Management of hair loss
Management of hair loss | |
---|---|
Specialty | dermatology |
The management of hair loss, includes prevention and treatment of
Prevention
Scratching of itchy scalp may contribute to hair loss.[1]
Health
Body weight
Prevention of obesity helps. Obesity is linked to hair thinning.[2]
Healthy diet
Oils with fatty acids that has been studied to prevent dermatitis includes:[3][4]
- Corn oil: Linoleic acid (LA)
- Fish oil: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
- alpha-Linolenic acid(ALA)
Alternative medicine
The scalp must be cleaned from
A 2020
- Oral supplementation of B, C, D, E, and trace element iron, selenium, and zinc, will prevent androgenic alopecia caused by malnutrition. Multivitaminscan be used.
- Topical application of saw palmetto, pumpkin seed oil, procyanidin, garlic gel, capsaicin, caffeine, amino acids, and curcuminhelped prevent hair loss.
Heating, ventilation, and air conditioning (HVAC)
Humidifier
A humidifier can be used to prevent low indoor humidity during winter (especially with indoor heating), and dry season.[6]
Commonly, patients with seborrhoeic dermatitis experience mild redness, scaly skin lesions and in some cases hair loss.[7]
Low humidity can cause adverse health effects and may cause atopic dermatitis,[8] and seborrhoeic dermatitis.[9]
Treatments
Combination therapy
Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use.[10]
Combination therapy of LLLT or microneedling with finasteride[11] or minoxidil demonstrated substantive increases in hair count.[12]
Medication
Add-hocs
The topical
Synthetic medicine
Treatments for the various forms of hair loss have only moderate success.[14] Three medications have evidence to support their use in male pattern hair loss: finasteride, dutasteride and minoxidil.[15] They typically work better to prevent further hair loss than to regrow lost hair.[15]
They may be used together when hair loss is progressive or further regrowth is desired after 12 months.[16] Other medications include ketoconazole, and in female androgenic alopecia spironolactone and flutamide.[17]
Baricitinib
In June 2022, the FDA authorized baricitinib for the treatment of severe alopecia areata.[18][19]
Minoxidil
Antiandrogens
Dutasteride is also used in the treatment of male pattern hair loss and appears to have better effectiveness than finasteride for the condition.[27][28][29] While used off-label for male pattern hair loss in most of the world, dutasteride is specifically approved for this indication in South Korea and Japan.[30][31]
There is tentative support for
There is tentative evidence for flutamide in women; however, it is associated with relatively high rates of liver problems and strong recommendations have been made against its use.[14][35] Like spironolactone, flutamide is typically only used by women.[36] Bicalutamide is another option for the treatment of female pattern hair loss.[37][38][39] It has a far lower risk of liver toxicity than flutamide and is said to have an excellent safety profile.[38][39][40] However, bicalutamide retains a small risk of liver toxicity and for this reason periodic liver monitoring is recommended during treatment.[38][40]
Ketoconazole
Ketoconazole may help in women.[41][42]
Technological treatments
Low-level laser therapy (LLLT)
Low-level laser therapy or photobiomodulation is also referred to as red light therapy and cold laser therapy. It is a non-invasive treatment option.
LLLT is shown to increase hair density and growth in both genders. The types of devices (hat, comb, helmet) and duration did not alter the effectiveness,[43] with more emphasis to be placed on lasers compared to LEDs.[44] Ultraviolet and infrared light are more effective for alopecia areata, while red light and infrared light is more effective for androgenetic alopecia.[45]
Medical reviews suggest that LLLT is as effective or potentially more than other non invasive and traditional therapies like minoxidil and finasteride but further studies such as RCTs, long term follow up studies, and larger double blinded trials need to be conducted to confirm the initial findings.[46][11][47]
Platelet-rich plasma (PRP)
Using ones own cells and tissues and without harsh side effects, PRP is beneficial for alopecia areata[48] and androgenetic alopecia and can be used as an alternative to minoxidil or finasteride.[49] It has been documented to improve hair density and thickness in both genders.[50] A minimum of 3 treatments, once a month for 3 months are recommended, and afterwards a 3-6 month period of continual appointments for maintenance.[51] Factors that determine efficacy include amount of sessions, double versus single centrifugation, age and gender, and where the PRP is inserted.[52]
Future larger randomized controlled trials and other high quality studies are still recommended to be carried out and published for a stronger consensus.[46][50][53] Further development of a standardized practice for procedure is also recommended.[48]
Surgical treatments
Hair transplantation
Hair transplantation is a
Since hair naturally grows in follicles in groups of 1 to 4 hairs,
Donor hair can be harvested in two different ways. Small grafts of naturally-occurring units of one to four hairs, called
In FUT, a strip of skin containing many follicular units is extracted from the patient and dissected under a stereoscopic microscope. The site of the strip removal is stitched closed. Once divided into follicular unit grafts, each unit is individually inserted into small recipient sites made by an incision in the bald scalp. In the newer technique, roots are extracted from the donor area and divided into strips for transplantation. The strip, two to three millimeters thick, is isolated and transplanted to the bald scalp.[54] After surgery, a bandage is worn for two days to protect the stitched strip during healing. A small strip scar remains after healing, which can be covered by scalp hair growing over the scar.[55]
Scalp reduction
Scalp reduction is a surgical procedure in which the hairless region of the scalp of a bald man is reduced. This procedure can reduce the area of the scalp without hair.[56][57]
Regrowth of hair
Facial hair
Eyebrows
Bimatoprost 0.03% has been used to grow eyebrows.[58]
Eyelashes
The FP receptor agonist,
Scalp hair
Alternative medication
Topical
Some popular plant juices sold as hair serum may instead of growing human hair actually inhibit the growth, including
Topical crude onion juice
A small 2002 study demonstrated that treatment twice daily for six weeks with crude onion juice from Australian brown onion, re-growth hair on alopecia areata (spot baldness) in 86.9% of the 23 participants.[63] Twice as many flavonols are found in red onion than in yellow onion.[64] Also, non-organic onions might contain pesticides on the peel and in the first scaly leaf. Compounds found in onion that stimulates hair growth:
- Quercetin:
- Quercetin (a flavanoid found in vegan food) supplements, has been suggested to treat baldness.[65] A 2012 study demonstrated that alopecia areata could be used to prevent ant treated with quercetin in mice.[65] Quercetin is found in onions primarily in the peel and the first scaly leaf but not in the flesh.[66] Onion bulb size or weight does not appear to be affected by quercetin concentration.[64]
- A 2020 study demonstrated that quercitrin stimulated hair shaft growth in cultured human hair follicles.[67]
- Volatile compounds responsible for pungency and tearing in onions when they are cut (e.g. syn-propanethial S-oxide gas). However, no formal studies have conducted to evaluate if these compounds promote hair growth or if they help other compounds to penetrate the skin to form hair follicles.
- To use the volatile compounds: Onions must be extracted and applied topically quickly before the volatile compounds evaporates. The extract will cause tearing eyes, but it can be prevented with a shower cap, or a pair of swimming goggles.
- To discard the volatile compounds: The onion juice is extracted and stored for a short while to evaporate the volatile compounds. The extract will not cause tearing eyes. Also, both
Dietary supplements
Dietary supplements are not typically recommended.[70] Many people use unproven treatments,[15] but there is little evidence of the effectiveness of vitamins, minerals, or other dietary supplements regrowing hair or retaining hair.[14] There is no evidence for biotin (vitamin B7).[70] While lacking both evidence and expert recommendation, there is a large market for hair growth supplements, especially for products that contain biotin.
However, one small trial of
Radiation-induced hair loss
Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression.[72][73] Radiation therapy has been associated with increased mucin production in hair follicles.[74]
Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia.[75]
Cosmeses
Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle.[76] There have also been developments in the fashion industry with wig design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a "constant companion".[77] Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use.[78]
Specialized tattoos, commonly known as scalp micropigmentation, can mimic the appearance of a short buzzed haircut.[79]
Human hair growth
Female androgenic alopecia is characterized by diffuse crown thinning without hairline recession, and like its male counterpart rarely leads to
More advanced cases may be resistant or unresponsive to medical therapy, however, and require
Research
Bimatoprost and latanoprost
Hormones
Estrogens are indirect anti-androgens and can be used to treat androgenetic hair loss in women with
There is tentative evidence for cyproterone acetate in women.[14]
IGF-1
In December 2012, topical application of
Stem cell therapy
Although follicles were previously thought gone in areas of complete baldness, they are more likely dormant, as recent studies have shown the scalp contains the stem cells from which the follicles arose.[98] Research on these follicular stem cells may lead to successes in treating baldness through hair multiplication (HM), also known as hair cloning.
Per a May 2015 review, no successful strategy to generate human hair follicles, for hair regrowth, from adult stem cells has yet been reported.[99] However, in April 2016, scientists from Japan published results of their work in which they created human skin from induced pluripotent stem cells; implanted into laboratory mice, the cells generated skin with hair and glands.[100]
Genetics
From 2005 to 2007, Curis and
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External links
- "Medical Treatments for Balding in Men", April 1999, American Family Physician (medical journal)