examination and possibly a scalp biopsy to clarify the diagnosis.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. The pattern of balding on the nape and thinning on the sides can sometimes be indicative of retrograde hair loss, which is less common than typical male pattern baldness. Retrograde hair loss involves thinning or receding in areas not typically associated with standard male pattern baldness, which usually starts at the temples and crown. To address thinning and balding in these areas, considering treatments like PRP (Platelet-Rich Plasma) or exosome injections can be beneficial. PRP involves using your own blood’s platelets to stimulate hair follicles and promote regrowth, while exosome injections leverage advanced cellular regenerative techniques to enhance hair follicle health and growth. Both options aim to rejuvenate the hair growth environment and can be tailored to target specific areas of thinning. I use both of these treatment all the time and absolutely love the results! I highly recommend these treatments. I hope this helps and best of luck!

Ross Kopelman, DO · Answer

Yes, thinning or balding at the nape of the neck and along the sides of the scalp can indeed be a sign of retrograde hair loss. Retrograde hair loss, also known as alopecia areata ophiasis, is characterized by hair thinning that starts from the lower sides and back of the head, unlike typical male pattern baldness, which generally begins at the crown or temples.

Is this retrograde hair loss?

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Is this retrograde hair loss?

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Everything you need to know about Hair Loss Treatment

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