As a diverse condition hair loss affects diverse people including both men and women with various treatments available. Medication, surgery and concealers are three top options on the market today.
There are two main hair growth stimulating medications on the market today; minoxidil and finasteride. Minoxidil is a topical solution approved to treat male pattern hair loss (androgenetic alopecia)1,2.
Minoxidil is primarily used to maintain current growth but can also promote hair growth3. There is significant scientific research to support the idea that minoxidil use leads to more hair and higher hair growth rates3. Some reported adverse or undesired effects of minoxidil include itching (pruritus), inflamed skin (contact dermatitis), increased hair shedding and “peach fuzz”-like regrowth3–6. However, the new foam formulation may help reduce the incidence of pruritus and contact dermatitis. Topical minoxidil should be applied for a minimum of three months, and preferably six months, to see results.
Another drug that promotes hair growth is finasteride. This oral therapy is approved by Health Canada and the FDA for male-pattern hair loss7,8. Finasteride can help stabilize hair loss9. In a systematic review of 16 studies conducted with finasteride and dutasteride, finasteride (1 mg and 5 mg) treated patients displayed superior hair growth as determined by photographic assessments as compared to untreated patients10. The adverse effects of these medications can include sexual dysfunction 11–13 (REF) Another oral agent called dutasteride has not been approved for hair regrowth although it is used for this purpose. It may be more effective than finasteride; however, it has a longer half-life and this may be a disadvantage if a patient develops side-effects such as sexual dysfunction.
A hair transplant can also help achieve natural-looking hair growth. During a hair transplant, hair from the back of the scalp are removed and implanted into balding areas14. There are two main hair harvesting techniques that are available today; the ‘strip’ method and the follicle unit extraction (FUE) method.
The strip method is considered the standard harvesting method used frequently in hair transplant surgeries15. During the strip method, a section of skin containing viable hair follicles is removed from the back of the scalp. This strip is then cut into grafts and implanted into desired balding area16. This procedure will result in a linear scar in the donor area that can be easily covered with long hair16. Strip harvesting is perfect for those with large balding areas as this method can yield lots of viable, high quality grafts in just one sitting16.
As an alternative to strip, the FUE harvesting method does not create a linear scar. During FUE individual follicular units are harvested and then implanted into balding areas16. FUE is recommended for small balding areas and is a great option for those that prefer shorter hair styles17. Not all patients are candidates for this technique as there are specific criteria (e.g., adequate donor supply) that need to be addressed before harvesting is performed17.
Some reported adverse or undesired effects with hair transplant surgeries include transient postoperative swelling (edema) especially if the front of the scalp is transplanted, numbness, and scarring18. Most adverse effects are temporary however, as with other surgeries, scarring is unavoidable. These scars, as stated previously, can be concealed with longer hairstyles. With transplant of the crown of the scalp frontal facial edema is minimal or non-existent.
Hair transplantations can be ill-advised in rare complicated hair loss conditions such as epidermolysis bullosa (a connective tissue disease)19. Concealers or camouflaging agents can be alternative options to hair transplants. The goal of concealers is to help make the scalp less visible by reducing the color contrast between the scalp and the remaining hair follicles20. Scalp tattooing and hair thickening fibers are among the many camouflaging agents currently available. Microscopic hair fibers can be sprinkled to target areas to help conceal hair thinning and/or hair loss. Additionally, hair-thickening fibers, colored to match your specific hair color, can also help camouflage hair loss21. Scalp micropigmentation (SMP), a tattoo applied to the scalp, is a more permanent option22. The stippling effect performed with this type of tattoo can mimic shaven hair follicles22.
If you’re unsure about what option best suites you ask your doctor or our hair transplant physician or specialist for more information.
Article by: Sarah Versteeg MSc, Mediprobe Research Inc.
- Product Monograph. Hair Regrowth Forumula. Minoxidil Topical Solution USP 20 mg/mL (2% w/v) [Internet]. Health Canada. Drug Product Database. 2016 [cited 2016 Oct 6]. Available from: file:///C:/Users/sversteeg/Downloads/PM00033538.PDF
- Drugs@FDA: FDA Approved Drug Products. Women’s Rogaine 5% Minoxidil Topical Aerosol, Approval History and Label [Internet]. [cited 2014 Jul 29]. Available from: https://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#apphist
- Gupta AK, Charrette A. Topical Minoxidil: Systematic Review and Meta-Analysis of Its Efficacy in Androgenetic Alopecia. Skinmed. 2015 Jun;13(3):185–9.
- Pazoki-Toroudi H, Babakoohi S, Nilforoushzadeh MA, Nassiri-Kashani M, Shizarpour M, Ajami M, et al. Therapeutic effects of minoxidil high extra combination therapy in patients with androgenetic alopecia. Skinmed. 2012 Oct;10(5):276–82.
- Civatte J, Laux B, Simpson NB, Vickers CF. 2% topical minoxidil solution in male-pattern baldness: preliminary European results. Dermatologica. 1987;175 Suppl 2:42–9.
- Katz HI, Hien NT, Prawer SE, Goldman SJ. Long-term efficacy of topical minoxidil in male pattern baldness. J Am Acad Dermatol. 1987 Mar;16(3 Pt 2):711–8.
- PrAURO-FINASTERIDE 1 mg Finasteride tablets BP 1 mg Type II 5α-reductase inhibitor [Internet]. Health Canada. Drug Product Database. 2014 [cited 2016 Nov 8]. Available from: https://health-products.canada.ca/dpd-bdpp/info.do?code=91262&lang=en
- PROPECIA® (finasteride) tablets for oral use [Internet]. FDA U.S. Food and Drug Administration. 2014 [cited 2016 Nov 8]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020788s024lbl.pdf
- Knudsen R. What would hair restoration surgery by like if we didn’t have finasteride? Hair Transpl Forum Int. 2015 Oct;25(5):200.
- Gupta AK, Charrette A. The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatol Treat. 2014 Apr;25(2):156–61.
- Hirshburg JM, Kelsey PA, Therrien CA, Gavino AC, Reichenberg JS. Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review. J Clin Aesthetic Dermatol. 2016 Jul;9(7):56–62.
- Liu L, Zhao S, Li F, Li E, Kang R, Luo L, et al. Effect of 5α-Reductase Inhibitors on Sexual Function: A Meta-Analysis and Systematic Review of Randomized Controlled Trials. J Sex Med. 2016 Sep;13(9):1297–310.
- Guo M, Heran B, Flannigan R, Kezouh A, Etminan M. Persistent Sexual Dysfunction with Finasteride 1 mg Taken for Hair Loss. Pharmacotherapy. 2016 Sep 19;
- Gho CG, Neumann HAM. Advances in Hair Transplantation: Longitudinal Partial Follicular Unit Transplantation. Curr Probl Dermatol. 2015 Feb;47:150–7.
- ISHRS Best Practices Survey Project Module: Who Does What Summary Analysis. Hair Transpl Forum Int. 2015 Aug;25(4):162–4.
- Avram M, Rogers N. Contemporary hair transplantation. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2009 Nov;35(11):1705–19.
- Rashid RM, Bicknell LTM. Follicular unit extraction hair transplant automation: Options in overcoming challenges of the latest technology in hair restoration with the goal of avoiding the line scar. Dermatol Online J [Internet]. 2012 Sep 1 [cited 2013 Sep 16];18(9). Available from: http://escholarship.org/uc/item/0x57s71r
- Loganathan E, Sarvajnamurthy S, Gorur D, Suresh DH, Siddaraju MN, Narasimhan RT. Complications of hair restoration surgery: a retrospective analysis. Int J Trichology. 2014 Oct;6(4):168–72.
- Tosti A, Duque-Estrada B, Murrell DF. Alopecia in epidermolysis bullosa. Dermatol Clin. 2010 Jan;28(1):165–9.
- Donovan JCH, Shapiro RL, Shapiro P, Zupan M, Pierre-Louis M, Hordinsky MK. A review of scalp camouflaging agents and prostheses for individuals with hair loss. Dermatol Online J. 2012 Aug 15;18(8):1.
- Harris AG, Kim M, Murrell DF. Pigmented Hair-Thickening Fibers: A Camouflage Technique for Alopecia in Patients with Epidermolysis Bullosa. Skin Appendage Disord. 2016 Feb;1(3):153–5.
- Rassman WR, Pak JP, Kim J, Estrin NF. Scalp micropigmentation: a concealer for hair and scalp deformities. J Clin Aesthetic Dermatol. 2015 Mar;8(3):35–42.
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