What are the treatment options for hair loss?

Hair Loss Treatment

For androgenetic alopecia (pattern hair loss), topical minoxidil is the first-line treatment for both men and women, with oral finasteride as an additional option for men only. 1, 2, 3

Treatment by Hair Loss Type

Androgenetic Alopecia (Pattern Hair Loss)

First-line pharmacologic therapy:

• Topical minoxidil 5% for men applied twice daily directly to the scalp, with results expected at 2-4 months and continued use required to maintain regrowth 1, 4
• Topical minoxidil 2% for women (the 5% formulation works no better in women and may cause unwanted facial hair growth) 1
• Oral finasteride for men only (a type II 5α-reductase inhibitor) can regrow noticeable hair in approximately 40% of men 5, 6

Emerging treatments:

• Autologous platelet concentrates (PRP) have shown promise for inducing dermal papilla proliferation and accelerating telogen-to-anagen transition, though they require repeated treatments every 6 months 4
• Low-level 655-nm laser devices used 3 times per week may promote hair regrowth 4

Critical caveat: Minoxidil requires continuous use—hair loss resumes if treatment stops 1. Results take 2-4 months minimum, and initial increased shedding for up to 2 weeks is expected and normal 1.

Alopecia Areata (Patchy Hair Loss)

Treatment algorithm based on extent:

Limited patchy hair loss (<50% scalp involvement):

• Intralesional corticosteroid injections (triamcinolone acetonide 5-10 mg/mL or triamcinolone hexacetonide) are first-line, with 62% achieving full regrowth with monthly injections 4, 2, 7
• Inject 0.05-0.1 mL just beneath the dermis in the upper subcutis, producing hair regrowth tufts approximately 0.5 cm in diameter 4
• Effects last approximately 9 months 4, 7
• Best for: Fewer than 5 patches <3 cm diameter, cosmetically sensitive sites like eyebrows 4

Extensive patchy hair loss (>50% scalp involvement):

• Contact immunotherapy is the best-documented treatment but stimulates cosmetically worthwhile regrowth in <50% of patients 4, 8
• Requires multiple hospital visits over several months with limited availability 4, 2
• May cause temporary local inflammation and pigmentary complications in patients with darker skin 2, 7

Alopecia totalis/universalis:

• Contact immunotherapy is the only treatment likely to be effective, though response rates are even lower than extensive patchy disease 4, 8
• Wigs or hairpieces are often the most effective solution for complete hair loss 4, 2, 7

Alternative options with limited evidence:

• Potent topical corticosteroids (clobetasol propionate 0.05% foam or ointment) may help some patients but evidence is limited 4, 2, 7
• In one study, 7 of 34 sites treated with clobetasol foam had ≥50% regrowth versus 1 of 34 placebo sites 4

Important consideration: No treatment alters the long-term course of alopecia areata 4, 8. Spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of <1 year duration, making observation without treatment a legitimate option 4, 7.

Telogen Effluvium (Diffuse Shedding)

• Identify and remove the precipitating cause (physiologic stress, medications, nutritional deficiencies) 3, 9
• In women, correct iron deficiency and ensure adequate L-lysine intake, as depleted iron stores compromised by suboptimal L-lysine are major causes 5
• This condition is typically self-limited once the trigger is removed 3, 9
• Hair regrowth takes many months after correcting nutritional imbalances 5

Tinea Capitis (Fungal Scalp Infection)

• Oral antifungal therapy is required (topical treatment is insufficient) 3, 9
• Look for erythematous, scaly patches of hair loss 9
• Obtain fungal culture when suspected 2

Traction Alopecia

• Decrease tension on hair by avoiding tight hairstyles (cornrows, tight ponytails) 3, 9
• Discontinue hair care practices causing pulling or scarring 1

Special Populations

Children

• Intralesional corticosteroids are often poorly tolerated in children 4, 8, 7
• Many clinicians avoid aggressive treatments like contact immunotherapy in pediatric patients 4, 8
• Consider mild potent topical corticosteroids or minoxidil for extensive cases 7
• Regular monitoring every 3-6 months is necessary 7

Women of Childbearing Age

• Minoxidil 5% should NOT be used as it may be harmful during pregnancy or breastfeeding 1
• Finasteride is contraindicated in women 1
• Use minoxidil 2% formulation only 1

Critical Pitfalls to Avoid

• Do not use systemic corticosteroids or PUVA therapy for alopecia areata due to serious side effects and inadequate efficacy evidence 4, 2, 7
• Do not expect frontal hairline restoration with minoxidil—it works primarily on vertex (crown) hair loss 1
• Warn patients about relapse following initially successful treatment of alopecia areata 4, 2, 8
• Do not routinely order extensive laboratory testing unless clinical suspicion warrants it (iron studies, autoimmune panels not routinely recommended for alopecia areata) 2
• Avoid treatments with unproven efficacy (oral zinc, isoprinosine) given the high spontaneous remission rate 8, 7

Psychological Support and Counseling

• Address the significant psychological impact of hair loss, particularly in young women and adolescents, including anxiety, depression, and reduced quality of life 2, 7, 3
• Discuss cosmetic options (wigs, hairpieces) early, especially for extensive hair loss 4, 2, 7
• Provide realistic expectations about treatment timelines, potential for relapse, and likelihood of response 4, 2
• Consider referral for psychological support when patients experience significant distress 2, 7

Follow-Up Protocol

• Schedule follow-up at 3 months to assess treatment response for most conditions 2, 7
• For minoxidil, expect results at 2-4 months with some men requiring up to 4 months before seeing results 1
• Provide written self-monitoring instructions and criteria for seeking further medical attention 2, 7
• Consider longer follow-up intervals for extensive, persistent, or atypical disease 2, 7