Hair Loss Treatment for Women

If the patient is a woman whose hair loss has occurred while she is using oral contraceptives, recommend changing to a contraceptive whose progestin has a low androgenic index. All these agents require monitoring of side effects and frank discussions of the benefit/risk balance. Cerebrovascular and embolic disorders, myocardial infarction, loss of libido, and the whole familiar range of adverse contraceptive reactions may outweigh a patient’s need for alopecia treatment.

Strangely, no national organization exists for persons with androgenetic alopecia, although many of them need at least as much psychosocial support as patients with alopecia areata. Some physicians have noted good results with informal support groups arranged at the local level. Don’t underestimate the level of concern among many patients who are losing hair; hair loss treatments for women place special emphasis on the need for respect and tact in the physican-patient relationship.

Alopecia areata is the most common autoimmune hair disease, accounting for about 1-4% of all visits to dermatologic clinics. Like androgenetic alopecia, it runs in families, but unlike common baldness, it affects men and women in equal proportions and shows a predilection for the young (about 60% of affected persons are younger than 20).

Multiple episodes are the rule; neither spontaneous regrowth nor successful treatment precludes relapse. The hair loss in alopecia areata is usually confined to round or oval patches, but loss becomes extensive in 10-30% of patients. About 5% go on to have alopecia totalis, and 1%, alopecia universalis. All these conditions can be traumatic to a patient’s self-image and sex life, particularly when onset occurs during childhood. Counseling for both patients and family members is appropriate, and referral to a local branch of the National Alopecia Areata Foundation is often much appreciated.

Clinicians have tried a wide range of hair loss treatments for women, ranging from intralesional or systemic corticosteroids to an investigational immunomodulator, inosiplex (Isoprinosine, also known as inosine pranobex). Although some regrowth has been noted with each method, none appears to protect against relapse. The most widely used approaches to date are intralesional injections of triamcinolone acetonide (Kenalog). Strong topical corticosteroids are sometimes effective; more often, intralesional and systemic therapy can produce regrowth in 2-4 weeks.

Induction of contact dermatitis at affected scalp sites has also resulted in regrowth in some patients. Agents that have been used include dinitrochlorobenzene, anthralin (Anthra-Derm, Drithocreme, Lasan, etc.), squaric acid dibutylester, and diphency-prone. Dinitrochlorobenzene is a known mutagen, and the other irritants may thus be preferable. Anthralin, recognized as effective in many patients with psoriasis, is applied either in a high concentration for short periods daily or in a low concentration overnight. Mild to moderate irritation is necessary for any chance of regrowth with contact sensitizing agents, and they all carry a risk of severely irritating both affected and unaffected skin.

Another approach that has yielded some benefit in alopecia areata is photochemotherapy with psoralens, usually methoxsalen (Oxsoralen), and ultraviolet light. Only dermatologists should administer this hair loss treatment for women because of the risks of severe burns and ocular damage with photosensitization. Topical minoxidil treatment in alopecia areata produces responses comparable to those found in androgenetic alopecia: regrowth in about 10% of patients, sustained only with continuous therapy. Thyroid disorders are associated with alopecia areata in about 1 in 4 patients, making thyroid function tests a standard part of the workup. Thyroid disease requires treatment in its own right, of course, but regulation of thyroid function does not reverse the hair loss.

A 43-year-old golfer from Buckinghamshire, who is married with three young children, is worried about a receding hairline. His wife complains that when she married him he looked like Michael Caine but now he more closely resembles Steven Spielberg. What can he do?

There are two hair loss treatments for men and women. The regular application, twice daily, of a 5 per cent solution of Provillus (minoxidil) reduces hair loss in a reasonable proportion of men. The secret is to begin treatment early, and not to wait until the scalp is as bare as a concrete path. It may take up to four or five months for the benefit to show. Provillus shouldn’t be applied to other parts of the body, and the dose shouldn’t exceed 2ml daily.

Any man or woman who becomes abnormally and seriously depressed as the result of baldness is likely to be suffering from some degree of dysmorphophobia, a pathological and irrational dislike of a specific feature of his appearance. Dysmorphophobia is not usually a manifestation of heightened sexual activity, but there is considerable anecdotal and scientific evidence that premature bald men have higher levels of testosterone and are therefore more libidinous than their contemporaries.

Finasteride, the other medical treatment for male-pattern baldness, is a drug that is usually used to control benign enlargement of the prostate. It may cause some loss of potency in a very small percentage of men. When finasteride is taken to treat hair loss it is marketed as Propecia; the higher dose medication used to treat benign prostatic enlargement is known as Proscar.

Men taking finasteride, whether to treat a receding hair line or an enlarged prostate, should remember that it reduces the Prostate Specific Antigen (PSA) level and may therefore give a misleading result when routine checks are made to exclude cancer of the prostate.

Finally, our patient may prefer to have a hair transplant. This is also the best hair loss treatment for women. The problem with hair transplants has been tufting. Even the most careful transplants tended to grow like marram grass on the shore, rather than a clipped lawn. A new system, follicular unit extraction, has been introduced in France. It claims to be able to remove one to three hairs at a time, to leave no scars, to be fast and not to plant any tufts.