What are the treatments for alopecia (hair loss)?

From the Guidelines

Hair loss treatments should prioritize a combination of FDA-approved medications, such as Minoxidil and Finasteride, alongside supportive therapies like low-level laser therapy and platelet-rich plasma injections, to improve outcomes in terms of morbidity, mortality, and quality of life. When considering treatment options, it's essential to evaluate the evidence from recent studies, such as 1 and 1, which highlight the potential benefits and limitations of various therapies. Key points to consider include:

• Minoxidil (Rogaine) is available over-the-counter as a 5% solution or foam for men and 2% or 5% for women, applied twice daily to the scalp.
• Finasteride (Propecia) is a prescription pill for men, taken at 1mg daily, which blocks DHT, the hormone responsible for male pattern baldness.
• Low-level laser therapy devices used 3 times weekly can stimulate follicles.
• Platelet-rich plasma injections, performed every 3-4 months, utilize your own blood components to stimulate growth.
• Hair transplantation offers a permanent solution for appropriate candidates. The most recent and highest quality study, 1, suggests that a complex combined therapy protocol, including the use of autologous platelet concentrates, may be beneficial for treating androgenetic alopecia. Additionally, 1 highlights the potential of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in promoting hair growth, with PRF showing promise as a safe and effective treatment for androgenetic alopecia. It's crucial to weigh the benefits and risks of each treatment option, considering factors such as efficacy, safety, and patient preferences, to develop an individualized treatment plan that prioritizes the patient's quality of life and minimizes potential harms. In terms of specific treatment protocols, the use of a manual double-spin method for preparing PRP, performing a minimum of 3-5 sessions, and using a recommended dose of 5-7 mL PRP, with a concentration of 1-1.5 million platelets per uL, may be beneficial, as suggested by 1. Ultimately, the choice of treatment should be guided by the most recent and highest quality evidence, with a focus on minimizing morbidity, mortality, and improving quality of life.

From the FDA Drug Label

When do I use minoxidil topical solution 5%? Apply minoxidil topical solution 5% once in the morning and once at night. Can I use hair sprays, mousses, conditioners, gels, etc. Yes. Hair sprays, spritz, or styling aids may be used on your hair while using minoxidil topical solution 5%. Can I have my hair colored or permed or use hair relaxers while using minoxidil topical solution 5%? Yes. We have no evidence that coloring or perming your hair or that the use of relaxers change the effect of minoxidil topical solution 5% For external use only For use by men only The most common side effects are itching and skin irritation of the treated area of the scalp.

Minoxidil topical solution 5% is a treatment for hair loss in men. It should be applied twice a day, in the morning and at night, directly to the scalp in the hair loss area.

• Key points to consider when using minoxidil topical solution 5% include:
  • Allow the solution to stay on the scalp for at least 4 hours before washing.
  • Use a mild shampoo if washing the scalp before applying the solution.
  • Styling products can be used after applying the solution.
  • Hair coloring, perming, or relaxers can be used, but with precautions to avoid scalp irritation.
• Common side effects include itching and skin irritation of the treated area.
• Important warnings include:
  • For external use only.
  • For use by men only.
  • Flammable: keep away from fire or flame.
  • Do not use if you have certain conditions, such as sudden or patchy hair loss, or if you are under 18 years of age.
  • Stop use and ask a doctor if you experience certain side effects, such as chest pain or scalp irritation. 2

From the Research

Hair Loss Treatments

• Androgenetic alopecia, or male pattern hair loss, is a hair loss disorder mediated by dihydrotestosterone, and treatments such as minoxidil and finasteride are Food and Drug Administration (FDA)-approved 3
• Low-level laser light therapy has been shown to be effective for promoting hair growth in men with androgenetic alopecia, and can be used as monotherapy or concomitant therapy with minoxidil or finasteride 4
• Topical minoxidil 2%-5% and finasteride 1 mg daily are recommended as first-line treatments for androgenetic alopecia, followed by the use of FDA-cleared HairMax LaserComb in patients who do not respond to first-line modalities 5

Treatment Options

• Minoxidil, finasteride, and low-level laser light therapy are effective for promoting hair growth in men with androgenetic alopecia, and minoxidil is effective in women with androgenetic alopecia 3
• Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients 6
• Platelet-rich plasma exhibits positive results as an off-label alopecia therapy, and hair transplantation proves effective for eligible individuals 7

Efficacy of Treatments

• All treatments were superior to placebo in the meta-analyses, with high heterogeneity in most studies 3
• Improvement was seen both with monotherapy and with concomitant therapy, and was sustained up to a maximum observation time of 24 months 4
• While there has been a great increase in the treatments available for androgenetic alopecia, the quality of evidence varies greatly and there is still a great need for randomized double-blinded clinical trials to adequately assess the clinical efficacy of some treatments 6