The management of hair loss, includes prevention and treatment of
alopecia
Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scar ...
,
baldness, and
hair thinning, and regrowth of hair.
Prevention
Scratching of itchy scalp may contribute to hair loss.
Health
Body weight
Prevention of
obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...
helps. Obesity is linked to
hair thinning.
Healthy diet
Oils with fatty acids that has been studied to prevent dermatitis includes:
*
Corn oil:
Linoleic acid
Linoleic acid (LA) is an organic compound with the formula COOH(CH2)7CH=CHCH2CH=CH(CH2)4CH3. Both alkene groups are ''cis''. It is a fatty acid sometimes denoted 18:2 (n-6) or 18:2 ''cis''-9,12. A linoleate is a salt or ester of this acid.
...
(LA)
*
Fish oil
Fish oil is oil derived from the tissues of oily fish. Fish oils contain the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), precursors of certain eicosanoids that are known to reduce inflammation in the b ...
:
Eicosapentaenoic acid
Eicosapentaenoic acid (EPA; also icosapentaenoic acid) is an omega-3 fatty acid. In physiological literature, it is given the name 20:5(n-3). It also has the trivial name timnodonic acid. In chemical structure, EPA is a carboxylic acid with a 20-c ...
(EPA) and
docosahexaenoic acid
Docosahexaenoic acid (DHA) is an omega-3 fatty acid that is a primary structural component of the human brain, cerebral cortex, skin, and retina. In physiological literature, it is given the name 22:6(n-3). It can be synthesized from alpha-lin ...
(DHA)
*
Hemp seed oil
Hemp oil (hemp seed oil) is oil obtained by pressing hemp seeds. Cold pressed, unrefined hemp oil is dark to clear light green in color, with a nutty flavor. The darker the color, the grassier the flavour. It should not be confused with hash oi ...
:
Linoleic acid
Linoleic acid (LA) is an organic compound with the formula COOH(CH2)7CH=CHCH2CH=CH(CH2)4CH3. Both alkene groups are ''cis''. It is a fatty acid sometimes denoted 18:2 (n-6) or 18:2 ''cis''-9,12. A linoleate is a salt or ester of this acid.
...
(LA), and
alpha-Linolenic acid
''alpha''-Linolenic acid (ALA), also known as α-Linolenic acid (from Greek ''alpha'' meaning "first" and ''linon'' meaning flax), is an ''n''−3, or omega-3, essential fatty acid. ALA is found in many seeds and oils, including flaxseed, wa ...
(ALA)
Alternative medicine
The scalp must be cleaned from
sebum
A sebaceous gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest nu ...
, sweat, and dirt, prior to topical application, for agents to penetrate it.
A 2020
systemic review
A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on t ...
on agents used to treat androgenic alopecia found that:
* Oral supplementation of
vitamin A
Vitamin A is a fat-soluble vitamin and an essential nutrient for humans. It is a group of organic compounds that includes retinol, retinal (also known as retinaldehyde), retinoic acid, and several provitamin A carotenoids (most notably ...
,
B,
C,
D,
E, and trace element
iron
Iron () is a chemical element with Symbol (chemistry), symbol Fe (from la, Wikt:ferrum, ferrum) and atomic number 26. It is a metal that belongs to the first transition series and group 8 element, group 8 of the periodic table. It is, Abundanc ...
,
selenium
Selenium is a chemical element with the symbol Se and atomic number 34. It is a nonmetal (more rarely considered a metalloid) with properties that are intermediate between the elements above and below in the periodic table, sulfur and tellurium, ...
, and
zinc
Zinc is a chemical element with the symbol Zn and atomic number 30. Zinc is a slightly brittle metal at room temperature and has a shiny-greyish appearance when oxidation is removed. It is the first element in group 12 (IIB) of the periodi ...
, will prevent androgenic alopecia caused by
malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
.
Multivitamins can be used.
* Topical application of
onion
An onion (''Allium cepa'' L., from Latin ''cepa'' meaning "onion"), also known as the bulb onion or common onion, is a vegetable that is the most widely cultivated species of the genus ''Allium''. The shallot is a botanical variety of the onio ...
juice,
rosemary
''Salvia rosmarinus'' (), commonly known as rosemary, is a shrub with fragrant, evergreen, needle-like leaves and white, pink, purple, or blue flowers, native to the Mediterranean region. Until 2017, it was known by the scientific name ''Rosmar ...
oil,
saw palmetto
''Serenoa repens'', commonly known as saw palmetto, is the sole species currently classified in the genus ''Serenoa''. It is a small palm, growing to a maximum height around . It is endemic to the subtropical and tropical Southeastern United S ...
,
pumpkin seed
A pumpkin seed, also known in North America as a pepita (from the Mexican es, pepita de calabaza, "little seed of squash"), is the edible seed of a pumpkin or certain other cultivars of squash. The seeds are typically flat and asymmetrically ...
oil,
procyanidin
Procyanidins are members of the proanthocyanidin (or condensed tannins) class of flavonoids. They are oligomeric compounds, formed from catechin and epicatechin molecules. They yield cyanidin when depolymerized under oxidative conditions.
See th ...
,
garlic gel,
capsaicin
Capsaicin (8-methyl-''N''-vanillyl-6-nonenamide) ( or ) is an active component of chili peppers, which are plants belonging to the genus ''Capsicum''. It is a chemical irritant for mammals, including humans, and produces a sensation of burnin ...
,
caffeine
Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine to ...
, amino acids, and
curcumin
Curcumin is a bright yellow chemical produced by plants of the ''Curcuma longa'' species. It is the principal curcuminoid of turmeric (''Curcuma longa''), a member of the ginger family, Zingiberaceae. It is sold as a herbal supplement, cosmet ...
helped prevent hair loss.
Heating, ventilation, and air conditioning (HVAC)
Humidifier
A
humidifier
A humidifier is a device, primarily an electrical appliance, that increases humidity (moisture) in a single room or an entire building. In the home, point-of-use humidifiers are commonly used to humidify a single room, while whole-house or furna ...
can be used to prevent low indoor humidity during
winter
Winter is the coldest season of the year in polar and temperate climates. It occurs after autumn and before spring. The tilt of Earth's axis causes seasons; winter occurs when a hemisphere is oriented away from the Sun. Different cultur ...
(especially with indoor heating), and
dry season
The dry season is a yearly period of low rainfall, especially in the tropics. The weather in the tropics is dominated by the tropical rain belt, which moves from the northern to the southern tropics and back over the course of the year. The te ...
.
Commonly, patients with
seborrhoeic dermatitis
Seborrhoeic dermatitis, sometimes inaccurately referred to as seborrhoea, is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the ...
experience mild redness, scaly skin lesions and in some cases
hair loss
Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scar ...
.
Low humidity can cause adverse health effects and may cause
atopic dermatitis, and
seborrhoeic dermatitis
Seborrhoeic dermatitis, sometimes inaccurately referred to as seborrhoea, is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the ...
.
Treatments
Medication
Add-hocs
The topical
bioavailability
In pharmacology, bioavailability is a subcategory of absorption and is the fraction (%) of an administered drug that reaches the systemic circulation.
By definition, when a medication is administered intravenously, its bioavailability is 100%. Ho ...
of synthetic medicines such as
antiandrogen
Antiandrogens, also known as androgen antagonists or testosterone blockers, are a class of drugs that prevent androgens like testosterone and dihydrotestosterone (DHT) from mediating their biological effects in the body. They act by blocking the ...
s, as well as phytochemicals such as
quercetin
Quercetin is a plant flavonol from the flavonoid group of polyphenols. It is found in many fruits, vegetables, leaves, seeds, and grains; capers, red onions, and kale are common foods containing appreciable amounts of it. It has a bitter flavor ...
, has been improved with incorporation of drugs in
nanoparticles, or
microneedling
Collagen induction therapy (CIT), also known as microneedling, dermarolling, or skin needling, is a Medical aesthetics, cosmetic procedure that involves repeatedly puncturing the Human skin, skin with tiny, sterile needles (microneedling the skin) ...
.
Synthetic medicine
Treatments for the various forms of hair loss have only moderate success.
[ Three medications have evidence to support their use in male pattern hair loss: finasteride, ]dutasteride
Dutasteride, sold under the brand name Avodart among others, is a medication primarily used to treat the symptoms of a benign prostatic hyperplasia (BPH), an enlarged prostate not associated with cancer. A few months may be required before benefi ...
and minoxidil
Minoxidil, sold under the brand name Rogaine among others, is a medication used for the treatment of high blood pressure and pattern hair loss. It is an antihypertensive vasodilator. It is available as a generic medication by prescription in or ...
.[ They typically work better to prevent further hair loss than to regrow lost hair.][
They may be used together when hair loss is progressive or further regrowth is desired after 12 months.] Other medications include ketoconazole, and in female androgenic alopecia spironolactone
Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. It is also used in the treatment of high blood press ...
and flutamide
Flutamide, sold under the brand name Eulexin among others, is a nonsteroidal antiandrogen (NSAA) which is used primarily to treat prostate cancer. It is also used in the treatment of androgen-dependent conditions like acne, excessive hair grow ...
. Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use.
= Minoxidil
=
Minoxidil
Minoxidil, sold under the brand name Rogaine among others, is a medication used for the treatment of high blood pressure and pattern hair loss. It is an antihypertensive vasodilator. It is available as a generic medication by prescription in or ...
, applied topically, is widely used for the treatment of hair loss. It may be effective in helping promote hair growth in both men and women with androgenic alopecia. About 40% of men experience hair regrowth after 3–6 months. It is the only topical product that is FDA approved in America for androgenic hair loss. However, increased hair loss has been reported.
=Antiandrogens
=
Finasteride is used to treat male pattern hair loss. Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken.[ There is no good evidence for its use in women.][ It may cause ]gynecomastia
Gynecomastia (also spelled gynaecomastia) is the abnormal non-cancerous enlargement of one or both breasts in males due to the growth of breast tissue as a result of a hormone imbalance between estrogens and androgens. Updated by Brent Wisse ( ...
, erectile dysfunction and depression.
Dutasteride
Dutasteride, sold under the brand name Avodart among others, is a medication primarily used to treat the symptoms of a benign prostatic hyperplasia (BPH), an enlarged prostate not associated with cancer. A few months may be required before benefi ...
is also used in the treatment of male pattern hair loss and appears to have better effectiveness than finasteride for the condition. While used off-label for male pattern hair loss in most of the world, dutasteride is specifically approved for this indication in South Korea
South Korea, officially the Republic of Korea (ROK), is a country in East Asia, constituting the southern part of the Korean Peninsula and sharing a land border with North Korea. Its western border is formed by the Yellow Sea, while its eas ...
and Japan.
There is tentative support for spironolactone
Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. It is also used in the treatment of high blood press ...
in women.[ Due to its feminising side effects and risk of infertility it is not often used by men. It can also cause ]low blood pressure
Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the di ...
, high blood potassium
Hyperkalemia is an elevated level of potassium (K+) in the blood. Normal potassium levels are between 3.5 and 5.0mmol/L (3.5 and 5.0mEq/L) with levels above 5.5mmol/L defined as hyperkalemia. Typically hyperkalemia does not cause symptoms. Occasi ...
, and abnormal heart rhythms. Also, women who are pregnant or trying to become pregnant generally cannot use the medication as it is a teratogen, and can cause ambiguous genitalia in newborn children.
There is tentative evidence for flutamide
Flutamide, sold under the brand name Eulexin among others, is a nonsteroidal antiandrogen (NSAA) which is used primarily to treat prostate cancer. It is also used in the treatment of androgen-dependent conditions like acne, excessive hair grow ...
in women; however, it is associated with relatively high rates of liver problems and strong recommendations have been made against its use. Like spironolactone, flutamide is typically only used by women. Bicalutamide
Bicalutamide, sold under the brand name Casodex among others, is an antiandrogen medication that is primarily used to treat prostate cancer. It is typically used together with a gonadotropin-releasing hormone (GnRH) analogue or surgical remo ...
is another option for the treatment of female pattern hair loss. It has a far lower risk of liver toxicity than flutamide and is said to have an excellent safety profile. However, bicalutamide retains a small risk of liver toxicity and for this reason periodic liver monitoring is recommended during treatment.
=Ketoconazole
=
Ketoconazole may help in women.[
]
Technological treatments
Low-level laser therapy (LLLT)
Low-level laser therapy
Low-level laser therapy (LLLT), cold laser therapy, or photobiomodulation (PBM) is a form of medicine that applies low-level (low-power) lasers or light-emitting diodes (LEDs) to the surface of the body. Whereas high-power lasers are used in la ...
is also referred to as red light therapy and cold laser therapy. It's less invasive than hair transplant surgery.
Both laser and lights appear to be safe. However, 2008 and 2012 reviews found little evidence to support the use of special lights or lasers to treat hair loss.
A 2014 and 2016 review found tentative evidence of benefit for lasers. While another 2014 review concluded that the results are mixed, have a high risk of bias, and that its effectiveness is unclear.
Surgical treatments
Hair transplantation
Hair transplantation is a surgical
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
technique that moves individual hair follicles from a part of the body called the donor site to bald or balding part of the body known as the recipient site. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore eyelash
An eyelash (also called lash) (Latin: ''Cilia'') is one of the hairs that grows at the edge of the eyelids. It grows in one layer on the edge of the upper and lower eyelids. Eyelashes protect the eye from debris, dust, and small particles and p ...
es, eyebrow
An eyebrow is an area of short hairs above each eye that follows the shape of the lower margin of the brow ridges of some mammals. In humans, eyebrows serve two main functions: first, communication through facial expression, and second, preven ...
s, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from skin graft
Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft.
Surgeons may use skin grafting to treat:
* extensive wounding or trauma
* burns
* areas of extensive skin loss du ...
ing in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.
Since hair naturally grows in follicles in groups of 1 to 4 hairs, transplantation takes advantage of these naturally occurring follicular units. This achieves a more natural appearance by matching hair for hair through Follicular unit transplantation
Follicular unit transplantation (FUT) is a hair restoration technique, also known as the strip procedure, where a patient's hair is transplanted in naturally occurring groups of 1 to 4 hairs, called follicular units. Follicular units also contain ...
(FUT).
Donor hair can be harvested in two different ways. Small grafts of naturally-occurring units of one to four hairs, called follicular units, can be moved to balding areas of the hair restoration
The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.
Prevention
Scratching of itchy scalp may contribute to hair loss.
Health
Body weight
Prevention of obesity helps. O ...
. These follicular units are surgically implanted in the scalp in very close proximity to one another and in large numbers. The grafts are obtained in one or both of the two primary methods of surgical extraction, follicular unit transplantation, colloquially referred to as "strip harvesting", or Follicular Unit Extraction
Follicular unit extraction (FUE), also known as follicular transfer (FT), is one of two primary methods of obtaining hair follicles, naturally occurring groups of one to four hairs, for hair transplantation. The other method is called strip harv ...
(FUE), in which follicles are transplanted individually.
In FUT, a strip of skin containing many follicular units is extracted from the patient and dissected under a stereoscopic microscope. The site of the strip removal is stitched closed. Once divided into follicular unit grafts, each unit is individually inserted into small recipient sites made by an incision in the bald scalp. In the newer technique, roots are extracted from the donor area and divided into strips for transplantation. The strip, two to three millimeters thick, is isolated and transplanted to the bald scalp. After surgery, a bandage is worn for two days to protect the stitched strip during healing. A small strip scar remains after healing, which can be covered by scalp hair growing over the scar.
Scalp reduction
Scalp reduction is a surgical procedure in which the hairless region of the scalp of a bald man is reduced. This procedure can reduce the area of the scalp without hair.
Regrowth of hair
Facial hair
Eyebrows
Bimatoprost
Bimatoprost, sold under the brand name Lumigan among others, is a medication used to treat high pressure inside the eye including glaucoma. Specifically it is used for open angle glaucoma when other agents are not sufficient. It may also be used ...
0.03% has been used to grow eyebrow
An eyebrow is an area of short hairs above each eye that follows the shape of the lower margin of the brow ridges of some mammals. In humans, eyebrows serve two main functions: first, communication through facial expression, and second, preven ...
s.
Eyelashes
The FP receptor agonist, bimatoprost
Bimatoprost, sold under the brand name Lumigan among others, is a medication used to treat high pressure inside the eye including glaucoma. Specifically it is used for open angle glaucoma when other agents are not sufficient. It may also be used ...
, in the form of an 0.03% ophthalmic solution termed Latisse
Bimatoprost, sold under the brand name Lumigan among others, is a medication used to treat high pressure inside the eye including glaucoma. Specifically it is used for open angle glaucoma when other agents are not sufficient. It may also be used ...
, is approved by the US Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
to treat hypotrichosis
Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scarri ...
of the eyelash
An eyelash (also called lash) (Latin: ''Cilia'') is one of the hairs that grows at the edge of the eyelids. It grows in one layer on the edge of the upper and lower eyelids. Eyelashes protect the eye from debris, dust, and small particles and p ...
es, in particular to darken and lengthen eyelashes for cosmetic purposes. Also, bimatoprost may be used to treat small or underdeveloped eyelash
An eyelash (also called lash) (Latin: ''Cilia'') is one of the hairs that grows at the edge of the eyelids. It grows in one layer on the edge of the upper and lower eyelids. Eyelashes protect the eye from debris, dust, and small particles and p ...
es.
Scalp hair
Alternative medication
=Topical
=
Some popular plant juices sold as hair serum may instead of growing human hair actually inhibit the growth, including 6-gingerol found in ginger.
=Topical crude onion juice
=
A small 2002 study demonstrated that treatment twice daily for six weeks with crude onion juice from Australian brown onion, re-growth hair on alopecia areata
Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often, it results in a few bald spots on the scalp, each about the size of a coin. Psychological stress and illness are pos ...
(spot baldness) in 86.9% of the 23 participants. Twice as many flavonols
Flavonols are a class of flavonoids that have the 3-hydroxyflavone backbone (IUPAC name : 3-hydroxy-2-phenylchromen-4-one). Their diversity stems from the different positions of the phenolic -OH groups. They are distinct from flavanols (with ...
are found in red onion
Red onions (also known as purple or blue onions in some mainland European countries, though not the UK) are cultivars of the onion ('' Allium cepa''), and have purplish-red skin and white flesh tinged with red. They are most commonly used in c ...
than in yellow onion
The brown onion or yellow onion (''Allium cepa'' L.) is a variety of dry onion with a strong flavour. They have a greenish-white, light yellow, or white inside; its layers of papery skin have a yellow-brown or pale golden colour.
It is higher i ...
. Also, non-organic onions might contain pesticides on the peel and in the first scaly leaf. Compounds found in onion that stimulates hair growth:
* Quercetin
Quercetin is a plant flavonol from the flavonoid group of polyphenols. It is found in many fruits, vegetables, leaves, seeds, and grains; capers, red onions, and kale are common foods containing appreciable amounts of it. It has a bitter flavor ...
: A 2012 study demonstrated that alopecia areata could be used to prevent ant treated with quercetin in mice. Quercetin is found in onions primarily in the peel and the first scaly leaf but not in the flesh. Onion bulb size or weight does not appear to be affected by quercetin concentration.
* Quercitrin
Quercitrin is a glycoside formed from the flavonoid quercetin and the deoxy sugar rhamnose.
Austrian chemist Heinrich Hlasiwetz (1825-1875) is remembered for his chemical analysis of quercitrin.
Occurrence
Quercitrin is a constituent of the ...
: A 2020 study demonstrated that quercitrin stimulated hair shaft growth in cultured human hair follicles.
* Volatile compounds responsible for pungency and tearing in onions when they are cut (e.g. ''syn''-propanethial ''S''-oxide gas). However, no formal studies have conducted to evaluate if these compounds promote hair growth or if they help other compounds to penetrate the skin to form hair follicles.
** To use the volatile compounds: Onions must be extracted and applied topically quickly before the volatile compounds evaporates. The extract will cause tearing eyes, but it can be prevented with a shower cap
A shower cap (also known as a bath cap) is a hat worn while showering or bathing to protect hair from becoming wet. Alternatively, shower caps for children can be crowns with wide brims that prevent water and shampoo from getting in the eyes while ...
, or a pair of swimming goggles.
** To discard the volatile compounds: The onion juice is extracted and stored for a short while to evaporate the volatile compounds. The extract will not cause tearing eyes. Also, both genetically modified
Genetic engineering, also called genetic modification or genetic manipulation, is the modification and manipulation of an organism's genes using technology. It is a set of technologies used to change the genetic makeup of cells, including ...
, and plant breed onions have been produced with significantly reduced levels of tear-inducing lachrymatory factor.
=Dietary supplements
=
Dietary supplements are not typically recommended.[ Many people use unproven treatments,] but there is little evidence of the effectiveness of vitamin
A vitamin is an organic molecule (or a set of molecules closely related chemically, i.e. vitamers) that is an essential micronutrient that an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrie ...
s, minerals, or other dietary supplements regrowing hair or retaining hair.[ There is no evidence for biotin (vitamin B7).][ While lacking both evidence and expert recommendation, there is a large market for hair growth supplements, especially for products that contain biotin.
However, one small trial of ]saw palmetto
''Serenoa repens'', commonly known as saw palmetto, is the sole species currently classified in the genus ''Serenoa''. It is a small palm, growing to a maximum height around . It is endemic to the subtropical and tropical Southeastern United S ...
which shows tentative benefit in those with mild to moderate androgenetic alopecia.[ There was no good evidence for ]gingko
''Ginkgo'' is a genus of non-flowering seed plants. The scientific name is also used as the English name. The order to which it belongs, Ginkgoales, first appeared in the Permian, 270 million years ago, and is now the only living genus within ...
, aloe vera, ginseng
Ginseng () is the root of plants in the genus '' Panax'', such as Korean ginseng ('' P. ginseng''), South China ginseng ('' P. notoginseng''), and American ginseng ('' P. quinquefolius''), typically characterized by the presence of ginsenosides ...
, bergamot, or hibiscus
''Hibiscus'' is a genus of flowering plants in the mallow family, Malvaceae. The genus is quite large, comprising several hundred species that are native to warm temperate, subtropical and tropical regions throughout the world. Member species ...
as of 2011.
Quercetin
Quercetin is a plant flavonol from the flavonoid group of polyphenols. It is found in many fruits, vegetables, leaves, seeds, and grains; capers, red onions, and kale are common foods containing appreciable amounts of it. It has a bitter flavor ...
(a flavanoid found in vegan food) supplements, has been suggested to treat baldness.
Radiation-induced hair loss
Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression. Radiation therapy has been associated with increased mucin
Mucins () are a family of high molecular weight, heavily glycosylated proteins (glycoconjugates) produced by epithelial tissues in most animals. Mucins' key characteristic is their ability to form gels; therefore they are a key component in most ...
production in hair follicles.
Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia.
Cosmeses
Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle. There have also been developments in the fashion industry with wig
A wig is a head or hair accessory made from human hair, animal hair, or synthetic fiber. The word wig is short for periwig, which makes its earliest known appearance in the English language in William Shakespeare's ''The Two Gentlemen of Verona' ...
design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a "constant companion". Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use.
Specialized tattoos, commonly known as scalp micropigmentation, can mimic the appearance of a short buzzed haircut.
Human hair growth
Type 1 and 2 5α reductase enzymes are present at pilosebaceous units in papillae of individual hair follicles. They catalyse formation of the androgens testosterone and DHT, which in turn regulate hair growth. Androgens have different effects at different follicles: they stimulate IGF-1 at facial hair, causing hair regrowth, but stimulate TGF β1, TGF β2, dickkopf1 and IL-6 at the scalp, causing hair follicle miniaturisation.
Female androgenic alopecia is characterized by diffuse crown thinning without hairline recession, and like its male counterpart rarely leads to total hair loss. Finasteride and minoxidil
Minoxidil, sold under the brand name Rogaine among others, is a medication used for the treatment of high blood pressure and pattern hair loss. It is an antihypertensive vasodilator. It is available as a generic medication by prescription in or ...
are usually first line therapy for its treatment. Other options include topical or systemic spironolactone
Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. It is also used in the treatment of high blood press ...
or flutamide
Flutamide, sold under the brand name Eulexin among others, is a nonsteroidal antiandrogen (NSAA) which is used primarily to treat prostate cancer. It is also used in the treatment of androgen-dependent conditions like acne, excessive hair grow ...
, although they have a high incidence of feminising side effects
In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...
and are better tolerated in female androgenic hair loss.
More advanced cases may be resistant or unresponsive to medical therapy, however, and require hair transplantation
Hair transplantation is a surgical technique that removes hair follicles from one part of the body, called the 'donor site', to a bald or balding part of the body known as the 'recipient site'. The technique is primarily used to treat male patt ...
. Naturally-occurring units of one to four hairs, called follicular units, are excised and moved to areas of hair restoration. These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either Follicular Unit Transplantation
Follicular unit transplantation (FUT) is a hair restoration technique, also known as the strip procedure, where a patient's hair is transplanted in naturally occurring groups of 1 to 4 hairs, called follicular units. Follicular units also contain ...
(FUT) – colloquially referred to as "strip harvesting" – or Follicular Unit Extraction
Follicular unit extraction (FUE), also known as follicular transfer (FT), is one of two primary methods of obtaining hair follicles, naturally occurring groups of one to four hairs, for hair transplantation. The other method is called strip harv ...
(FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites. Specialized scalp tattoos can also mimic the appearance of a short buzzed haircut. Androgenic alopecia also occurs in women, and more often presents as diffuse thinning without hairline recession. Like its male counterpart, the condition rarely leads to total hair loss. Treatment options are similar to those for men, although topical or systemic estrogen is used more often.
Research
Bimatoprost and latanoprost
Latanoprost
Latanoprost, sold under the brand name Xalatan among others, is a medication used to treat increased pressure inside the eye. This includes ocular hypertension and open angle glaucoma. It is applied as eye drops to the eyes. Onset of effects i ...
and bimatoprost
Bimatoprost, sold under the brand name Lumigan among others, is a medication used to treat high pressure inside the eye including glaucoma. Specifically it is used for open angle glaucoma when other agents are not sufficient. It may also be used ...
are specific PGF2a analogues applied topically, and have been found to lengthen eyelashes, darken hair pigmentation and elongate hair. Bimatoprost is available as treatment for eyelash growth. Latanoprost has shown ability to promote scalp hair density and pigmentation, and is theorized to function at the dermal papilla
The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided in ...
. A study found latanoprost ineffective on eyelashes in a patient with alopecia areata
Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often, it results in a few bald spots on the scalp, each about the size of a coin. Psychological stress and illness are pos ...
. It has also been found ineffective in treatment of eyebrow hair loss.
Hormones
Estrogens are indirect anti-androgens and can be used to treat androgenetic hair loss in women with oral contraceptives Oral contraceptives, abbreviated OCPs, also known as birth control pills, are medications taken by mouth for the purpose of birth control.
Female
Two types of female oral contraceptive pill, taken once per day, are widely available:
* The combin ...
. Systemic estrogen increases SHBG, which binds androgens, including testosterone and DHT, in turn reducing their bioavailability. Topical formulations are available in Europe
Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a subcontinent of Eurasia and it is located entirel ...
. Hair follicles have estrogen receptors and it is theorized that topical compounds act on them directly to promote hair growth and antagonize androgen action. Large clinical studies showing effectiveness are absent. Topical treatment is also usually unavailable in North America.
There is tentative evidence for cyproterone acetate
Cyproterone acetate (CPA), sold alone under the brand name Androcur or with ethinylestradiol under the brand names Diane or Diane-35 among others, is an antiandrogen and progestin medication used in the treatment of androgen-dependent condition ...
in women.[
]
IGF-1
In December 2012, topical application of IGF-1 in a liposomal vehicle led to thicker and more rapid hair growth in transgenic mice with androgenic alopecia. The study did not show measurable systemic levels or hematopoietic side effects, suggesting potential for use in humans. Low energy radiofrequency irradiation induces IGF-1 in cultured human dermal papilla cells. Adenosine stimulates dermal papillae in vitro to induce IGF-1, along with fibroblast growth factors FGF7
Keratinocyte growth factor is a protein that in humans is encoded by the ''FGF7'' gene.
Function
The protein encoded by this gene is a member of the fibroblast growth factor (FGF) family. FGF family members possess broad mitogenic and cell surv ...
, FGF-2
Fibroblast growth factor 2, also known as basic fibroblast growth factor (bFGF) and FGF-β, is a growth factor and signaling protein encoded by the ''FGF2'' gene. It binds to and exerts effects via specific fibroblast growth factor receptor ''(FG ...
and VEGF
Vascular endothelial growth factor (VEGF, ), originally known as vascular permeability factor (VPF), is a signal protein produced by many cells that stimulates the formation of blood vessels. To be specific, VEGF is a sub-family of growth factors ...
. β-catenin
Catenin beta-1, also known as beta-catenin (β-catenin), is a protein that in humans is encoded by the ''CTNNB1'' gene.
Beta-catenin is a dual function protein, involved in regulation and coordination of cell–cell adhesion and gene transcripti ...
transcription increased, which promotes dermal papillae as well. Dietary isoflavones increase IGF production in scalp dermal papillae
The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided in ...
in transgenic mice. Topical capsaicin also stimulates IGF at hair follicles via release of vanilloid receptor-1, which in turn leads to more CGRP. Ascorbic acid has led to increased IGF expression ''in vitro''.
Platelet-rich plasma (PRP)
Reviews in 2013 and 2017 on the use of platelet-rich plasma
Platelet-rich plasma (PRP), also known as autologous conditioned plasma, is a concentrate of platelet-rich plasma protein derived from whole blood, centrifuged to remove red blood cells. Though promoted to treat an array of medical problems, evid ...
to regrow hair found insufficient evidence to draw clear conclusions.
Stem cell therapy
Although follicles were previously thought gone in areas of complete baldness, they are more likely dormant, as recent studies have shown the scalp contains the stem cells from which the follicles arose. Research on these follicular stem cells may lead to successes in treating baldness through ''hair multiplication'' (HM), also known as ''hair cloning
Hair multiplication or hair cloning is a proposed technique to counter hair loss. The technology to clone hair is in its early stages. Experts previously assumed that in the case of complete baldness, follicles are completely absent from the scal ...
''.
Per a May 2015 review, no successful strategy to generate human hair follicles, for hair regrowth, from adult stem cells has yet been reported. However, in April 2016, scientists from Japan published results of their work in which they created human skin from induced pluripotent stem cell
Induced pluripotent stem cells (also known as iPS cells or iPSCs) are a type of pluripotent stem cell that can be generated directly from a somatic cell. The iPSC technology was pioneered by Shinya Yamanaka's lab in Kyoto, Japan, who showed in ...
s; implanted into laboratory mice, the cells generated skin with hair and glands.
Genetics
From 2005 to 2007, Curis and Procter & Gamble
The Procter & Gamble Company (P&G) is an American multinational consumer goods corporation headquartered in Cincinnati, Ohio, founded in 1837 by William Procter and James Gamble. It specializes in a wide range of personal health/consumer he ...
collaborated on developing a topical hedgehog
A hedgehog is a spiny mammal of the subfamily Erinaceinae, in the eulipotyphlan family Erinaceidae. There are seventeen species of hedgehog in five genera found throughout parts of Europe, Asia, and Africa, and in New Zealand by introductio ...
agonist for hair loss; the agent did not meet safety standards, and the program was terminated. In 2008, researchers at the University of Bonn
The Rhenish Friedrich Wilhelm University of Bonn (german: Rheinische Friedrich-Wilhelms-Universität Bonn) is a public research university located in Bonn, North Rhine-Westphalia, Germany. It was founded in its present form as the ( en, Rhine ...
announced they have found the genetic basis of two distinct forms of inherited hair loss. They found the gene P2RY5 causes a rare, inherited form of hair loss called hypotrichosis simplex. It is the first receptor
Receptor may refer to:
* Sensory receptor, in physiology, any structure which, on receiving environmental stimuli, produces an informative nerve impulse
*Receptor (biochemistry), in biochemistry, a protein molecule that receives and responds to a ...
in humans known to play a role in hair growth. Researchers found that disruption of the gene
In biology, the word gene (from , ; "... Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation'' or ''birth'' or ''gender'') can have several different meanings. The Mendelian gene is a b ...
SOX21 in mice caused cyclical hair loss. Research has suggested SOX21 as a master regulator of hair shaft cuticle differentiation, with its disruption causing cyclical alopecia in mice models. Deletion of SOX21 dramatically affects hair lipids.
References
External links
"Medical Treatments for Balding in Men"
April 1999, ''American Family Physician'' (medical journal)
Dermatologic procedures
Plastic surgical procedures