Hair Loss

Treatment Overview

Some people choose to treat hair loss with medications or surgery, such as hair transplantation. Others choose to wear hairpieces (wigs or toupees) or use different methods of hair styling (dyeing or combing). The approach you use depends on the cause of your hair loss. Some people feel they need treatment, while others are not as concerned about thinning hair or baldness.

If a disease, medication, or stress is the underlying cause, treating the disease, changing medications, or eliminating or learning to manage the stress may stop the hair loss.

Treatment for hair loss may boost self-esteem and overall well-being, although the trade-off might be that it affects your health. Some medications may have harmful side effects, and surgery may carry certain risks.

Inherited hair loss

Treatment for inherited hair loss (androgenetic alopecia) aims to prevent hair loss, promote hair growth, and cover bald areas of the scalp. But treatment is not successful for everyone, and you should not expect to regrow a full head of hair.

Medications include:

• Minoxidil. Minoxidil (Rogaine) is available without a prescription and is sprayed on and/or rubbed into the scalp twice a day.
• Finasteride. Finasteride (Propecia) is available by prescription and is taken once daily in pill form. Finasteride has not been proven effective in women and is not approved for women by the U.S. Food and Drug Administration (FDA).³ Women who are or may become pregnant should not take or handle crushed or broken tablets, because finasteride can cause birth defects.

For more information, see:

Should I treat inherited hair loss with medication?

Surgery includes:

• Hair transplantation surgery. During this surgery, your health professional will move small grafts (pieces of skin with hair follicles) from areas of your scalp with full hair to areas of your scalp that are bald or thinning. The grafts may include single hairs or up to 30 hairs in one graft. This is the most common type of surgery used to treat hair loss.
• Scalp reduction. Scalp reduction involves removing large areas of bald scalp from the head. Sections of the scalp with growing hair are then stretched and sewn together to fill in the bald areas.
• Scalp flaps. Scalp flaps involve moving a large section of scalp containing hair from the side and back of the scalp to a bald area. One side of the flap remains attached to the scalp as the section of scalp with hair is moved to cover a bald area. The complication rate of this procedure is higher than other procedures because of bleeding, scarring, and infection after surgery.

Cosmetic approaches to hair loss include:

• Wearing hairpieces or having weaves. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape. Hair weaving involves sewing or braiding pieces of long hair into existing hair.
• Using certain hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp. However, continual use of perms or dyes may result in more hair loss.

Treatment for other causes of hair loss

Hair loss can be caused by diseases, medications or medical treatments, recent surgery, high fevers, emotional stress, lack of protein or iron, and hair care, such as using dyes. Often, treating the underlying cause stops the hair loss, and hair grows back. In some cases, other treatment is necessary.

Hair loss caused by cancer treatment requires special care: use mild shampoos and do not use a hair dryer.

Alopecia areata occurs when the immune system attacks hair follicles, where hair growth begins. Because hair usually grows back within a year, you may decide not to have treatment. Understanding the come-and-go nature of hair loss in this condition can help you make the best treatment decision. Children and teens may need counseling to help them adjust to the hair loss.

Medication used for alopecia areata includes:

• Corticosteroid ointments or creams you put on the scalp. There is little evidence that they cause hair growth.⁴
• Corticosteroids injected into the scalp. The corticosteroid is injected many times about 1 cm (0.4 in.) apart every 4 to 6 weeks. This is the most common treatment and is best used for treating patchy hair loss. Limited research reports that hair grows back at the site of injection in some people.⁴
• Corticosteroids you take by mouth (oral). Although this results in hair growth, it is rarely used because of the side effects of oral corticosteroids.
• Contact immunotherapy. Contact immunotherapy is an experimental therapy that may be the most effective treatment for severe alopecia areata.⁴ A common medication used is diphenylcyclopropenone (DPCP), which is "painted" on the scalp once a week.

Other medications used to treat alopecia areata include minoxidil (Rogaine), anthralin, and cyclosporine. Anthralin is sometimes used in combination with minoxidil. These medications affect the immune system and may stimulate hair growth, but they do not prevent hair loss.

What To Think About

How successful your treatment is depends on your expectations and the cause of hair loss. Treatment for hair loss caused by an illness, medication, or damage to the hair usually is more successful than treatment for inherited hair loss.

Considerations about inherited hair loss include:

• The cost. Medication or surgery to treat hair loss can be expensive and often is not covered by insurance.
• Length of treatment. Medications must be taken continuously or the regrown or thickened hair will fall out. Surgery can be lengthy, and in most cases you will need several surgeries to achieve the coverage you want.
• Side effects. Long-term effects of some hair loss medications are not known.
• Type of treatment. Medications that must be taken continuously can be expensive and can increase the chance of side effects. Surgery, which may be a more permanent solution, is also expensive. In addition, surgery involves risks and the chance that not all hair follicles will remain healthy.

Women with inherited hair loss who wish to take birth control pills should use a pill type that does not add to hair loss, such as a norgestimate or ethynodiol diacetate.⁵

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Author:	Robin Parks, MS	Last Updated: July 3, 2006
Medical Review:	Patrice Burgess, MD - Family Medicine Martin Gabica, MD - Family Medicine Randall D. Burr, MD - Dermatology
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