What are the treatment options for alopecia (hair loss)?

From the Guidelines

For the treatment of alopecia, I recommend a multi-faceted approach, prioritizing the patient's quality of life and psychological well-being, as the disease can cause considerable psychological and social disability 1.

Treatment Options

• Intralesional corticosteroids are a suitable option for limited patchy hair loss, with a strength of recommendation B and quality of evidence III 1.
• Contact immunotherapy is the best-documented treatment for severe alopecia areata, including alopecia totalis and universalis, although it is not widely available and has a response rate of less than 50% 1.
• Wigs or hairpieces can be an effective solution for patients with extensive alopecia areata, particularly for female patients, and can be considered as part of the treatment approach 1.

Additional Considerations

• A balanced diet rich in protein, iron, zinc, and vitamins A, C, D, and E can help support hair growth.
• Gentle, sulfate-free shampoos and avoiding heat styling or tight hairstyles can help minimize hair damage.
• Counselling and psychological support are essential for patients with alopecia areata, as the disease can have a significant impact on mental health and quality of life 1.

Prioritizing Patient Needs

• The treatment approach should prioritize the patient's individual needs and circumstances, taking into account the extent of hair loss, psychological impact, and lifestyle factors.
• A comprehensive treatment plan should be developed in consultation with the patient, considering all available options and potential benefits and risks.

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 amount of hair regrowth is different for each person. Not everyone will respond to minoxidil topical solution 5%. Results may be seen as early as 2 months with twice daily use. For some men, it may take at least 4 months for results to be seen

Treatment Options for Alopecia (Hair Loss):

• Minoxidil topical solution 5% is a treatment option for alopecia (hair loss) in men.
• It is used to help regrow hair on the scalp, specifically for men with gradually thinning hair or hair loss on the top of the scalp (vertex only).
• The treatment should be used twice a day, and results may be seen as early as 2 months, but it may take at least 4 months for some men to see results 2, 2.
• It is essential to note that minoxidil topical solution 5% may not work for everyone, and the amount of hair regrowth can vary from person to person 2.

From the Research

Treatment Options for Alopecia

The following are treatment options for alopecia (hair loss):

• Minoxidil: a Food and Drug Administration (FDA)-approved treatment for androgenetic alopecia, available in topical form (2-5%) 3, 4, 5
• Finasteride: an FDA-approved oral medication for the treatment of androgenetic alopecia in men, with a dose of 1 mg daily 3, 6, 4
• Low-level laser light therapy: an FDA-cleared treatment for androgenetic alopecia, which can be used as monotherapy or concomitant therapy with minoxidil or finasteride 3, 6, 7
• Dutasteride: an oral medication that has been shown to be effective in improving androgenetic alopecia in men, although it is not FDA-approved for this indication 6
• Topical finasteride: a useful option to avoid systemic therapy, with a dose of 0.25% daily 6
• Mesotherapy with dutasteride: a treatment option with limited evidence of effectiveness 6
• Oral minoxidil: a treatment option that has not been approved by the FDA, but has been shown to be effective in clinical studies, with a recommended initial dose of 2.5 mg daily 6
• Platelet-rich plasma: a non-pharmacological option that has been shown to improve hair count in some clinical trials 6, 4
• Light devices with wavelengths of between 630 and 660 nm: a treatment option with limited evidence of effectiveness 6
• Botulinum toxin: a treatment option that may improve androgenetic alopecia, although evidence is limited 6
• Scalp threading: a treatment option that may increase the total hair count, although evidence is limited 6

Novel Treatments

Novel treatments for androgenetic alopecia include:

• Pyrilutamide and GT20029: topical antagonists of the androgen receptor that are being studied as potential treatments 6
• Cetirizine: a topical option with some initial promising results 6
• Regenerative medicines: such as autologous platelet-rich plasma, adipose-derived stem cells, micrograft generation, and exosome 4