What are the treatment options for a young person experiencing hair loss?

Treatment Options for Young Person Hair Loss

For young people experiencing hair loss, the most effective treatment depends on the specific type of hair loss, with intralesional corticosteroids being the first-line treatment for limited patchy alopecia areata and topical minoxidil 5% being the first-line treatment for androgenetic alopecia. 1, 2

Diagnosis First: Identifying the Type of Hair Loss

Before treatment can begin, it's crucial to identify the specific type of hair loss:

Alopecia Areata

• Presentation: Patchy hair loss with smooth, round bald spots; may see "exclamation mark" hairs at the periphery
• Distinguishing features: No scalp inflammation, normal-appearing scalp skin
• Key diagnostic clues: Short broken hairs around margins of expanding patches 1

Androgenetic Alopecia

• Presentation: Gradual thinning at the crown/vertex in males; diffuse thinning with preservation of frontal hairline in females
• Distinguishing features: Family history often present, progressive miniaturization of hair follicles 2, 3

Other Common Causes in Young People

• Tinea capitis: Scalp is inflamed with scaling; requires fungal culture
• Traction alopecia: History of tight hairstyles; hair loss along the hairline
• Trichotillomania: Incomplete hair loss with broken hairs of varying lengths 1

Treatment Algorithm Based on Type of Hair Loss

1. Alopecia Areata Treatment

For Limited Patchy Hair Loss (fewer than 5 patches, <3cm diameter)

1. First-line: Intralesional corticosteroid injections

   • Triamcinolone acetonide (5-10 mg/mL) injected into affected areas
   • 62% of patients achieve full regrowth with monthly injections 1
   • Inject 0.05-0.1 mL just beneath the dermis to produce hair growth in a 0.5 cm diameter area

2. Alternative options:

   • Potent topical corticosteroids (though evidence for effectiveness is limited) 1
   • No treatment is a legitimate option as spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of short duration (<1 year) 1

For Extensive Patchy Hair Loss

1. First-line: Contact immunotherapy
   • Most effective documented treatment for severe alopecia areata
   • Stimulates cosmetically worthwhile hair regrowth in <50% of patients 1
   • Requires multiple hospital visits over several months

For Alopecia Totalis/Universalis

1. First-line: Contact immunotherapy (though response rates are lower than for patchy hair loss) 1
2. Alternative: Wigs or hairpieces (particularly important for psychological support) 1

2. Androgenetic Alopecia Treatment

1. First-line: Topical minoxidil

   • 5% solution twice daily for men
   • 2% solution for women 2, 4
   • Results may take 2-4 months to appear; maximum results at 6-12 months 4

2. For men only: Oral finasteride 1mg daily

   • Not for use by women or individuals under 18 years 2, 4

3. Combination therapies for better results:

   • Minoxidil + topical finasteride (81 hairs/cm² increase after 6 months) 2
   • Minoxidil + PRP therapy (particularly for poor responders) 2

Important Considerations and Pitfalls

Psychological Impact

• Hair loss can cause significant psychological distress, especially in young people
• Consider psychological support or referral if signs of significant distress are present 1

Treatment Expectations

• Critical pitfall: Setting unrealistic expectations
• Inform patients that:
  1. Complete hair restoration is unlikely
  2. Maintenance of existing hair and modest regrowth is considered successful
  3. Results take time (2-4 months minimum) 2, 4
  4. Treatment is typically ongoing; stopping treatment may result in loss of gained hair

Monitoring Response

• Take baseline photos before starting treatment
• Evaluate at 3 months for initial response
• Critical evaluation at 6 months
• Comprehensive assessment at 12 months to determine continuation 2

Safety Considerations

• Minoxidil is contraindicated in pregnancy and breastfeeding
• Finasteride is absolutely contraindicated in women of childbearing potential due to teratogenicity 2
• Intralesional corticosteroids may cause skin atrophy at injection sites 1

When to Refer to a Specialist

• Scarring alopecia (requires dermatologist evaluation)
• Hair loss resistant to first-line treatments after 4-6 months
• Diffuse hair loss with systemic symptoms (may indicate underlying medical condition)
• Severe psychological impact requiring additional support 5, 6

By following this structured approach to diagnosis and treatment, most young people with hair loss can achieve improvement in their condition, leading to better quality of life and psychological well-being.