What are the treatment options for diffuse hair loss?

Treatment Options for Diffuse Hair Loss

The most effective treatment for diffuse hair loss depends on identifying the specific cause, with topical minoxidil being the first-line treatment for most cases of diffuse non-scarring alopecia. 1

Diagnostic Approach

• Diffuse hair loss can be categorized as telogen effluvium, anagen effluvium, or diffuse alopecia areata 2, 1
• Laboratory testing should be considered when diagnosis is uncertain, including:
  • Fungal culture when tinea capitis is suspected 2
  • Skin biopsy for difficult cases or early scarring alopecia 2
  • Serology for lupus erythematosus when systemic lupus is suspected 2
  • Thyroid stimulating hormone (TSH) to rule out thyroid disease 2
  • Vitamin D, zinc, and folate levels to identify nutritional deficiencies 2

Treatment Options by Type

Telogen Effluvium

• Primarily self-limited and depends on identifying and stopping the underlying cause (e.g., stress, nutritional deficiencies) 1, 3
• Spontaneous remission occurs in up to 80% of cases with short duration (<1 year) 4
• Nutritional supplementation may be beneficial if deficiencies are identified:
  • Vitamin D supplementation if deficient 2
  • Zinc supplementation if deficient 2
  • Folate supplementation if deficient 2

Androgenetic Alopecia (Pattern Hair Loss)

• Topical minoxidil 5% solution applied twice daily is first-line treatment 5, 1
• Proper application instructions:
  • Apply 1 mL twice daily directly to scalp in the hair loss area 5
  • Allow to stay on scalp for about 4 hours before washing 5
  • May take 2-4 months to see results 5
• Oral finasteride (1 mg daily) is an option for male patients 1, 6
• For women, androgen receptor antagonists may be considered:
  • Spironolactone 6
  • Cyproterone acetate 6

Diffuse Alopecia Areata

• Corticosteroids are the mainstay of treatment:
  • Intralesional corticosteroids (triamcinolone acetonide 5-10 mg/mL) for patchy involvement 4
  • Topical corticosteroids have limited evidence of efficacy 4
  • Oral prednisolone (starting at 40 mg daily with 6-week tapering course) may show >25% regrowth in 30-47% of patients 4
• No treatment is a legitimate option, as spontaneous remission occurs in many cases 4

Anagen Effluvium

• Typically caused by chemotherapy or radiation therapy 1
• Treatment focuses on supporting hair regrowth after the causative agent is discontinued 1, 3

Special Considerations

• Hair styling products can be used with treatments but should be applied after minoxidil has dried 5
• Hair coloring or perming should be avoided on the same day as minoxidil application 5
• Common side effects of minoxidil include scalp irritation and itching 5
• Unwanted facial hair growth is a rare but reversible side effect of minoxidil 5
• The psychological impact of hair loss should be addressed as part of management 7, 1

Treatment Algorithm

1. Identify the type of diffuse hair loss through clinical examination and appropriate testing 2, 1
2. For telogen effluvium: address underlying cause and consider nutritional supplements if deficiencies are present 2, 3
3. For androgenetic alopecia: start topical minoxidil 5% twice daily 5, 1
4. For diffuse alopecia areata: consider intralesional corticosteroids or oral immunosuppressant therapy 4, 1
5. For all types: provide realistic expectations about treatment outcomes and timeline 5, 1

Common Pitfalls to Avoid

• Failing to identify the specific cause of diffuse hair loss 3
• Using minoxidil more than twice daily will not improve results and may increase side effects 5
• Expecting immediate results; most treatments require 2-4 months minimum 5
• Overlooking the psychological impact of hair loss 1, 6
• Discontinuing treatment prematurely; consistent application is necessary for effectiveness 5