Do Hair Loss Treatments Actually Work? – Scientific American

Although there are currently no treatments that work for everyone with alopecia areata, some treatments are effective for some people. Depending on which type of alopecia areata you have, your age and the extent of hair loss, there are a variety of treatment options available. The main goals of treatment are to block the immune system attack and/or stimulate the regrowth of hair. This can be effective, especially for people with milder forms of the disease (less than 50% hair loss).

For those who have more than 50% hair loss on their scalp or other areas of the body, there are also oral (taken as a pill) and topical (applied to the skin) medications available as well as phototherapy or light treatments.

While none of the medications or devices commonly used to treat alopecia areata are approved specifically for this disease by the Food and Drug Administration (FDA), they have been approved for other diseases. It’s important to know that while these therapies may offer benefits to some people with alopecia areata, there is no single option that will work for everyone. Even if your hair is regrown, there is no guarantee that it won’t fall out again once treatment is stopped.

This is not an extensive review of all possible treatments, just an overview of the more common ones you are likely to encounter. It’s best to discuss all of your options for treatment with a dermatologist, who can work with you to find the right medications or therapies for your particular type and severity of alopecia areata.

There are a variety of treatments for both mild and severe alopecia areata — it’s important to stay informed, so you and your doctor can choose the best course for yours. Goals of therapy include stopping active hair loss and regrowing hair.

This method of treatment — the most common form of treatment for alopecia areata — uses corticosteroids that are injected into bare patches of skin with a tiny needle. These injections are repeated about every four to six weeks and are usually given by a dermatologist.

Corticosteroid injections, like all treatments for alopecia areata, do not prevent new hair loss from developing. While there are few reported side effects related to this kind of treatment, temporary depressions (called “dells”) in the skin may result from the injections. However, these usually improve with time. People may experience slight discomfort from the needle pricks and tingling from the medication, but usually there is no other pain or discomfort after leaving the dermatologist’s office.

With this form of treatment, a 5% topical minoxidil solution is applied once or twice a day to help stimulate hair on the scalp, eyebrows and beard to regrow. Two and 5% topical minoxidil solutions are available but aren’t usually effective for alopecia areata when used alone, but when applied in combination with topical corticosteroid medications, some people see improved results.

This synthetic, tar-like substance — also widely used for psoriasis — is a common form of treatment for alopecia areata. Anthralin is applied to the hairless patches once a day and then washed off typically after a short time (usually 30-60 minutes later) or in some cases, after several hours.

This form of medication may irritate the skin and cause a temporary, brownish discoloration of the skin that’s been treated. However, some patients can reduce these side effects by using anthralin for shorter periods of time, without decreasing the treatment’s effectiveness. 

In alopecia areata, corticosteroids are thought to decrease the inflammation around the hair follicle. Topical steroids can come in different brands, strengths and preparations, such as solutions, lotions, foams, creams, or ointments. 

Studies have shown that there is a reduction of hair loss when using topical steroids. In addition, improved regrowth of approximately 25% has been observed with the use of highly potent topical corticosteroids. They can be good adjunct medications especially when treating children with alopecia areata.

There are many therapies which can offer benefits for someone with alopecia areata, however there is no single option proven to work for everyone. Some people with alopecia areata may choose accessories, wigs, or cosmetic alternatives to address their hair loss, while others opt not to cover affected areas.

Healthy, young adults can usually tolerate corticosteroid pills with few side effects. However, doctors do not prescribe corticosteroid pills as often as other treatments for alopecia areata, because of the health risks and side effects associated with using them for a long period of time. It’s important to talk to your doctor about your goals for treatment and possible side effects of the medication, to be sure the benefits of using corticosteroid pills in your case are greater than the risks. As with other options, hair regrown with corticosteroid use may fall back out once treatment is stopped.

Topical immunotherapy is used to treat extensive alopecia areata, alopecia totalis and alopecia universalis. This form of treatment involves applying chemicals such as diphencyprone (DPCP), dinitrochlorobenzene (DNCB) or squaric acid dibutyl ester (SADBE) to the scalp. This causes an allergic rash (allergic contact dermatitis) that looks like poison oak or ivy, which alters the immune response.

Patients who successfully regrow scalp hair usually must continue treatment in order to maintain the regrowth. Side effects — redness, itching and a rash at the site of application — are common. Topical immunotherapy isn’t widely available and is typically performed and prescribed by dermatologists. The National Alopecia Areata Foundation can help you find a specialist who offers this treatment in the U.S.

Immunomodulatory drugs — specifically, Janus kinase (JAK) inhibitors — such as tofacitinib (Xeljanz) and ruxolitinib (Jakafi), are a new type of therapy being tested for alopecia areata. These medications were originally approved to treat certain blood disorders and rheumatoid arthritis. They are not approved by the FDA for alopecia areata yet, and are only available right now in the form of an oral medication. A topical formulation is currently in clinical trials in the United States.

Oral immunomodulators have proven to be effective at helping some patients with extensive alopecia areata regrow hair — even if they’ve had the disease (and hair loss) for many years. This has been observed in the small number of patients studied so far.

Because this is a new form of therapy, there isn’t a lot of information known about the side effects of taking this medication. Clinical trials are being done in order to evaluate the oral and topical medication’s effectiveness and safety in treating alopecia areata. 

Patients with alopecia areata, alopecia totalis and alopecia universalis can be treated based on age and severity of the condition. This algorithm outlines an approach that can be used from mild to severe forms of the disorder. There are now choices that the patient can decide on what is best for them based on efficacy, cost and side effect profile.

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Sometimes, it can lead to the complete loss of hair on the scalp (alopecia totalis) or, in extreme cases, the entire body (alopecia universalis). The condition can affect anyone regardless of age and gender, though most cases occur before the age of 30.

The most common form of alopecia areata treatment is the use of corticosteroids, powerful anti-inflammatory drugs that can suppress the immune system. These are mostly commonly administered through local injections, topical ointment application, or orally.

Other medications that can be prescribed that either promote hair growth or affect the immune system include Minoxidil, Anthralin, SADBE, and DPCP. Although some of these may help with the re-growth of hair, they cannot prevent the formation of new bald patches.

Alopecia areata does not directly make people sick, nor is it contagious. It can, however, be difficult to adapt to emotionally. For many people, alopecia areata is a traumatic disease that warrants treatment addressing the emotional aspect of hair loss, as well as the hair loss itself.

Alopecia areata has been compared by some to vitiligo, an autoimmune skin disease where the body attacks melanin-producing cells, leading to white patches. Research suggests that these two conditions may share a similar pathogenesis, with similar types of immune cells and cytokines driving the diseases and common genetic risk factors.

Preliminary research in animals has found that quercetin, a naturally occurring bioflavonoid found in fruits and vegetables, can protect against the development of alopecia areata and effectively treat existing hair loss.

The condition occurs when white blood cells attack the cells in hair follicles, causing them to shrink and dramatically slow down hair production. It is unknown precisely what causes the body’s immune system to target hair follicles in this way.

While scientists are unsure why these changes occur, it seems that genetics are involved as alopecia areata is more likely to occur in a person who has a close family member with the disease. One in five people with the disease has a family member who has also developed alopecia areata.

Other research has found that many people with a family history of alopecia areata also have a personal or family history of other autoimmune disorders, such as atopy, a disorder characterized by a tendency to be hyperallergic, thyroiditis, and vitiligo.

Despite what many people think, there is very little scientific evidence to support the view that alopecia areata is caused by stress. Extreme cases of stress could potentially trigger the condition, but most recent research points toward a genetic cause.

There are some people that recommend rubbing onion or garlic juice, cooled green tea, almond oil, rosemary oil, honey, or coconut milk into the scalp. While none of these are likely to cause harm, their effectiveness is also not supported by research.

The most prominent symptom of alopecia areata is patchy hair loss. Coin-sized patches of hair begin to fall out, mainly from the scalp. Any site of hair growth may be affected, though, including the beard and eyelashes.

The loss of hair can be sudden, developing in just a few days or over a period of a few weeks. There may be itching or burning in the area before hair loss. The hair follicles are not destroyed and so hair can re-grow if the inflammation of the follicles subsides. People who experience just a few patches of hair loss often have a spontaneous, full recovery without any form of treatment.

About half of patients recover from alopecia areata within 1 year, but many will experience more than one episode. Around 10 percent of people will go on to develop alopecia totalis or alopecia universalis.

Alopecia areata can also affect the fingernails and toenails, and sometimes these changes are the first sign that the condition is developing. There are a number of small changes that can occur to nails:

If, after an initial clinical examination, the doctor is not able to make a diagnosis, they can perform a skin biopsy. If they need to rule out other autoimmune diseases, they might perform a blood test.

Article last updated by Adam Felman on Fri 22 December 2017. Visit our Dermatology category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Dermatology. All references are available in the References tab.

Açıkgöz. G, Yeşil, H., Çalışkan, E., Tunca, M., & Akar, A. (2013, October 9). Targeted photochemotherapy in alopecia areata [Abstract]. Photodermatology, Photoimmunology & Photomedicine, 29(6),318-22. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24102724

Nilforoushzadeh, M. A., Keshtmand, G., Jaffary, F., & Kheirkhah, A. (2012, July 1). Diphencyprone induced vitiligo: A case report [Abstract]. 2012:356236. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22811720

Wikramanayake, T. C., Villasante, A. C., Mauro, L. M., Perez, C. I., Schachner, L. A., & Jimenez, J. J. (2012, March). Prevention and treatment of alopecia areata with quercetin in the C3H/HeJ mouse model [Abstract]. 17(2):267-74. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22042611

© 2004-2019 All rights reserved. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.

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With all forms of alopecia area, the body’s immune system attacks healthy hair follicles, which causes them to become smaller and decrease in production to the point where hair growth may stop altogether.

For people who have less than 50 percent hair loss, current treatment options work to disrupt or distract the immune attack and stimulate the hair follicle. For people who experience more than 50 percent hair loss, there are oral and injectable medications available. However, these treatments are not successful for everyone.

Columbia University Medical Center (CUMC) researchers conducted an open-label clinical trial – whereby both researchers and participants knew what treatment was administered – of 12 people with alopecia areata.

While there is currently no treatment capable of completely restoring hair, CUMC investigators have shown that topical and oral drugs that inhibit the Janus kinase (JAK) family of enzymes, known as JAK inhibitors, could potentially fill the role of stimulating hair regrowth.

“Although our study was small, it provides crucial evidence that JAK inhibitors may constitute the first effective treatment for people with alopecia areata,” says Dr. Julian Mackay-Wiggan, associate professor of dermatology and director of the Clinical Research Unit in the Department of Dermatology at CUMC, and a dermatologist at NewYork-Presbyterian/Columbia.

Previous research by the team revealed specific immune cells and dominant inflammatory signaling pathways that are responsible for attacking the hair follicle in people with alopecia areata, resulting in the follicle entering a dormant state.

The U.S. Food and Drug Administration (FDA) have already approved two JAK inhibitors: a medication used to treat bone marrow malignancies called ruxolitinib, which was the focus of the CUMC research, and a treatment for rheumatoid arthritis called tofacitinib that the Stanford/Yale study explored.

“These disorders are both characterized by dysregulated signaling pathways, similar to alopecia areata, which is dominated by the interferon signaling pathway. Even though the diseases are very different, this common feature gave us the initial idea to test JAK inhibitors in people with alopecia,” says Dr. Raphael Clynes, Ph.D., associate professor of dermatology at CUMC.

The researchers tested their hypothesis by enrolling 12 people with moderate to severe alopecia with more than 30 percent hair loss. Participants were administered 20 milligrams of oral ruxolitinib twice a day for 3-6 months. Follow-up took place over a further 3 months to assess the permanence of treatment response.

Results showed that nine of the patients – 75 percent – presented 50 percent or more hair regrowth. By the end of the treatment period, 77 percent of participants who responded to ruxolitinib therapy achieved more than 95 percent hair regrowth.

Skin biopsies were performed before, during, and after treatment. In responders, the biopsies showed a reduction in levels of interferon signaling and cytotoxic T lymphocytes, which are indicators of inflammatory response. They also had increased levels of hair keratins, which are proteins that indicate hair growth. These levels are similar to those seen in people without alopecia areata.

People with alopecia areata who did not respond to treatment had lower levels of inflammatory signatures in biopsy results before treatment began, which may indicate that scientists could potentially distinguish between people who will and will not respond to treatment.

“We are very excited about the use of biomarkers to follow the response of patients to this treatment,” says Angela M. Christiano, Ph.D., the Richard and Mildred Rhodebeck professor of dermatology and professor of genetics and development at CUMC. “This will allow us to so monitor improvements in their gene expression signatures even before hair growth appears.”

“While larger, randomized trials are needed to confirm the safety and efficacy of ruxolitinib in people with moderate to severe alopecia areata, our initial results are very encouraging,” Mackay-Wiggan adds.

The Stanford/Yale study also showed a positive response to the JAK inhibitor tofacitinib. “Together, the two studies show that we’re on the right track,” says Dr. Christiano, a co-author of the tofacitinib paper.

Future research by the CUMC team will focus on testing JAK inhibitors in conditions such as vitiligo, scarring alopecia, and male pattern baldness. “We expect JAK inhibitors to have widespread utility across many forms of hair loss based on their mechanism of action in both the hair follicle and immune cells,” concludes Dr. Christiano.

© 2004-2019 All rights reserved. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.

2019 Healthline Media UK Ltd. All rights reserved. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.

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However, the immune system may not be the only cause of alopecia universalis. The National Alopecia Areata Foundation say alopecia areata can run in families. But, unlike many inherited conditions, both parents must contribute specific genes to pass alopecia areata on to their children.

This is known as a polygenic disease, which means “multiple genes.” Because it requires genes from both parents, many people with any form of alopecia areata, including alopecia universalis, will not pass the condition to their children.

This suggests that environment, combined with genetics and the immune system, could ultimately trigger the hair loss. This environmental trigger remains unknown and could be an illness, allergy, hormones, toxins — or any combination of these.

Alopecia universalis has not been proven to be related to stress. It is possible that extreme stress, combined with genetics and immune system problems, could trigger alopecia areata and universalis. No medical studies have proven this link, however.

Hair loss caused by stress is known as telogen effluvium. This type of hair loss is temporary and not related to immune or genetic factors. Usually, telogen effluvium is caused by physical or mental stress, such as severe illness, surgery, childbirth, emotionally stressful events, extreme diets, and medications.

The hair loss can happen very suddenly, producing bald spots in a matter of days. As it progresses to alopecia universalis, hair loss will continue to spread until there is no hair left on the head or body.

Alopecia universalis may be diagnosed with a physical exam and other medical tests. A healthcare professional or dermatologist may be able to diagnose the condition with a medical history and by checking for loss of hair throughout the body.

Support groups may be helpful to help people cope with hair loss. The National Alopecia Areata Foundation says nearly 150 million people worldwide have some form of alopecia areata. And, about 1 in 4,000 people in the world has alopecia universalis.

A cure has yet to be found, but new possibilities for treatment may offer hope for those with alopecia universalis. Recent statistics show that only 10 percent of people with alopecia universalis will experience a full recovery, so connecting with others through support groups is a valuable part of living with the condition.

Alopecia universalis does not pose any threat to a person’s physical health, but emotional health may be affected. Exploring support groups, clinical trials for new treatments, and organizations for those with hair loss may be helpful.

Article last reviewed by Fri 19 January 2018. Visit our Dermatology category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Dermatology. All references are available in the References tab.

Chiang, K. S., Mesinkovska, N. A., Piliang, M. P., & Bergfeld, W. F. (2015, November). Clinical efficacy of diphenylcyclopropenone in alopecia areata: retrospective data analysis of 50 patients. Journal of Investigative Dermatology Symposium Proceedings 17(2), 50–55. Retrieved from http://www.sciencedirect.com/science/article/pii/S1087002416300284

Cho, H. H., Jo, S. J., Paik, S. H., Jeon, H. C., Kim, K. H., Eun, H. C., … Kwon, O. S. (2012, July). Clinical characteristics and prognostic factors in early-onset alopecia totalis and alopecia universalis [Abstract]. Journal of Korean Medical Science, 27(7), 799–802. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390731/

Craiglow, B. & King. B. (2014, July 17). Killing two birds with one stone: Oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis. Journal of Investigative Dermatology, 134, 2988-2991. Retrieved from https://www.researchgate.net/publication/263208380_Killing_Two_Birds_with_One_Stone_Oral_Tofacitinib_Reverses_Alopecia_Universalis_in_a_Patient_with_Plaque_Psoriasis

Craiglow, B. G., Tavares, D., & King, B. A. (2016). Topical ruxolitinib for the treatment of alopecia universalis. JAMA dermatology, 152(4), 490–491. Retrieved from https://jamanetwork.com/journals/jamadermatology/fullarticle/2474311

Jaffe, A., Nir, Y., Zbar, A. P., Gonen-Shahar, M., & Gonen, S. (2016). Hair regrowth following topical HairUpTM treatment in subjects with alopecia totalis (AT) and alopecia universalis (AU): A retrospective analysis of efficacy and cosmetic acceptability. Hair Therapy & Transplant, 6(2. Retrieved from http://www.shmuel-gonen.com/files/hair-up-article.pdf

Rodriguez, T. A., Fernandes, K. E., Dresser, K. L., & Duvic, M. (2010). Concordance rate of alopecia areata in identical twins supports both genetic and environmental factors. Journal of the American Academy of Dermatology, 62(3), 525–527.Retrieved from http://www.jaad.org/article/S0190-9622(09)00143-1/fulltext

Tiwary, A. K., Mishra, D. K., & Chaudhary, S. S. (2016, June). Comparative study of efficacy and safety of topical squaric acid dibutylester and diphenylcyclopropenone for the treatment of alopecia areata. North American Journal of Medical Sciences, 8(6), 237–242. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960932/

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2019 Healthline Media UK Ltd. All rights reserved. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.

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female hair lossAbout one-third of women experience hair loss (alopecia) at some time in their lives; among postmenopausal women, as many as two-thirds suffer hair thinning or bald spots. Hair loss in women often has a greater impact than hair loss does on men w, because it’s less socially acceptable for them. Alopecia can severely affect a woman’s emotional well-being and quality of life.

The main type of hair loss in women is the same as it is men. It’s called androgenetic alopecia, or female (or male) pattern hair loss. In men, hair loss usually begins above the temples, and the receding hairline eventually forms a characteristic “M” shape; hair at the top of the head also thins, often progressing to baldness. In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman’s hairline rarely recedes, and women rarely become bald.

There are many potential causes of hair loss in women , including medical conditions, medications, and physical or emotional stress. If you notice unusual hair loss of any kind, it’s important to see your primary care provider or a dermatologist, to determine the cause and appropriate treatment. You may also want to ask your clinician for a referral to a therapist or support group to address emotional difficulties. Hair loss in women can be frustrating, but recent years have seen an increase in resources for coping with the problem.

Clinicians use the Ludwig Classification to describe female pattern hair loss. Type I is minimal thinning that can be camouflaged with hair styling techniques. Type II is characterized by decreased volume and noticeable widening of the mid-line part. Type III describes diffuse thinning, with a see-through appearance on the top of the scalp.

Almost every woman eventually develops some degree of female pattern hair loss. It can start any time after the onset of puberty, but women tend to first notice it around menopause, when hair loss typically increases. The risk rises with age, and it’s higher for women with a history of hair loss on either side of the family.

As the name suggests, androgenetic alopecia involves the action of the hormones called androgens, which are essential for normal male sexual development and have other important functions in both sexes, including sex drive and regulation of hair growth. The condition may be inherited and involve several different genes. It can also result from an underlying endocrine condition, such as overproduction of androgen or an androgen-secreting tumor on the ovary, pituitary, or adrenal gland. In either case, the alopecia is likely related to increased androgen activity. But unlike androgenetic alopecia in men, in women the precise role of androgens is harder to determine. On the chance that an androgen-secreting tumor is involved, it’s important to measure androgen levels in women with clear female pattern hair loss.

In either sex, hair loss from androgenetic alopecia occurs because of a genetically determined shortening of anagen, a hair’s growing phase, and a lengthening of the time between the shedding of a hair and the start of a new anagen phase. (See “Life cycle of a hair.”) That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also changes, shrinking and producing a shorter, thinner hair shaft — a process called “follicular miniaturization.” As a result, thicker, pigmented, longer-lived “terminal” hairs are replaced by shorter, thinner, non-pigmented hairs called “vellus.”

Each hair develops from a follicle — a narrow pocket in the skin — and goes through three phases of growth. Anagen (A), the active growth phase, lasts two to seven years. Catagen (B), the transition phase, lasts about two weeks. During this phase, the hair shaft moves upward toward the skin’s surface, and the dermal papilla (the structure that nourishes cells that give rise to hair) begins to separate from the follicle. Telogen (C), the resting phase, lasts around three months and culminates in the shedding of the hair shaft.

A clinician diagnoses female pattern hair loss by taking a medical history and examining the scalp. She or he will observe the pattern of hair loss, check for signs of inflammation or infection, and possibly order blood tests to investigate other possible causes of hair loss, including hyperthyroidism, hypothyroidism, and iron deficiency. Unless there are signs of excess androgen activity (such as menstrual irregularities, acne, and unwanted hair growth), a hormonal evaluation is usually unnecessary.

Minoxidil (Rogaine, generic versions). This drug was initially introduced as a treatment for high blood pressure, but people who took it noticed that they were growing hair in places where they had lost it. Research studies confirmed that minoxidil applied directly to the scalp could stimulate hair growth. As a result of the studies, the FDA originally approved over-the-counter 2% minoxidil to treat hair loss in women. Since then a 5% solution has also become available when a stronger solution is need for a woman’s hair loss.

Clearly, minoxidil is not a miracle drug. While it can produce some new growth of fine hair in some — not all — women, it can’t restore the full density of the lost hair. It’s not a quick fix, either for hair loss in women . You won’t see results until you use the drug for at least two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you’ll need to keep using it to maintain those results. If you stop, you’ll start to lose hair again.

How to use minoxidil: Be sure that your hair and scalp are dry. Using the dropper or spray pump that’s provided with the over-the-counter solution, apply it twice daily to every area where your hair is thinning. Gently massage it into the scalp with your fingers so it can reach the hair follicles. Then air-dry your hair, wash your hands thoroughly, and wash off any solution that has dripped onto your forehead or face. Don’t shampoo for at least four hours afterwards.

Some women find that the minoxidil solution leaves a deposit that dries and irritates their scalp. This irritation, called contact dermatitis, is probably caused not by the minoxidil itself, but rather by the alcohol that is included to facilitate drying.

Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in color and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.)

Because the patent on Rogaine (the brand-name version of minoxidil) has expired, many generic products are available. They all contain the same amount of minoxidil, but some include additional ingredients, such as herbal extracts, which might trigger allergic reactions.

Anti-androgens. Androgens include testosterone and other “male” hormones, which can accelerate hair loss in women. Some women who don’t respond to minoxidil may benefit from the addition of the anti-androgen drug spironolactone (Aldactone) for treatment of androgenic alopecia. This is especially true for women with polycystic ovary syndrome (PCOS) because they tend to make excess androgens. Doctors will usually prescribe spironolactone together with an oral contraceptive for women of reproductive age. (A woman taking one of these drugs should not become pregnant because they can cause genital abnormalities in a male fetus.) Possible side effects include weight gain, loss of libido, depression, and fatigue.

Iron supplements. Iron deficiency could be a cause of hair loss in some women . Your doctor may test your blood iron level, particularly if you’re a vegetarian, have a history of anemia, or have heavy menstrual bleeding. If you do have iron deficiency, you will need to take a supplement and it may stop your hair loss. However, if your iron level is normal, taking extra iron will only cause side effects, such as stomach upset and constipation.

Hair transplantation, a procedure used in the United States since the 1950s to treat androgenic alopecia, involves removing a strip of scalp from the back of the head and using it to fill in a bald patch. Today, 90% of hair-transplant surgeons use a technique called follicular unit transplantation, which was introduced in the mid-1990s.

During this procedure, surgeons remove a narrow strip of scalp and divide it into hundreds of tiny grafts, each containing just a few hairs. Each graft is planted in a slit in the scalp created by a blade or needle in the area of missing hair. Hair grows naturally this way, in small clusters of one to four follicles, called follicular units. As a result, the graft looks better than the larger “plugs” associated with hair transplants of yesteryear.

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Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body.[1] Often it results in a few bald spots on the scalp, each about the size of a coin.[2] Psychological stress may result.[2] People are generally otherwise healthy.[2] In a few cases, all the hair on the scalp or all body hair is lost and loss can be permanent.[1][2]

Alopecia areata is believed to be an autoimmune disease resulting from a breach in the immune privilege of the hair follicles.[4] Risk factors include a family history of the condition.[2] Among identical twins if one is affected the other has about a 50% chance of also being affected.[2] The underlying mechanism involves failure by the body to recognize its own cells with subsequent immune mediated destruction of the hair follicle.[2]

There is no cure for the condition.[2] Efforts may be used to try to speed hair regrowth such as cortisone injections.[1][2] Sunscreen, head coverings to protect from cold and sun, and glasses if the eyelashes are missing is recommended.[2] In some cases the hair regrows and the condition does not reoccur.[2] In others hair loss and regrowth occurs over years.[2] Among those in whom all body hair is lost less than 10% recover.[5]

About 0.15% of people are affected at any one time and 2% of people are affected at some point in time.[2][5] Onset is usually in childhood.[2] Males and females have the condition in equal numbers.[1] The condition does not affect a person’s life expectancy.[2]

Typical first symptoms of alopecia areata are small bald patches. The underlying skin is unscarred and looks superficially normal. Although these patches can take many shapes, they are usually round or oval.[6] Alopecia areata most often affects the scalp and beard, but may occur on any part of the body with hair.[7] Different areas of the skin may exhibit hair loss and regrowth at the same time. The disease may also go into remission for a time, or may be permanent. It is common in children.

Exclamation point hairs, narrower along the length of the strand closer to the base, producing a characteristic “exclamation point” appearance, are often present.[9] These hairs are very short (3–4 mm) and can be seen surrounding the bald patches.[10]

When healthy hair is pulled out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp. In cases of alopecia areata, hair will tend to pull out more easily along the edge of the patch where the follicles are already being attacked by the body’s immune system than away from the patch where they are still healthy.[11]

Alopecia areata is thought to be a systemic autoimmune disorder in which the body attacks its own anagen hair follicles and suppresses or stops hair growth.[9] For example, T cell lymphocytes cluster around affected follicles, causing inflammation and subsequent hair loss. It has been suggested that hair follicle in a normal state are kept secure from the immune system, a phenomenon called immune privilege. A breach in this immune privilege state is considered as the cause of alopecia areata.[4] A few cases of babies being born with congenital alopecia areata have been reported.[12]

Alopecia areata is not contagious.[9] It occurs more frequently in people who have affected family members, suggesting heredity may be a factor.[9] Strong evidence of genetic association with increased risk for alopecia areata was found by studying families with two or more affected members. This study identified at least four regions in the genome that are likely to contain these genes.[13] In addition, alopecia areata shares genetic risk factors with other autoimmune diseases, including rheumatoid arthritis, type 1 diabetes, and celiac disease.[3] It may be the only manifestation of celiac disease.[14][15]

In 2010, a genome-wide association study was completed that identified 129 single nucleotide polymorphisms that were associated with alopecia areata. The genes that were identified include those involved in controlling the activation and proliferation of regulatory T cells, cytotoxic T lymphocyte-associated antigen 4, interleukin-2, interleukin-2 receptor A, and Eos (also known as Ikaros family zinc finger 4), as well as the human leukocyte antigen. The study also identified two genes, PRDX5 and STX17, that are expressed in the hair follicle.[17]

Trichoscopy may aid in establishing the diagnosis. In alopecia areata, trichoscopy shows regularly distributed “yellow dots” (hyperkeratotic plugs), small exclamation-mark hairs, and “black dots” (destroyed hairs in the hair follicle opening).[18]

Oftentimes, however, discrete areas of hair loss surrounded by exclamation mark hairs is sufficient for clinical diagnosis of alopecia areata. Sometimes, reddening of the skin, called erythema, may also be present in the balding area.[5]

A biopsy is rarely needed to make the diagnosis or aid in the management of alopecia areata. Histologic findings include peribulbar lymphocytic infiltrate (“swarm of bees”). Occasionally, in inactive alopecia areata, no inflammatory infiltrates are found. Other helpful findings include pigment incontinence in the hair bulb and follicular stelae, and a shift in the anagen-to-telogen ratio towards telogen.[citation needed]

The objective assessment of treatment efficacy is very difficult and spontaneous remission is unpredictable, but if the affected area is patched, the hair may regrow spontaneously in many cases.[21] None of the existing therapeutic options are curative or preventive.[21]

In cases of severe hair loss, limited success has been achieved by using the corticosteroid medications clobetasol or fluocinonide, corticosteroid injections, or cream. Application of corticosteroid creams to the affected skin is less effective and takes longer to produce results. Steroid injections are commonly used in sites where the areas of hair loss on the head are small or especially where eyebrow hair has been lost. Whether they are effective is uncertain.[citation needed] Some other medications that have been used are minoxidil, Elocon (mometasone) ointment (steroid cream), irritants (anthralin or topical coal tar), and topical immunotherapy ciclosporin, sometimes in different combinations. Topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target,[7] and small lesions typically also regrow spontaneously. Oral corticosteroids may decrease the hair loss, but only for the period during which they are taken, and these medications can cause serious side effects.[7] No one treatment is effective in all cases, and some individuals may show no response to any treatment.[22] Few treatments have been well evaluated. A 2008 meta-analysis of oral and topical corticosteroids, topical ciclosporin, photodynamic therapy, and topical minoxidil showed no benefit of hair growth compared with placebo, especially with regard to long-term benefits.[23]

When alopecia areata is associated with celiac disease, treatment with a gluten-free diet allows for complete and permanent regrowth of scalp and other body hair in many people, but in others there are remissions and recurrences.[14] This improvement is probably due to the normalization of the immune response as a result of gluten withdrawal from the diet.[14]

In most cases which begin with a small number of patches of hair loss, hair grows back after a few months to a year.[8] In cases with a greater number of patches, hair can either grow back or progress to alopecia areata totalis or, in rare cases, alopecia areata universalis.[8]

There is no loss of body function, and effects of alopecial areata are mainly psychological (loss of self-image due to hair loss), although these can be severe. Loss of hair also means the scalp burns more easily in the sun. Patients may also have aberrant nail formation because keratin forms both hair and nails.

Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, but rather a natural cycle of growth-and-shedding from a relatively synchronised start; such a pattern will fade over time. Episodes of alopecia areata before puberty predispose to chronic recurrence of the condition.[7]

The condition affects 0.1%–0.2% of the population,[25] and occurs equally in both males and females. Alopecia areata occurs in people who are otherwise healthy and have no other skin disorders.[7] Initial presentation most commonly occurs in the early childhood, late teenage years, or young adulthood, but can happen at any ages.[9] Patients also tend to have a slightly higher incidence of conditions related to the immune system, such as asthma, allergies, atopic dermatitis, and hypothyroidism.

In 2014, preliminary findings showing that oral ruxolitinib, a drug approved by the US Food and Drug Administration (FDA) for bone marrow disorder myelofibrosis, restored hair growth in three individuals with long-standing and severe disease.[27] The medicine costs almost USD $10,000 a month.[28]

Alopecia areata and alopecia barbae have been identified by some as the biblical nethek condition that is part of the greater tzaraath family of skin disorders; the said disorders are purported to being discussed in the Book of Leviticus, chapter thirteen.[29]

Alopecia (al-oh-PEE-shah) means hair loss. When a person has a medical condition called alopecia areata (ar-ee-AH-tah), the hair falls out in round patches. The hair can fall out on the scalp and elsewhere on the body.

Alopecia is not contagious. It is not due to nerves. What happens is that the immune system attacks the hair follicles (structures that contain the roots of the hair), causing hair loss. This disease most often occurs in otherwise healthy people.

Sometimes the dermatologist will perform a skin biopsy to confirm that the disease is alopecia areata. To perform a skin biopsy, the dermatologist removes a small piece of skin so that it can be studied under a microscope.

There is no cure for alopecia areata. Hair often re-grows on its own. Treatment can help the hair re-grow more quickly. A dermatologist may prescribe one or more of the following to help the hair re-grow more quickly:

Researchers are working to advance the treatment of alopecia areata. They are exploring other medicines that work on the patient’s immune system. They also are looking at lasers and other light-based therapies.

When a person has alopecia areata, the hair will start to re-grow when the body gets the right signals. Sometimes this happens without treatment. Even with treatment, new hair loss can occur. Everything depends on how the immune system reacts.

Baldness caused by alopecia areata could soon be treated safely and effectively, after an international University of Melbourne-led trial found two new drugs to be safe and effective.

Until now there has been no effective treatment for the debilitating condition that causes patchy hair loss and affects up to 147 million people globally. About 15 per cent of people with the condition experience total or universal .

Professor Sinclair said new molecules used in the trial drugs had also been tested for atopic dermatitis, but this was the first trial conducted in alopecia. He said the latest results were potentially life-changing for those living with alopecia.

“This is a game changer,” he said. “Both compounds performed significantly better than placebo in patients with alopecia totalis and alopecia universalis. Both JAK inhibitors were safe and well tolerated.”

“Other medications that target this pathway have been used to treat rheumatoid arthritis and to correct blood disorders,” he said. “Some of these drugs also work in eczema, psoriasis and a range of other inflammatory and autoimmune conditions.”

Professor Sinclair said several patients in the trial experienced adverse events, including infections, gastrointestinal and skin/subcutaneous tissue issues. Two experienced a serious adverse event (rhabdomyolysis) but the patients were asymptomatic and recovered completely when the medication was ceased. There were no serious infections or herpes zoster reactivation.

The trials involve clinics and universities in Victoria, New South Wales, Queensland, Manitoba, Ontario, Alabama, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Massachusetts, New York, Oklahoma, South Dakota, Utah and Virginia.

Autoimmune diseases, allergies, and even malignancies are often due to a persistent imbalance within complex immune mechanisms. The actions of several cytokines underlie these complex processes, as they play a critical role in the control of the immune responses and inflammatory processes.

Several studies have linked various cytokines, and the receptors or molecules involved in their chemical reactions, to immune-mediated and inflammatory diseases. Therefore, cytokine function modulation has been the focus of intensive research and drug development. Drugs targeting cytokines or their receptors have become the main weapon of physicians dealing with such as areata.

The four JAKs (JAK1, 2, 3 and TYK2) have been shown to be critical components of cytokine-mediated effects.

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Alopecia areata is a disease that causes hair to fall out in small patches, which can remain unnoticeable. These patches may eventually connect and then become noticeable, however. This disease develops when the immune system attacks the hair follicles, resulting in hair loss.

The condition can result in total hair loss, called alopecia universalis, and it can prevent hair from growing back. When hair does grow back, it’s possible for the hair to fall out again. The extent of hair loss and regrowth varies from person to person.

There’s currently no cure for alopecia areata. However, there are treatments that may help hair grow back more quickly and that can prevent future hair loss, as well as unique ways to cover up the hair loss. Resources are also available to help people cope with the stress of the disease.

The main symptom of alopecia areata is hair loss. Hair usually falls out in small patches on the scalp. These patches are often several centimeters or less. Hair loss might also occur on other parts of the face, like the eyebrows, eyelashes, and beard, as well as other parts of the body. Some people lose hair in a few places. Others lose it in a lot of spots.

You may first notice clumps of hair on your pillow or in the shower. If the spots are on the back of your head, someone may bring it to your attention. However, other types of diseases can also cause hair to fall out in a similar pattern. Hair loss alone isn’t used to diagnose alopecia areata.

Doctors might avoid using the terms “totalis” and “universalis” because some people may experience something between the two. It’s possible to lose all hair on the arms, legs and scalp, but not the chest, for example.

The hair loss associated with alopecia areata is unpredictable and, as far as doctors and researchers can tell, appears to be spontaneous. The hair may grow back at any time and then may fall out again. The extent of hair loss and regrowth varies greatly from person to person.

Alopecia areata is an autoimmune disease. An autoimmune disease develops when the immune system mistakes healthy cells for foreign substances. Normally, the immune system defends your body against foreign invaders, such as viruses and bacteria.

If you have alopecia areata, however, your immune system mistakenly attacks your hair follicles. Hair follicles are the structures from which hairs grow. The follicles become smaller and stop producing hair, leading to hair loss.

However, it most often occurs in people who have a family history of other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis. This is why some scientists suspect that genetics may contribute to the development of alopecia areata.

Psoriasis causes a rapid buildup of skin cells. It happens when the immune system mistakenly attacks the skin cells and causes the skin cell production process to go into overdrive. This results in thick patches of skin called plaques, as well as red, inflamed areas of skin.

Treating psoriasis with alopecia can be tricky. The scaling associated with psoriasis can make the skin itchy, and scratching can make hair loss worse. In addition, biologic treatments often used for psoriasis, called TNF inhibiters, have been associated with hair loss in some people.

For others, treating the psoriasis may help regrow hair. In one small study, over two-thirds of participants with alopecia areata who took a common psoriasis treatment called methotrexate had hair regrowth greater than 50 percent.

One area of interest for treating both atopic dermatitis and alopecia is a class of drugs called JAK inhibitors. They’re currently used to treat rheumatoid arthritis and other conditions. One oral JAK inhibitor known as tofacinitib has already shown promise in small clinical trials for both atopic dermatitis and alopecia areata.

Another biologic treatment called dupilumab (Dupixent), which has recently been approved by the FDA to treat atopic dermatitis, is also a drug of interest for treating alopecia. A clinical study evaluating dupliumab in people with alopecia — both with and without atopic dermatitis — is currently underway.

A doctor will review your symptoms to determine if you have alopecia areata. They may be able to diagnose alopecia areata simply by looking at the extent of your hair loss and by examining a few hair samples under a microscope.

Your doctor may also perform a scalp biopsy to rule out other conditions that cause hair loss, including fungal infections like tinea capitis. During a scalp biopsy, your doctor will remove a small piece of skin on your scalp for analysis.

The specific blood test performed depends on the particular disorder the doctor suspects. However, a doctor will likely test for the presence of one or more abnormal antibodies. If these antibodies are found in your blood, it usually means that you have an autoimmune disorder.

The condition is difficult to predict, which means it may require a large amount of trial and error until you find something that works for you. For some people, hair loss may still worsen despite treatment.

Oral immunosuppressants, like methotrexate and cyclosporine, are another option you can try. They work by blocking the immune system’s response, but they can’t be used for a long period of time due to the risk of side effects, such as high blood pressure, liver and kidney damage, and an increased risk of serious infections and a type of cancer called lymphoma.

Additionally, the U.S. Food and Drug Administration doesn’t require supplement makers to prove their products are safe. Sometimes the claims on the supplement labels are inaccurate or misleading. Always talk to a doctor before trying any herbal or vitamin supplement.

The effectiveness of each treatment will vary from person to person. Some people don’t even need treatment since their hair grows back on its own. In other cases, however, people never see improvement despite trying every treatment option.

It’s important to keep in mind that more than 5 million people in the United States have alopecia areata. You aren’t alone. Depending on your age, there are lifestyle changes you can make to help cope with the condition:

According to the National Alopecia Areata Foundation, children younger than age 5 typically don’t experience much of an emotional impact from alopecia. After age 5, however, hair loss can be traumatizing for young children as they start noticing how they’re different from others.

If possible, try to find a hairstylist in your area who is used to working with children who have lost their hair. Nonprofits like Locks of Love and Wigs for Kids can provide low-cost or free wigs for your child.

The unpredictability of the condition can be an emotional roller coaster for teens and young adults. Hair can come and go in an erratic fashion. When hair starts to grow back, it can cause false hope for recovery. It’s important to seek counseling for young adults to deal with body image and self-confidence issues at a young age.

If you’re looking for help with wigs, eyelash extensions, or eyebrow stencils, the National Alopecia Areata Foundation maintains an online shop with hair accessories and products. Wig companies like Godiva’s Secret Wigs also have online videos and tutorials for help with styling and care.

New wig technologies, like the vacuum wig, which is made from silicon and a suction base, mean that people with alopecia can even swim with their wigs still in place. Vacuum wigs, however, are typically more expensive.

If you’re feeling overwhelmed, counselors or support groups can help you cope with the effects of the disease. You may also find others with the disease in an online community, like Alopecia World, for people with alopecia and similar conditions.

You can cover up bald patches with a hat or stylish scarf, but this solution won’t work all the time. You may feel pressured to remove the hat or scarf during the singing of the National Anthem or at your place of employment.

Wearing scarves can create problems with airport security. Most TSA agents will trust you if you say that you’re covering your head due to a medical condition, and offer to test your head covering for security instead. It may be a good idea to travel with a doctor’s note to be safe, or if you are traveling internationally.

Wigs and hairpieces have come a long way over the years. Though they can be expensive, hair extensions and coverups, such as those offered by Hidden Crown, are designed to blend in with just about any hair color and type.

Another option, though more extreme, is to remove the remaining hair through shaving or laser hair removal. being totally bald may be less noticeable than having multiple bald spots. Some people even find that shaving their heads is quite liberating. It can also minimize the depression of watching hair slowly fall off.

Effective treatments for some types of hair loss are available. You might be able to reverse hair loss, or at least slow further thinning. With some conditions, such as patchy hair loss (alopecia areata), hair may regrow without treatment within a year.

If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. This may include drugs to reduce inflammation and suppress your immune system, such as prednisone. If a certain medication is causing the hair loss, your doctor may advise you to stop using it for at least three months.

Minoxidil (Rogaine). This is an over-the-counter (nonprescription) medication approved for men and women. It comes as a liquid or foam that you rub into your scalp daily. Wash your hands after application. At first it may cause you to shed hair. New hair may be shorter and thinner than previous hair. At least six months of treatment is required to prevent further hair loss and to start hair regrowth. You need to keep applying the medication to retain benefits.

Finasteride (Propecia). This is a prescription drug approved for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain benefits. Finasteride may not work as well for men over 60.

Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.

During a hair transplant procedure, a dermatologist or cosmetic surgeon removes tiny patches of skin, each containing one to several hairs, from the back or side of your scalp. Sometimes a larger strip of skin containing multiple hair groupings is taken. He or she then implants the hair follicle by follicle into the bald sections. Some doctors recommend using minoxidil after the transplant, to help minimize hair loss. And you may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.

The Food and Drug Administration has approved a low-level laser device as a treatment for hereditary hair loss in men and women. A few small studies have shown that it improves hair density. More studies are needed to show long-term effects.

You may want to try shaving, other styling techniques and products, scarves, a wig, or a hairpiece. Talk with a hair stylist for ideas. These nonmedical solutions can be used to cover permanent or temporary hair loss.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For hair loss, some basic questions to ask your doctor include:

A single copy of these materials may be reprinted for noncommercial personal use only. “Mayo,” “Mayo Clinic,” “MayoClinic.org,” “Mayo Clinic Healthy Living,” and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

In the United States, treatments for hair loss are a $3.6 billion industry with products ranging from supplements to shampoos, laser-producing helmets, and even surgery. But do any of these treatments actually work?

First, hair grows and gets longer in the anagen phase which can go on for several years. Then, during the ~10-day catagen phase, hair stops actively growing and separates from its follicle, which is what holds the hair in place beneath the skin. Finally, in the telogen phase, the follicle goes into rest mode for several months until the hair falls out. Then, the process starts anew.

The average person loses 50 to 100 hairs per day naturally due to this cycle. But if the process is interrupted at any stage—for example, if the follicle doesn’t come back out of resting mode or starts to shrink—hair loss and hair thinning can result. Interruptions to the cycle can be caused by hormones, stress, poor diet, chemical hair treatments, certain medications, and, of course, good ol’ genetics.

The most common form of hair loss is androgenetic alopecia, or, in other words, male or female pattern baldness or hair loss. Androgenetic alopecia is genetic and affects an estimated 50 million men and 30 million women in the United States. Among white women in the U.S., an average of 19% are affected by female pattern hair loss, but that percentage increases with age. The prevalence is nearly doubled in Australia at 32% and much lower in Korea and China at < 6%. As of 2015, no studies had been done on the prevalence of female pattern hair loss in Brazil or Africa.

Male pattern baldness is linked to a sensitivity to the hormone dihydrotestosterone and usually manifests as a receding hairline or ring of missing hair. Female pattern baldness instead typically causes the hair to thin all over the scalp but not fall out.

Another fairly common form of hair loss is alopecia areata, which usually presents as patches of hair loss over the scalp and is autoimmune related. In autoimmune conditions, the body’s immune system attacks bodily tissues even when they are healthy. In the case of alopecia areata, the hair follicles are prevented from growing new hair.

A more temporary form of hair loss is telogen effluvium or when hair follicles get stuck in the telogen or resting phase and stop growing new hair. Telogen effluvium can occur three months after a significant medical event like childbirth, surgery, or a high fever, but can also be caused by a thyroid imbalance or iron deficiency. Certain medications like blood thinners and birth control pills are also linked to this form of hair loss.

To determine the cause of your hair loss, a doctor will typically conduct blood work to diagnose any missing nutrients or autoimmune disorders, take down your family history, study the pattern of the hair loss (in other words, is it a receding hair line or patchier in nature?) and potentially take a scalp biopsy.