Topical or oral preparations may be used for a few weeks to reduce inflammation. Long term use of topical steroids has not shown benefits for growth and the use of long term oral steroids has many risks that typically outweigh the benefits.Immunotherapy
Diphenylcyclopropenone or squaric acid may be used topically for the treatment of alopecia areata as an alternative to steroids. This treatment may cause a local skin reaction.Minoxidil
Minoxidil is a topical treatment that comes in a solution or foam. The foam provides increased delivery of the drug and less irritation. This drug has been shown to decrease telogen and increase anagen phase of hair follicles, increase VEGF expression, and have indirect vasodilation effects. FDA has approved this drug for use in androgenetic alopecia, but frequent offlabel uses include alopecia areata, chemotherapy induced alopecia, telogen effluvium, and traction alopecia.Redensyl
Redensyl is emerging as an alternative hair loss treatment containing a newly discovered molecule called dihydroquercetin-glucoside (DHQG), a compound derived from plant extracts known to target the stem cells in hair follicles and encourages the division of the cells. Still in development stage it has been approved by FDA as many of its medication are available widelyHormone modulating
Androgenetic alopecia is routinely treated with drugs that alter hormonal function, in particular DHTs effects. Male pattern hair loss is treated with oral finasteride which is a 5-alpha reductase inhibitor that blocks the formation of DHT from testosterone. Finasteride may cause sexual dysfunction, but it is typically reversed upon discontinuation of the treatment.
Female pattern hair loss is treated with spironolactone or flutamide that block the effects of DHT receptors.Anti-fungal
Topical anti-fungal treatments such as ketoconazole and pyrithione zinc shampoo are sometimes effective for male pattern hair loss. Topical therapy is not usually effective for tinea capitis for which oral therapy with terbinafine, fluconazole, or griseofulvin is superior.PRP
Patients may benefit from injections of plasma into the scalp to promote the delivery of nutrients in the plasma to the hair follicles. This has been shown to promote growth, blood supply, and collagen production.Surgical
The two common surgical methods to treat hair loss are hair transplantation and scalp reduction. Hair transplantation involves the transfer of intact growing hair follicles from areas such as the back of the head to balding spots. This occurs in multiple visits as the number of transplanted follicles increased to restore a natural look. Scalp reduction is a technique that removes balding spots of skin and stretches the remaining skin that has normal hair growth. This is typically only possible in the back and top of the head and may cover up to half of the balding area. Prognosis
It is important to note that treatment response to hair loss may be unpredictable and variable depending on the cause. 8.5% of patients with alopecia totalis may achieve complete recovery. Certain conditions such as tinea capitis and trichotillomania usually respond once the infection or hair pulling behaviors are stopped. Despite this many patients will achieve at least a temporary or partial recovery of hair loss.