Alopecia

Signs and Symptoms

Symptoms of alopecia may include:

• Male pattern hair loss: Thinning or complete loss of hair at the hairline and top of the head.
• Female diffuse hair loss: A gradual thinning of hair, especially on the top of the head. The hairline usually stays the same.
• Alopecia areata: Broken hairs, or hairs easily removed; one or more round or oval bald patches.

What Causes It?

Causes may include:

• Aging
• Genetics
• Illness
• Some medications, such as chemotherapy
• Malnutrition
• Autoimmune disorder, in the case of alopecia areata
• Smoking

What to Expect at Your Provider's Office

Your doctor can usually diagnose androgenetic alopecia by examining you and taking a medical history. If your health care provider suspects alopecia areata, the provider may order a fluorescent antinuclear antibody (FNA) test, which can help determine if there is a problem with your immune system.

Treatment Options

Treatment depends on the type of alopecia you have. With many temporary forms of alopecia, hair will grow back without treatment. For people with alopecia areata, medications may help reduce hair loss. Some men with male pattern hair loss may consider surgery, such as hair transplants, scalp reduction, and strip or flap grafts.

For male pattern hair loss:

• Minoxidil (Rogaine)
• Finasteride (Propecia)

In the case of both medications, if you stop using the drug, your hair will fall out again. If you use these medications, your health care provider should monitor you for side effects.

For female diffuse hair loss:

• Minoxidil (Rogaine). Rogaine must be used indefinitely to keep regrown hair.

For alopecia areata:

• Corticosteroids, usually given by injection in the scalp each month. In severe cases, corticosteroids may be taken by mouth.

Surgical options include hair transplants, scalp reduction, and strip or flap grafts.

These therapies have only slight success in treating male pattern baldness.

For alopecia areata

• Biotin and trace minerals, such as those found in blue-green algae, may promote hair growth. Some health care professionals recommend biotin and zinc aspartate to treat alopecia areata in children. However, there is no evidence that biotin will help if you are already getting enough biotin in your diet. Biotin is found in chard, romaine lettuce, carrots, and tomatoes.

For androgenetic alopecia

• Beta-sitosterol and saw palmetto seem to help hair growth in men with male pattern hair loss. In one study, men who took this combination had greater hair growth than men who took a placebo. If you take other medications, particularly hormone therapy, talk to your doctor before taking this combination. Saw palmetto may increase the risk of bleeding, especially if you take blood thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a provider.

For androgenetic alopecia

• Saw palmetto (Serenoa repens) and beta-sitosterol (see Nutrition and Supplements).

For alopecia areata

• Aromatherapy. One study found that massaging the scalp with a combination of several essential oils, including lavender, rosemary, thyme and cedarwood, improved hair growth. Since essential oils can be toxic, they are mixed with another oil, in this case, jojoba or grapeseed oil, before putting it on the skin. Add 3 to 6 drops of essential oil to 1 tablespoon of jojoba or grapeseed oil. Massage into scalp daily.

Therapeutic massage increases circulation (helping bring more blood to the scalp) and reduces stress. Scalp massage using essential oils of rosemary, lavender, thyme, and cedarwood may help increase circulation (see Herbs).

Special Considerations

Some men using finasteride (Propecia) may have a decreased sex drive or trouble getting an erection. There also appears to be a relationship between vertex pattern androgenic alopecia and an increased risk of prostate cancer. Speak with your doctor.

If you are pregnant, wait to treat alopecia until after your baby is born.

Studies show that alopecia may impact quality of life. Other studies suggest alopecia may be correlated with certain disease processes, including prostate cancer and amyotrophic lateral sclerosis (ALS).

Supporting Research

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Arias-Santiago S, Arrabal-Polo MA, Buendia-Eisman A, et al. Androgenetic alopecia as an early marker of benign prostatic hyperplasia. J Am Acad Dermatol. 2012;66(3):401-408.

Blume-Peytavi U, Hillmann K, Dietz E, Canfield D, Garcia Bartels N. A randomized, single-blind trial of 5% minoxidil foam once dailty versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. Journal of the American Academy of Dermatology. 2011;65(6).

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Hajheydari Z, Jamshidi M, Akbari J, Mohammadpour R. Combination of topical garlic gel and betamethasone valerate cream in the treatment of localized alopecia areata: a double-blind randomized controlled study. Indian J Dermatol Venereol Leprol. 2007;73(1):29-32.

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