What are the management options for androgenetic alopecia (male/female pattern baldness) and other causes of hair fall?

Management Options for Androgenetic Alopecia and Other Causes of Hair Fall

For androgenetic alopecia, the most effective FDA-approved treatments are topical minoxidil, oral finasteride, and low-level laser therapy, which should be initiated early for best results. 1, 2

Diagnosis and Classification

• Determine the pattern of hair loss (diffuse, patchy, or patterned) to guide diagnosis and treatment 3
• Androgenetic alopecia presents with characteristic patterns:
  • In men: preferentially affecting temples, vertex, and mid-frontal scalp 4
  • In women: central region thinning with preserved frontal hairline 4
• Use Hamilton-Norwood classification for males and Ludwig system for females to describe patterns 4
• Consider dermoscopy to identify diagnostic features of different types of alopecia 3

Treatment Options for Androgenetic Alopecia

FDA-Approved Treatments

• Topical Minoxidil:

  • 5% solution for men, applied twice daily 5, 2
  • Results may be seen as early as 2 months, but may take at least 4 months for some men 5
  • Initial hair loss may temporarily increase for up to 2 weeks as part of the treatment process 5
  • Hair regrowth has not been shown to last longer than 48 weeks in large clinical trials with continuous treatment 5

• Oral Finasteride:

  • 1 mg daily dose for men 2, 6
  • Works by inhibiting 5-alpha reductase, reducing DHT levels 7
  • Not approved for women due to potential teratogenic effects 6

• Low-Level Laser Therapy:

  • FDA-cleared devices with wavelengths between 630-660 nm 2, 6
  • Can be used at home daily for 15-30 minutes 6
  • Effective but limited evidence comparing efficacy to other treatments 6

Emerging Treatments

• Oral Minoxidil:

  • Not FDA-approved for androgenetic alopecia but showing promising results 6
  • Initial dose of 2.5 mg daily, sometimes increased to 5 mg 6
  • Main side effect is hypertrichosis, with less common effects including dizziness or lower limb edema 6

• Platelet-Rich Plasma (PRP):

  • Non-pharmacological option with some clinical trials showing improvement in hair count 6
  • Common regimen: treatment every 4 weeks for 3 months initially 6
  • Promising evidence for lip rejuvenation but limited long-term data for hair loss 4

Treatment for Alopecia Areata

• Limited Patchy Hair Loss:

  • Intralesional corticosteroid injections (triamcinolone acetonide 5-10 mg/mL) 4, 3
  • Injections stimulate hair regrowth at the site, with effects lasting about 9 months 4

• Extensive Patchy Hair Loss:

  • Contact immunotherapy (though availability is limited) 4, 3
  • Potent topical corticosteroids, though evidence for effectiveness is limited 4, 3

• No Treatment Option:

  • Observation without active treatment is appropriate for many cases, especially with limited patchy hair loss 4
  • Spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of short duration 4

Special Considerations

For Children

• Avoid aggressive treatments in young children, including contact immunotherapy and systemic corticosteroids 8
• Mild potent topical corticosteroids or minoxidil solution may be considered for extensive cases 8
• Regular monitoring every 3-6 months to assess disease progression and psychological impact 8

Treatment Pitfalls to Avoid

• Hazardous treatments with unproven efficacy should be avoided 3
• Continuous or pulsed systemic corticosteroids and PUVA therapy should be used with caution due to potential serious side effects 3
• Treatment response may be poor in longstanding extensive alopecia 3
• Intralesional corticosteroids may be poorly tolerated in children 3

Psychological Support

• Address the psychological impact of hair loss, which can be significant 3
• Consider referral for psychological support for patients experiencing significant distress 3
• Discuss cosmetic options such as wigs or hairpieces, particularly for extensive hair loss 3

Follow-up Recommendations

• Schedule follow-up at 3 months to assess treatment response 3
• Provide written instructions for self-monitoring 3
• Consider longer follow-up for patients with extensive, persistent, or atypical disease 3