Alopecia areata is an autoimmune skin disease that results in varying degrees of hair loss on the scalp and elsewhere on the body. This incurable disorder affects more than an estimated 6.6 million people in the U.S. alone. Alopecia is unpredictable and people with the disorder may experience many periods of remission and flare-ups. In all cases of alopecia, the hair follicles remain alive and have the potential to resume normal hair production when they receive the appropriate signal.Although complete resolution often occurs, the disorder may also become chronic and unresponsive to treatment. Treatment that works for one person does not necessarily work for another person because alopecia is complex and varies greatly from person to person.
One of the challenges with treating alopecia is it's unpredictable nature. Hair may fall out and regrow and never fall out again. It may fall out and not come back in for many years or it may come back temporarily only to fall out again. The efficacy of treatments should be considered because while treatment are believed to stimulate hair growth there is no evidence it will impact the coarse of alopecia itself. There are no FDA-approved treatments for alopecia, but some medical professionals prescribe off-label treatments. Here is a look at 10 documented alopecia treatments, classified into two categories.
Treatments for Hair Loss of Less than 50%
Corticosteroids (creams, lotions, or injections):
Topical creams/lotions are applied to the area(s) with hair loss and are especially useful for children who cannot endure injections. Commonly prescribed creams include fluocinolone acetonide 0.2% and betamethasone dipropionate 0.05%. Corticosteroid injections can be given directly into or around the bald area(s). Four to six injections a month are typically required to induce any improvement, but in some people, the injections have no impact. While this alopecia treatment can spur some hair regrowth, the hair falls out after the treatment is stopped.
Anthralin cream or ointment: This is a synthetic, tar-like substance that has been used widely for the treatment of psoriasis. It is applied in 0.2-1% concentrations to bare patches once a day and washed off typically after 30-60 minutes. If new hair growth occurs, it is realized within 8-12 weeks.Side effects include skin irritations and a brownish skin discoloration that is temporary. Precautions must be taken to avoid getting anthralin in the eyes, and to wash hands immediately after applying it.
Minoxidil (brand name Rogaine): This FDA approved drug is available in 2% or 5% formulas; the latter appears to be more effective in the treatment of extensive disease (50-99% hair loss), but has no benefit in alopecia totalis or alopecia universalis. A maximum of 25 drops are applied twice a day regardless of the extent of the affected area. Initial regrowth is usually seen within 12 weeks, but continued application is needed to achieve cosmetically visible regrowth. The drug can help maintain existing hair, but does nothing to promote regrowth. Topical Minoxidil can be effective on patchy alopecia, but will not do much for people with extensive alopecia.
Oral Zinc: There is evidence that prolonged treatment with zinc capsules (25-50 mg) is somewhat beneficial for alopecia patients who have a documented zinc deficiency, since there may be a correlation. However, taking too high a concentration can cause digestive issues.
Finasteride (brand name of Propecia): The enzyme in this medication converts testosterone to dihydrotestosterone, so it is strictly used for male pattern baldness and is not currently prescribed for females. Like corticosteroids, when the treatment ceases, hair regrowth stops and the hair can fall out again.
This involves the use of chemicals applied to the scalp to induce an allergic rash or contact dermatitis that resembles poison oak or ivy. The most common chemicals used are diphencyprone (DPCP), dinitrochlorobenzene (DNCB), and squaric acid dibutyl ester (SADBE). About 40% of patients treated with topical immunotherapy experience regrowth, however, some patients may stop responding to the chemicals and will lose all their hair again. If no hair regrowth is achieved after five months of treatment, topical immunotherapy should be discontinued. This treatment is not available everywhere in the U.S. and side effects include severe itching, eczema, lymph node enlargement, and skin discoloration.
Retin-A: Originally used for the treatment of acne and other skin problems, some studies have shown that rubbing it into the area of hair loss alone, or in combination with topical Minoxidil can result in moderate to good hair growth in individuals with alopecia. The gel is rubbed onto the area of hair loss, either alone, or in combination with topical Minoxidil.It is recommended that Minoxidil is used in the morning and Retin-A in the evening because the latter increases skin sensitivity to sunlight.
Diphenylcyclopropenone (DPCP): This topical sensitizer is applied in a 2% solution to the scalp to provoke an allergic reaction that leads to itching, scaling, and eventually hair growth. When the medication works, new hair growth usually occurs in 3 to 12 months. Even after full growth of hair, some patients may no longer respond to DPCP and will lose all their hair again. If no hair regrowth is noticed after five months of treatment, DPCP should be discontinued. Side effects include eczema, lymph node enlargement, and skin discoloration.
Treatments for Hair Loss of More Than 50%
Immunosuppressive drugs: It is believed that by suppressing the immune system, hair will be given the chance to regrow. However, it is risky taking these drugs because they lower a person’s resistance to infections and may affect bone marrow, liver, or kidneys.
Systemic Corticosteroids: Taken orally, these are often used in conjunction with Minoxidil as the dosage is being reduced. When taking oral corticosteroids, there is usually some hair regrowth. However, unless the immune system kicks into normal action and enables hair to grow back naturally, after alopecia treatment is stopped, regrowth will cease and hair will fall out again. In addition, there are numerous adverse effects associated with both short- and long-term treatment. Therefore they are not typically recommended as the treatment of choice for alopecia.
PUVA Therapy: This involves taking or applying a light sensitive drug and then being exposed for a short period of time to UVA (ultraviolet light). The more recent the hair loss, the better the likelihood hair will regrow. This alopecia treatment has a low success rate (around 6-12%), can be very painful, and is not considered to be an effective long-term treatment.About 20-40 treatments usually are sufficient for some regrowth, but most patients relapse within 4-8 months after treatment is stopped.
Similar to PUVA, this involves a different wavelength of light. Generally used to treat skin conditions like vitiligo, it is also used for people with severe hair loss of more than 90%. It involves standing in a cubicle of ultraviolet lights 2-3 times a week with sessions progressively increasing in duration. Typically, this treatment is ineffective, can be quite painful, and possibly increase one’s risk of skin cancer.
Treatment for Cicatricial Alopecia
Treatment strategies are different for each subtype and customized because every patient is unique. Treatment continues until symptoms and signs of scalp inflammation decrease, and progression of the condition is under control. Itching, burning, pain, tenderness, scalp redness, and scaling can usually be controlled with existing treatments. Hair loss may continue even after other visible symptoms and signs have disappeared. Cicatricial alopecia can recur after being dormant and treatment may need to be repeated. Specific medications target the underlying inflammatory processes that are involved in each of the subtypes. Some of the treatments are similar to those used in the more common types of alopecia.
Lymphocytic group: Oral medications are used including hydroxychloroquine, doxycycline, mycophenolate mofetil, cyclosporine, and pioglitazone. Topical medications include corticosteroids, topical tacrolimus, topical pimecrolimus, and Derma-Smoothe/FS scalp oil. In addition, a specific type of corticosteroid may be injected into inflamed, symptomatic areas of the scalp.
Neutrophilic group: Administration of oral antibiotics is the primary therapy. Topical antibiotics and anti-inflammatory medications may be used to supplement oral antibiotics.
Mixed group: Several medications may be prescribed including antimicrobials, anti-inflammatory medications, and isotretinoin (with a small starting dose). Infliximab may be helpful for cases of treatment-resistant dissecting cellulitis.
For some the psychological impact of alopecia can be profound and for other's they find a way to embrace the uniqueness of hair loss. For some no solution is the answer. They choose not to attempt treatments or to conceal their hair loss at all. While other wish to take advantage of hair loss alternatives including, wigs, hairpieces, hats, false eyebrows and eyelashes will help those with alopecia to cope with their hair loss and maintain their appearance.
Quackery vs. Legitimate Treatments
As far back as ancient Egypt, people looked for miracle cures for hair loss. Among the weirdest were a concoction of fat from a lion, hippopotamus, crocodile, goose, snake, and ibex; and a compound of ground-up burnt domestic mice, horse teeth, bear grease, and deer, both of which were liberally applied to bald areas. When you experience hair loss from alopecia, it can be tempting to try anything – albeit not as exotic as these ancient hair loss treatments!
Many so-called alopecia treatments will impact your pocketbook and nothing else, while others could present health risks. Remember, the old adage – if it sounds too good to be true, it likely is! Always consult a doctor before undergoing any treatment for alopecia.
More Information on Alopecia
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