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

Treatment Options for Hair Fall (Alopecia)

For hair fall treatment, intralesional corticosteroid injections are the first-line option for limited patchy hair loss, while contact immunotherapy is recommended for extensive patchy hair loss. 1

Diagnosis and Classification

Hair loss (alopecia) can be categorized into several types, each requiring specific treatment approaches:

1. Limited Patchy Hair Loss (Alopecia Areata)

   • Characterized by well-defined patches of hair loss
   • High rate of spontaneous remission (80% within 1 year for limited patches) 1
   • Diagnosis confirmed through pull test and trichoscopy

2. Extensive Patchy Hair Loss

   • Multiple or large patches of hair loss
   • Lower rate of spontaneous remission
   • May progress to alopecia totalis or universalis

3. Androgenetic Alopecia

   • Pattern hair loss (vertex of scalp in men, central thinning in women)
   • Genetic predisposition with androgen influence
   • Affects up to 50% of white males by age 50 2

4. Telogen Effluvium

   • Diffuse shedding following stress, illness, or medication changes
   • Usually self-limited once underlying cause is addressed 3

Treatment Algorithm

For Limited Patchy Hair Loss (Alopecia Areata):

1. First-line: Intralesional Corticosteroid Injections

   • Triamcinolone acetonide (5-10 mg/mL)
   • Success rate of approximately 62% 1
   • Administered every 4-6 weeks

2. Alternative: Topical Corticosteroids

   • If intralesional injections are not tolerated
   • Limited evidence for efficacy 1
   • Apply as directed by physician

3. Consider "No Treatment" Option

   • Especially for recent onset (<1 year)
   • High spontaneous remission rate (80%) 4, 1

For Extensive Patchy Hair Loss:

1. First-line: Contact Immunotherapy

   • Diphenylcyclopropenone (DPCP)
   • Response rate of 50-60% 1
   • Requires multiple hospital visits over several months
   • Side effects: occipital/cervical lymphadenopathy, dermatitis, pigmentary changes 1

2. Second-line Options:

   • Methotrexate (15-25 mg/week) with or without prednisolone 1
   • Sulfasalazine (though high relapse rate) 1
   • Cyclosporine (limited evidence, side effects limit long-term use) 1

For Androgenetic Alopecia:

1. Topical Minoxidil

   • 5% solution for men, applied twice daily 5
   • Results may be seen as early as 2 months, but may take 4+ months 5
   • Continuous use necessary to maintain results 5
   • Apply 1 mL directly to scalp in affected area twice daily 5

2. Oral Finasteride (for men only)

   • Not mentioned in the provided guidelines but noted in research evidence 3

For Telogen Effluvium:

• Focus on identifying and addressing the underlying cause (stress, nutritional deficiencies, etc.) 3
• Self-limited condition once trigger is removed

Important Considerations and Cautions

1. Temporary Increased Shedding

   • When starting minoxidil, shedding may increase temporarily (up to 2 weeks)
   • This is expected and indicates the medication is working 5
   • If shedding continues beyond 2 weeks, consult a physician

2. Realistic Expectations

   • Complete hair regrowth is unlikely for most treatments 5
   • Results vary significantly between individuals
   • Continuous treatment is necessary to maintain results

3. Special Populations

   • Children: Intralesional corticosteroids often poorly tolerated; clinicians may be reluctant to use aggressive treatments 4
   • Women: Should not use 5% minoxidil (2% formulation recommended instead) 5

4. Non-Pharmacological Approaches

   • Wigs or hairpieces for extensive hair loss
   • Acrylic wigs: cheaper, easier maintenance
   • Human hair wigs: better fit, more natural appearance 4
   • Psychological support may be beneficial due to emotional impact of hair loss 1

Treatment Duration and Follow-up

• For minoxidil: Continuous use necessary; hair loss will recur 3-4 months after stopping 5
• For alopecia areata treatments: Follow-up visits to assess response
• Documentation with photography to track progress 1
• If no improvement after 4 months of minoxidil use, discontinue treatment 5

Remember that hair loss can significantly impact quality of life and psychological well-being. Addressing both the physical and emotional aspects of hair loss is essential for comprehensive management.