Rapid Rx: Hair Loss Treatments

Medscape

6 days ago

Hair loss due to androgenetic alopecia remains a widespread concern for patients across the globe, as it severely affects their quality of life and self-esteem. With deeper insights into the biological mechanisms behind hair loss, a broader range of interventions are becoming available. Innovative methods ranging from laser-based treatments to microneedling and regenerative techniques are now entering clinical practice. These novel strategies offer promising alternatives, particularly for individuals who have seen limited benefit from traditional options or seek treatments with fewer systemic effects.
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Spironolactone reduces the influence of androgens, which are hormones that contribute to follicular miniaturization and hair thinning. In managing female-pattern hair loss, oral spironolactone is emerging as a novel therapeutic approach. It is commonly used to treat acne and hirsutism in females, especially those diagnosed with polycystic ovary syndrome (PCOS). Patients with PCOS are often diagnosed with androgenetic alopecia.
Topical spironolactone can be used for both men and women. Botulinum toxin is a treatment currently being studied for hair loss, although more research is needed before it can be recommended as a standard treatment. Low-level laser therapy can be used for both men and women. Low-dose oral finasteride (1 mg) has shown limited benefit in women but has not been as effective in postmenopausal women.
Learn more about low-level laser therapy.
Hair transplantation is a surgical procedure that harvests follicles from non-androgen-sensitive areas to areas affected by androgenetic alopecia. This procedure is best suited to individuals with nonscarring, patterned hair loss (typically androgenetic alopecia) who have a consistent and healthy donor area. Scarring conditions such as cicatricial alopecia damage the scalp and hair follicles permanently. For an effective surgery, the hair loss should be stable, and the patient should have a reliable zone from which follicles can be harvested.
Similarly, widespread thinning across the scalp (diffuse unpatterned alopecia) compromises donor-site quality. In alopecia areata, the immune system targets hair follicles unpredictably, making transplant outcomes unreliable.
Learn more about cicatricial alopecia.
For women with androgenic alopecia who wish to evade systemic hormonal effects, topical finasteride offers a practical alternative. Unlike oral formulations, which circulate throughout the body and might affect hormone levels (potentially causing adverse effects such as irregular periods or reduced libido), topical finasteride delivers its action more locally, with minimal absorption. Although not formally approved by the FDA for this use, it has shown promising results in reducing hair loss.
Oral dutasteride and high-dose oral finasteride are generally avoided in women of childbearing age due to their broad hormonal influence and risk for birth defects. Although topical minoxidil is a well-established treatment, it does not directly address the androgen-driven aspect of the condition.
Learn more about androgenetic alopecia.
Micronutrients, such as vitamins and minerals, probably play an important role in follicle function. According to a systematic review, zinc is supported by research as a possible nutritional intervention for hair loss.
The average dietary intake of vitamin A and biotin is adequate. Excess levels of vitamin A can cause hair loss, and neither biotin (vitamin B7) nor vitamin E supplementation are supported by the literature. In addition, biotin supplementation can cause potentially dangerous false troponin laboratory results.
Learn more about zinc supplementation.
Low-dose oral minoxidil (doses ranging from 0.25 mg to 2.5 mg daily) has been used off-label with good clinical efficacy and safety. Caution is advised when prescribing low-dose oral minoxidil to individuals with preexisting heart or vascular conditions. Although it is commonly used off-label to address hair loss in both female- and male-pattern hair loss due in part to its ability to enhance blood flow to the scalp, minoxidil was originally designed to lower blood pressure. Rare but potentially serious systemic effects such as increased heart rate or shifts in blood pressure could worsen underlying cardiovascular problems with its use. The magnitude of cardiovascular adverse effects is dose dependent, with 1 mg oral minoxidil being generally safe and well tolerated. (Oral minoxidil might also contribute to facial hypertrichosis, and it is not advised for use in pregnant women or in those who are breastfeeding.)
Minoxidil is not the treatment of choice for autoimmune-related hair loss, such as with lupus and alopecia areata, but it could be used as an adjunct therapy. Adolescents with alopecia areata can be treated with minoxidil, which had similar efficacy to that in adults.
Learn more about minoxidil.