Hair Loss Treatments and Medications

Folliscope, a new device that is a handheld microscopic camera, can automatically assess hair density and hair shaft diameter.It’s normal to lose 50-100 hairs on your scalp each day, but what happens when you lose more than that? Hair loss ranges from a mild thinning of the hair and a receding hairline to total baldness. Hair loss can happen on the scalp or all over the body. There are many causes of hair loss and it is important to know what is causing hair loss in order to treat it. Let’s take an in-depth look at what causes hair loss and ways to treat it.

What is alopecia?

Hair loss, also known as alopecia, is excessive loss of hair from your body, typically on your head. While hair loss sometimes leads to baldness, other times, it can just cause overall thinness of the hair. Common types of hair loss include:

• Androgenetic alopecia: This type of hair loss is the most common, known as male-pattern hair loss or female-pattern hair loss. In the United States, it affects over 50 million men and 30 million women.

• Alopecia areata: This autoimmune condition causes hair all over the body to fall out and not grow back because the body’s immune system attacks hair follicles. It may result in total hair loss.

• Anagen effluvium: This is rapid hair loss due to medical treatments that shut down hair follicle production, such as chemotherapy. Hair will typically grow back on its own after treatment.

• Cicatricial alopecia: This type of alopecia, also known as scarring alopecia, causes hair to fall out when the hair follicles become inflamed. Then the follicle becomes scarred and is unable to produce new hair. There are a few types of this rare condition: central centrifugal cicatricial alopecia, dissecting cellulitis of the scalp, discoid lupus erythematosus, folliculitis decalvans, lichen planopilaris, and frontal fibrosing alopecia.

• Hair shaft abnormalities: This type of hair loss does not occur at the follicle, but rather when hair is breaking off somewhere in the hair shaft. They include:

  • Loose anagen syndrome causes children’s hair to fall out easily and not grow past their shoulders, typically in lighter hair colors, and it clears up during puberty.

  • Trichotillomania is a behavior where the person pulls out their own hair which can lead to permanent hair loss if the behavior lasts over a long period of time.

  • Traction alopecia is another type of hair shaft abnormality, in which the hair falls out due to a hairstyle that is too tight, like braids or a ponytail, and results in damaging the hair

• Hypotrichosis: This is a rare genetic condition in which a person grows very little hair and typically has no hair by the age of 25.

• Telogen effluvium: This condition causes hair follicles to go into a resting phase and not produce new hair. It often leads to thinness, but not necessarily baldness. A person with telogen effluvium may lose 300-500 hairs daily. It may happen due to thyroid imbalance, fever, childbirth, change in birth control, a vitamin deficit, or surgery.

• Tinea capitis: This condition, also known as scalp ringworm, is a fungal infection that causes hair loss. It is most commonly the cause of hair loss in children.

The most common causes of hair loss are genetics and age. By 35, two-thirds of men are affected with some degree of hair loss or balding. By the age of 50, 85% of men have notable hair loss. Alopecia affects 40% of women by the age of 50. Depending on the cause, there are many treatment options for hair loss. These can include shampoos, topical medication, hair transplant surgery, and natural remedies.

How is alopecia diagnosed?

There are a variety of reasons for hair loss, so it is important to have it diagnosed by a doctor to find the root cause. While a primary care physician can do some tests for hair loss, such as a blood test to determine thyroid levels, a more complete diagnosis will be done by a dermatologist. There are a variety of tests your dermatologist may perform, some of which may include:

• A physical examination will help a dermatologist look at the pattern of hair loss and if there are any scalp conditions, i.e., redness or scarring. The hair loss may also be measured on either the Ludwig or Salvin Scale, which is a hair loss density rating scale. During this time, your doctor may ask you questions, such as:

  • When did you first notice your hair loss/thinning hair?

  • Are you losing hair from a specific area, or is it all over hair loss?

  • Has anyone in your family experienced hair loss?

  • What medications are you taking?

  • Does anything improve/worsen your symptoms?

• A pull test may be performed, in which the doctor tugs on a section of hair and counts how many hairs come loose from the root.

• The tug test is another test in which the doctor hangs on to the root end of the hair with one hand and pulls from the ends of the hair with the other hand to see if there are any breaks in the middle of the strands.

• A card test may be performed in which the doctor holds a felt-covered card that contrasts with the hair color to the hair roots to measure the thickness of the hair, detect breakage, and check for new growth.

• Folliscope a new device that is a handheld microscopic camera, can automatically assess the hair density and hair shaft diameter. It also gives an up-close look at the scalp and hair follicles.

• A fungal culture is performed for anyone who shows signs of fungus in the scalp cells. This is done by scraping or swabbing the scalp cells.

• Punch biopsy is rarely performed but will sometimes be done when a diagnosis needs to be confirmed. A small amount of tissue is biopsied and sent to the lab, and the incision is then stitched.

• Blood tests may be done to test for iron deficiency, thyroid disease, or androgen excess (a cause of hormone imbalance in women).

• VDRL, which is a screening for syphilis, since one of the side effects of syphilis is hair loss.

• Photographs will likely be taken to assess current hair loss and to document changes or progress in hair growth once treatment starts.

During the appointment with your doctor or dermatologist, it is important to ask questions you may have. Questions to ask your doctor may include:

• What is causing my hair loss?

• Is my hair loss permanent?

• What are my treatment options?

• Are there any lifestyle changes I can make to improve my hair loss?

• How long will it take for my hair to grow back?

Hair loss cures

Currently, there are no cures for hair loss, and medications for hair loss typically do not completely reverse it. Hair loss caused by chemotherapy or fungal infection can be resolved once chemotherapy has ended or the fungal infection has been treated. Promising research in 3D printing and stem cells may one day cure hair loss.

Hair loss treatment options

Treatment aims to help prevent more hair loss and regrow hair when possible. Possible treatments include medications, hair transplant surgery, laser therapy, or natural and home remedies. There are a few differences in medications to treat hair loss between males and females. The most common medication for hair loss prescribed to men and women is topical minoxidil, or Rogaine, which comes in liquid or foam and is rubbed into the scalp.

Rogaine helps prevent hair thinning and encourages new hair growth. Home remedies may include supplements that encourage hair growth, such as Omega-3, or changing hairstyles that may be damaging to the hair. Scientists are currently working on new treatments for hair loss, such as laser treatment or finding breakthroughs in treating hair loss for cancer patients.

Hair loss medications

Depending on the type of hair loss it is possible your doctor will prescribe medication. Common medications for hair loss include:

• Topical minoxidil commonly known as Rogaine, prevents hair loss and can promote new hair growth. It comes in liquid or foam and is rubbed into the scalp twice a day. This medication may cause scalp redness and irritation and takes 4 months to a year to show improvement in the hair. If treatment stops, hair loss typically starts again. It is used for multiple types of hair loss, including male and female pattern hair loss, alopecia areata, telogen effluvium, hypotrichosis, and scarring alopecia.

• Finasteride is a prescription medication for men with male-pattern hair loss, specifically loss at the crown and middle of the scalp. It decreases the rate of hair loss and promotes new hair growth by stopping the body’s production of a hormone, dihydrotestosterone (DHT), that destroys hair follicles. Progress will not be seen for four months to a year. Once treatment stops, hair loss may recur. This medication can cause erectile dysfunction in some patients.

• Antiandrogens, or medications that inhibit sex hormones, may be prescribed to women exhibiting female pattern baldness when sex hormones may be damaging the hair follicles. These medications include spironolactone and birth control pills. This medication can cause irregular periods and should not be used for women trying to become pregnant. Therefore contraception is mandatory, especially with spironolactone

• Corticosteroids are used when hair loss is caused by an autoimmune disease, such as alopecia areata, discoid lupus erythematosus, and lichen planopilaris. They stop the autoimmune disease from attacking hair follicles and allow hair to grow. Corticosteroids may come in a topical solution, oral tablet, or steroid shot given at the doctor’s office. However, they may cause skin on the scalp to thin.

• Antifungal medications are given when scalp ringworm causes hair loss. Once the fungus is cleared, hair typically regrows back. However, antifungal medications can sometimes cause a rash.

• Dutasteride, while not currently approved by the FDA for hair loss, has been shown to improve hair growth in some men. This medication is said to more effectively block DHT than Finasteride in some studies. Dutasteride can also cause erectile dysfunction

What is the best medication for hair loss?

The best medicine for hair loss should be determined by a doctor and depends on your medical condition, medical history, and the current prescriptions you may be taking.

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Best medications for hair loss