dermatologic disorders
Alopecia
Treatment of Alopecia
Drugs (including hormonal modulators) Laser light therapy Surgery is generally not effective or indicated for other causes of hair loss except possibly Alopecia Areata . Hair regrowth can take 8 to 12 months. Treatment is continued indefinitely because, once treatment is stopped, hair loss resumes. The most frequent adverse effects are mild scalp irritation, 1 mg orally once/day can stop hair loss and can stimulate hair growth. Efficacy is usually evident within 6 to 8 months of treatment. Adverse effects include decreased libido; erectile and ejaculatory dysfunction, which may persist even after cessation of treatment (see Erectile Dysfunction ); hypersensitivity reactions; Dutasteride,a drug used to treat benign prostatic hyperplasia, is a stronger inhibitor of 5-alpha-reductase thanfinasterideand is sometimes used to treat androgenetic alopecia. Hormonal modulatorssuch as oral contraceptives orspironolactonemay be useful for female-pattern hair loss. Low-level laser light therapyis an alternate or additional treatment for androgenetic alopecia that has been shown to promote hair growth. Physician-dispensed and over-the-counter devices are available. injected into the scalp is thought to contain growth factors that promote hair follicle growth and maintenance ( Treatment references ). include follicle transplant, scalp flaps, and alopecia reduction. Few procedures have been subjected to scientific scrutiny, but patients who are self-conscious about their hair loss may consider them ( Treatment references ). Underlying disorders are treated. Treatment for alopecia areata includes topical, intralesional, or, in severe cases, systemic corticosteroids, topicalminoxidil, topicalanthralin, topical immunotherapy (diphenylcyclopropenone or squaric acid dibutylester), ormethotrexate. Treatment for traction alopecia is elimination of physical traction or stress to the scalp. Treatment for Tinea Capitis (Scalp Ringworm) is oral antifungals. Trichotillomania is difficult to treat, but behavior modification, Scarring alopecia as in central centrifugal cicatricial alopecia or dissecting cellulitis of the scalp is best treated with an oraltetracyclineplus a potent topical corticosteroid. Severe or chronic acne keloidalis nuchae can be treated similarly or with intralesionaltriamcinolone; if mild, topical retinoids, topical antibiotics, and/or topicalbenzoyl peroxidemay suffice. Lichen planopilaris; its variant, frontal fibrosing alopecia; and chronic cutaneous lupus lesions may be treated with drugs such as oral antimalarials, topical or intralesional corticosteroids, topical or oral retinoids, topicaltacrolimus, or oral immunosuppressants. Hair loss due to chemotherapy (anagen effluvium) is temporary and is best treated with a wig; when hair regrows, it may be different in color and texture from the original hair. Hair loss due to telogen effluvium is usually temporary as well and abates after the precipitating agent is eliminated. 1.Randolph M, Tosti A: Oralminoxidiltreatment for hair loss: A review of efficacy and safety.J Am Acad Dermatol84(3):737–746, 2021. doi: 10.1016/j.jaad.2020.06.1009 2.Gupta AK, Venkataraman M, Talukder M, Bamimore MA: Relative efficacy ofminoxidiland the 5-α reductase inhibitors in androgenetic alopecia treatment of male patients: A network meta-analysis.JAMA Dermatol158(3):266–274, 2022. doi: 10.1001/jamadermatol.2021.5743 3.Hesseler MJ, Shyam N: Platelet-rich plasma and its utilities in alopecia: A systematic review.Dermatol Surg46(1):93–102, 2020. doi: 10.1097/DSS.0000000000001965 4.Adil A, Godwin M: The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis.J Am Acad Dermatol77(1):136–141.e5, 2017. doi: 10.1016/j.jaad.2017.02.054 