Hair Loss

Alopecia areata is known to be an unpredictable hair disease affecting about 2% of the world’s population and is the second most common type of hair loss after hereditary baldness. It is often called patch baldness or spot baldness due to its patchy, balding pattern. In severe cases, it can affect the whole scalp (alopecia totalis) or the entire body (alopecia universalis). It is not yet known what causes alopecia areata. It is thought to be an autoimmune disease triggered by a person’s autoimmune system, which decides to attack its own hair follicles. Sometimes the hair grows back a few years later and stays and sometimes it falls out again. Although there is no treatment for alopecia areata that works 100%, some treatments have been proven to improve this condition. The most popular treatment option, which does not require a doctor’s prescription, is topical minoxidil, such as Rogaine. It can be used alone or in combination with other medicinal treatments that will be discussed later.

The best known prescription treatments for alopecia areata are corticosteroid shots, injected straight into the bald spot, and steroid gels and creams. Corticosteroid injections are a more effective but also the more painful option of the two. The aim of this approach is to suppress the autoimmune reaction but it has been proven to work only on small bald spots. Another common treatment for small bald spots, which is supposed to affect the autoimmune reaction, is the application of topical anthralin. Anthralin is a tar-like substance used to treat psoriasis.

Topical immunotherapy is the most common form of treatment for extensive conditions. It uses an immunosuppressant such as cyclosporine that is applied to the skin to cause a skin reaction similar to mild eczema, which in some cases leads to hair regrowth. This method is also the most drastic form of treatment, causing various negative side effects.

Another therapy for extensive alopecia areata is PUVA, which stands for "psoralen plus ultraviolet A radiation", consisting of a topical or oral application of psoralen, followed by ultraviolet radiation. This treatment is better tolerated than topical immunotherapy but is also less effective.

A recently conducted research study with sulfasalazine also spells some promise for patients with severe conditions of alopecia areata. Sulfasalazine is an anti-inflammatory medication first used to treat rheumatoid arthritis and is hoped to be soon used to treat alopecia areata.

This is the brief overview of the most common medicinal treatments for alopecia areata. There obviously is a number of other alternative therapies that are claimed to help treat this condition and do not require a doctor’s visit. Consumers should be aware that none of these products has ever been clinically shown to be effective in treating alopecia areata and such claims are legitimate only because these products are not regulated pharmaceuticals but non-regulated cosmetics.

Hair loss and eventual baldness can be caused by a number of factors but heredity appears to be the main reason why men and women lose their mane. Hereditary hair loss in men and women happens to have the same main cause, which is dihydrotestosterone (DHT) attacking and killing our hair follicles. DHT is a metabolite of the male hormone testosterone but it also happens to be present in the female body. Men and women lose their hair not because of increased levels of DHT in their bodies but due to the susceptibility of their hair follicles to harmful DHT attacks, although the mechanism and reasons why some hairs, mostly those on the top of the head, are more vulnerable to such attacks are not yet exactly know.

The main difference between the male and female form of hereditary hair loss is in its shape. The male form has a characteristic horseshoe pattern whereas the female form is typically a diffuse thinning across the entire scalp and is thus less easily-recognised. The female form of hereditary baldness is, in its form, practically indistinguishable from hair loss caused by various other factors. The second most common reason for a woman to lose her hair is hormonal imbalances during and after pregnancy or menopause. Such changes are typically of a temporary nature and so also is the hair loss, although post-menopausal hair loss is in most instances permanent.

When it comes to treating hair loss in female patients there are certain specifics. First, most women do not make very good candidates for hair transplantation due to their diffuse thinning pattern, which makes it impossible to identify the hair that will be resistant to future miniaturisation. Secondly, finasteride, which is one of the only two FDA-approved hair loss treatments available today, cannot be used in women and neither can dutasteride, which is its closest and assumedly yet more powerful relative. Rogaine (generic name minoxidil) is the second FDA-approved hair loss treatment and its approved concentration for women is only 2% versus 5% for men. However, many doctors recommend their female patients use male formulations of minoxidil, with a concentration of 5%, such as Rogaine foam. Aminexil is a molecule similar to minoxidil and it is most often recommended to women who are pregnant or breastfeeding as a safer option than minoxidil.

Although some antiandrogens such as finasteride or dutasteride cannot be prescribed to women, there are other antiandrogen medications that can be effectively used to treat female pattern baldness. Spironolactone (trade name Aldactone) and cyproterone acetate (used in contraceptives such as Ginette 35, Diane 35 and Diane 50) are antiandrogens most commonly used to treat female pattern hair loss.

Another treatment with seemingly high rates of success is topical estrogen solutions such as Crinohermal, which use a female hormone, estradiol, as their main active substance. Estradiol is capable of inhibiting the conversion of testosterone into follicle-harming DHT. Hormone replacement therapy is another hormonal treatment suitable for women at menopause, with estrogens and progesterone pills and creams being the most common forms of treatment. Estrogen levels in the body decline with time. As women enter the menopause, estrogen levels decline and, therefore, more of the male hormone testosterone is then available to be converted into follicle-harming DHT.

This list of treatments for female pattern baldness is not exhaustive. A variety of other existing remedies are claimed to help promote hair growth in women, such as ketoconazole, fluridil, flutamide, alfatradiol, as well as various substances of natural origin. Despite the fact that there are female patients who will swear by some of these alternative treatments, none of them has ever been sufficiently clinically tested, let alone approved by any major national health supervisory authority as a treatment for female hair loss and the claims of their guaranteed effectiveness should be taken with a grain of salt.

It pays to have some basic understanding of the existing hair loss treatment options before you decide on your treatment. The hair loss treatment options can be, in the first place, divided into surgical and non-surgical therapies. There are only a few surgical techniques currently used but the non-surgical spectrum is wide and confusing. There seem to be thousands of non-surgical treatments available to those who wish to avoid hair transplant surgery. Propecia and Rogaine might be the best known medicinal hair loss treatments, while dried fruits of saw palmetto and a Chinese herb, He Shou Wu, also known as Fo-Ti, are the natural ingredients most frequently found as the main active ingredients in alternative hair loss remedies.

The non-surgical hair loss therapies can be in principle divided into medicinal and alternative treatments, whereas when considering methods of application, they can be administered as oral treatments, topicals and others, such as LaserComb. Irrespective of the aforementioned breakdowns, hair growth treatments work either by blocking the activity of dihydrotestosterone (DHT), also called anti-androgens, or by stimulating hair growth.

DHT is a biologically-active metabolite of the male hormone testosterone and it is held to be the main cause of both male and female pattern baldness. DHT causes hair miniaturization as the hair becomes finer and thinner with every new hair growth cycle until the hair follicles refuse to produce another hair and die. The exact mechanism by which DHT acts on hair follicles is not known, though. Finasteride, better known under its trade name Propecia, is the only clinically-proven and FDA-approved anti-androgen used for treating male pattern baldness. It acts by preventing the creation of harmful DHT in the scalp. Since the introduction of Propecia, many other drugs and natural therapies have emerged claiming anti-androgen activity. Some of them are thought to work by a different mode of action than Propecia, such as preventing DHT from binding to the receptor sites in the hair follicle or blocking activity in the androgen receptor itself.

Minoxidil, also known under its trade name Rogaine (Regaine in Europe), is the best-known hair loss medicine amongst hair growth stimulants. It is assumed that hair growth stimulants work by stimulating epithelial growth of hair follicles and some of them may also counteract the hardening of the hair follicles but the exact mechanism of their action has never been described. One thing that all hair growth stimulants appear to have in common is their ability to increase the length of the hair growth cycle, thus improving the ratio of hair in the growth phase and to increase the hair’s thickness.

The natural hair loss remedies are assumed to work by the aforementioned modes of action and are often presented as safer alternatives than medicinal treatments. There are not too many hair loss treatments out there that have been clinically proven and independently verified to be effective in treating baldness. Of those few existing, all happen to be medicinal drugs. Natural hair loss remedies have still to live up to their originator’s claims.

When deciding about the most suitable hair loss treatment option, you should consider approaching the problem from different angles. It is best advised to use a combination of anti-androgen and hair growth stimulant, such as a Propecia/Rogaine combo. Alternative, hair loss treatments, for instance herbal remedies, should largely be considered as a method of fine-tuning this basic regimen in order to achieve additional benefits.

The available medical options for reversing hair loss hair in people suffering from hereditary forms of baldness are limited to relatively few products with most of them being effective only in the early stages of baldness. Once you have lost a big portion of hair due to hereditary factors or an accident, such as a burn, the only remaining option is to replace the missing hair. Your options can be either of a temporary nature, such as the use of hair pieces and hair loss concealers, or a permanent surgical solution. Hair transplantation happens to be the most effective way of surgical hair replacement and the only permanent solution that offers satisfactory results.

Hair transplantation consists in transplanting patient’s own hair from the back of his scalp to the frontal, balding area. The main limiting factor of hair transplantation is the shortage of donor hair and, therefore, many patients do not make a good candidate. The suitable hair transplant candidate should have a high hair density in the back of the scalp, his hair should be thick and wavy, his scalp flexible and the contrast between the colour of his hair and scalp should not be too great, and he must be in good physical condition. Women largely suffer from a diffuse form of hair loss and, therefore, do not make very good hair transplant candidates. Hair transplantation also cannot be performed on patients suffering from unpredictable forms of hair loss such as alopecia areata.

Given the limited supply of donor hair, the hair transplant surgeon must be able to utilise the little hair he can use to create the optical illusion of a full head of hair. This represents the biggest risk in hair transplantation, as it can sometimes happen that the patient does not like the final result. Although you can usually arrange for another hair transplant procedure, some damage can be irreparable. Other risks and side effects occurring during and after hair transplant surgery include excessive bleeding and scarring, the lengthy healing of wounds, the transaction and eventual death of many implanted hair follicles, post transplant shock hair loss, which, though only temporary, can affect your newly-implanted hair as well the hair in the donor area, scalp numbness and tension and the further progression of hair loss post surgery, which can lead to unnatural patterns of baldness. In one recent study, which examined the experiences of 425 hair transplant patients who had undergone 533 hair transplant procedures in total, it was determined that about 5% of the patients experienced complications either during or after surgery.

Hair transplantation can cost more than ten thousand dollars, depending on the technique used, the location and reputation of the clinic, the extent of hair loss and the number of hair transplant sessions needed to achieve the desired change in density. However, sometimes it is impossible to estimate the final cost, which represents another risk you take when deciding on hair transplant surgery. Given the pain, time and cost involved, it pays to educate oneself prior to signing up for hair transplant surgery. The hair transplant industry is a fast-growing area and the quality and affordability of hair surgeries are improving, so do not let anybody push you into hasty uninformed decisions.