Hair Loss
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Hair Loss-Evidence Based Approach
Hair loss is one of the most common reasons for a visit to the dermatologist. Despite this condition been very common, there are very few medications for hair loss approved by the FDA.
Hair loss affects 50% of the male population nationwide and about 15% of the female population. The most common form of hair loss is called Androgenic alopecia and it affects both male and female. 80% of male hair loss is due to androgenic alopecia. Male hair loss starts at adolescence to age 30 while female hair loss starts around age 20 and for some at menopause. Testosterone plays a significant and leading role in androgenic alopecia. Testosterone is converted in the body to dihydrotestosterone(DHT). This DHT is toxic to the hair follicles leading to thinning out of the hair and eventual bald spots and hair shedding. There are several evidenced based treatments for hair loss that works. Some of this treatments are used off label.
Minoxidil
Minoxidil is a blood pressure medication that causes vasodialation and therefore effective for the treatment of blood pressure. It is found to induce DNA synthesis, cell proliferation and stimulation and its anti inflammatory property maybe the reason for its use in hair loss. The topical solution is FDA approved for hair loss and marketed under Rogaine brand. There are some generics available. However, several clinical studies have shown low dose oral minoxidil to be superior to the topical version for treatment of hair loss, 12% for oral dose compared to 7% improvement with the topical version. Minoxidil has side effects which include low blood pressure, excessive growth of hair in the temple and sideburn areas, fluid retention, headache and tachycardia. Low dose minoxidil in clinical trials produced 80% improvement compared to placebo.
Finasteride/Dutasteride
Finasteride and Dutasteride are both alpha reductase inhibitors which stop the conversion of testosterone to dihydrotestosterone. Recall that dihydrotestosterone is toxic to the hair follicles and therefore the leading cause of hair loss. The difference between Finasteride and Dutasteride is that dutasteride is about 5 times more potent than finasteride. Dutasteride has been shown to be superior to finasteride in reversing and maintaining healthy hair growth. Only finasteride is FDA approved for treating hair loss. Both drugs can be used orally and topically with mesotherapy where it is injected under the scalp to stimulate new hair growth. There are many strategies and options to use and frequency of injection to achieve the goal of therapy. There are adverse effects associated with both drugs. There is loss of sex drive and female of child bearing age should use contraceptive while on this medication and for 6 months thereafter , shorter for finasteride due to risk of feminization of the fetus. Both drugs has been shown to produce about 25% reduction of the risk of prostate cancer in men.
Oral contraceptives
Oral contraceptives are used in combination with other drugs and methods to reverse hair loss. Not all oral contraceptives are indicated for this. Ethinyl estradiol and progestagens with anti androgenic activity are preferred, like dienogest or drospirenone derivatives. Avoid first and second generation testosterone derived progestagens due to their higher androgenic activity. Oral contaceptives are contra indicated in BMI over 40, history of blood cloth disorder, breast or uterine cancer, migraine, hepatomegaly or history of cerebrovascular disease or ischemic heart disease.
PRP
PRP-platelet rich plasma has shown in several clinical trials to produce a profound and sustained improvement in hair loss. It contains growth factors, collagen, anti inflammatory substances, hyaluronic acid, cytokines and other substances not yet identified. PRP have been used extensively off label for hair loss, knee and joint injections for arthritis and acute inflammatory conditions. It is obtained by drawing your blood and spinning it in a centrifuge and injecting to top clear layer which is the plasma known as PRP. A recent clinical trial with PRP has shown a significant increase in hair density. PRP can be used alone or in combination with other methods shown above.
Light Therapy
Light therapy has anti inflammatory and immune modulatory activity which seems to improve local blood flow. Recent data suggest significant improvement with light therapy. The only problem is the proliferation of light therapy equipment with no standardization and difficulty in accessing them, but the technology works Other new agents been studied include topical cetirizine and absorbable threads. It is important to note that reversing hair loss is not a quick fix and will take 24 weeks to one year to see a significant difference in hair density and coverage. Let us know if you have any questions.