Understanding Hair Loss - Treatment

What Are the Treatments?

Although remedies that promise to restore hair to balding heads have been around since ancient times, most men and women with thinning hair can do little to reverse the process. For cosmetic purposes, or after hair loss from surgical or drug treatments, many people turn to wigs, hairpieces, and hair weaving -- even tattooing to simulate lost eyebrows and eyelashes. Some drugs may slow hair loss, and certain alternative treatments can relieve stress or bolster the health of remaining hair, but until recently no treatment could start hair growth where no hair existed.

Minoxidil (Rogaine). Under certain circumstances, a topical (applied to the skin) preparation containing the drug minoxidil appears to provide moderate regrowth of hair on areas of the scalp that have gone bald. Minoxidil works on hair follicles to reverse their shrinking process to stimulate new growth. The effects are most promising in younger people who are just beginning to show signs of balding or who have small bald patches. The medication is a solution that is applied to balding spots twice a day and must be continued daily; hair loss will recur if the application is stopped. More than 50% of users claim that it can thicken hair and slow hair loss, but it is not considered effective in men who already have extensive male pattern baldness. Side effects appear to be minimal, but in some users the drug may cause skin irritation. The drug is approved for use in men and women. It's available over-the-counter.

Propecia. Originally used for the treatment of prostate problems in higher doses, Propecia is now being used for male pattern hair loss. Propecia works by blocking the formation of the male hormones in the skin that can cause hair loss. Propecia is available by prescription and is taken once a day in pill form. As with most medications, there are side effects. Be sure to talk to your doctor about it. Propecia cannot be used by women of childbearing potential because the drug can cause birth defects.

Hair transplantation. Hair transplantation involves the relocation of plugs of skin from parts of the scalp containing active hair follicles to bald areas. A patient may need several hundred plugs -- implanted 10 to 60 at a session. The transplanted hair may drop out, but new hair usually begins to grow from the transplanted follicles within several months. Newer hair transplantation procedures called follicular unit hair transplants can transplant one to four hairs, transplanted very close together, for a more natural look.

Skin Lifts and Grafts. A "flap" of hair-bearing skin is created by making surgical cuts near the balding area. The flap is then rotated onto the balding section.

Scalp reduction. A form of cosmetic surgery called scalp reduction involves tightening the scalp so that hair-bearing skin from the back and sides of the head is pulled toward the crown. Hair may then be transplanted to the remaining bald area at the top of the head. Like hair transplants, the process is painful and expensive, and it does nothing to retard genetic or age-related hair loss. This procedure is rarely done any more.

Although most cases of alopecia areata are resolved spontaneously, some doctors try to speed recovery with corticosteroids applied topically or injected in the scalp. The treatment may be painful and may cause temporary skin atrophy. Prednisone, another oral steroid, has proven effective for alopecia areata patients, but its potential side effects include weight gain, metabolic abnormalities, acne, and menstrual problems.  Its positive effects are often only temporary.