Alopecia in Women – American Family Physician

C. CAROLYN THIEDKE, M.D., Medical University of South Carolina, Charleston, South Carolina

Am Fam Physician. 2003 Mar 1;67(5):1007-1014.

Patient Information Handout

Alopecia can be divided into disorders in which the hair follicle is normal but the cycling of hair growth is abnormal and disorders in which the hair follicle is damaged. Androgenetic alopecia is the most common cause of hair loss in women. Other disorders include alopecia areata, telogen effluvium, cicatricial alopecia, and traumatic alopecias. The diagnosis is usually based on a thorough history and a focused physical examination. In some patients, selected laboratory tests or punch biopsy may be necessary. Topically administered minoxidil is labeled for the treatment of androgenetic alopecia in women. Corticosteroids and other agents are typically used in women with alopecia areata. Telogen effluvium is often a self-limited disorder. Because alopecia can be devastating to women, management should include an assessment for psychologic effects.

Although alopecia can occur anywhere on the body, it is most distressing when it affects the scalp. Hair loss can range from a small bare patch that is easily masked by hairstyling to a more diffuse and obvious pattern. Alopecia in women has been found to have significantly deleterious effects on self-esteem, psychologic well-being, and body image.1,2

Pathophysiology

Every hair follicle continually goes through three phases: anagen (growth), catagen (involution, or a brief transition between growth and resting), and telogen (resting).3 Disorders of alopecia can be divided into those in which the hair follicle is normal but the cycling of hair growth is abnormal (e.g., telogen effluvium) and those in which the hair follicle is damaged (e.g., cicatricial alopecia).

Diagnosis

A careful history often suggests the underlying cause of alopecia. Crucial factors include the duration and pattern of hair loss, whether the hair is broken or shed at the roots, and whether shedding or thinning has increased. The patient’s diet, medications, present and past medical conditions, and family history of alopecia are other important factors.

The physical examination has three parts. First, the scalp is examined for evidence of erythema, scaling, or inflammation. Follicular units are apparent in nonscarring alopecias but absent in scarring types. Second, the density and distribution of hair are assessed. Third, the hair shaft is examined for caliber, length, shape, and fragility.4

The “pull test” is an easy technique for assessing hair loss. Approximately 60 hairs are grasped between the thumb and the index and middle fingers. The hairs are then gently but firmly pulled. A negative test (six or fewer hairs obtained) indicates normal shedding, whereas a positive test (more than six hairs obtained) indicates a process of active hair shedding. Patients should not shampoo their hair 24 hours before the test is performed.4

If the diagnosis is not clear based on the history and physical examination, selected laboratory tests and, occasionally, punch biopsy may be indicated. A stepwise approach to the diagnosis of hair loss is provided in Figure 1.5,6

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Evaluation of Alopecia in Women

FIGURE 1.

Suggested approach to the evaluation of alopecia in women. (DHEA-S = dehydroepiandrosterone sulfate; ANA = antinuclear antibody)

Adapted with permission from Healey PM, Jacobson EJ. Common medical diagnoses: an algorithmic approach. 3d ed. Philadelphia: Saunders, 2000:208–11, with additional information from Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, et al. Guidelines of care for androgenetic alopecia. American Academy of Dermatology. J Am Acad Dermatol 1996;35(3 pt 1):465–9.

Evaluation of Alopecia in Women

FIGURE 1.

Suggested approach to the evaluation of alopecia in women. (DHEA-S = dehydroepiandrosterone sulfate; ANA = antinuclear antibody)

Adapted with permission from Healey PM, Jacobson EJ. Common medical diagnoses: an algorithmic approach. 3d ed. Philadelphia: Saunders, 2000:208–11, with additional information from Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, et al. Guidelines of care for androgenetic alopecia. American Academy of Dermatology. J Am Acad Dermatol 1996;35(3 pt 1):465–9.

Androgenetic Alopecia

Androgenetic alopecia, or hair loss mediated by the presence of the androgen dihydrotestosterone, is the most common form of alopecia in men and women. Almost all persons have some degree of androgenetic alopecia.7 The hair loss usually begins between the ages of 12 and 40 years and is frequently insufficient to be noticed. However, visible hair loss occurs in approximately one half of all persons by the age of 50 years8 (Figure 2). In women, hairstyling may mask early hair loss.

FIGURE 2.

Androgenetic alopecia.

Hair follicles contain androgen receptors. In the presence of androgens, genes that shorten the anagen phase are activated, and hair follicles shrink or become miniaturized. With successive anagen cycles, the follicles become smaller (leading to shorter, finer hair), and nonpigmented vellus hairs replace pigmented terminal hairs. In women, the thinning is diffuse, but more marked in the frontal and parietal regions. Even persons with severe androgenetic alopecia almost always have a thin fringe of hair frontally. The remaining hair configuration may resemble a monk’s haircut.

Women with androgenetic alopecia do not have higher levels of circulating androgens. However, they have been found to have higher levels of 5α-reductase (which converts testosterone to dihydrotestosterone), more androgen receptors, and lower levels of cytochrome P450 (which converts testosterone to estrogen).6

Most women with androgenetic alopecia have normal menses, normal fertility, and normal endocrine function, including gender-appropriate levels of circulating androgens. Therefore, an extensive hormonal work-up is unnecessary. If a woman has irregular menses, abrupt hair loss, hirsutism, or acne recurrence, an endocrine evaluation is appropriate. In this situation, total testosterone, free testosterone, dehydroepiandrosterone sulfate, and prolactin levels should be obtained.6

Because the hair loss in androgenetic alopecia is an aberration of the normal hair cycle, it is theoretically reversible. Advanced androgenetic alopecia, however, may not respond to treatment, because the inflammation that surrounds the bulge area of the follicle may irreparably damage the follicular stem cell.

TREATMENT

Minoxidil (Rogaine)

The currently preferred treatment for androgenetic alopecia is topically administered 2 percent minoxidil.6,8,9 Minoxidil appears to affect the hair follicle in three ways: it increases the length of time follicles spend in anagen, it “wakes up” follicles that are in catagen, and it enlarges the actual follicles. The mechanism by which minoxidil effects these changes is not known. Vellus hairs enlarge and are converted to terminal hairs. In addition, shedding is reduced.

In a randomized, controlled, double-blind clinical trial involving 550 women 18 to 45 years of age, treatment with 2 percent minoxidil solution resulted in a higher hair count compared with placebo.10 [Evidence label A, randomized controlled trial] In another study,11 50 percent of women treated with 2 percent minoxidil had at least minimal hair regrowth, and 13 percent had moderate regrowth. No significantly increased benefit has been shown for the 5 percent minoxidil solution compared with the 2 percent solution.8 The U.S. Food and Drug Administration (FDA) has labeled topically administered minoxidil for the treatment of androgenetic alopecia. A dropper is used to apply minoxidil solution directly onto dry scalp twice daily. After each use, hands should be washed thoroughly to avoid inadvertent application to other parts of the body. Minoxidil is listed as a pregnancy category C drug. It is not recommended for use in persons younger than 18 years.

The primary side effect of topical minoxidil therapy is hypertrichosis (excessive hair growth). The hair growth is most often noted above the eyebrows, in the malar region, and on the lateral cheeks. It occasionally occurs above the upper lip and on the chin. Facial hypertrichosis has been reported to affect 3 to 5 percent of women treated with the 2 percent solution and more than 5 percent of women treated with the 5 percent solution.8

Hypertrichosis disappears after a year, even with continued use of minoxidil, and remits within one to six months if treatment is stopped.8 Bleaching of longer, darker hair is helpful cosmetically. Hair removal procedures are seldom necessary. Explanations for the occurrence of this side effect include local intravascular spread of minoxidil, inadvertent manual transfer of the drug to the face, and transmission of residual minoxidil from pillows.8

Commercial preparations contain minoxidil in a propylene glycol base. Allergic reactions to this base limit the usefulness of minoxidil therapy in some women. A compounding pharmacist can prepare an alternative preparation in which minoxidil is suspended in a less sensitizing agent such as polyethylene glycol.12

Exogenous Estrogen

In the past, exogenous estrogen was used to treat androgenetic alopecia. This treatment is used less often now, because minoxidil is more effective. In fertile women with androgenetic alopecia who request oral contraception, it is important to select a pill containing the least androgenic progestin, such as norgestimate (in Ortho-Cyclen, Ortho Tri-Cyclen), norethindrone (in Ovcon 35), desogestrel (in Mircette), or ethynodiol diacetate (in Demulen, Zovia).8

Spironolactone (Aldactone)

This drug is a weak competitive inhibitor of androgen binding to androgen receptors. It also decreases the synthesis of testosterone. For these reasons, orally administered spironolactone has been tried in the treatment of androgenetic alopecia, although questions remain about its usefulness. Spironolactone can be beneficial in women who also have hirsuitism. 13 However, the FDA has not labeled this drug for the treatment of androgenetic alopecia.

Finasteride (Proscar)

This agent has been shown to be effective in men with alopecia. However, finasteride should not be used in women of childbearing age, because 5α-reductase inhibitors may cause abnormalities of the external genitalia in the male fetus. Moreover, finasteride has not been shown to be useful in postmenopausal women with androgenetic alopecia.8

Tretinoin (Retin-A)

Topical tretinoin therapy as an adjunct to minoxidil has shown some promise.6,14

Other Treatments and Hair-Care Practices

When hair loss is extensive, wigs may be worn. The use of minigrafts, rather than larger plugs, in hair transplantation provides a more cosmetically pleasing outcome.15

Hairstyling, teasing, coloring, permanents, and the use of hair spray are supported, rather than prohibited, as means of dealing with the cosmetic effects of androgenetic alopecia. Women may shampoo their hair as frequently as they wish without fear of worsening hair loss. 8

Alopecia Areata

Alopecia areata is patchy hair loss of autoimmune origin7 (Figure 3). It usually presents as a single oval patch or multiple confluent patches of asymptomatic, well-circumscribed, non-scarring alopecia. Severity varies from a small bare patch to loss of hair on the entire scalp. So-called “exclamation point” hairs are a hallmark of the disorder. These hairs are usually located at the periphery of the patch and extend several millimeters above the scalp.16

FIGURE 3.

Alopecia areata.

Alopecia areata occurs in 2 percent of the general population, with men and women equally affected. The condition may be present in persons of any age, but is more common in children and young adults.16,17

The course of alopecia areata is one of spontaneous remissions and recurrences. Although patients with this disorder are usually otherwise healthy, some have comorbid conditions such as atopy, thyroid disease, or vitiligo. Alopecia areata has been strongly associated with certain human leukocyte antigen class II alleles. 17

TREATMENT

Immunomodulating agents used in the treatment of alopecia areata include corticosteroids, 5 percent minoxidil, and anthralin cream (Psoriatec). Topical immunotherapeutic agents (e.g., dinitrochlorobenzene, squaric acid dibutyl ester, and diphenylcyclopropenone) are also used, although management regimens for these potent agents are challenging. Dermatology consultation or referral may be necessary. All of these agents stimulate hair growth but do not prevent hair loss. Moreover, they probably do not influence the course of the disease.

Unless alopecia areata is mild and easily masked, psychologic distress can be extreme. Therefore, most physicians feel obliged to offer some form of treatment to affected patients.

Corticosteroids

The most common treatment for alopecia areata is intralesional injection of a corticosteroid, preferably tri-amcinolone acetonide (Kenalog). The recommended dose is up to 3 mL of a 5 mg per mL solution injected into the mid-dermis in multiple sites 1 cm apart. 17 A 0.5-inch-long 30-gauge needle is used, and 0.1 mL is injected into each site. Hair growth usually becomes apparent in four weeks. Treatment can be repeated every four to six weeks. Local skin atrophy, the predominant side effect, can be minimized by taking care to inject into the mid-dermis, rather than into the more superficial epidermis or the subdermal fat.

Topical corticosteroid therapy can be used, although it is not as effective as intralesional injections. Twice-daily application of 1 mL of an intermediate-potency corticosteroid solution or lotion to the entire scalp is routinely used to supplement corticosteroid injections.16 Regimens that combine topical corticosteroid therapy with anthralin or minoxidil also can be beneficial.

Although oral corticosteroid therapy is effective in the treatment of alopecia areata, it is seldom used because of potential adverse effects. Systemic treatment may be indicated in women with progressive alopecia areata. For active, extensive, or rapidly spreading alopecia areata, the recommended treatment in adults weighing more than 60 kg (132 lb) is prednisone in a dosage of 40 mg per day for seven days; the corticosteroid is then tapered slowly by 5 mg every few days for six weeks. 8 For less extensive alopecia areata, prednisone is given in a dosage of 20 mg per day or every other day, followed by slow tapering in increments of 1 mg once the condition is stable. Oral prednisone therapy can be used in combination with topical or injected corticosteroid therapy, as well as with topical minoxidil therapy.

Minoxidil

Topical administration of minoxidil, particularly the 5 percent solution, has been found to be somewhat effective in the treatment of alopecia areata. In one study,8 this treatment produced acceptable results in 40 percent of patients who had lost 25 to 99 percent of their scalp hair. The FDA has not labeled topically administered minoxidil for the treatment of alopecia areata.

Anthralin

Treatment with anthralin, a nonspecific immunomodulator, is safe and effective, particularly in patients with widespread alopecia areata. Anthralin is available in 0.1, 0.25, 0.5, and 1.0 percent creams, which can be applied once daily at home for progressively longer periods, starting with five minutes at a time and working up to as long as one hour. After each application period, the scalp is rinsed thoroughly with cool to lukewarm water and then cleaned with soap. New hair growth becomes apparent in two to three months. Approximately 25 percent of patients have cosmetically acceptable results within six months.18

Selection of the optimal treatment approach depends on the extent of the hair loss (Table 1). If less than 50 percent of the scalp is affected, intralesional corticosteroid injections alone or with topical corticosteroid therapy can be tried. If more than 50 percent of the scalp is involved, a multiple-agent regimen is appropriate. Treatment should be continued until remission of the condition or until residual bare patches can be covered with newly grown hair. Hence, treatment may need to be continued for months to years.

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TABLE 1

Treatment Options for Alopecia Areata in Adult Women

TABLE 1

Treatment Options for Alopecia Areata in Adult Women

Telogen Effluvium

Telogen effluvium is diffuse hair loss caused by any condition or situation that shifts the normal distribution of follicles in anagen to a telogen-predominant distribution. 3 Women with this disorder usually note an increased number of loose hairs on their hairbrush or shower floor. Daily loss may range from 100 to 300 hairs. If hair loss is at the lower end of the range, it may be inapparent. Telogen effluvium may unmask previously unrecognized androgenetic alopecia.

A number of conditions are associated with telogen effluvium (Table 2).19 Although stress is the most common underlying cause, the disorder also can develop because of normal physiologic events (e.g., lengthening of telogen in the postpartum state), some medications,20 and several endocrinopathies (thyroid, pituitary, and parathyroid disease). Telogen effluvium usually begins two to four months after the causative event and lasts for several months. If telogen effluvium is suspected, a thorough history should be obtained.

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TABLE 2

Causes of Telogen Effluvium

TABLE 2

Causes of Telogen Effluvium

Treatment is based on identifying and treating or correcting the underlying cause of telogen effluvium. It can be reassuring for women to understand the relationship of their hair loss to a specific event or agent, and to know that hair regrowth is probable (Figure 4).

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FIGURE 4.

Short hairs frontally, reflecting new growth after telogen effluvium.

FIGURE 4.

Short hairs frontally, reflecting new growth after telogen effluvium.

Alopecia from Damage to Hair Follicles

Cicatricial alopecia is hair loss resulting from a condition that damages the scalp and hair follicle7 (Figure 5). In addition to a bald spot, the scalp usually has an abnormal appearance. Plaques of erythema with or without scaling or pustules may be present. Conditions that can be associated with cicatricial alopecia include infections (e.g., syphilis, tuberculosis, acquired immunodeficiency syndrome, herpes zoster), autoimmune disease (discoid lupus erythematosus), sarcoidosis, scalp trauma (e.g., injuries, burns), and radiation therapy.7

FIGURE 5.

Cicatricial alopecia with damage to the underlying scalp.

If the cause of the disorder is not readily apparent, a 4-mm punch biopsy of the scalp can be helpful. Frequent findings on biopsy include lymphocytic proliferation around the follicle, destroyed follicles, a thin and atrophic epidermis, and a densely sclerotic dermis.

Traumatic alopecia can be caused by cosmetic practices that damage hair follicles over time.7 Cosmetic alopecia has been linked to the use of brush rollers, curling irons, hair brushes with square or angular tips, and tight braiding of the hair (Figure 6). Chemicals used repetitively on the hair also can damage follicles. Examination of the scalp shows short broken hairs, folliculitis and, frequently, scarring.

FIGURE 6.

Traumatic alopecia caused by tight braiding.

Trichotillomania, another cause of traumatic alopecia, is a compulsive behavior involving the repeated plucking of one’s hair.21 The behavior is frequently a response to a stressful situation. Women display this behavior more often than men, and children more often than adults. Children are often aware that they are plucking their hair and may be amenable to behavioral interventions. When the behavior persists into adulthood, patients may not acknowledge the behavior.

Trichotillomania is often difficult to treat. A variety of pharmacologic agents, mostly antidepressants, have been tried with some success.22 A combination of pharmacologic and behavioral therapies also has been attempted.23

What is the role of minoxidil in the treatment of alopecia areata?

Minoxidil (Rogaine) for Hair Loss in Women & its Side Effects

7 Things Not to Do for Hair Loss

Who May Need Minoxidil and How It Works

Minoxidil applied topically to the scalp only works if your hair loss is a result of female pattern baldness and not some other condition, says Clarissa Yang, MD, a dermatologist at Brigham and Women’s Hospital in Boston.

Normally, hair grows about half of an inch each month. Each hair grows for up to six years, then it stops growing, rests for a while, and eventually falls out and is replaced by a new hair that grows for six years. If your hair is growing normally, about 85 percent of it is growing at any given time and 15 percent of it is resting.

But if you have female pattern baldness, your hair follicles get smaller and smaller over time, Dr. Yang says. The smaller they are, the shorter the amount of time your hair grows. Eventually, when strands of hair fall out, they’re not replaced with normal new hair, but instead by thinner, finer strands of hair.

Doctors think that, among other possible causes, aging, genetics, and a change in the level of male hormones, or androgens, after menopause may be part of what brings on female pattern baldness. (That’s why female pattern baldness is also called androgenetic alopecia).

Minoxidil is the only drug which is FDA-approved to treat female pattern baldness. It works by prolonging the growth phase of the hair follicles, Yang says. It’s recommended that women use minoxidil 2%, while men can use the 5% formula.

Minoxidil: Pros

In most women, minoxidil slows down or stops hair loss. And in up to a quarter of the women who take it, minoxidil can actually encourage new hair to grow. It works best when you use it as soon as you notice that you’re losing hair, Yang says.

It’s available over the counter, so you don’t need a prescription from a doctor to get it. However, Yang encourages everyone to see a primary care doctor or a dermatologist before beginning treatment, because there could be a medical problem that’s causing the hair loss, such as thyroid dysfunction or nutritional abnormalities.

Try the Hair Loss Prevention Diet

Minoxidil: Cons

There also are some disadvantages to taking minoxidil as a hair loss treatment. These include:

• It’s expensive. Buying Rogaine for women can cost about $30 for two ounces, but a generic form of minoxidil 2% costs almost half the price. It’s also something you have to continue using indefinitely because the results go away if you stop the medication, Yang says.
• It can be inconvenient. You have to apply it to the scalp two times a day.
• It can cause unwanted hair growth. Some women may experience facial hair growth when they use minoxidil. That can happen if the medication trickles down onto your face or simply as a side effect when you apply it only to your scalp. The risk is lower for women who use the 2 percent concentration of the drug, as opposed to the 5 percent concentration that’s designed for men.
• It can cause more hair loss at first. You may notice an increase in hair loss during the first two to four weeks of using minoxidil, Yang says. That happens because some of the old hairs are being pushed out by new ones, she says.
• It can take months to see results. You have to use it for at least four months — and possibly a year — before you see results. Even then, only about one in five women will have moderate hair regrowth, with a larger percentage noticing only that their hair loss seems to slow down or stop.
• It can irritate your skin. You may experience some irritation, flaking, and redness.

It’s not easy knowing you may never have the same long locks or hairstyles you had when you were younger, but minoxidil is a relatively easy, safe way to fight the loss of your hair.

What Types of Alopecia Can Minoxidil Treat?

There are many types of alopecia. Find out if the medication minoxidil might be the right hair loss treatment for you.

Alopecia is the medical term for hair loss. Since there are different types of alopecia, you need to see a medical professional to find out which kind you have. Depending on the reason for your hair loss, they may recommend the medication minoxidil.

What Is Minoxidil?

Minoxidil is a non-prescription drug that can spur hair growth and keep you from losing more hair, according to the American Academy of Dermatology. Minoxidil comes in foam and solution forms. You rub it into your scalp, typically once or twice a day, the academy says.

What Types of Alopecia Does Minoxidil Treat?

“Minoxidil is the FDA-approved treatment of male- and female-pattern hair loss, known as androgenetic alopecia,” dermatologist Adam Mamelak, MD, tells WebMD Connect to Care. Androgenetic alopecia is the most common form of alopecia, according to NYU Langone Health. About 50 million men in the United States have it.

Mamelak says minoxidil “is also showing its usefulness” for:

• Alopecia areata: an autoimmune disease that often causes round or oval bald patches, according to the American Academy of Dermatology 
• Telogen effluvium: hair loss that can be triggered by a variety of things, from childbirth to surgery to severe stress, according to Harvard Medical School
• Chemotherapy-induced hair loss

Minoxidil works best if you use it soon after you start losing hair. Once you begin taking it, you may continue losing hair for about 2 weeks before minoxidil starts to take effect.

You may have to take minoxidil for several months before you see results—and you’ll have to keep using it exactly as directed to hold onto any new hair you grow. Minoxidil can be more effective if you use it along with another hair loss treatment that your dermatologist recommends, the American Academy of Dermatology says.

The medication’s effectiveness has its limits. It’s not used for a receding hairline or baldness at the front of your scalp. 

Don’t Wait. Get Help Today.

The sooner you address the symptoms of hair loss, the more likely you are to benefit from a medication like minoxidil. Speak to a medical professional today to begin your journey to a fuller head of hair.

Alopecia Areata: Causes, Symptoms & Management

Overview

What is alopecia areata?

Alopecia areata is a condition that causes a person’s hair to fall out. (Alopecia is the medical term for hair loss; there are various types of alopecia, including alopecia areata.)

Who gets alopecia areata?

Anyone can develop alopecia; however, your chances of having alopecia areata are slightly greater if you have a relative with the condition. In addition, alopecia areata occurs more often among people who have family members with autoimmune disorders such as diabetes, lupus or thyroid disease.

Symptoms and Causes

What are the causes and symptoms of alopecia areata?

Alopecia areata is an autoimmune disease, where a person’s immune system attacks the body, in this case, the hair follicles. When this happens, the person’s hair begins to fall out, often in clumps the size and shape of a quarter. The extent of the hair loss varies; in some cases, it is only in a few spots. In others, the hair loss can be greater. On rare occasions, the person loses all of the hair on his or her head (alopecia areata totalis) or entire body (alopecia areata universalis).

It is believed that the person’s genetic makeup may trigger the autoimmune reaction of alopecia areata, along with a virus or a substance the person comes into contact with.

Alopecia areata is an unpredictable disease. In some people, hair grows back but falls out again later. In others, hair grows back and remains. Each case is unique. Even if someone loses all of his or her hair, there is a chance that it will grow back.

Management and Treatment

How is alopecia areata treated?

Alopecia areata cannot be cured; however, it can be treated and the hair can grow back.

In many cases, alopecia is treated with drugs that are used for other conditions. Treatment options for alopecia areata include:

• Corticosteroids: anti-inflammatory drugs that are prescribed for autoimmune diseases. Corticosteroids can be given as an injection into the scalp or other areas, orally (as a pill), or applied topically (rubbed into the skin) as an ointment, cream, or foam. Response to therapy may be gradual.
• Rogaine ® (minoxidil): this topical drug is already used as a treatment for pattern baldness. It usually takes about 12 weeks of treatment with Rogaine before hair begins to grow.

Other drugs that are used for alopecia with varying degrees of effectiveness include medications used to treat psoriasis and topical sensitizers (drugs that are applied to the skin and cause an allergic reaction that can cause hair growth).

Living With

Living with alopecia areata

Apart from drug treatments, there are various cosmetic and protective techniques that people with alopecia can try. These include:

• Use makeup to hide or minimize hair loss.
• Wear sunglasses to protect the eyes from the sun and the environment (if there is loss of eyelashes).
• Wear coverings (wigs, hats, or scarves) to protect the head from the elements.
• Eat a well-balanced diet. Hair growth is a vitamin- and mineral-dependent process. People on fad diets often have problems with hair loss (although not specifically related to alopecia areata.)
• Reduce stress. Although never proven through large trials and investigations, many people with new onset alopecia areata have had recent stresses in life, such as work, family, deaths, surgeries, accidents, etc.

Resources

Resources

While the disease is not medically serious, it can impact people psychologically. Support groups are available to help people with alopecia areata deal with the psychological effects of the condition. Further information may be found at the National Alopecia Areata Foundation (www.naaf.org).

Alopecia Areata – Dermatologic Disorders

• Sometimes topical anthralin, minoxidil, or both

• Sometimes topical immunotherapy

• Rarely photochemotherapy or psoralen plus ultraviolet A (PUVA)

• Use of hairpieces and camouflage techniques

If therapy is considered, intralesional corticosteroid injection is the treatment of choice in adults. Triamcinolone acetonide suspension (typically in doses of 0.1 to 3 mL of 2.5 to 5 mg/mL concentration every 4 to 8 weeks) can be injected intradermally if the lesions are small. Potent topical corticosteroids (eg, clobetasol propionate 0.05% foam, gel, or ointment 2 times a day for about 4 weeks) can be used; however, they often do not penetrate to the depth of the hair bulb where the inflammatory process is located. Oral corticosteroids are effective, but hair loss often recurs after cessation of therapy and adverse effects limit use.

Topical anthralin cream (0.5 to 1% applied for 10 to 20 minutes daily then washed off; contact time titrated as tolerated up to 1 hour/day) may be used to stimulate a mild irritant reaction. Minoxidil 5% solution may be helpful as an adjuvant to corticosteroid or anthralin treatment.

Induction of allergic contact dermatitis using diphenylcyclopropenone or squaric acid dibutylester (topical immunotherapy) leads to hair growth due to unknown mechanisms, but this treatment is best reserved for patients with diffuse involvement who have not responded to other therapies.

Systemic and topical PUVA have been used with limited success in patients who fail conventional therapy. However, this is a less favored treatment option because of high relapse rates, lack of randomized controlled trials, and increased risk of cancer with PUVA.

Alopecia areata may spontaneously regress, become chronic, or spread diffusely. Risk factors for chronicity include extensive involvement, onset before adolescence, atopy, and involvement of the peripheral temporal and occipital scalp (ophiasis).

Hairpieces and camouflage techniques can be used to mask the effects of hair loss.

• 1. Strazzulla LC, Wang EHC, Avila L, et al: Alopecia areata: An appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol 78(1):15-24, 2018. doi: 10.1016/j.jaad.2017.04.1142

• 2. Damsky W, King BA: JAK inhibitors in dermatology: The promise of a new drug class. J Am Acad Dermatol 76(4):736-744, 2017. doi: 10.1016/j.jaad.2016.12.005

• 3. Bavart CB, DeNiro KL, Brichta L, et al: Topical Janus kinase inhibitors for the treatment of pediatric alopecia areata. J Am Acad Dermatol 77(1):167-170, 2017. doi: 10.1016/j.jaad.2017.03.024

UC Davis Health | Department of Dermatology

Regardless of gender, it can be upsetting to unexpectedly start losing your hair. If you have hair loss or thinning hair, you may also have an itchy, painful or sensitive scalp. In the UC Davis Health Specialty Clinic for Hair Disorders, we offer effective, advanced treatments for all types of alopecia, or unexplained hair loss.

What is alopecia?

This skin disorder causes hair to fall out from the scalp, face or body. There are different types of alopecia, including:

• Alopecia areata causes isolated, circular bald patches on the scalp.
• Central centrifugal cicatricial alopecia (CCCA) causes hair to thin outward from the crown of the scalp.
• Lichen planopilaris causes thinning hair or bald patches along with itchy, scaly skin. It may lead to permanent hair loss.
• Androgenetic alopecia causes the hairline to cede as well as hair loss on the top and front of the head.
• Telogen effluvium causes temporary hair loss typically due to stress or a traumatic event.

What causes alopecia?

Alopecia affects people of all ages, genders, races and ethnicities. It can start in childhood. Several factors may contribute to hair loss, including:

• Autoimmune disease: For unknown reasons, the immune system mistakenly attacks healthy hair follicles, stopping hair growth.
• Genetics: Genes play a small role in alopecia. Most children with alopecia do not have a parent with the disorder. And most parents with alopecia do not pass on the disorder to their children. UC Davis Health counselors in genomic medicine can help you understand potential genetic links.
• Hair products: Women who use hot oils and chemical relaxers may be more prone to CCCA. These hair products can inflame the scalp and cause hair follicle scarring that stops hair growth.
• Hairstyles: Repeatedly pulling on hair to create certain hairstyles can damage hair follicles. This condition, called traction alopecia, is more common in Black women.
• Hormones: The androgen hormone regulates hair growth in both men and women. People with high androgen levels may experience rapid hair loss. Others have a faulty androgen receptor gene that causes androgenetic alopecia. Men with this faulty gene experience male-pattern baldness while women have thinning hair.
• Nutritional deficiencies: A diet lacking in certain vitamins and nutrients may affect hair growth.

Why choose UC Davis for alopecia and hair disorder care

Our Specialty Clinic for Hair Loss Disorders stands out in Sacramento for many reasons. We offer:

• Leading expertise: Our clinic director Oma Agbai, M.D., has completed the highest level of training in the treatment of hair loss and ethnic skin conditions. She uses her advanced education and experience to accurately assess your situation and identify a treatment that works. We are the only hair loss disorders clinic in Sacramento that has this level of expertise. Dr. Agbai also oversees the Multicultural Dermatology Clinic.
• Wide range of treatments: Once we know what is causing the hair loss, we customize your treatment plan for maximum effectiveness. Dr. Agbai is actively involved in dermatology research and clinical trials to find new ways to stop unwanted hair loss. You may be able to try new therapies still in development.
• Specialized team: Our team of board-certified dermatologists provides advanced care for all types of common and complex skin and hair problems. Learn more about our dermatology specialties.
• Advanced diagnostics: Pinpointing the underlying cause and type of alopecia is key to proper treatment. You undergo a thorough evaluation that includes:
  • Personal medical history
  • Dietary assessment
  • Blood tests
  • Tissue sample (biopsy) sent to our Dermatopathology Service for tests

Our hair loss treatments

Depending on the hair loss type and cause, treatments may help your hair grow back. When hair regrowth is not possible, we offer treatments to stop or slow hair loss. Your physician may recommend one or more of these treatments:

Rogaine® (minoxidil)

Twice-daily treatment with topical minoxidil (Rogaine) can slow hair loss and stimulate new hair growth. This prescription cream may be combined with a topical corticosteroid cream. Hair may gradually fall out when treatment stops. Minoxidil is not effective on people who have complete hair loss.

Topical corticosteroids

Topical (applied directly to skin) corticosteroid products decrease hair follicle inflammation, which promotes new hair growth. Your physician may combine this topical treatment with other therapies.

Topical anthralin

This anti-inflammatory product stimulates new hair growth. You apply the substance to bald patches daily and then wash it off within an hour.

Topical immunotherapy

Topical immunotherapy creams alter the immune system by causing an allergic rash (also known as allergic contact dermatitis). The rash looks like poison ivy and may be red and itchy. It lasts about 36 hours.

Approximately 40% of people with alopecia areata experience hair regrowth within six months, but you must continue treatment to maintain your results.

Corticosteroid injections

This treatment for alopecia areata stimulates hair follicles to grow new hair. New hair growth may be noticeable within two months.

Corticosteroid injections do not prevent hair loss. New hair growth may fall out when treatments end.

Your physician:

1. Injects a steroid solution into and around bald patches
2. Repeats the process every six to eight weeks

Propecia® (finasteride)

This prescription oral medication lowers the dihydrotestosterone (DHT) hormone in men that shrinks hair follicles. You take the medication daily to stop hair loss and stimulate hair regrowth. Results can take up to six months. Hair loss resumes when treatment stops.

Oral immunosuppressants

If an autoimmune disease is the cause of alopecia, immunosuppressants can lessen the abnormal immune response. The new hair growth may fall out when treatment stops.

Immunosuppressants, such as oral corticosteroids, can cause side effects. Your physician will closely monitor your health. Potential side effects include:

Vitamins and supplements for hair loss

Certain nutritional deficiencies can affect hair growth. Your physician will review your nutrient intake and recommend supplements to support hair growth. These supplements may include:

Contact us

To schedule an appointment, please call (800) 770-9282 or (916) 734-6111.

Alopecia areata

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Alopecia areata belongs to recurrent non-scarring forms of alopecia, and any area of ​​the scalp can be involved in the pathological process.

Hair loss lesions that form within the framework of the disease can take any shape: round, oval or point. The balding process is benign, which does not exclude the appearance of psychoemotional trauma in patients.

The true causes of the development of alopecia areata remain unclear today.The risk factors for the development of this disease are also not fully determined, we can confidently say only that an important role in the development of the pathological process is played by unfavorable heredity and stress. At the same time, experts attribute stress only to indirect risk factors that can cause the disease in the presence of a genetic predisposition and cannot be the root cause of the disease.

The pathogenesis of alopecia areata is also not fully understood.The most likely version is the T-cell-mediated autoimmune condition, it can cause alopecia areata in patients with a genetic predisposition.

Another area of ​​studying the mechanisms of development of focal alopecia, which is of interest to specialists, is the study of the processes occurring in the perifollicular nerves. This theory is supported by the fact that patients with alopecia areata sometimes complain of itching or pain in the lesions, this indicates violations in the fibers of the peripheral nervous system.

According to the viral theory, alopecia areata can begin after a viral infection, but sufficient evidence has not yet been collected in favor of this assumption.

Clinical manifestations: Alopecia areata is characterized by a smooth, even surface of the skin in the alopecia areata, the skin in the areas of baldness turns slightly red or does not change color. The tops of the hair take on the shape of a question mark, and the hair shaft itself does not pass the strength test.Hair that is easily pulled out speaks in favor of the active stage of the disease, which will be accompanied by further hair loss.

Alopecia areata often occurs with hair loss not only in the lesion focus: in most cases, alopecia occurs in several areas at once with the formation of round or oval pathological foci.

Treatment: Therapeutic procedures are mostly aimed at stimulating hair growth. An individually selected course of treatment usually depends on the duration of the course of alopecia areata, the patient’s age, the area of ​​the pathological foci and the patient’s state of health.

Great attention should be paid to assessing the effectiveness of the therapy in order to make the most accurate prognosis of the course of the disease and to prevent the development of relapses. Spontaneous remission can confuse the doctor, masking the real effectiveness of treatment.

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The third stage of hair loss. In the sixth month of use, hair that has grown after using minoxidil will fall out again. Therefore, prepare for this stage in advance. Moreover, such periods of loss can. Canceling Minoxidil – How Much Hair Loss? … Minoxidil cannot cure ”androgenic alopecia, it does not eliminate the cause of androgenic alopecia, it is used to get an effect on the time of use.Minoxidil also does not reverse the effects of androgens on. Victory over the drop. Without Minoxidil! My hair story on April 17th. In addition, the hair did not fall out, but almost did not grow. 3 cm in half a year not. You have come across an illiterate trichologist, minoxidil is not needed at all for hormonal loss, indeed, it is required only for androgenic. Minoxidil for hair loss. Minoxidil is an effective and affordable remedy for. Application. In the first weeks of using the product, amplification is possible. Hair loss during breastfeeding: what to do? The rule that minoxidil should be used forever or lost hair if you stop using it applies to.Therefore, any such use for alopecia areata is called off-label. Because minoxidil is only officially approved for. Minoxidil is the most effective remedy aimed at combating androgenetic alopecia, which exists today in Russia and abroad, but this group is not dedicated to him. Let’s see why. Minoxidil has a direct effect on the cellular. One of the most common ways to combat hair loss is to use products based on minoxidil and its analogues.Minoxidil is an antihypertensive drug. Consultation on the topic – Hair loss from minoxidil – Hello! By nature, I have thin and not thick hair that does not grow below the shoulder blades. Hair did not fall out, only gradually broke at a certain length.

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Recently I was looking closely at myself in the mirror and noticed a small bald patch, I ordered a Minoxidil solution. I’m very glad I took the risk. the composition strengthens the roots well and awakens the follicles. After 4 months my bald patch was covered with new hairs. Now I will periodically repeat the course

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Vitamins for hair loss: do they work?

Disclaimer

If you have any medical questions or concerns, please contact your doctor.Articles in the Health Guide are based on peer-reviewed research and information gleaned from medical societies and government agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

There are many myths about male pattern baldness. It has always been. In ancient Egypt, doctors swore that a mixture of hippopotamus, crocodile and snake fat would make a difference – literally snake oil, one might say. A little later, Hippocrates prescribed the local application of pigeon droppings as a medicine.

Today we received a more sophisticated Skoch, but the fiction remained. One of the most important is that you can take specially formulated hair vitamins or hair health supplements to nourish the follicles and improve hair growth. Your dermatologist may even buy some from his office. Whether it’s zinc, B vitamins or folic acid, there is no shortage of manufacturers who claim their formulations to thicken, strengthen, preserve or grow hair.

But the reality is this: almost always male-pattern hair loss is caused by a biological process that the vast majority of vitamins and nutritional supplements cannot change.

In 2019, a team of researchers reviewed 125 scientific articles on vitamins and hair loss and published their findings in a journal. Dermatology and Therapy . They concluded that there was insufficient data to recommend many vitamins and minerals that promote hair growth, including zinc, riboflavin, folate, vitamin B12, vitamin E, and biotin. In fact, they warned against using biotin (Almohanna, 2019). While there is no upper limit on the amount of biotin you can take, biotin can affect lab test results if you check other things, such as cardiovascular health and hormone levels (FDA, 2017).

Exactly one vitamin and one mineral has been found to affect male pattern baldness (androgenetic alopecia if you are nasty). More on that in a second.

Vitals

• Many vitamin formulations and supplements have been advertised or widely believed to slow, stop or reverse male pattern baldness.
• The vast majority of them are not supported by scientific data.
• A 2019 review of decades of research on vitamins and hair loss found that just one vitamin and one mineral could help with baldness.
• One popular hair health supplement, biotin, can be especially dangerous when taken in large quantities – not because it is toxic, but because it can interfere with other laboratory test results.

For decades, research on zinc and hair loss has been ubiquitous: some studies show a link between low zinc levels and hair loss; other studies have not. Some studies show a correlation between accurate zinc levels and the severity of hair loss; other studies contradict this.

Recommendations

1. Almohanna, H.M., Ahmed, A.A., Tsatalis, J.P., & Tosti, A. (2019). The role of vitamins and minerals in hair loss: an overview. Dermatology and Therapy , 9 (1), 51–70. DOI: 10.1007 / s13555-018-0278-6
2. Daroach, M., Narang, T., Saykiya, U.N., Sachdeva, N., and Sendhil Kumaran, M. (2017). Correlation of vitamin D and vitamin D receptor expression in patients with alopecia areata: a clinical paradigm. International Journal of Dermatology , 57 (2), 217-222.DOI: 10.1111 / ijd.13851
3. Gade, V.K.V., Moni, A., Munisami, M., Chandrashekar, L., & Rajappa, M. (2018). Study of vitamin D status in alopecia areata. Clinical and Experimental Medicine , 18 (4), 577-584. DOI: 10.1007 / s10238-018-0511-8
4. McFarquar, J.C., Broussard, D.L., Melstrom, P., Hutchinson, R., Volkin, A., Martin, K., … Jones, T.F. (2010). Acute selenium toxicity associated with dietary supplementation. Archives of Internal Medicine , 170 (3), 256-261.DOI: 10.1001 / archinternmed.2009.495
5. Naziroglu M. and Kokkam I. (2000). The status of antioxidants and lipid peroxidation in the blood of patients with alopecia. Biochemistry and Cell Function , 18 (3), 169-173. DOI: 10.1002 / 1099-0844 (200009) 18: 33.0.co; Volume 2
6. Ramadan R., Tawdy A., Hay R. A., Rashed L. & Tawfik D. (2013). Antioxidant role of paraoxonase 1 and vitamin E in three autoimmune diseases. Pharmacology and physiology of the skin , 26 , 2-7.