Management of hair loss


The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.

Prevention

Scratching of itchy scalp may contribute to hair loss.

Health

Body weight

Prevention of obesity helps. Obesity is linked to hair thinning.

Healthy diet

Oils with fatty acids that has been studied to prevent dermatitis includes:
The scalp must be cleaned from sebum, sweat, and dirt, prior to topical application, for agents to penetrate it.
A 2020 systemic review on agents used to treat androgenic alopecia found that:

Humidifier

A humidifier can be used to prevent low indoor humidity during winter, and dry season.
Commonly, patients with seborrhoeic dermatitis experience mild redness, scaly skin lesions and in some cases hair loss.
Low humidity can cause adverse health effects and may cause atopic dermatitis, and seborrhoeic dermatitis.

Treatments

Combination therapy

Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use.
Combination therapy of LLLT or microneedling with finasteride or minoxidil demonstrated substantive increases in hair count.

Medication

Treatments for the various forms of hair loss have only moderate success. Three medications have evidence to support their use in male pattern hair loss: finasteride, dutasteride and minoxidil. They typically work better to prevent further hair loss than to regrow lost hair.
They may be used together when hair loss is progressive or further regrowth is desired after 12 months. Other medications include ketoconazole, and in female androgenic alopecia spironolactone and flutamide.

Baricitinib

In June 2022, the FDA authorized baricitinib for the treatment of severe alopecia areata.

Minoxidil

, applied topically, is widely used for the treatment of hair loss. It may be effective in helping promote hair growth in both men and women with androgenic alopecia. About 40% of men experience hair regrowth after 3–6 months. It is the only topical product that is FDA approved in America for androgenic hair loss. However, increased hair loss has been reported.

Ketoconazole

may help in women.

Antiandrogens

Finasteride
is used to treat male pattern hair loss. Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken. There is no good evidence for its use in women. It may cause gynecomastia, erectile dysfunction and depression.
Dutasteride
is also used in the treatment of male pattern hair loss and appears to have better effectiveness than finasteride for the condition. 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.
Spironolactone
There is tentative support for spironolactone in women. Due to its feminising side effects and risk of infertility it is not often used by men. It can also cause low blood pressure, high blood potassium, and abnormal heart rhythms. Also, women who are pregnant or trying to become pregnant generally cannot use the medication as it is a teratogen, and can cause ambiguous genitalia in newborn children.
Flutamide
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. Like spironolactone, flutamide is typically only used by women. Bicalutamide is another option for the treatment of female pattern hair loss. It has a far lower risk of liver toxicity than flutamide and is said to have an excellent safety profile. However, bicalutamide retains a small risk of liver toxicity and for this reason periodic liver monitoring is recommended during treatment.

Technological treatments

Low-level laser therapy (LLLT)

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 and duration did not alter the effectiveness, with more emphasis to be placed on lasers compared to LEDs. Ultraviolet and infrared light are more effective for alopecia areata, while red light and infrared light is more effective for androgenetic alopecia.
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.

Platelet-rich plasma (PRP)

Using ones own cells and tissues and without harsh side effects, PRP is beneficial for alopecia areata and androgenetic alopecia and can be used as an alternative to minoxidil or finasteride. It has been documented to improve hair density and thickness in both genders. 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. Factors that determine efficacy include amount of sessions, double versus single centrifugation, age and gender, and where the PRP is inserted.
Future larger randomized controlled trials and other high quality studies are still recommended to be carried out and published for a stronger consensus. Further development of a standardized practice for procedure is also recommended.

Surgical treatments

Hair transplantation

Hair transplantation is a surgical technique that moves individual hair follicles from a part of the body called the donor site to bald or balding part of the body known as the recipient site. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.
Since hair naturally grows in follicles in groups of 1 to 4 hairs, transplantation takes advantage of these naturally occurring follicular units. This achieves a more natural appearance by matching hair for hair through Follicular unit transplantation.
Donor hair can be harvested in two different ways. Small grafts of naturally occurring units of one to four hairs, called follicular units, can be moved to balding areas of the hair restoration. These follicular units are surgically implanted in the scalp in very close proximity to one another and in large numbers. The grafts are obtained in one or both of the two primary methods of surgical extraction, follicular unit transplantation, colloquially referred to as "strip harvesting", or Follicular Unit Extraction, in which follicles are transplanted individually.
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. 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.

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.

Regrowth of hair

Facial hair

Eyebrows

0.03% has been used to grow eyebrows.

Eyelashes

The FP receptor agonist, bimatoprost, in the form of an 0.03% ophthalmic solution termed Latisse, is approved by the US Food and Drug Administration to treat hypotrichosis of the eyelashes, in particular to darken and lengthen eyelashes for cosmetic purposes. Also, bimatoprost may be used to treat small or underdeveloped eyelashes.

Scalp hair

Alternative medication

Topical
Some popular plant juices sold as hair serum may, instead of growing human hair, actually inhibit the growth, including 6-gingerol found in ginger.
Among the indigenous peoples of California, plants in the genus Marah were used as a topical treatment for hair loss, with the seeds roasted, mashed, and applied to the scalp as a salve. The cucurbitacins found in Marah are structurally similar to finasteride.
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 in 86.9% of the 23 participants. Twice as many flavonols are found in red onion than in yellow onion. Also, non-organic onions might contain pesticides on the peel and in the first scaly leaf. Compounds found in onion that stimulate hair growth:
  • Quercetin:
  • *Quercetin supplements, has been suggested to treat baldness. A 2012 study demonstrated that alopecia areata could be used to prevent ant treated with quercetin in mice. Quercetin is found in onions primarily in the peel and the first scaly leaf but not in the flesh. Onion bulb size or weight does not appear to be affected by quercetin concentration.
  • *A 2020 study demonstrated that quercitrin stimulated hair shaft growth in cultured human hair follicles.
  • Volatile compounds responsible for pungency and tearing in onions when they are cut. However, no formal studies have been 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 evaporate. 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 genetically modified, and plant breed onions have been produced with significantly reduced levels of tear-inducing lachrymatory factor.