Hair Loss, Current Treatment Concepts

Fortunately, hair fall can be a symptom of a short-term condition as stress, pregnancy, disease, medication, malnutrition or after chemotherapy. In these situation, hair will grow back when the occurrence or the illness is addressed, hairs go back to their pattern of growth and shedding, and the problem of hair fall will be under control. 

There are many hair restoration therapies, techniques and cosmetic hair procedures available today. Efforts are made to match hair loss treatment type with the causes of hair loss to get optimal result. Early diagnosis of the form of Hair Loss, as well as the early introduction of therapy may promote better clinical results than those achieved in more advanced cases or even stop the progression of the disease and this can improve the quality of life of patients affected by this disease. 

  • For non-genetic causes of hair loss, has to treat the cause first as the hair loss will stop and lost hair recovered after proper diagnosis and treatment.
  • For hair loss due to genetic, hormonal and aging causes, there are non-surgical modalities of treatment which has to start first with and if No any progress, the second step will be the surgical option.

Non-surgical Modalities of Treatment for Hair Restoration

Pharmacological Treatment:

The following two treatments have been clinically proven to successfully treat hair loss in men to varying degrees.

  1. Finasteride, Proscar/Propecia:

Finasteride is the generic name for the brand name drugs Proscar and Propecia. Finasteride was originally developed by Merck as a drug to treat enlarged prostate glands. And during trials they have discovered its effect on hair growth. 1997 FDA approved a 1 mg dose of finasteride for the treatment of androgenic alopecia in men MPB. Propecia is the first drug in history to effectively treat male pattern baldness in the vast majority of men who use it.

How Propecia works?

Finasteride has the ability to specifically inhibit the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT). Propecia 1 mg dose of finasteride can effectively lower DHT levels by as much as 60% when taken daily. It is the DHT that shrinks or miniaturizes the hair follicle, which eventually leads to baldness. This 60% reduction in DHT has proven to stop the progression of hair loss in 86% of men taking the drug with 65% experienced what was considered a substantial increase in hair growth.

But, Propecia cannot restore the large healthy follicles in androgenic alopecia and have been reported to have many unwanted side effects, some of which appear to be permanent even after discontinuing the medication.

What are Propecia drug side effects?

While Propecia is generally well tolerated, as with all drugs side effects can occur. 

  • Impotence
  • Loss of interest in sex
  • Trouble having an orgasm
  • Abnormal ejaculation
  • Swelling in the hands and feet
  • Swelling or tenderness in breasts
  • Dizziness
  • Weakness
  • Headache
  • Runny nose
  • Skin rash

The sexual side effects of Propecia may continue after you stop taking it and for this reason many patients have a concern to use this medication

2. Minoxidil (Rogaine) (Rogaine) for female pattern hair loss, can slow or stop it in most women and may help hair grow back but, the benefits go away when the patient stop using it.

Minoxidil, in pill form, was widely used to treat high pressure. The unwanted side effect that people taking this medication were growing hair in unexpected places like on their cheeks and the back of their hands, some even grew hair on their foreheads. So, the researchers had the notion that applying minoxidil topically, directly on the head, might grow hair on balding areas. Well it did this to varying degrees depending on the extend of the hair loos for its time, this treatment was revolutionary.

Minoxidil is more effective for maintaining hair already on the scalp than they are in re-growing hair so it is slow the progression of hair loss but its effect is relatively marginally effective in the fight against the fall. Since minoxidil has no effect on the hormonal process of hair fall, its positive effects are at best temporary and usually yield somewhat disappointing long-term results.  

So, currently, Rogaine and Propecia are the only two medications for baldness approved by the FDA..

3. Corticosteroid can help regrow hair for alopecia areata when there is immunological underlying cause. If the reason is other underlying medical problem or malnutrition, the hair mostly grows back on their own once the pathological reason become under control. 

4. Vitamin D: Recent research has focused on Vitamin D and the Vitamin D receptor to stimulate hair follicle growth. 

Adjunctive Nonpharmacological Treatment

  • PRP (Platelet Rich Plasma): There has been some recent interest in hair restoration by the uncontrolled injection of Platelet Rich Plasma (PRP) (mostly growth factors and a few stem cells).

Platelet Rich Plasma Therapy is non-surgical injection procedure, widely used by us the plastic surgeon for wound healing, defect of soft tissue and by orthopaedic to stimulate bone and joint healing. Today it is one of the modality of treatment for hair loss in men and women due to androgenic alopecia as well as other hair loss types, by healing inflamed stem cells that originally in the bed of the scalp or eyebrow and raising immunity in miniaturised hair.

How Platelet Rich Plasma works?

 Blood Plasma is a component of blood that functions as an extracellular matrix for blood cells, when concentrated from blood; it is a yellow liquid substance. Platelets are another component of blood that functions in clogging blood vessels and help stop bleeding and are a living body’s very own property for healing wounds through coagulation and many growth factors. Platelet found in the blood plasma are believed to have greater strength in repairing wounds than in circulating blood.

Platelet rich blood plasma could be cultured and made into an injectable serum that has great healing properties and growth factors majorly the vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) an many bioactive proteins. this injection therapy is widely used in medicine for internal wound healing, bone marrow transplantation and many more diseases, including promote growth miniaturising hair.

How is the treatment with PRP will be?

The autologous blood uses platelet extracted from the patient own blood plasma by first taking 8-16 cc of blood from your vein which is very limited amount (same amount of blood for annual health laboratory check-up), the taken blood spin it in a centrifuge with platelet activators. After the centrifuge the plasma has been isolated from other products of the blood, an activator adding it to it and be ready to inject into the scalp, beard or eyebrows.

Protocol of treatment can vary according to the preferred by your physician according to your cause and severity of hair loss. For androgenic alopecia usually, the treatment takes 8-10 months initially between intervals 4-6 weeks, and after that once session a year for maintenance. Significant number of patients have noticed a reduction in their hair thinning with the 2nd or 3rd session of the treatment.

PRP can also used in conjunction with hair transplantation, to stimulate the new relocated hair grafts from shock loss. It repairs any trauma or dryness in the hair grafts, promoting hair growth against telogen effluvium, which is a significant complication associated with hair restoration surgery.

What are the complications of this procedure?

The procedure is generally safe and no side effect, almost NO complications associated with it and any one can get the benefit from this treatment to keep healthy hair. Infection can be a considerable risk, but at very minimal chances with uncontrol diabetic patient.

Ineffectiveness or insignificant response to this modality of treatment should be taken in consideration before starting the treatment and this can be for various reasons including irreparable genetic and hormonal baldness, or the type of hair loss that need medical treatment for primary cause of it. Abdication

 

  • Devices that emit low-energy laser light may help new hair grow and available in clinics and for home use. studies approved its effect for women and men but, it might take 2-4 months before seeing the outcome of treatment. The long-term testing for effect and safety these devices are not known yet. 

All treatments need to be continued to maintain the effect. An initial therapeutic response often takes 12 or even 24 months. Given this delay, monitoring for treatment effect through clinical photography or standardized clinical severity scales is helpful.

  • An adjunctive nonpharmacological treatment modality such as counselling cosmetic camouflage.
  • Surgical Hair Restoration: are important measures for some patients. 

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