The best hair loss treatments available
Hair loss affects a large proportion of the population, including women and children. Our society puts a lot of value on appearance, and a full head of hair is sometimes viewed as an indication of good health, virility and beauty. Losing one’s hair, particularly at an early age, can be a highly distressing and upsetting. There are multiple reasons why people lose their hair, and many conditions which contribute. I won’t discuss the reasons in this article, but instead want to focus on the treatment used to slow the rate of hair loss, stop the hair loss, and encourage new hair growth. Given the highly emotive impact of hair loss, there are many products and so called ‘miracle-cures’ out in the market place. While there are no miracle-cures, clinical trials and medical research have demonstrated that a number of treatments do work for treating some types of hair loss. It is these treatments I will focus on in this article.
1. Eliminating the root cause
Lifestyle factors are over-rated with respect to hair loss, however a poor diet, low iron levels and stress can contribute to some forms of hair loss. With male patterned baldness, however, it has a purely genetic basis, but can be accelerated by the use of exogenous androgens (anabolic steroids).
Finasteride is a drug which blocks the conversion of Testosterone into dihydrotestosterone. It is mainly indicated for male patterned baldness where it can either reverse the miniaturisation process, slow it down or arrest it. This has been tested in large clinical studies and shown to be very effective for men. This drug is also used as an unlicenced indication, prescribed only by medical specialists, for female patterned hair loss.
3. Anti-androgen therapy
Anti-androgen therapy has been shown to be effective in women with female patterned hair loss. The drugs used include Spironolactone, Cyproterone Acetate and the oral contraceptive pills Dianette and Yasmin. A retrospective clinical study has shown that more than 80% of women can respond to this form of treatment, however regrowth is modest.
4. Topical formulations such as Minoxidil
Minoxidil is an effective topical treatment for some different forms of hair loss. It is mainly used for male and female patterned hair loss where it works to stimulate the hair follicles to produce a thicker hair at a faster rate. It also converts more of the resting hair follicles into the growing phase of the hair cycle. Topical Minoxidil is also used for chronic telogen effluvium and has been reported to stimulate hair growth in patients with alopecia areata. The recommended concentrations are the 5% lotions to be applied twice daily for men and the 2% lotion to be applied twice daily for women. In practice most people only manage to apply the solution on a daily basis. A 5% foam formulation is now available in the United Kingdom.
5. Topical steroid preparations
Inflammatory causes of hair loss or hair loss that have an auto-immune basis may respond to the application of a topical steroid lotion. Conditions such as scarring alopecia, lichen planopilaris or discoid lupus may respond to a topical steroid as may some cases of alopecia areata. Topical steroids will not help male or female patterned hair loss.
6. Injections into the scalp
Injections of low-dose steroid directly into the scalp can be very effective treatments for alopecia areata and some of the scarring alopecias. The dose, quantity and site of injection are all important in obtaining the best outcome without any side-effects.
For resistant cases of alopecia areata immunotherapy in the form of DCP therapy can sometimes be used with good results. This treatment involves making a patient allergic to a particular synthetic chemical and then using a weaker concentration of this chemical on the scalp on a weekly basis to try and elicit a mild dermatitis on the scalp. This treatment is time-consuming and fiddly and is offered only in specialist centres.
8. Systemic treatments such as tablets
For some of the scarring alopecias and more severe cases of alopecia areata systemic medications are sometimes required to slow down or arrest the inflammatory process. This may include antimalarial medications for some of the scarring alopecias or immunosuppressive medication for alopecia areata or the scarring alopecias. Very occasionally systemic steroids are indicated for rapid hair loss due to alopecia areata or some of the autoimmune scarring alopecias.
9. Biologics and other treatments
Recent research with some of the newer biologic agents which are delivered as injections into the body which are now being used for more severe cases of psoriasis have also been tested for some forms of hair loss. Unfortunately to date all the biologic medications have been disappointingly ineffective for alopecia areata. Another treatment sometimes cited in the literature is PUVA or phototherapy, however results of this treatment are slow and sporadic.
Unfortunately, there is a proportion of the population who do not respond to treatment to hair loss.