Diagnosis and Treatment
Only a physician can confirm the presence of alopecia, so if you experience any of its symptoms, make anappointment to see your doctor. Your doctor will examine your scalp, hair shafts and pattern of hair loss to narrow down potential causes. Determining the cause of the condition is sometimes difficult, so a doctor may take a scalp biopsy, s alp scraping, or blood test to make a diagnosis. A biopsy will help your doctor determine if the hair follicles are healthy and normal, and in the case of alopecia areata, ensure that it is not a symptom of another illness.
Treatment for alopecia varies based on the specific type.
There are two medications approved in Canada to treat androgenetic alopecia: minoxidil and finasteride. Both drugs are approved for use by men only.
Minoxidil is a topical solution of 2 per cent minoxidil, applied to the scalp, that effectively promotes hair growth in men and women. A 5 per cent solution is also available. The treatment is continued indefinitely. Discontinuation of treatment results in reversion to hair loss. Side effects include itching and skin irritation.
Finasteride is an oral treatment that effectively promotes hair growth in men. Discontinuation of treatment results in reversion to hair loss. Finasteride is not used to treat the condition in premenopausal women as the drug can affect developing fetuses. In post-menopausal women, finasteride had no effect on hair regrowth. Side effects include loss of sex drive and difficulty achieving an erection.
Other options to treat androgenetic alopecia include hair follicle transplantation and use of cosmetic aids (wigs or hair-weaving techniques).
In most cases, alopecia areata will spontaneously regress, with hair reappearing within a year. Because of this, many patients opt for no treatment at all and wear hairpieces, hair weaves or wigs until the hair grows back in. However, in other cases, the disease may persist for long periods or spread to other areas. In approximately 10 per cent of cases, the hair may never regrow. Patients whose alopecia areata began before adolescence or involves the peripheral scalp (ophiasis) or who also have hay fever, eczema or asthma may be at greater risk for progression to the chronic form.
Currently, there are no approved treatments specifically for the disease. However, many agents commonly used to treat other forms of baldness can promote hair growth, though no treatment has been shown to work consistently for all cases. The regrown hair often falls out when treatment is discontinued. However, some ways to treat alopecia areata include:
- For small bald patches, corticosteroids may be applied directly to the skin.
- For small and medium-sized areas, corticosteriods are typically injected under the skin in and around the bare patches.
- For larger bare patches, corticosteroids are sometimes given orally. However, hair often falls out when treatment is discontinued. This option is not often used, as some patients may suffer adverse side effects.
Chemicals called contact sensitizers are applied to the area to induce a mild allergic reaction that may trigger hair growth. Common topical contact sensitizers are anthralin, diphenylcyclopropenone (DPCP), dinitrochlorobenzene and squaric acid dibutylester. The use of this treatment is limited to those for whom other treatments are ineffective.
Minoxidil, typically used for male pattern baldness, may be applied to the bare areas. It is not effective in treating those with 100 per cent scalp hair loss.
Psoralen is a compound that enhances absorption of ultraviolet rays. It is usually applied to the skin and followed by exposure to ultraviolet A radiation. This treatment may prevent the immune system from attacking hair follicles. The required frequent exposure to UV light may pose an unacceptable risk of skin cancer. Side effects include skin redness and a burning sensation.
Scientists continue to research alopecia, specifically in the areas of genetics (to determine who is susceptible and why), autoimmunity (to determine the cause and possible treatments) and new medications.
As alopecia areata is often temporary (hair grows back without treatment), some people choose to not treat the condition at all. Many wear a natural-looking wig, hair piece, or hair weave. Other people may consider having a hair transplant. However, a hair transplant involves moving a patient’s own hair follicles from the back or sides of the head to the affected area. For this treatment to work, the person must have healthy hair follicles in these areas. Before deciding which treatment is best for you, talk to your doctor to discuss your expectations as well as each treatment’s limitations. No one treatment is the best for every patient.
*All information on medical treatments on this site is provided as an overview only. For a complete and up-to-date list of side effects, warnings and precautions, read the product’s package insert and consult your doctor or a pharmacist.
**If you are considering an alternative or complementary therapy, discuss it with your doctor first, and always be sure to keep your doctor up to date about any vitamins, supplements, or other forms of alternative treatment you are taking. Like any medication, alternative therapies can interact with other medications/treatments and, in some cases, have side effects of their own. Remember that “natural” does not mean “safe.”