Alopecia

Alopecia is the loss of hair. Hair loss can be caused by different reasons, including damage to the hair shaft or follicles. Fungal infections can also cause hair loss.

There are two main types of alopecia: Alopecia Areata, when the body's immune system mistakenly attacks hair follicles and causes hair to fall out (often in patches all over the body), and androgenetic alopecia, an inherited condition where hair on the head thins and falls out. In men, this is called male pattern hair loss; in women, it is called female diffuse hair loss.

About 60% of people with androgenetic alopecia are men. Hair loss caused by androgenetic alopecia is permanent.

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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.

Drug Therapies

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 and Other Procedures

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

Complementary and Alternative Therapies

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

Nutrition and Supplements

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.

Herbs

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.

Massage

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

Abdullah F, Rashid RM. Alopecia: botanical approaches in review. J Drugs Dermatol. 2010;9(5):537-541.

Amoretti A, Laydner H, Bergfeld W. Andorgenetic alopecia and risk of prostate cancer: a systemic review and meta-analysis. J Am Acad Dermatol. 2013;68(6):937-943.

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).

Chu SY, Chen YJ, Tseng WC, et al. Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. J Am Acad Dermatol. 2011;65(5):949-956.

Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database Syst Rev. 2008;(2):CD004413.

Elder JT. What can the genetics of psoriasis teach us about alopecia areata? J Investig Dermatol Symp Proc. 2013;16(1):S34-S36.

Ferri: Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier, 2016.

Fischer TW, Burmeister G, Schmidt HW, Elsner P. Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial. Br J Dermatol. 2004;150:341-345.

Foitzik K, Hoting E, Förster T, Pertile P, Paus R. L-carnitine-L-tartrate promotes human hair growth in vitro. Exp Dermatol. 2007;16(11):936-945.

Gatherwright J, Liu MT, Amirlak B, Gliniak C, Totonchi A, Guyuron B. The contribution of endogenous and exogenous factors to male alopecia: a study of identical twins. Plast Reconstr Surg. 2013;131(5):794e-801e.

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.

Harada N, Okajima K, Arai M, Kurihara H, Nakagata N. Administration of capsaicin and isoflavone promotes hair growth by increasing insulin-like growth factor-I production in mice and in humans with alopecia. Growth Horm IGF Res. 2007;17(5):408-415.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Questions and Answers about Alopecia Areata. Pub. No. 03-5143

Ozturk P, Kurutas E, Ataseven A, et al. BMI and levels of zinc, copper in hair, serum and urine of Turkish male patients with androgenetic alopecia. J Trace Elem Med Biol. 2014;28(3):266-270.

Paus R, Arck P. Neuroendocrine perspectives in alopecia areata: does stress play a role? J Invest Dermatol. 2009;129(6):1324-1326.

Prager N, Bicketee K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complent Med. 2002;8(2):143-52.

Reid EE, Haley AC, Borovicka JH, et al. Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia. J Am Acad Dermatol. 2012;66(3):e97-102.

Sinclair R, Patel M, Dawson TL Jr, Yazdabadi A, Yip L, Perez A, Rufaut NW. Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness. Br J Dermatol. 2011 Dec;165 Suppl 3:12-8. PMID: 22171680 www.ncbi.nlm.nih.gov/pubmed/22171680.

van den Biggelaar FJ, Smolders J, Jansen JF. Complementary and alternative medicine in alopecia areata. Am J Clin Dermatol. 2010;11(1):11-20. PMID: 20000871 www.ncbi.nlm.nih.gov/pubmed/20000871.

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Review Date: 12/19/2015  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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