Alopecia Treatments

A range of treatments is available for alopecia however the effectiveness of treatments is variable.

There is no cure for alopecia and no universally proven therapy to induce hair re-growth and sustain remission, however, there are treatments. The effectiveness of treatments tends to vary and something that works well for one person may not work well for another. If you find one treatment doesn't work don't assume others won't either. However, bear in mind for some people none of the treatments are effective. Treatments for alopecia are generally divided into two groups:

1. People with less than 50% hair loss
2. People with over 50% hair loss

All of the therapies have documented side effects, some of which can be unpleasant. Treatments such as topical immunotherapy can be very time consuming. Individuals may decide that the adverse effects of treatment and the unpredictable outcome are unacceptable.

Treatment for less than 50% hair loss

Corticosteroids
Today, corticosteroids are the most common treatment for alopecia. In mild cases of alopecia the first choice of treatment would be a corticosteroid cream or lotion which is applied directly to the area(s) of hair loss. Alternatively an injection of corticosteroid can be given directly onto and around the bald area(s).
Side Effects
Side effects are generally rare when corticosteroids are used for a short time. However, when they are used over a longer period, they may lower the body's ability to fight off infections or may make infections harder to treat. Other common side effects include changes in appetite (increase or decrease), nervousness, restlessness, sleep problems, and indigestion. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Less common side effects may occur with some forms of corticosteroids. Gels or creams may irritate the skin. Again, these side effects do not need medical attention unless they don't go away or they interfere with normal activities. More serious side effects are very unlikely, but they may occur.
Cost
In the UK corticosteroids are only available on prescription.
Effectiveness
This type of treatment can sometimes cause a spontaneous recovery or can cause hair to grow only for the period during which the treatment occurs, so when the treatment is stopped the hair may fall out again. In the case of corticosteroid injections an average of 4 to 6 monthly injections are usually required for significant improvement. However although some re-growth is common it does not always occur.

Dithranol
Dithranol is a tar-like ointment that is applied to the scalp and is especially good in the treatment of psoriasis (a skin condition causing red scaly patches). The pharmacist can compound it in various different pastes, ointments, and creams, and the strength may vary from 0.1 to 4%.
Side Effects
It can irritate the skin when applied and can cause burning and redness. It can also stain.
Cost
Available on prescription. Commercial and spontaneous Dithranol preparations are inexpensive and, in most cases, the cost is easily covered by the prescription charge. If Dithranol has to be applied by a trained nurse, or combined with UVB therapy, the cost rises sharply but the treatment can then be more effective.
Effectiveness
Dithranol can be effective even if only left on the skin for 10 minutes. This 'short contact' method allows stronger concentrations of Dithranol to be used with much less burning and staining. The stronger the Dithranol, the better the effect on psoriasis.

DPCP
DPCP stands for diphenylcyclopropenone. It is a chemical agent used to treat severe alopecia areata. DPCP is considered an experimental medication. It is said to be safe although there is no information about the long term side effects when used over many years. DPCP comes as a fluid and is applied to the bald areas once a week. Testing is done with a 2% solution and is applied to a 4x4cm area on the scalp. One week later the area is examined. If there is a severe response with blisters , intense redness , scaling and itching, treatment is postponed till the following week. If there is only mild redness , scaling and itching, DPCP is applied on the hairloss areas. After every administration of DPCP, the painted area should not be washed for 48 hours and kept covered because sunlight inhibits the action of DPCP.
Side Effects
Eczema, Lymph node enlargement and skin discoloration are all possible side effects.
Cost
Available via a dermatologist on prescription.
Effectiveness
First evidence of hair growth is expected to occur after 3 months, full growth after 6 months. Once full regrowth occurs, the frequency of application is decreased. Even after full growth of hair, some patients may stop responding to furthur application of DPCP and may lose all their hair again. If after 5 months of using DPCP no hair regrowth is noticed DPCP is discontinued.

Retin A / Tretinoin
Retin-A was originally used for the treatment of acne and other skin problems. However studies have shown that Retin-A, when used alone in the form of a gel, which is rubbed onto the area of hair loss, or in combination with topical Minoxidil can result in moderate to good hair growth in individuals with Alopecia. It is recommended that Minoxidil is used in the morning and Retin-A in the evening as Retin-A increases the skin's sensitivity to sunlight.
Side Effects
Immediately after applying, the skin may feel warm or mild stinging or redness may occur. Some peeling of the skin may occur. These effects should subside as your skin adjusts to the medication.
Cost
1 tube of Retin-A cream starts at around £20 at online pharmacies. Generally the more you buy the less each tube is.
Effectiveness
Studies have shown that Retin-A, when used alone in the form of a gel, which is rubbed onto the area of hair loss, or in combination with topical Minoxidil can result in moderate to good hair growth in individuals with alopecia.

Topical Minoxidil / Regaine, Rogaine or Headway
Topical Minoxidil can be successful in alopecia, slowing down hair loss, and bridging the gap until hair starts growing again on its own.
Side Effects
Side effects may include irritation of the scalp, itching, scaling, a rash, and on the odd occasion excessive hair growth.
Cost
Minoxidil is not available on prescription. In the high street prices are about £30 for a 5% solution. However the 2% and 5% solutions can be ordered online for about £20 a bottle. A bottle will normally last for about a month. The 5% solution is not suitable for women who may become pregnant.
Effectiveness
Topical Minoxidil can be effective on patchy alopecia. Unfortunately topical Minoxidil is not normally effective in individuals with major loss of hair.

Zinc
Oral zinc has been shown to be of occasional benefit in Alopecia.
Side Effects
Very high doses are needed for it to be effective and this can result in side effects such as vomiting and diarrhoea.
Cost
Zinc can be bought in any chemist or health food shop. A variety of tablets are sold with different amounts of zinc. 100 caplets of zinc 25mg costs under £10.
Effectiveness
Prolonged treatment with zinc sulphate is helpful. There is no zinc deficiency noticeable in the body, and short term treatment with zinc is not helpful.

Treatments for over 50% hair loss

Immunosuppressive drugs
It is thought that Immunosuppressive drugs should be able to suppress the immune system giving the hair a chance to re-grow. The main problem with taking immunosuppressive drugs is that it can lead to a lowered resistance to infection.
Side Effects
Increased chance of infection as the immune system is suppressed.
Cost
These can be obtained via the NHS by prescription.

Irritants (Anthralin)
When irritants are applied to the scalp they cause an allergic reaction. This allergic reaction draws the T lymphocytes away from the follicle in order to deal with the irritant and allows the hair a chance to start re-growing.
Side Effects
It can cause an itchy and red scalp. This can lead to blisters.
Cost
Certain irritants are available with an NHS prescription.
Effectiveness
Some studies show hair growth response ranges from sparse re-growth to almost total recovery. Other dermatologists report less successful response rates.

PUVA
PUVA treatment involves taking a light sensitive drug and then undergoing a short exposure to UVA (ultraviolet light). Treatment takes place over a three to six week period with sessions two to three times a week. The more recent the hair loss, the more likely it is that there will be a response to treatment.
Side Effects
The likelihood is your skin will burn, as if over tanned, but it's hoped the body's immune system gets so busy repairing skin tissue that it lets your hair begin to grow.
Cost
This is available on the NHS, but can be very time consuming involving 2 or 3 treatments per week.
Effectiveness
It has not been shown to have a very high success rate (around 6-12%) - and it can be very painful. It is not considered to be an effective long-term treatment.

Systemic Corticosteroids
Oral corticosteroids (Prednisone) are used to try and encourage the immune system to kick into action and grow hair. Corticosteroids taken orally are sometimes prescribed for extensive hair loss or when the condition is rapidly spreading. Corticosteroids taken internally are much more powerful than local injections into the skin. May be used in conjunction with Minoxidil as the dose is being reduced.
Side Effects
The most common side effects reported with the short-term (days to weeks) use of oral corticosteroids include a bigger appetite, weight gain, upset stomach, headache, mood changes, and trouble sleeping. Some people may also have upswings in blood sugar and blood pressure. In general, all of these side effects go away after you stop taking corticosteroids. Side effects associated with long-term (months to years) oral corticosteroid include weakening of the immune system, elevations in cholesterol levels, and weight gain. These side effects also usually improve when you stop taking corticosteroids. Long-term use of corticosteroids may also cause brittle bones (osteoporosis), fat deposits on the face and back, thinning of the skin, and cataracts in the eyes. These side effects may improve but usually don't go away completely after stopping the drug. In children, long-term use of oral corticosteroids may cause stunted growth.
Cost
Available on prescription.
Effectiveness
When taking oral corticosteroids you are likely to experience some re-growth. However unless your immune system kicks into `normal’ action and allows you to produce hair yourself, the re-growth you have experienced will cease and the hair will unfortunately fall out again after you cease the treatment.

UVB
This treatment is similar to PUVA. It is generally used to treat skin conditions but is also used for people with severe hair loss (e.g. more than 90%). It involves standing in a cubicle of ultraviolet lights two to three times a week for an increasing amount of time.
Side Effects
Like PUVA you may have redness and burning of the skin, similar to spending too long in the sun.
Cost
Again this is free on the NHS. Alternatively you could arrange a course of sessions on a sun bed.
Effectiveness
Although there is some documented evidence of success, in most cases this treatment does not appear to help with hair growth and the redness and burning can be quite painful. It may also increase your chance of getting skin cancer.

No Treatment
One of the most difficult aspects of alopecia is that it is very unpredictable and nobody can say what will happen in the future. People have found that even after several years of having no hair they have regrowth, others have found that while patches of hair loss start to grow they experience hair loss elsewhere. You may also find that you have regrowth and then it all falls out again. There are cases where the hair regrows and never falls out again (the majority) or a few where the hair falls out and never regrows. Having said that, as a general rule, the longer you have no regrowth and the more severe the hair loss, the less likely the hair is to grow back permanently. This doesn't mean that it won't - it just means it's less likely to. The pattern of your hair loss is not going to be changed by treatments, but the treatments may help with regrowth. It is your choice.

Advice and guidelines for anyone considering alternative/complementary treatments.