Alopecia

Androgenetic alopecia is the most prevalent type of hairloss in males, and female pattern hairloss is the most general kind of hairloss in females. Regular methods of dealing with hair loss have included finasteride, minoxidil and surgical hair transplants. Presently there are numerous new and unique treatments. Additionally, low-level light therapy (LLLT) has lately been approved by the FDA for the treatment of hairloss.

Rogaine/Minoxidil

Rogaine first came to the market in 1988 as a prescription medication to help regrow hair.

Minoxidil which is the active ingredient in Rogaine was originally for treating high blood pressure. It was soon acknowledged that an adverse reaction for some people was hair growth.

This was originally assumed to be because of the increased blood flow to the scalp.

It was later discovered that the reason Minoxidil grows hair has nothing to do with its vasodilation capabilities at all. Instead it was found that Minoxidil is also a mild anagen antagonist.

Anagen antagonists helps to speed up the catagen phase of hair growth and help new hair to grow more quickly and to be slightly thicker than the previous ones. This effect was found to work for about thirty to forty percent of Minoxidil users and more generally those who were younger.

While Minoxidil may help the majority of user with hair growth, however the problem is that it does not stop hair loss or the production of DHT. This means that DHT will continue to bind to the hair shaft eventually overturning any hair growth caused by the Minoxidil. Evenutally this hair will die, making Minoxidil a temporary solution at best.

Another issue to be aware of with Minoxidil is that in order to become active, the medicine is required to be delivered in an alcohol base. This mixture may cause slight irritation to some number of users.

Hairloss is incredibly common. Half of the population will be affected by the age of 50. Males and females are affected in equal proportion.

There are several types of alopecia, which can be classified by underlying pathological mechanisms and the possibility of regrowth. The former can guide possible therapeutic options.

The most common types of hair loss are non-scarring alopecia, telogen effluvium and alopecia areata. These three types represent over 75% of cases of hairloss.

Scarring alopecia is also important to note because this hair loss is irreversible, so prompt diagnosis and treatment is crucial.



In non-scarring alopecia, hair follicles are not damaged and there is always a possibility of hair regrowth. There are usually no signs of overt inflammation such as erythema, scale or scarring.

Male pattern hairloss is characterized by non-scarring retraction of the hair line and hairloss on the crown.

Female pattern hair loss is characterised by thinning of hair on the crown with relative preservation of hair density on the posterior aspect of the scalp.

Treatment includes topical minoxidil and, if desirable hair transplantation. effluvium

Telogen effluvium is characterised by excessive hair shedding. This is caused by a relatively large number of hair follicles simultaneously entering the resting, or telogen, phase of the hair cycle.

Clinically, telogen effluvium presents with a history of hair shedding and diffuse thinning of hair on the whole scalp.

Common causes of telogen effluvium are illnesses, pregnancy, crash diets, medications and stress. Any medications can cause telogen effluvium, but common culprits include anticoagulants, antihypertensives, hormones, anticonvulsants, antidepressants, retinoids, cimetidine, cholesterol lowering drugs.

Telogen effluvium starts around three months after an inciting event (this can range from 1-6 months).

Anxiety related to hair loss can cause or maintain telogen effluvium. It is important to reassure patients that they will not go bald because of telogen effluvium.

If the trigger is identified and removed hair shedding should resolve and hair density should recover, although this can take six months or longer.

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Alopecia areata

Alopecia areata is fairly common and it has around a 2% lifetime risk.

It can affect any part of the body including eyebrows and eyelashes. Alopecia areata is characterized by well-defined patches of complete non-scarring hair loss.


The scalp will show tenting on gentle hair pull. Alopecia areata is associated with other autoimmune diseases including atopic dermatitis, vitiligo and thyroid disease.



Alopecia totalis is identified as total hair loss on the head and alopecia universalis is full hair loss on the scalp and body.

There is a potential for regrowth; spontaneous hair growth is common when the disease is limited and often happens within the first year. Expectant treatment is a reasonable option.

Potent topical corticosteroids are recommended for the treatment of alopecia areata on the scalp in adults. Intralesional corticosteroids are the second-line treatment for limited scalp disease.

A course of oral steroids can be considered as a one-off option. Unfortunately minoxidil, tacrolimus ointment and pimecrolimus cream were not effective in clinical trials. Although topical bimatoprost is an effective treatment to make eyelashes longer and thicker, it does not work for alopecia areata.

Newer therapeutic agents including JAK inhibitors showed promising results in phase 2 clinical trials.

Topical diphencyprone immunotherapy is an effective treatment which has been used off licence in NHS and privately for over twenty years.

In patients who failed corticosteroid therapy it induces 50-75% regrowth. Half of the patients maintain regrowth and another half require a maintenance treatment.