What are the treatment options for hair loss?

Treatment Options for Hair Loss

The most effective treatment for hair loss depends on the specific type of alopecia, with minoxidil being the first-line treatment for androgenetic alopecia, intralesional corticosteroids for alopecia areata, and addressing underlying causes for telogen effluvium. 1

Types of Hair Loss and Diagnosis

• Hair loss (alopecia) can be categorized as nonscarring (diffuse, patterned, or focal) or scarring, with proper diagnosis guiding treatment selection 1
• Diagnostic evaluation should exclude conditions like trichotillomania, tinea capitis, scarring alopecia, telogen effluvium, anagen effluvium, lupus erythematosus, and secondary syphilis 2, 3
• Dermoscopy can aid diagnosis of alopecia areata by revealing regular round yellow dots in areas of hair loss and dystrophic hairs with broken ends 3
• Laboratory testing may include thyroid function, iron stores, vitamin D and zinc levels for suspected endocrine-related alopecia 3

Treatment Options by Type of Alopecia

Androgenetic Alopecia (Most Common Form)

• Topical minoxidil is FDA-approved as first-line treatment for both men and women 1, 4
• Oral finasteride is approved for male pattern hair loss only 1, 4
• Hormonal therapies like 5-alpha-reductase inhibitors (finasteride, dutasteride), spironolactone, and bicalutamide may be considered for hormone-related hair loss 5

Alopecia Areata

• Spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of short duration (<1 year), making no treatment a legitimate option 2
• Intralesional corticosteroids are recommended for limited patchy alopecia areata 2
  • Triamcinolone acetonide (5-10 mg/mL) or hydrocortisone acetate (25 mg/mL) injected just beneath the dermis can stimulate regrowth 2
  • Studies show 62% of patients achieved full regrowth with monthly injections, with better response in those with fewer than five patches of <3 cm diameter 2
• Topical corticosteroids have limited evidence of effectiveness but are widely used 2
  • Clobetasol propionate foam (0.05%) showed better regrowth compared to vehicle in one study 2
  • Folliculitis is a common side effect of potent topical steroids 2

Telogen Effluvium

• Typically self-limited once the precipitating cause (stress, physical trauma, medications) is removed 6, 4
• Treatment focuses on addressing the underlying trigger rather than specific hair treatments 7

Other Types

• Tinea capitis requires oral antifungal treatment 1, 6
• Traction alopecia improves by reducing tension on hair 1
• Trichotillomania requires treatment of the underlying psychiatric condition 6

Psychological Aspects and Support

• Hair loss can have significant psychological effects, impacting quality of life and potentially leading to anxiety and depression 1, 5
• Patient education about the nature and course of the disease, along with available treatments, is essential 2, 3
• Contact with patient support groups can help individuals cope with the changing aspects of alopecia 3

Important Considerations

• An overriding consideration in management is that while alopecia may have serious psychological effects, it generally has no direct impact on general health that would justify hazardous treatments of unproven efficacy 2
• Many treatments can induce hair growth but none has been shown to alter the long-term course of diseases like alopecia areata 2
• For long-standing extensive alopecia with poor prognosis, wigs may be a better option than treatments unlikely to be effective 2
• Treatment expectations should be realistic, as regrowth cannot be expected within 3 months of development of any individual patch in alopecia areata 2