Losing hair? A quick guide to treatment options

Dr A Bolin

Hair loss can be worrying for both men and women, but there are things that you can do about it. Dr A Bolin explains.

 

Have you noticed your hair getting thinner or perhaps a receding hairline? Hair loss can have a huge impact on your self confidence.

Generally, unless there is an underlying medical condition or treatment (such as chemotherapy) that is causing the hair loss, it’s often genetically determined. But, there is some good news: there are some medical grade treatments that actually work and can give you a thicker head of hair.

Let’s have a look at what can cause hair loss and the treatments that have been proven (evidence-based) to really work.

 

What causes hair loss or alopecia?

There are many causes of hair loss, or as it’s formally known, alopecia. It may be part of the process in natural ageing or it can caused by sudden things such as stress, malnutrition or medical treatments like chemotherapy. In these cases it’s often temporary.

It may also be caused by medical conditions such as lichen planus, severe eczema, lupus.

Different patterns of hair loss exist such as male-pattern baldness (androgenic alopecia) as well as female-pattern baldness.

Other types of alopecia are due to hyperactivity of the immune system, medical conditions or genetic factors. Some variants of alopecia are the autoimmune condition alopecia areata, telogen effluvium (where hair loss is greater than usual), traction alopecia (hair loss caused by pulling or tension on the hair) and chemotherapy-induced alopecia.

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Permanent of temporary: Watch and wait

In some cases, bald patches and hair loss due to alopecia areata and telogen effluvium may improve within a year on their own without any treatment at all. This might be your approach if there is minimal subtle hair loss. For obvious patches or thinning of hair read on and be prepared to discuss with your GP, dermatologist or plastic surgeon.

Underlying conditions need to be treated

If you have a skin condition or medical condition that has caused the hair loss, the underlying condition must be treated. Depending on the medical condition, the hair may grow back.

There is variable evidence for treatments of alopecia, as it truly depends on the underlying cause. Furthermore, what might work for one person might not necessarily work for the next. If one treatment doesn’t work, it is possible to combine treatments. Remember that stopping your treatments usually results in gradual hair loss back to your baseline pattern of balding.

Treatment options at a glance

Treatments that been shown to benefit to varying degrees include:

  • topical creams or injectable medications that modulate the immune system
  • oral medications (finasteride:for men, minoxidil: for men and women)
  • phototherapy (light laser)
  • hair implantation/transplant surgeries.

More evidence is needed:

  • “Vampire” Platelet-rich plasma injections (PRP)
  • Low-level laser treatment

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Treatments in detail

Topical creams, ointments or injections.

  • Topical steroids such as betamethasone and hydrocortisone have variable efficacy in treating balding areas of hair (not recommended for beard or eyebrows). However, injections of corticosteroids such as triamcinolone into bare areas have been shown to work, with hair growth occurring in certain cases of alopecia areata. Alopecia areata is suspected to be related to an autoimmune condition where your body targets it’s own hair cells. The immunosuppressive effect of the corticosteroid stops your body from attacking the hair follicle and hence allows the hair to grow.  Other alopecias may not respond as well. Risks associated with both topical and injectable steroids is thinning of the skin and hypopigmentation.

  • Anthralin or dithranol

Anthralin cream or ointment can be used topically with some success but also some people have sensitivity and flaking skin as a result. It is unclear how it works, but is suspected to be an irritant which in turn stimulates the body’s natural inflammatory pathways of repair.

Minoxidil is normally topical solution, gel or foam but can also be oral tablets.

Minoxidil, also known as Regaine or Rogaine, was initially used as a blood pressure medication in the 1960’s.  Patients did not want to stop using it since they found their hair looked better than ever after using it.  It then went on to be marketed as the first hair loss treatment available for both men and women. It is used topically alone or in combination with other treatments.

Finasteride (oral tablets)

Also known as Propecia, this medication is a daily oral tablet and is also used by men as treatment for benign prostatic hyperplasia. It can be used long term and has been found to be useful in treatment for androgenetic alopecia (in men).  It takes 3-6 months to start seeing an effect. An undesirable side effect can be decreased libido and erectile dysfunction.

“Vampire Therapy” platelet-rich plasma (PRP) injections

People who suffer hair loss due to male pattern baldness  and have not responded to other treatments may consider trying out these injections. Their own blood is taken, centrifuged and then injected or dermarollered into bald areas. The treatment is usually repeated every few  weeks for 2-3 months.  There is some evidence that it improves hair growth and the mechanism responsible for increasing hair is likely growth factors that stimulate repair in the area. More studies are needed.

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Because it is relatively new treatment there is a large body of evidence yet to support it, but those who have tried it have reported being pleased with the result.

Phototherapy: UV light

Psoralen ultraviolet A and psoralen ultraviolet B treatments for the skin are not very effective and can take up to a year to show any results. There is also an increased risk of skin cancer. However, low level laser treatments appear to help with hair growth, although further studies are needed to assess efficacy. This is a safe form of light/heat treatment which is being evaluated for treating for a variety of health indications including male and female pattern balding.

Often called red light therapy, cold laser, soft laser, biostimulation and photobiomodulation, it is is believed to work by increasing blood flow in the scalp and stimulating the metabolism in the follicles where the hair is produced, resulting in the hair growth.

Hair Transplants:

If all of these treatments do not work, or you want a quicker option, you might want to consider surgery.

There are several types of surgery and it is best to discuss with a surgeon which would be the best match for your hair loss type.

A hair transplant, also known as a hair restoration or hair implant, restores the hair by transplanting new follicles from an area with hair to the bald or thinning area. The healthy follicles are most often taken from the back or the sides of the head either by removing a single strip of skin and hair or removing the follicles individually.

The number of grafts or follicles needed depends on the patient and the size of the area being treated. A typical surgery involves anywhere from 1,000 to 3,000 grafts.

If you are considering hair loss surgery, always make sure your surgeon is qualified to perform the procedure. There is a risk of infection and complications so paying less by travelling abroad could end up costing you more in the long run.

Camouflage:

If you do not wish to undergo treatments or have surgery there are a few ways to cover up or camouflage the area.

Options include tattooing, microblading, wigs and hair piece extensions that can help visually cover bald areas.

 

Harley Street Emporium surgeons who perform hair transplants include:

Plastic Surgeon Mr Reza Nassab

Harley Street Emporium doctors who perform PRP inlcude:

Dr Shirin Lakhani 

Dr Penelope Tympanidis

Dr Shaddi Eddin

Dr Ruhul Amin

Dr Pamela Benito

Dr Unnati Desai

Dr Bhajvit Kaur

Dr Nick Lowe

 

For more information, support and how to contact specialists:

Alopecia UK

The Belgravia Centre

British Association of Dermatologists (patient information leaflets)

 

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