What are the treatment options for hair loss?

Treatment Options for Hair Loss

For hair loss treatment, intralesional corticosteroids are recommended for limited patchy alopecia areata, while contact immunotherapy is the best option for extensive patchy hair loss. 1

Types of Hair Loss and First-Line Treatments

Androgenetic Alopecia (Pattern Hair Loss)

• First-line treatment: Topical minoxidil 5% solution 2, 3
  • Apply directly to scalp twice daily
  • Results may be seen as early as 2 months but may take at least 4 months 2
  • Continued use necessary to maintain results; hair loss will resume if treatment stops 2
• For men only: Oral finasteride 3

Alopecia Areata

• Limited patchy hair loss: Intralesional corticosteroid injections (Strength of recommendation B) 1
  • Triamcinolone acetonide (5-10 mg/mL) for older children/adults 4
• Extensive patchy hair loss: Contact immunotherapy (Strength of recommendation B) 1
  • Best-documented treatment for severe cases
  • Multiple hospital visits over several months
  • Effective in <50% of patients with extensive hair loss
  • May cause temporary local inflammation
• Topical options: Potent topical corticosteroids (e.g., clobetasol propionate 0.05%) 4
  • Applied in thin layer twice daily
  • Plastic film occlusion may increase efficacy

Telogen Effluvium

• Usually self-limited
• Focus on identifying and removing the underlying cause (stress, medications, etc.) 3

Special Considerations

Children with Alopecia Areata

• Potent topical corticosteroids are first-line treatment 4
• Intralesional corticosteroids may be poorly tolerated 1
• Monitor for side effects like folliculitis and skin atrophy 4
• Assess response after 6-12 weeks of treatment 4

Severe or Resistant Cases

• For alopecia totalis/universalis: Contact immunotherapy is the only treatment likely to be effective, though response rates are low 1
• Wigs or hairpieces are practical solutions, especially for women with extensive hair loss 1
  • Acrylic wigs are cheaper and easier to maintain
  • Real hair wigs may provide better fit for wider range of activities

Treatment Efficacy and Expectations

• Up to 80% of patients with limited patchy alopecia areata of short duration (<1 year) experience spontaneous remission 4
• Poor prognostic factors include:
  • Childhood onset
  • Extensive hair loss at presentation
  • Long duration of hair loss
  • Associated nail changes 4
• Initial hair regrowth is often soft, downy, and colorless before developing normal characteristics 2
• Temporary increased hair loss may occur in the first 2 weeks of minoxidil treatment 2

Important Caveats

• No treatment has been shown to alter the long-term course of alopecia areata 4
• Relapse is common during or after initially successful treatment 4
• Avoid treatments with significant side effects for conditions that don't affect general health 4
• PUVA treatment has shown variable success rates (up to 60-65%) but carries risk of high cumulative UVA exposure 1
• Systemic corticosteroids are not recommended due to potentially serious side effects and inadequate evidence of efficacy 1
• Hair loss can significantly impact psychological well-being and quality of life 3

Emerging Treatments

• Light-based therapies show promise:
  • Low-level light therapy for androgenetic alopecia
  • Fractional laser for androgenetic alopecia
  • Excimer laser for alopecia areata 5

When selecting treatment, consider the type and extent of hair loss, patient age, and potential side effects. For many patients with limited patchy alopecia areata, not treating may be the best option given the tendency for spontaneous remission and lack of adverse effects on general health.