Alopecia

Alopecia – Treatment Overview

Introduction
Alopecia refers to partial or complete hair loss from areas of the body where hair normally grows, most commonly the scalp. It can be caused by autoimmune processes (e.g., alopecia areata), genetic predisposition (androgenetic alopecia), hormonal imbalance, nutritional deficiencies, infections, medications, or physical/psychological stress. The impact is not only cosmetic but also psychological, often reducing self-esteem and quality of life. Treatment depends on the underlying cause, severity, and patient preference, aiming to slow progression, stimulate regrowth, and improve appearance.

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Treatment Options and Doses

1. Topical Therapy

• Minoxidil (first-line for androgenetic alopecia and alopecia areata):

  • 2% or 5% topical solution/foam: Apply 1 mL to affected scalp twice daily.

  • Continuous use is required to maintain results.

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2. Oral Therapy

• Finasteride (for androgenetic alopecia in men):

  • 1 mg orally once daily.

  • Not recommended in women of childbearing age due to teratogenicity.

• Dutasteride (alternative in men):

  • 0.5 mg orally once daily.

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3. Corticosteroids (for alopecia areata)

• Intralesional injections:

  • Triamcinolone acetonide 2.5–10 mg/mL, injected into affected patches every 4–6 weeks.

• Topical corticosteroids (high-potency, e.g., clobetasol propionate 0.05%):

  • Apply once or twice daily to affected areas.

• Oral corticosteroids (for severe or widespread alopecia areata):

  • Prednisolone: 0.5–1 mg/kg/day orally, tapered over weeks.

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4. Immunotherapy (for extensive alopecia areata)

• Topical immunotherapy (e.g., diphenylcyclopropenone [DPCP] or squaric acid dibutyl ester [SADBE]):

  • Applied weekly in specialist settings to induce contact dermatitis and stimulate hair regrowth.

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5. Janus Kinase (JAK) Inhibitors (newer therapies for alopecia areata)

• Baricitinib: 2–4 mg orally once daily (FDA-approved for severe alopecia areata).

• Ruxolitinib or Tofacitinib: Off-label in some settings; dosing depends on indication and guidelines.

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6. Supportive and Adjunctive Therapies

• Nutritional supplementation if deficiencies (iron, vitamin D, zinc, biotin).

• Wigs, hairpieces, camouflage sprays for cosmetic support.

• Psychological support for coping with self-image concerns.