Understanding hair loss - treatment
What are the treatments?
Although remedies that promise to restore hair to balding heads have been around since ancient times, most men and women with thinning hair can do little to reverse the process. For cosmetic purposes, or after hair lossfrom surgical or drug treatments, many people turn to wigs, hairpieces, and hair weaving - even tattooing to simulate lost eyebrows and eyelashes. Some drugs may slow hair loss, and certain alternative treatments can relieve stress or bolster the health of remaining hair, but until recently no treatment could start hair growth where no hair existed.
Minoxidil. Under certain circumstances, a topical (applied to the skin) preparation containing the drug minoxidil appears to provide moderate re-growth of hair on areas of the scalp that have gone bald. Minoxidil works on hair follicles to reverse their shrinking process to stimulate new growth. The effects are most promising in younger people who are just beginning to show signs of balding or who have small bald patches. The medication is a solution or foam that is applied to balding spots twice a day and must be continued daily; hair loss will recur if the application is stopped. More than 50% of users claim that it can thicken hair and slow hair loss, but it is not considered effective in men who already have extensive male pattern baldness. Side effects appear to be minimal, but in some users the drug may cause skin irritation. The drug is approved for use in men and women. It's available over-the-counter, and not available on the NHS.
Finasteride. Finasteride works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size. Although more research is needed, studies suggest that two-thirds of men who take finasteride, experience some hair regrowth. In the remaining third, there is no hair regrowth, but most do not experience any further hair loss. It normally takes at least four months of using finasteride before any effect is seen, and the balding process will normally resume if treatment is stopped. Finasteride is not available on the NHS, but is available on private prescription from your doctor. It comes as a tablet that you take every day. Side effects are uncommon, although about two in 100 men who use it experience a loss of sex drive. Finasteride is not used to treat female-pattern baldness.
Hair transplantation. Hair transplantation involves the relocation of plugs of skin from parts of the scalp containing active hair follicles to bald areas. A patient may need several hundred plugs - with 10 to 60 implanted at a session. The transplanted hair may drop out, but new hair usually begins to grow from the transplanted follicles within several months. Newer hair transplantation procedures called follicular unit hair transplants can transplant one to four hairs, transplanted very close together, for a more natural look.
Skin lifts and grafts. A "flap" of hair-bearing skin is created by making surgical cuts near the balding area. The flap is then rotated onto the balding section.
Scalp reduction. A form of cosmetic surgery called scalp reduction involves tightening the scalp so that hair-bearing skin from the back and sides of the head is pulled towards the crown. Hair may then be transplanted to the remaining bald area at the top of the head. Like hair transplants, the process is painful and expensive, and it does nothing to slow genetic or age-related hair loss. This procedure is rarely carried out any more.
Steroid injections. Although most cases of alopecia areata are resolved spontaneously, steroid injections appear to be the most effective treatment for small patches of alopecia. A steroid solution is injected several times into the bald areas of skin. This stops the immune system from attacking the hair follicles, and it can stimulate hair to grow again in those patches after about four weeks. Injections are repeated every few months. Alopecia may return when injections are stopped.
Topical steroids and steroid tablets. Topical steroids (creams and ointments) are widely prescribed for alopecia areata, but their long-term benefits are not known. There is some evidence that they can make hair re-grow. Steroids can also be taken as tablets, but alopecia often returns when the tablets are stopped, and taking them for a prolonged period can produce serious side effects, such asdiabetes and stomach ulcers. Other possible side effects are itching or hair growth in other areas.
Immunotherapy. Immunotherapy appears to be the most effective treatment for extensive or total hair loss. A chemical solution called diphencyprone (DPCP) is applied to a small area of bald skin. This is repeated every week, using a stronger amount each time. Eventually, the DPCP causes an allergic reaction and the skin develops mild eczema ( dermatitis). With many people, hair then starts to re-grow after about twelve weeks. A possible side effect is a severe skin reaction, although this can be avoided by increasing the DPCP concentration gradually. Less common side effects include a rash and patchy-coloured skin ( vitiligo). In many cases, if treatment is stopped, the hair falls out again, meaning treatment needs to be maintained. Immunotherapy is only available in specialised centres.
Dithranol cream. Similar to immunotherapy, dithranol cream is applied regularly to the scalp and then washed off. It causes a skin reaction, followed by hair re-growth in some cases. It is not as effective as immunotherapy, it can cause itchiness and scaling of the skin, and it can stain the scalp and hair. For these reasons, dithranol is not widely used.
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