Androgenetic Alopecia is the medical term for genetic hair loss commonly seen in men and woman as they age. Both sides of one’s family plays into the genetic and hormonal makeup of your individual hair and how one will experience hair loss. Androgentic Alopecia typically affects 50% of people, both men and women, by the age of 50. In males, (male pattern alopecia) one typically sees thinning in the temples and the crown. In females, (female pattern alopecia) it typically affects the front and top of scalp.
All individuals will have some variability in their response to treatment. In general starting soon after hair loss has begun will allow for best results. For men, as soon as hair loss is noticed is ideal and for women when they enter menopause. The best improvement is seen with a combination of modalities – oral and topical and lights. Combining treatments that help promote hair growth as well as to help decrease hair loss is also wise. For all treatments, improvement will be seen only while using them. If you stop treatment, your hair will gradually return to your genetically pre-determined state. Microneedling and injected treatments are typically done monthly over several months, then can be decreased to a maintenance program. Oral and topical treatments will need to be used daily to maintain their effect.
PREGNANCY AND BREASTFEEDING
The only medications / treatments that can be used while pregnant, trying to get to get pregnant, or breastfeeding are Prenatal Vitamins, B-Vitamins/Biotin, LLLT caps and PRP treatments.
OVER THE COUNTER ORAL MEDICATIONS
Nutrafol, is a nutritional supplement designed to treat hair loss. It provides standard nutrients to encourage hair growth, as well as herbal-based ingredients to help fight inflammation and hormonal influences.
Prenatal Vitamins (PNV), B-complex, Biotin are all nutrients that can help serve as building blocks for hair (and nail) growth. In some studies, supplementing your diet with these has been shown to help increase hair growth. Supplements with iron will be better but can cause constipation in some patients.
PRESCRIPTION ORAL MEDICATIONS
Minoxidil: is used off label for hair loss in men and women. Minoxidil works in multiple ways: It dilates blood vessels of the scalp to increase the availability of oxygen, nutrients, and growth factors to hair follicles. Minoxidil reverses miniaturization of follicles, and stimulates follicle movement from the resting to hair growth phase. Since this medication was developed as a blood pressure medication, we will need to check your baseline and you will need to check your blood pressure each morning and night and send it to us the first week. This should not be combined with any other blood pressure or heart medications.
Propecia: prevents the conversion of testosterone to dihydrotestosterone (DHT) in the body, thus blocking the hormonal affects on hair. It is used to treat men and post-menopausal women.
Viviscal Pro: is a dietary supplement, that nourishes thinning hair while also promoting existing hair growth from within. It focuses on restoring nutrients, vitamins, minerals and protein to increase hair growth. Viviscal Pro increases the growing phase of hair follicles, promotes growth of existing hair that has slowed or stopped growing, and makes hair noticeably stronger, healthier and more vibrant.
Spironolactone: is used off label to decrease the process of Female Pattern Hair Loss. Spironolactone, a diuretic, was originally developed for the treatment of elevated blood pressure but has antiandrogenic properties. This medication block the action of androgen by way of stopping dihydrotestosterone the form of testosterone that causes hair loss. Potassium levels need to be checked while taking this medication.
OVER THE COUNTER HOME TOPICALS
Minoxidil (Rogaine): a topical version of minoxidil was the first FDA approved brand to treat hair loss in both men and women. It works by counteracting the effects of hereditary hair loss and revitalizing hair follicles. It increases the duration of the hair follicle growth phase, and will induce a new hair growth cycle— resulting in thicker and fuller hair.
Kerafactor, contains a proprietary Kerafactor Peptide Complex (KPC), which is unique in that it contains specifically selected proteins to help with hair and scalp health. These key ingredients help to promote stronger, smoother, thicker and healthier hair growth. It can be applied directly to the scalp twice daily. Since minoxidil helps decrease hair loss and Kerafactor promotes healthy hair growth, the use of the two medications together is recommended.
MinoxiKare is a prescription strength topical compound utilizing minoxidil and other hormones that can be used daily to decrease hair loss. It speeds up the hair growth cycle by prematurely putting your hair follicles into the anagen phase, causing hair follicles to quickly go through the resting and shedding phases before they start to regrow.
Cetrizine (for men), is an antihistamine medication that blocks the formation and accumulation of inflammation that occur with different stressors, and contribute to hair loss. By inhibiting the formation of inflammation with Cetrizine, we can decrease hair loss and help facilitate hair growth. Cetrizine is to be applied topically to the scalp daily and is shown to increase total hair density; especially of the thicker hairs on the scalp.
Low level led light therapy (LLLT) is beneficial for hair loss in several different ways. LLLT causes vasodilatation which in turn increased blood circulation, delivering more oxygen, and nutrients to the hair bulb, resulting in improved hair quality. In addition, it stimulates the growth phase of the hair cycle to promote longer healthier hair. LLLT can help decrease progression of hair loss if one begins treatment during the earlier stages of hair loss. There are several companies offering these devices. All devices require daily use and will take 4-6 months to see improvement. All devices below use the 650nm diode lights .
- KeraCap – 272 individual 650nm laser diodes allows for excellent coverage of the scalp. Use for 6 minutes/day.
- Illumiflow – 272 laser diodes. Use for 6 minutes/day.
- Capillus – Three different laser caps available, the 272 laser diode cap is recommended to insure most scalp coverage. Use for 6 minutes/day.Best price on Costco.com.
- Hair Max / Hair Pro -Low level laser hair comb or brush, works similarly to the caps. One must comb/brush hair in the affected areas for 10-15 minutes per day. These are therefore more difficult to use.
IN OFFICE TREATMENTS – TOPICAL TREATMENTS
Platelet Rich Plasma (PRP) injections are performed by using your own blood. The blood is spun in a centrifuge; which separates the plasma from the red blood cells. The plasma is full of platelets, which is why it is called “Platelet Rich Plasma”. This Plasma is then injected into your scalp, and the nutrients target the hair follicles directly to stimulate new hair growth. Platelet Rich Plasma also stimulates the hair follicles that have stopped growing and helps result in over all new hair growth and better hair health.
Kerafactor Treatments, listed above, can also be used as an in office treatment, with an advanced delivery mechanism. A skilled provider performs Microneedling (a procedure that uses tiny needles to make micro holes) on the scalp, and the micro holes created in the skin are used to introduce the hair growth stimulating product, causing increased absorption and better results. This can also be combined with PRP injections at the site to produce more effective results.
MOST INVASIVE TREATMENT – SURGERY
Hair Transplants, removes hair from one part of the body, usually the lower scalp and transplants it into an area of hair loss. This is performed in a medical office under local anesthesia. The number of hair grafts and the size of them both depend on ones hair type, quality, color and the size of the area that the hair is being transplanted to. You will likely have to wear bandages on your head for 1-3 days, and you will be able to return to work in 2-5 days.
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Have more questions about hair loss and treatment options? Contact us today at Grossman Dermatology and schedule your consultation with our professional staff! We proudly serve you from Santa Monica, California and New York, New York.