Tag Archive for: Hair Loss

Male Pattern Hair Loss: Part 2

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By Koji Ota, MD, FAAD

In my previous blog post, I reviewed the natural history of male pattern hair loss, also known as androgenetic alopecia (AGA). In this section, I will discuss some of the newer treatments that have developed in recent years.

Platelet-Rich Plasma (PRP)

Platelet-Rich Plasma (PRP) is a medical procedure that involves having your own blood drawn in the doctor’s office. The blood is then centrifuged, or spun down in specialized equipment that separates the PRP portion from other blood components. PRP is then injected back into the scalp. This is usually done in a series of a few treatments about 1 month apart. Many studies have shown that it can be helpful in increasing the density as well as hair thickness. It is important to note that these studies are small in size with variable results, and that PRP continues to be an evolving area of research. Side effects of PRP are usually mild, most often temporary pain at the injection site. Downtime after the procedure is minimal.

Low-Level Laser Therapy

Low-Level Laser Therapy (LLLT) has become increasingly more prevalent in recent years. It involves emitting low-level lasers or light-emitting diodes (LED) to the scalp. Multiple studies found that using LLLT in the red-light range multiple times a week has shown improvement in hair density as early as 3 months. LLLT appears to be more effective when combined with other therapies, such as topical minoxidil. Side effects are minimal and mild, but include temporary hair shedding, itching, and tenderness of the scalp, as well as acne.

Microneedling

Microneedling is another therapy that can be used for hair loss. It involves using small needles to create micro-wounds in the skin and is used for multiple conditions in dermatology. In hair loss, it is often combined with other agents such as topical minoxidil and PRP. The preliminary data from some studies shows promise, however, this remains an area of continued research.

KeraFactor

KeraFactor is a new treatment for hair loss that is offered in our office. It involves applying a proprietary formula consisting of a combination of growth factors and skin proteins that can improve hair growth. With this in-office treatment, we use a specialized device to make very small channels on the surface of the scalp with minimal discomfort, then apply the KeraFactor serum onto the scalp. The application is then followed by lower level laser (LLLT) to enhance effectiveness. KeraFactor has been shown to improve hair density and hair diameter as well as increase the total hair count.

Hair Transplantation

Lastly, hair transplantation is an effective surgical method for hair restoration for certain types of hair loss. During a hair transplant, the hair follicles that are androgen-resistant (most commonly from the back of the scalp) are surgically transferred to the area of hair loss. It can offer long-lasting and natural-looking results. However, not everyone is a good candidate as one must have enough hair that can be transplanted, and the scalp must be healthy enough to grow hair. It is important to discuss whether you are a good candidate with your dermatologist when considering hair transplantation.

The therapies mentioned above as well as in the ones discussed in part one do not cover the entirety of options available for AGA. There are other medications, procedures, and supplements that are available on the market today. The range can be overwhelming! It is always important to have a thorough examination and evaluation and to discuss with your dermatologist the benefits and risks of the plan to determine which is the right one for you.

 

 

 

 

References:

Shapiro J, Ho A, Sukhdeo K, Yin L, Lo Sicco K. Evaluation of platelet-rich plasma as a treatment for androgenetic alopecia: A randomized controlled trial. J Am Acad Dermatol. 2020 Nov;83(5):1298-1303. doi: 10.1016/j.jaad.2020.07.006. Epub 2020 Jul 9. PMID: 32653577.

Stevens J, Khetarpal S. Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol. Int J Womens Dermatol. 2018 Sep 21;5(1):46-51. doi: 10.1016/j.ijwd.2018.08.004. PMID: 30809579; PMCID: PMC6374694.

Gupta AK, Quinlan EM, Venkataraman M, Bamimore MA. Microneedling for Hair Loss. J Cosmet Dermatol. 2022 Jan;21(1):108-117. doi: 10.1111/jocd.14525. Epub 2021 Oct 29. PMID: 34714971.

Zito PM, Raggio BS. Hair Transplantation. 2024 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 31613520.

Gupta AK, Danika CA et al. “Progression of surgical hair restoration techniques.” J Cutan Med Surg. 2015 Jan-Feb;28(1):17-21.

American Academy of Dermatology. A Hair Transplant Can Give You Permanent, Natural-looking Results. https://www.aad.org/public/diseases/hair-loss/treatment/transplant. Accessed 12/5/2024

Male Pattern Hair Loss: Part 1

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By Koji Ota, MD

Male androgenetic alopecia (AGA), also known as male pattern hair loss, is a very common condition affecting more than 50% of adult men over the age of 50. It is one of the more common concerns that patients bring to a dermatologic practice. In this post we will be discussing the cause of AGA and different treatment options. It is important to note, however, that there are many causes of hair loss, and that it is important to have your hair loss evaluated by a qualified provider to make a proper diagnosis and treatment plan.

Male pattern hair loss: how does it happen?

AGA is driven by androgens which are important hormones for the development and regulation of the human body. Testosterone is the most active androgen in males and is converted to dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. DHT leads to changes in hair to become thinner and eventually leads to balding.

Genetics play a large role in androgenetic alopecia, contributing to about 80% of susceptibility. Many genes contribute to an individual’s susceptibility to male androgenetic alopecia which explains the diverse range of how hair loss presents in different people.

Treatments, part 1

The two commonly used treatments that are FDA approved for AGA in men are topical minoxidil and oral finasteride.

Topical minoxidil, also commonly known by its brand name Rogaine, is one of the most studied medications for hair loss. Multiple studies have shown efficacy of topical minoxidil in treating AGA in both men and women. It is thought that minoxidil affects the circulation around hair follicles that stimulates growth. It helps hair stay in its growth phase (anagen phase) longer, leading to thicker and fuller hair.

It’s important to note that once this medication is discontinued, hair loss will return. This is the case with most treatments for hair loss so it’s important to understand this is a long-term commitment Additionally, when first starting minoxidil, there can be a period of increased shedding. It typically happens about 2-4 weeks after starting treatment, and can last about 3-6 weeks. This is temporary and the subsequent hair that grows back will be thicker and fuller.

More recently, low dose oral minoxidil has gained popularity as a treatment option of AGA, as many would find taking one pill a day easier to do compared to using a topical solution twice a day. It has shown similar efficacy to topical minoxidil.

Studies have shown that at the low doses that are used for hair loss the medication is considered effective and safe, however, it may not be suitable for everyone. The most common side effect is increased hair growth on other areas of the body other than the scalp. Additionally, minoxidil was originally used at higher doses as a blood pressure medication; side effects are rare at the low dose, but can include leg swelling, dizziness, and EKG changes. It is important to discuss any significant past medical history including any heart issues when discussing initiation of oral minoxidil.

Oral finasteride is another commonly used medication for male pattern hair loss. It works by decreasing production of DHT, which as mentioned before is a key cause of hair loss. It is important to note a small number of patients may experience sexual side effects, such as decreased libido when taking finasteride. It is important to discuss treatment options with your provider to determine which medications are the right ones for you.

In Part 2, we will be further discussing treatment options for AGA in men, including newer and procedural treatments such as platelet-rich plasma, low-level laser light therapy, and others.

 

 

 

Reference

  1. Courtney, A., Triwongwarant, D., Chim, I., Eisman, S., & Sinclair, R. (2023). Evaluating 5 alpha reductase inhibitors for the treatment of male androgenic alopecia. Expert Opinion on Pharmacotherapy, 24(18), 1919–1922. https://doi.org/10.1080/14656566.2023.2280630
  2. Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jul;77(1):136-141.e5. doi: 10.1016/j.jaad.2017.02.054. Epub 2017 Apr 7. PMID: 28396101.
  3. Patel P, Nessel TA, Kumar D D. Minoxidil. [Updated 2023 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482378/#
  4. Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol. 2021 Mar;84(3):737-746. doi: 10.1016/j.jaad.2020.06.1009. Epub 2020 Jul 2. PMID: 32622136.
  5. Nohria A, Desai D, Sikora M, Mandal S, Shapiro J, Lo Sicco K. Combating “dread shed”: The impact of overlapping topical and oral minoxidil on temporary hair shedding during oral minoxidil initiation. JAAD Int. 2024 Mar 25;15:220-224. doi: 10.1016/j.jdin.2024.03.005. PMID: 38707927; PMCID: PMC11067493.

 

 

A New Purpose for an Old Hair Loss Therapy

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By Kyleen Davis

If you are like many of our patients, you probably read the New York Times. Chances are that you or someone you know came across a recent article about a new and inexpensive treatment that can help grow your hair back. This article, entitled, An Old Medicine Grows New Hair for Pennies a Day, was published in the late summer of last year and quickly began trending. Many of you have brought up this article during your office visits to discuss hair loss.  Others may be curious about the validity of these claims. What are these new therapies? And do they actually work?

About Hair Loss

Unfortunately, hair loss is an extremely common condition, affecting an estimated 50 million men and 30 million women in the United States. The American Academy of Dermatology reports that over half of men will have moderate to severe hair loss by the age of 50. Similarly, more than 50% of women will develop some form of female pattern hair loss by age 79.

Treatments for Hair Loss

The good news is that there are many treatment options available for patients who are struggling with hair loss. Determining the type of hair loss is crucial to tailor the treatment plan to the patient’s specific needs. In dermatology, we can diagnose the type of patient hair loss with a careful history, physical examination, and close-up inspection of the hair follicles, a process known as trichoscopy. Lab work or scalp biopsy may also be ordered to confirm the diagnosis. While multiple types of hair loss, or alopecia, exist, androgenetic alopecia (male and female pattern hair loss) is the most common cause of hair loss in the United States.

Androgenetic alopecia (AGA) has traditionally been treated with topical minoxidil (Rogaine) since the Food and Drug Administration (FDA) approved the 5% solution for men in 1988 and the 2% solution for women in 1991. Prior to its approval, minoxidil’s side effect of hypertrichosis (excessive hair growth) was found incidentally when patients taking this medication at doses of 10-40 mg daily for high blood pressure started to grow more hair. For many years the oral form of minoxidil was avoided as a therapeutic option for hair loss due to potential adverse effects and because topical minoxidil was effective.

New Type of Hair Loss Treatment

That is, until recently when an Australian physician named Dr. Rodney Sinclair conducted a study showing that a fraction of the standard dose of minoxidil could help grow hair with less risk of side effects. Since that time, multiple studies have been conducted on the use of oral minoxidil in the treatment of hair loss. Most studies have demonstrated that low-dose oral minoxidil (LDOM) at doses ranging from 0.25 mg to 2.5 mg per day was generally safe and highly efficacious for the treatment of alopecia, especially for AGA. While a significant portion of patients taking LDOM developed hair growth of the sides of the face and temples, this did not typically result in discontinuation of the medication.

There are several treatments for androgenetic alopecia, including other oral agents, topical therapy, platelet rich plasma (PRP), low level laser therapy, and vitamin supplements. Many of them work well together and each has a specific risk benefit profile that should be considered for an individual patient. The great news is that thinning hair can be improved!

 

 

 

References

American Academy of Dermatology. (2022). What is male pattern hair loss, and can it be treated? Available online at: https://www.aad.org/public/diseases/hair-loss/treatment/male-pattern-hair-loss-treatment.

Beach, R., McDonald, K., & Barrett, B. (2021). Low-dose oral minoxidil for treating alopecia: A 3-year North American retrospective case series. Journal of the American Academy of Dermatology, 84(3), 761-763.

Fabbrocini, G., Cantelli, M., Masara, A., Annunziata, M., Marasca, C., & Cacciapuoti, S. (2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. International Journal of Women’s Dermatology, 4(4), 203-211.

Heymann, W. (2022). Coming full circle (almost): low dose oral minoxidil for alopecia. American Academy of Dermatology, Dermatology World Insights and Inquiries, 4(1). Available online at: https://www.aad.org/dw/dw-insights-and-inquiries/archive/2022/low-dose-oral-minoxidil-alopecia.

Jimenez-Cauhe, J., Saceda-Corralo, D., Rodrigues-Barata, R., Moreno-Arrones, O., Ortega-Quijano, D., Fernandez-Nieto, D., Jaen-Olasalo, P., & Vano-Galven, S. (2020). Safety of low-dose oral minoxidil treatment for hair loss. A systematic review and pooled-analysis of individual patient data. Journal of Dermatology Research and Therapy, 33(6), e14106.

Kolata, G. (2022). An old medicine grows new hair for pennies a day, doctors say. The New York Times. Available online at: https://www.nytimes.com/2022/08/18/health/minoxidil-hair-loss-pills.html.

Pfizer (Pharmacia & Upjohn Company). (2015). Loniten ™ minoxidil tablets, USP, package insert. Available online at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/018154s026lbl.pdf.

Rajab, F. (2022). Low-dose oral minoxidil for hair growth. Dermatology Times, 43(11).

Ramos, P., Sinclair, R., Kasprzak, M., & Miot, H. (2020). Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female pattern hair loss: A randomized clinical trial. Journal of the American Academy of Dermatology, 82(1), 252-253.

Randolph, M. & Tosti, A. (2021). Oral minoxidil treatment for hair loss: A review of efficacy and safety. Journal of the American Academy of Dermatology, 84(3), 737-746.

Rhodes, T., Girman, C., Savin, R., Kaufman, K., Guo, S., Lilly, F., Siervogel, R., & Chumlea, W. (1998). Prevalence of male pattern hair loss in 18-49 year-old men. Dermatologic Surgery, 24(12), 1330-1332.

Sharma, A., Michelle, L., Juhasz, M., Ramos, P., Mesinkovska, N. (2020). Low dose oral minoxidil as treatment for non-scarring alopecia: a systematic review. International Journal of Dermatology, 59(8), 1013-1019.

Sinclair, R. (2018). Female pattern hair loss: A pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. International Journal of Dermatology, 57(suppl 65). Available online at: https://www.researchgate.net/profile/Rodney-Sinclair/publication/321756113_Female_pattern_hair_loss_A_pilot_study_investigating_combination_therapy_with_low-dose_oral_minoxidil_and_spironolactone/links/5a81583fa6fdcc0d4bacaa59/Female-pattern-hair-loss-A-pilot-study-investigating-combination-therapy-with-low-dose-oral-minoxidil-and-spironolactone.pdf?origin=publication_detail.

What is Alopecia Areata and How to Treat It

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By Laura Monaghan, PA, MMS

Do you or a loved one suffer from patches of non-scarring hair loss? This type of hair loss, known as alopecia areata (AA), is considered a chronic autoimmune disorder. It affects about 300,000 people in the US annually. AA severity can range from one singular patch of hair loss to complete baldness. Patients may also suffer from loss of eyebrow, eyelash, facial, and body hair. Beyond physical implications, AA can also have a significant negative impact on mental health. Hair is often linked to self-identity, especially for women. Research supports the fact that AA causes psychologic distress, which can manifest as personal, social, and work-related problems.

Treatment Options for Alopecia Areata

There are multiple approaches to treating alopecia areata. A common and relatively simple treatment is the administration of intralesional steroid injections every 4-6 weeks. Other therapies include topical or oral steroids, topical minoxidil, anthralin, and topical immunotherapy with Diphenylcyclopropenone (DPCP), dinitrochlorobenzene (DNCB) or squaric acid dibutyl ester (SADBE). While some patients see hair regrowth with these treatments, others have been left feeling frustrated by lack of response.

JAK Inhibators for Hair Loss Treatment

In June of this year, the first oral medication gained FDA approval for treatment of alopecia areata, Baricitinib (Olumiant). Baricitinib is a JAK inhibitor, a class of medications traditionally used for treating rheumatoid arthritis and certain blood disorders. Patients with these rheumatologic conditions incidentally noticed hair regrowth, and subsequent clinical trials supported the efficacy of JAK inhibitors for treating AA.

The promise of JAK inhibitors, however, is not without some risk. Because JAK inhibitors target multiple cellular signaling pathways involved in the immune system, they can increase the risk of serious infection, heart attack, stroke, blood clots, cancer, and death. Yet data for these adverse effects is from patients with rheumatoid arthritis; it is unclear if these warnings apply equally to patients with AA. As long-term data is collected, we will gain a better understanding of the impact of JAK inhibitors on the AA population.

Given the demand for more effective AA treatment, two additional JAK inhibitors are expected to gain FDA approval in the near future. These exciting developments bring hope for patients suffering with alopecia areata.

 

Contact us to make an appointment for a hair loss consultation with a dermatologist. We can help diagnose the type of hair loss and find a treatment that’s best for you.

Post-COVID Hair Loss

Post-COVID Hair Loss

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Post-COVID hair loss? It’s very much real.

Post-COVID Hair Loss

Did you have an uninvited holiday guest named COVID this year? If so, you’re not alone. Given the extraordinarily high levels of the Coronavirus in the Washington, DC area, nearly everyone had COVID or knew someone who did. As our vaccination and booster rate is very high, most people emerged with minimal or moderate symptoms.

Post-COVID Condition: Hair Loss

Even with only a mild COVID infection, however, it’s common to experience post-COVID conditions, such as hair loss. The phenomenon called telogen effluvium is not limited to COVID infections but can occur 2-3 months after any severe illness, high fever, surgery, or child birth, to name a few.

Why Does Post-COVID Hair Loss Occur?

It’s not completely understood, but the physical or psychological stress can induce hair follicles to prematurely move into the telogen or resting phase.

Normally 90% of scalp hair is in the growth or anagen phase, which lasts 2-6 years. The hair then regresses and stops growing. Approximately 1% of hair is in this regressing or catagen phase. In acute telogen effluvium, a larger than normal percentage of hairs move to the resting phase and are lost “at the root” with a club visible on the end. More than 100-150 hairs may be lost each day. Up to 50% of the scalp hairs may be affected but complete hair loss does not occur. The hair does grow back, but it may take 6-12 months.

If there is itching, scaling skin or pustules, it is likely that the hair loss is attributable to another cause and it’s important to be evaluated. Telogen effluvium can also sometimes unmask other conditions such as androgenetic or hereditary hair loss and can co-exist with other types of alopecia.

Treatments for Post-COVID Hair Loss

Telogen effluvium doesn’t usually require treatment, although there are some topical and oral regimens that may accelerate regrowth. Don’t be alarmed if you have some shedding 2- 3 months after an episode of COVID, but if the shedding is associated with other changes in your scalp or does not seem to be resolving, schedule a consultation with a dermatologist.

Contact us to schedule and appointment.

PRP Therapy for Hair Loss

PRP Treatment for Hair Loss

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“You’re not imagining it: the pandemic is making your hair fall out,” says the NY Times. And in our practice, we can confirm that observation. After covid-19 infection, many patients experience post-viral hair loss known as telogen effluvium, beginning a few months after infection. Telogen effluvium can occur after the body is stressed by a high fever, surgery or childbirth—and usually reverses itself. It’s not surprising that we see more viral related hair loss. What is unusual is that even hereditary thinning known as androgenetic alopecia seems to be worsening this year.

Many patients have inquired about PRP (Platelet-Rich Plasma) for hair loss. There are no studies examining its use in post-covid hair loss patients; however, it can be very effective for patients with hereditary thinning — and possibly other types of hair loss.

Platelet-Rich Plasma (PRP) Treatments

Platelet-Rich Plasma is a type of regenerative medicine in which the injection stimulates or restores the body’s own repair mechanism. Physicians have used PRP injections to treat acute sports injuries, such as pulled hamstring muscles or knee sprains and after surgery to repair a torn tendon (such as a rotator cuff tendon in the shoulder) or ligaments (such as the anterior cruciate ligament, or ACL).

Chronic wounds have also responded to PRP and multiple studies are currently examining the practice for the treatment of dermal atrophy, wound healing, and other conditions.

More recently, however, PRP has emerged as an effective therapy for hair loss, which can be a challenging dermatologic problem to treat.

PRP Treatment for Hair Loss

PRP Treatment for Hair Loss

Understanding PRP begins with recognizing the function of platelets. Platelets are components of the blood that promote blood clotting as well as cell growth and healing. Normal concentrations of platelets in the bloodstream are between 150,000-450,000 per microliter of blood. However, when blood is spun down by a centrifuge machine, concentrations of platelets increase, leading to even greater benefits in wound healing and tissue regrowth.

While the exact mechanism is unknown, scientists theorize that PRP stimulates certain types of cells in the scalp that play an important role in hair growth. PRP also appears to keep hairs in the growing (anagen) phase of development longer than usual, resulting in a greater number of hairs on the scalp relative to shedding hairs.

How does it work?

First, a small amount of blood is drawn from a vein in your arm. This blood is spun down to separate the red blood cells from the plasma — where the highest concentration of platelets can be found. Using a small needle, the plasma is then injected into areas of the scalp where hair loss has occurred. For best results, a series of three-monthly treatments should be completed, followed by maintenance sessions every six months.

What are the risks?

First, PRP can be mildly painful. Small needles are used to insert PRP into specific areas of the scalp. Local numbing medicine, cold compresses and vibrational devices used to offset the sensation of pain can be helpful and may be utilized during treatment. Bruising may also occur, but typically resolves within one to two weeks. There is also a small risk of infection with the venipuncture used to obtain the sample.

What conditions can be treated with PRP?

Patients experiencing hair loss associated with genetics or age-related changes, known as androgenetic alopecia, are good candidates for PRP. This type of hair loss typically runs in families and presents with a widening part on the crown of the scalp. Additionally, new research suggests that PRP may have a role in other forms of alopecia, such as alopecia areata (autoimmune disease resulting in patchy hair loss) and scarring forms of alopecia (lichen planopilaris and frontal fibrosing alopecia).

Interested in PRP for hair loss? Contact us to schedule a consultation with a dermatologist to discuss treatment options for you.

 

 

 

 

 

 

 

 

 

Sources:

https://www.nytimes.com/2021/02/18/style/hair-loss-coronavirus-pandemic.html

https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/resources-related-regenerative-medicine-therapies

https://journals.lww.com/dermatologicsurgery/Fulltext/2017/05000/Regenerative_Medicine_and_Stem_Cells_in.2.aspx

Butt G, Efficacy of platelet-rich plasma in androgenetic alopecia patients. J Cosmet Dermatol. 2019 Aug;18(4):996-1001. doi: 10.1111/jocd.12810. Epub 2018 Nov 4. PMID: 30393988.

J Cosmet Dermatol

  • 2020 May;19(5):1071-1077.

doi: 10.1111/jocd.13146. Epub 2019 Sep 18

Cosmet Dermatol

  • 2019 Aug;18(4):996-1001.

doi: 10.1111/jocd.12810.

hair loss treatments

Treatment for Androgenetic Alopecia in Men and Women

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By Kyleen Davis, FNP

Androgenetic alopecia (AGA) is the medical term used to describe a type of hormone-related hair loss that occurs in genetically-susceptible men and women. It is extremely common, affecting approximately 50 million men and 30 million women in the United States. Androgenetic alopecia can be significantly distressing to affected individuals and seriously impact their quality of life. Fortunately, multiple treatment strategies have been shown to help.

The onset of AGA is typically between the ages of 20 to 40 years old, but can start as early as a person’s teens. The risk of developing this condition increases later in life. Men are more commonly affected than women and may present in different ways. In males, recession of the frontal hairline is noted early on, followed by a gradual thinning at the temples and crown, forming an “M” shape. In females, the frontal hairline is preserved with a generalized thinning of the hair and widening of the part. AGA rarely leads to complete baldness in women. Other common features of AGA include gradual onset of hair loss, increased hair shedding, and a transition from large, thick, pigmented hairs to thin, short, wispy hairs.

Medication-hair-loss

Nhtindia / CC BY-SA

Diagnosing Androgenetic Alopecia

Patients with suspected AGA should be evaluated by an experienced dermatologic provider. A careful medical history and physical examination of the hair, scalp, and nails should be obtained, along with laboratory testing to rule out underlying diseases or vitamin deficiencies. A biopsy of the scalp is occasionally necessary to differentiate AGA from other types of alopecia.

Treatment of Androgenetic Alopecia

Once a diagnosis of AGA is established, treatment may be initiated with one of the following medications:

  • Minoxidil:
    • Available in 2% or 5%, topical minoxidil is the most commonly recommended treatment for AGA. Patients need to use this medication continuously for one year before determining if it will work for them. At the beginning of treatment, individuals may notice a temporary increase in hair loss, which stops as the hair begins to regrow. Common side effects include dryness, scaling, and/or itching of the scalp. Occasionally, excessive hair growth in unwanted places, like the cheeks or forehead, may occur as a result of taking this medication.
  • Prescription medications:
    • Finasteride is an FDA-approved medication used to treat AGA in men. It has been shown to halt the progression of hair loss while also leading to regrowth of hair in many cases. A commonly reported side effect is sexual dysfunction, which is reversible once the medication is stopped.
    • Spironolactone is often used in women with female-pattern hair loss. This medication acts to suppress the effects of certain hormones, and can be particularly useful in polycystic ovarian syndrome (PCOS) and hirsutism—defined as excessive hair growth on the body.
  • Vitamins:
    • Many supplements containing biotin, folic acid, and antioxidants have helped patients with thinning hair.  It is important to mention any supplements you are taking to your physician prior to laboratory testing as they may affect results.
  • Shampoos:
    • One prescription shampoo, ketoconazole, has been shown to increase hair thickness in several studies. In addition, other over-the-counter shampoos can help hair hold moisture, making it appear thicker and fuller, as well as reduce breakage.
  • Laser therapy:
    • The FDA has approved low-level laser devices to treat hair loss at home. These lasers emit a low level of light that has been shown to help grow hair in a limited number of studies.
  • Platelet-rich plasma therapy:
    • Platelet-rich plasma therapy (PRP) uses a person’s own blood to stimulate cells to grow hair. After the blood is drawn, it is spun down in a machine, separating it into different components. The plasma is then injected into the scalp. PRP therapy is a relatively new therapy with studies currently underway to help determine its safety and efficacy.

If you suspect you have AGA, it is important you see your dermatologist as soon as possible to discuss the treatment options that are best for you. Treatment works best when started at the first sign of hair loss.

 

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References:

Hair Treatments: Separating Fact from Fiction, Part I

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Hair loss is one of the most complicated issues in Dermatology. There are numerous potential causes including auto-immune conditions, hormonal abnormalities, nutritional deficiencies, malignancies and heredity. In addition to the challenges of establishing a diagnosis, the remedies are neither fool-proof nor universally beneficial. Unlike many other areas in medicine, studies on hair growth medications and treatments are often not well-designed or double-blinded. End points are difficult to quantify. Growing hair can be elusive and determining if what you’re using is actually effective turns out to be even harder.

We know that half of all men and women over the age of 50 will experience hair loss. For those whose gradual hair thinning is a result of heredity or age and not a reversible condition– what options are scientifically based? Does anything really work? How much of what we believe about hair growth and hair care is just a myth?

Hair Loss Treatments

As of today, the only FDA-approved medications for the treatment of hair loss are topical Minoxidil and oral Finasteride.

Minoxodil is an over-the-counter solution or foam found in two different strengths: 2% and 5% . Although how it works is not entirely clear, minoxidil does seem to increase hair growth rate and hair follicle diameter.

What I have observed is that it increases hair growth in about 1/3 of patients, maintains hair in another third and doesn’t do much in the rest.

Recommended Usage of Hair Loss Treatments

There are a lot of misconceptions about its use, however, and that leads to less than optimal results.  Patients will often stop using minoxidil if it doesn’t work within the first 2 months, believing that it’s not going to be effective for them. It turns out that many people won’t see results until 4- 6 months of daily use. I recommend continuing for a full year before giving up.

I also find that patients are reluctant to start Minoxidil because they think they must commit to it for the rest of their lives and if they stop their hair will all fall out. NOT TRUE! Like many things, such as sunscreen or hair spray, it’s only going to work when you use it. But that doesn’t mean someone has to apply it forever or that you’ll lose all your hair if you stop. You won’t. Your hair just goes back to where it was before you started Minoxidil.

Contrary to what some believe, Minoxidil will not cause hair loss to worsen. It can seem like it does for some people, because as new hair growth begins, resting or not-growing hairs are pushed out. This shedding can make it seem like hair is actually being lost; however overall hair count and the size of the hair shaft are actually increasing when this happens.

Suggested Hair Care for Those Experiencing Hair Loss

What about hair care? If you’re losing hair should you shampoo or brush less frequently, and stop dying your treating your hair?

Shampooing often enough to eliminate scale on the scalp helps optimize hair growth. Certain shampoos are better for this than others. However the frequency of hair washing will not make an impact on hair growth. You might be more aware of the loss when you shampoo, but there is no evidence linking hair loss to hair washing.

Similarly neither brushing your hair nor using chemical treatments such as dyes, perms or straighteners will cause you to lose your hair. What they can do, though, is make hair weaker and more susceptible to breakage, which can make hair loss more noticeable. So proceed with caution.

More Information

Hair loss is more than just having a bad hair day. It can signify a health problem and it can also be psychologically devastating for both men and women. We are exposed to a deluge of options regarding hair growth— only some of which are legitimate. Some treatments may turn out to be helpful, but data to support them is limited or non-existent.

In a future blog I’ll explore what we know and don’t know about the other approved medication, finasteride, along with supplements, hair lasers and PRP.

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