There is no cure for alopecia and no universally proven therapy to induce hair re-growth and sustain remission, however, there are treatments. The effectiveness of treatments tends to vary and something that works well for one person may not work well for another. If you find one treatment doesn't work don't assume others won't either. However, bear in mind for some people none of the treatments are effective. Treatments for alopecia are generally divided into two groups:
People with less than 50% hair loss
People with over 50% hair loss
All of the therapies have documented side effects, some of which can be unpleasant. Treatments such as topical immunotherapy can be very time consuming. Individuals may decide that some of the adverse effects of treatment and the unpredictable outcome are unacceptable.
One of the most difficult aspects of alopecia is
that it is very unpredictable and nobody can say what will happen in the
future. People have found that even after several years of having no
hair they have regrowth, others have found that while patches of hair
loss start to grow they experience hair loss elsewhere. You may also
find that you have regrowth and then it all falls out again. There are
cases where the hair regrows and never falls out again (the majority) or
a few where the hair falls out and never regrows. Having said that, as a
general rule, the longer you have no regrowth and the more severe the
hair loss, the less likely the hair is to grow back permanently. This
doesn't mean that it won't - it just means it's less likely to. The
pattern of your hair loss is not going to be changed by treatments, but
the treatments may help with regrowth. It is your choice. Side Effects None. Most people,
however, do feel that they would like to try some sort of treatment at
some stage, in case it might help.
Treatment for less than 50% hair loss
Today, corticosteroids are the most common treatment for alopecia. In mild cases of alopecia the first choice of treatment would be a corticosteroid cream or lotion which is applied directly to the area(s) of hair loss. Alternatively an injection of corticosteroid can be given directly onto and around the bald area(s). Side Effects Side effects are generally rare when corticosteroids are used for a short time. However, when they are taken by mouth and when used over a longer period, they may lower the body's ability to fight off infections or may make infections harder to treat. Other common side effects include changes in appetite (increase or decrease), nervousness, restlessness, sleep problems, and indigestion. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Less common side effects may occur with some forms of corticosteroids. Gels or creams may irritate the skin. Again, these side effects do not need medical attention unless they don't go away or they interfere with normal activities. More serious side effects are very unlikely, but they may occur. Cost In the UK corticosteroids are only available on prescription. Effectiveness This type of treatment can sometimes result in a recovery or can cause hair to grow only for the period during which the treatment occurs, so when the treatment is stopped the hair may fall out again. In the case of corticosteroid injections an average of 4 to 6 monthly injections are usually required for significant improvement. However although some re-growth is common it does not always occur.
Finasteride is marketed under the brand name of Propecia along with other generic names. It is a licensed synthetic type II 5α-reductase inhibitor. The enzyme converts testosterone to dihydrotestosterone. Systemic Finasteride (1mg Propecia) can be used for the treatment of male pattern baldness. It is still in the experimental stages of use for female pattern baldness.
Side Effects Side effects of finasteride can include impotence and reduced libido, abnormal ejaculation, decreased ejaculatory volume, abnormal sexual function, swelling and tenderness of the breast tissue and testicular pain. Effectiveness It has shown a significant improvement for men (80% of men presenting with male pattern baldness, with 60% of those showing some regrowth). The effects do not continue if the treatment is stopped. For women the results have been less successful (if not disappointing) and it must not be used for women likely to become pregnant. It is not available on the NHS as a treatment for androgenetic hair loss but any problems or questions connected to use of Finasteride should be referred to your doctor.
IRRITANT CONTACT SENSITISATION: Dithranol (also known as Anthralin)
Dithranol is a tar-like ointment that is applied to the scalp and is especially good in the treatment of psoriasis (a skin condition causing red scaly patches). The pharmacist can compound it in various different pastes, ointments, and creams, and the strength may vary from 0.1 to 4%. Side Effects It can irritate the skin when applied and can cause burning and redness. It can also stain. Cost Available on prescription. Commercial and spontaneous Dithranol preparations are inexpensive and, in most cases, the cost is easily covered by the prescription charge. If Dithranol has to be applied by a trained nurse, or combined with UVB therapy, the cost rises sharply but the treatment can then be more effective. Effectiveness Dithranol can be effective even if only left on the skin for 10 minutes. This 'short contact' method allows stronger concentrations of Dithranol to be used with much less burning and staining. The stronger the Dithranol, the better the effect on psoriasis.
Retin A / Tretinoin
Retin-A was originally used for the treatment of acne and other skin problems. However studies have shown that Retin-A, when used alone in the form of a gel, which is rubbed onto the area of hair loss, or in combination with topical Minoxidil can result in moderate to good hair growth in individuals with Alopecia. It is recommended that Minoxidil is used in the morning and Retin-A in the evening as Retin-A increases the skin's sensitivity to sunlight. Side Effects Immediately after applying, the skin may feel warm or mild stinging or redness may occur. Some peeling of the skin may occur. These effects should subside as your skin adjusts to the medication. Cost 1 tube of Retin-A cream starts at around £20 at online pharmacies. Generally the more you buy the less each tube is. Effectiveness Studies have shown that Retin-A, when used alone in the form of a gel, which is rubbed onto the area of hair loss, or in combination with topical Minoxidil can result in moderate to good hair growth in individuals with alopecia.
ALLERGIC CONTACT SENSITISATION: DPCP
DPCP stands for diphenylcyclopropenone. It is a chemical agent used to treat severe alopecia areata. It is said to be safe although there is no information about the long term side effects when used over many years. DPCP comes as a fluid and is applied to the bald areas once a week. Sensitising is achieved with the application of a 2% solution and is applied to a 4x4cm area on the scalp. One week later the area is examined. If there is a severe response with blisters , intense redness , scaling and itching, treatment is postponed till the following week. If there is only mild redness , scaling and itching, a lower concentrate of DPCP can be applied on the hairloss areas. After every administration of DPCP, the painted area should not be washed for 48 hours and kept covered because sunlight inhibits the action of DPCP. Side Effects Eczema, Lymph node enlargement and skin discoloration are all possible side effects. Cost Available from and applied by a dermatologist or nurse. Effectiveness First evidence of hair growth is expected to occur after 3 months, full growth after 6 months. Once full regrowth occurs, the frequency of application is decreased. Even after full growth of hair, some patients may stop responding to further application of DPCP and may lose all their hair again. If after 5 months of using DPCP no hair regrowth is noticed DPCP is discontinued.
Topical Minoxidil / Regaine, Rogaine (this is our name in the US only) or Headway
Topical Minoxidil can be successful in alopecia, slowing down hair loss, and bridging the gap until hair starts growing again on its own. Side Effects Side effects may include irritation of the scalp, itching, scaling, a rash, and on the odd occasion excessive hair growth. Cost Minoxidil is not available on prescription. In the high street prices are about £30 for a 5% solution. However the 2% and 5% solutions can be ordered online for about £20 a bottle. A bottle will normally last for about a month. The solution should not be used by women during pregnancy.
A Minoxidil 5% foam is also available, and is shown to be just as effective as the 5% solution. The foam will last about a month and costs around £35 or £70 for a triple pack.
Effectiveness Topical Minoxidil can be effective on patchy alopecia. Unfortunately topical Minoxidil is not normally effective in individuals with extensive, total or universal alopecia.
Oral zinc has been shown to be of occasional benefit in alopecia. Side Effects Very high doses are needed for it to be effective and this can result in side effects such as vomiting and diarrhoea. Cost Zinc can be bought in any chemist or health food shop. A variety of tablets are sold with different amounts of zinc. 100 caplets of zinc 25mg costs under £10. Effectiveness Prolonged treatment with zinc sulphate is helpful. There is no zinc deficiency noticeable in the body, and short term treatment with zinc is not helpful.
Treatment for over 50% hair loss
It is thought that Immunosuppressive drugs should be able to suppress the immune system giving the hair a chance to re-grow. The main problem with taking immunosuppressive drugs is that it can lead to a lowered resistance to infection. Side Effects Increased chance of infection as the immune system is suppressed and may affect bone marrow, liver or kidneys. Cost These can be obtained via the NHS on prescription.
PUVA treatment involves taking or applying a light sensitive drug and then undergoing a short exposure to UVA (ultraviolet light). Treatment takes place over a three to six week period with sessions two to three times a week. The more recent the hair loss, the more likely it is that there will be a response to treatment. Side Effects The likelihood is your skin will burn, as if over tanned, but it's hoped the body's immune system gets so busy repairing skin tissue that it lets your hair begin to grow. Cost This is available on the NHS, but can be very time consuming involving two or three treatments per week. Effectiveness It has not been shown to have a very high success rate (around 6-12%) - and it can be very painful. It is not considered to be an effective long-term treatment.
Oral corticosteroids (Prednisone) are used to try to partially suppress the immune system and allow hair to grow. Corticosteroids taken orally are sometimes prescribed for extensive hair loss or when the condition is rapidly spreading. Corticosteroids taken internally are much more powerful than local injections into the skin. May be used in conjunction with Minoxidil as the dose is being reduced. Side Effects The most common side effects reported with the short-term (days to weeks) use of oral corticosteroids include a bigger appetite, weight gain, upset stomach, headache, mood changes, and trouble sleeping. Some people may also have an increase in blood sugar and blood pressure. In general, all of these side effects go away after you stop taking corticosteroids. Side effects associated with long-term (months to years) oral corticosteroid include weakening of the immune system, elevations in cholesterol levels, and weight gain. These side effects also usually improve when you stop taking corticosteroids. Long-term use of corticosteroids may also cause brittle bones (osteoporosis), fat deposits on the face and back, thinning of the skin, and cataracts in the eyes. These side effects may improve but usually don't go away completely after stopping the drug. In children, long-term use of oral corticosteroids may cause stunted growth. Cost Available on prescription. Effectiveness When taking oral corticosteroids you are likely to experience some re-growth. However unless your immune system kicks into `normalí action and allows you to produce hair yourself, the re-growth you have experienced will cease and the hair will unfortunately fall out again after you cease the treatment.
This treatment is similar to PUVA but using a different wavelength of light. It is generally used to treat skin conditions but is also used for people with severe hair loss (e.g. more than 90%). It involves standing in a cubicle of ultraviolet lights two to three times a week for an increasing amount of time. Side Effects Like PUVA you may have redness and burning of the skin, similar to spending too long in the sun. Cost Again this is free on the NHS. Alternatively you could arrange a course of sessions on a sun bed. Effectiveness Although there is some documented evidence of success, in most cases this treatment does not appear to help with hair growth and the redness and burning can be quite painful. It may also increase your chance of getting skin cancer.
Information supplied with advice from Dr David Fenton, Consultant Dermatologist.