Can Penlac (ciclopirox) be used to treat alopecia?

Penlac (Ciclopirox) Is Not Recommended for Treating Alopecia

Penlac (ciclopirox) is not recommended for the treatment of any form of alopecia as there is no evidence supporting its efficacy for this condition. 1

Evidence-Based Treatment Options for Alopecia

For Androgenetic Alopecia:

• First-line treatments include FDA-approved options:
  • Topical minoxidil (1-5%) for both men and women 2
  • Oral finasteride 1mg daily for men 2, 3
• Second-line treatments with evidence of efficacy:
  • Oral dutasteride 0.5mg daily (better response than finasteride, especially in frontal area) 3
  • Oral minoxidil at 2.5-5mg daily (not FDA-approved but shown effective in clinical studies) 3
  • Topical finasteride 0.25% daily (less systemic effects than oral) 3

For Alopecia Areata:

• For limited patchy hair loss:
  • Intralesional corticosteroids are the first-line treatment (Strength of recommendation B, Quality of evidence III) 1, 4
  • Hydrocortisone acetate (25 mg/mL) or triamcinolone acetonide (5-10 mg/mL) injected just beneath the dermis 1
• For extensive patchy hair loss:
  • Contact immunotherapy (Strength of recommendation B, Quality of evidence II-ii) 1
  • DPCP (diphenylcyclopropenone) is typically used with a protocol starting at 0.001% concentration 1
• For severe/refractory cases:
  • JAK inhibitors: baricitinib (JAK 1/2) for adults and ritlecitinib (JAK 3/TEC) for ages 12+ are now EMA-approved 5
  • Methotrexate (15-25mg weekly) for refractory cases 4
  • Systemic corticosteroids (limited evidence of efficacy, significant side effects) 1

Adjunctive Therapies

• Platelet-rich plasma (PRF) has shown promise for androgenetic alopecia, particularly in mild cases 1
  • Protocol typically involves 3-5 sessions at 1-month intervals 1
• Low-level laser therapy (630-660nm wavelength) can be used daily for 15-30 minutes 3
• For cosmetic coverage in extensive alopecia:
  • Wigs or hairpieces (acrylic or human hair) 1

Important Clinical Considerations

• Ciclopirox (Penlac) is an antifungal medication with no established role in treating any form of alopecia 1
• Spontaneous remission occurs in alopecia areata, so not treating is sometimes the best option 1
• Treatment response rates decrease with more extensive hair loss, particularly in alopecia totalis/universalis 1
• Children with alopecia areata may require modified approaches as they often poorly tolerate intralesional corticosteroids 1
• Combination therapies may be more effective than monotherapy, especially in resistant cases 1, 6

Treatment Algorithm

1. Identify the type of alopecia (androgenetic vs. areata vs. other)
2. Assess extent and duration of hair loss
3. For androgenetic alopecia: Start with minoxidil and/or finasteride (men) or minoxidil alone (women) 2, 3
4. For limited alopecia areata: Begin with intralesional corticosteroids 1, 4
5. For extensive alopecia areata: Consider contact immunotherapy or systemic options 1
6. Monitor response after 3-6 months and adjust treatment accordingly 1, 3