Hair Loss
Treatment
Androgenetic Alopecia Treatment
Two drugs, finasteride and minoxidil, are approved by the Food and Drug Administration (FDA) for the treatment of hair loss in men. Finasteride is an oral medication that inhibits 5-alpha reductase and blocks the conversion of testosterone to DHT (AHLA 2010; Qi 2014). Minoxidil lengthens the anagen phase, shortens the telogen phase, increases the growth rate, and increases the size of hair follicles. Minoxidil can be considered in men who do not respond adequately to finasteride treatment, or as an add-on to other treatments. Topical minoxidil is FDA approved in both 2% and 5% formulations for treatment of pattern hair loss in men and women (Ahanogbe 2015; Stough 2005).
These medications are only effective during active use, so they must be used continuously and indefinitely (Qi 2014; Levy 2013). In addition, they may cause unwanted side effects. Minoxidil may cause itching and irritation of the scalp, as well as excessive facial hair growth in women (Levy 2013). Finasteride may cause sexual dysfunction in some men (Ahanogbe 2015).
Alopecia Areata Treatment
In about 80% of cases, alopecia areata resolves without treatment over 6 to 12 months. In patients who opt for treatment, corticosteroids that suppress the underlying autoimmune process can be applied to affected areas either as cream or injections, and oral corticosteroids are used in some cases of extensive hair loss (Ahanogbe 2015; Qi 2014). Another option in severe cases is topical immunotherapy, which uses certain chemicals to modulate local immune response (Qi 2014; Santos 2015).
Ultraviolet (UV) light therapy has been investigated as a treatment for alopecia areata. Some case reports have described successful treatment of patchy hair loss due to alopecia areata with UVB therapy; however, in rigorous trials, neither UVA nor UVB therapy have been found to be effective for alopecia areata (Shapiro 2013).
Telogen Effluvium Treatment
Telogen effluvium is generally triggered by a major physical or psychological stressor; the stressor typically occurs two to four months before hair loss begins. Hair regrowth typically occurs within four to six months if the stressor is short-lived, but if repetitive or chronic, hair loss may continue and topical minoxidil may be suggested (Qi 2014; Harrison 2009; Ahanogbe 2015).
Anagen Effluvium Prevention
Anagen effluvium is usually caused by chemotherapy or radiation therapy and normal hair regrowth typically begins within three to six months of treatment discontinuation. Scalp cooling is an effective method of preventing hair loss in some cases of chemotherapy-induced alopecia, reducing the risk of this type of hair loss by 62% (Shin 2015; FDA 2015; Qi 2014; Nangia 2017). A scalp cooling procedure that applies a refrigerated cap 30 minutes before, during, and up to 90 minutes after chemotherapy treatment is believed to prevent hair loss by reducing the amount of chemotherapeutic drug reaching the hair follicle, and lowering the rate of biochemical activity within the hair follicles (Shin 2015; FDA 2015; Qi 2014).