Retrograde Alopecia: Understanding its Causes, Symptoms, Diagnosis, and Treatment

Shilpi Jain
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retrograde alopecia

Have you ever noticed hair loss in areas where you wouldn’t typically expect it? If so, you might be experiencing Retrograde Alopecia (RA), a type of Androgenetic Alopecia. 

It is an uncommon type of hair loss that occurs at the back of the head, the nape, and the ears. This condition is relatively common in those suffering from hereditary hair loss, but the good news is it’s a treatable condition. Read along to learn more about the condition, its causes, symptoms, and treatments. 

What is Retrograde Alopecia

Retrograde Alopecia is a lesser-known form of Male Pattern Hair loss (Male Androgenetic Alopecia). 

In Androgenetic Alopecia, hair loss occurs along the temples and on the crown, but Retrograde Alopecia affects the lower part of the neck and the sides of the scalp above the ears. It is also called vertical Alopecia because the hair fall occurs in a vertical manner, moving up from the nape to the lower occipital zone and, in rare cases, also reaching the occipital bone. 

The occipital zone refers to the back of the head, encompassing the occipital bone, which forms the lower rear skull.

What causes Retrograde Alopecia

Understanding the Retrograde Alopecia causes can help you in managing and treating the condition effectively. Like Androgenetic Alopecia, Retrograde is caused due to excessive response to Androgens. 

Testosterone hormone, an Androgen, in men and women leads to thinning of hair follicles and hair loss. Other causes of RA include the following, 

  • Family history: People in your family may have some form of Androgenetic Alopecia
  • Traction Alopecia: It arises from prolonged pulling or traction on the hair. This can occur due to habits like excessive brushing, use of hot styling tools, or even habitual scratching of the scalp

It typically happens in men with extensive hair loss at stages 6-7 of the Norwood Scale. 

Did you know?:
Norwood was a dermatologist and a hair transplant surgeon. He studied hair loss in more than 1000 males. He proposed seven stages of hair loss. These seven stages mark hair loss at different severities. 

Retrograde Alopecia symptoms

Recognizing the symptoms of Retrograde Alopecia is crucial for early intervention. If you are affected by Retrograde Alopecia, you will notice hair loss happening in a circular pattern from the scalp. It is usually identified through hair loss at the back or side of the head. Hair loss begins from the nape, travels upwards, or develops downwards from the crown. You are more likely to lose hair beneath the occipital zone.

The symptoms of RA are similar to other hair loss conditions, such as Alopecia Areata.
If you’re experiencing these symptoms, you must see a doctor as soon as possible to rule out other conditions to prevent misdiagnosis.


Unlike Male Pattern Baldness, RA thinning is often not visible easily. Unless someone else points out your back hair thinning, paying attention to the hair loss is challenging. Thus, if you are experiencing an unusual hair fall, it is advisable to consult a dermatologist. 

They may ask about your hairstyling habits and any unusual symptoms you’ve noticed, like itching or tenderness in the scalp. After initial consultation, they can perform a trichoscopy to examine your scalp in detail. Through trichoscopy, they primarily look for miniaturized hairs in the different parts of the scalp. Sometimes, they might perform a scalp biopsy to confirm the diagnosis. 

Remember, early detection is key, so don’t hesitate to seek professional help if you suspect you’re experiencing Retrograde Alopecia.

Retrograde Alopecia treatment

Retrograde Alopecia treatment is similar to the Male Pattern Baldness treatment. These include:

  • Finasteride: This medication works by blocking the hormone responsible for hair loss, helping to slow down the process and even promote some regrowth. It’s usually taken in pill form, but make sure to chat with your doctor about any potential side effects
  • Minoxidil: This topical solution is applied directly to the scalp, where it stimulates hair follicles, encouraging them to grow thicker, healthier strands. It’s easy to use but remember to be patient – results can take a few months to show up
  • Low-level Laser Therapy (LLLT): This non-invasive treatment involves using a special device that emits low-level laser light onto the scalp. It’s thought to increase blood flow to the hair follicles and stimulate cell activity, leading to improved hair growth. Plus, it’s painless and can be done at home with a handheld device
  • Platelet-Rich Plasma (PRP): This innovative treatment involves drawing a small amount of your blood, spinning it in a centrifuge to separate the platelet-rich plasma, and then injecting it into your scalp. The growth factors in the plasma help to rejuvenate hair follicles and stimulate new hair growth
  • Hair transplant: This option is typically reserved for more severe cases of Retrograde Alopecia. During the procedure, hair follicles are harvested from a donor area and transplanted into the balding areas. It’s a permanent solution that can give you natural-looking results, but it does require some downtime for recovery


Retrograde Alopecia may sneak up on you, causing hair loss in unexpected areas like the nape and ears. Understanding its causes, symptoms, and treatment options is vital for taking control of this condition. 

Whether it’s genetic predisposition or hair styling habits triggering RA, early detection is key. Remember, seeking professional help ensures accurate diagnosis and effective treatment tailored to your needs. From medications like Finasteride and Minoxidil to innovative therapies like Platelet-rich Plasma and hair transplants, numerous options are available to restore your confidence and reclaim your locks. 

Frequently Asked Questions

What is Retrograde Alopecia?

Retrograde Alopecia is a type of Androgenetic Alopecia that causes hair loss from the nape of the neck. It is commonly caused in people suffering from hereditary hair loss. 

Is Retrograde Alopecia permanent?

Retrograde Alopecia is not a permanent condition. You can reverse the hair loss caused due to RA with medicines like Minoxidil or Finasteride. If your doctor recommends, you can also go for minimally invasive surgeries or hair transplant to treat the condition.

Is Retrograde Alopecia common?

Retrograde Alopecia is not a common type of Alopecia. People with genetic hair loss may experience hair loss at the back of the head, but the reported cases are significantly less.

What differentiates Retrograde Alopecia from Androgenetic Alopecia?

The distinction between Retrograde Alopecia and Androgenetic Alopecia lies in the pattern of hair loss. AGA typically involves thinning and receding of the hairline, progressing from the front to the crown. RA initiates hair loss from the neck’s base, moving upwards, and affecting the areas around the ears.

Is hair transplant surgery beneficial for Retrograde Alopecia? 

There is limited evidence to support that surgical hair restoration would be beneficial in Retrograde Alopecia. Doctors mostly prefer prescribing Finasteride and Minoxidil for treating the hair loss. However, in cases where no other treatment would work doctors may prescribe hair transplant. 

What are the preferred treatments for Retrograde Alopecia?

Retrograde Alopecia can be treated with medicines such as Minoxidil or Finasteride. Surgical treatments like Low-level Laser Therapy, and PRP, are other options available to treat this uncommon type of hair loss. 

Is extensive hair loss a symptom of Retrograde Alopecia?

There is limited evidence to show that Retrograde Alopecia may cause extensive hair loss. It usually causes hair loss at the back or side of the head, but the hair loss is gradual and not sudden. 

Does Retrograde Alopecia get worse?

Retrograde Alopecia is not a life-threatening condition. It causes hair thinning and hair loss from the back of the head in circular patterns. In worse cases, the person can suffer complete hair loss or have tiny, thin hair on the scalp.  

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