What is the best treatment for alopecia (hair loss)?

From the Guidelines

The best treatment for alopecia is a combination of topical minoxidil and oral finasteride for androgenetic alopecia, while corticosteroids are typically used for alopecia areata, with platelet-rich plasma injections and low-level laser therapy being alternative options. The treatment of alopecia depends on the specific type, with minoxidil (Rogaine) being the most common first-line treatment for many forms 1. For androgenetic alopecia (male/female pattern baldness), a combination of topical minoxidil (2% for women, 5% for men) applied twice daily and oral finasteride (1mg daily, men only) often yields the best results 1.

Treatment Options

• Topical minoxidil: applied twice daily, with 2% concentration for women and 5% for men
• Oral finasteride: 1mg daily, for men only
• Corticosteroids: used for alopecia areata, either as topical solutions, injections directly into affected areas, or oral medications in severe cases
• Platelet-rich plasma injections: an alternative option for androgenetic alopecia
• Low-level laser therapy: an alternative option for androgenetic alopecia

Key Considerations

• The effectiveness of these treatments varies based on the extent and type of alopecia, with some patients requiring combination approaches 1
• Treatment works by either stimulating hair follicles, reducing inflammation, blocking hormones that contribute to hair loss, or physically replacing lost hair
• It's essential to start treatment early for better outcomes and to understand that results typically take 3-6 months to become noticeable, with continued use necessary to maintain benefits 1

Recent Studies

Recent studies have shown that platelet-rich plasma (PRP) injections can be an effective treatment for androgenetic alopecia, with a significant increase in hair density and thickness 1. However, the optimal number of PRP treatments, interval between treatment, and amount of PRP injected per treatment still need to be assessed 1. Additionally, platelet-rich fibrin (PRF) has been proposed as a promising treatment for androgenetic alopecia, with some studies showing its effectiveness in promoting hair growth 1.

From the FDA Drug Label

Minoxidil topical solution 5% is a clear, light amber liquid medication containing 5% minoxidil for use only on the scalp to help regrow hair in men. Minoxidil topical solution 5% is for use only by men Minoxidil topical solution 5% may be appropriate for you if you are a male at least 18 years old and experiencing gradually thinning hair or gradual hair loss on the top of the scalp (vertex only, as shown). The best treatment for alopecia, according to the provided drug labels, is minoxidil topical solution 5% for men with gradually thinning hair or hair loss on the top of the scalp.

• It is not intended for frontal baldness or receding hairline.
• It is not for use by women.
• Results may be seen as early as 2 months with twice daily use 2, 2.

From the Research

Treatment Options for Alopecia

• The treatment of alopecia depends on the type and cause of the condition, with various options available, including medications, therapies, and surgical procedures 3, 4, 5, 6, 7.
• For androgenetic alopecia, finasteride and minoxidil are approved by the Food and Drug Administration and offer stability and improvement in scalp coverage 3.
• Platelet-rich plasma (PRP) has shown positive results as an off-label therapy for alopecia, with options for intradermal injection or topical application with transepidermal delivery via fractional carbon dioxide laser or microneedling 3, 6.
• Hair transplantation is an effective option for eligible individuals, using healthy follicular units to restore hair-bearing areas 3.
• For alopecia areata, treatment options include pentoxifylline, topical corticosteroids, minoxidil, and systemic corticosteroids, among others, with varying degrees of success 4, 5.

Comparison of Treatment Effectiveness

• A systematic review and network meta-analysis found that pentoxifylline plus topical corticosteroids had the highest treatment success rate for alopecia areata, followed by other treatments such as pentoxifylline alone and minoxidil plus topical corticosteroids 4.
• A retrospective cross-sectional study found that topical and injected corticosteroids were the most commonly prescribed treatments for alopecia areata, followed by minoxidil and topical tacrolimus 5.
• A study comparing intradermal injection of PRP versus topical application with enhanced transepidermal delivery found that all groups showed satisfactory results, with statistically insignificant differences in the degree of improvement among patients 6.

Considerations for Treatment

• The choice of treatment for alopecia depends on various factors, including the type and severity of the condition, patient characteristics, and physician preference 3, 4, 5, 6, 7.
• Treatment outcomes can have a significant impact on the quality of life of affected patients, highlighting the importance of recognizing and distinguishing between different types of alopecia to provide adequate and timely treatment 7.