Hair loss treatments

For most people, hair loss is mild and occurs later in life. However, when hair loss is premature or severe, it can be a source of distress. Although there is no cure, a number of treatments are available that can effectively slow or reduce hair loss and stimulate partial regrowth. Surgical treatment involving hair transplantation is available from some specialist dermatologists and can be helpful for some men with advanced balding.

Why hair loss occurs
Hair is in a constant cycle of growth, rest and renewal – it is natural to lose some hair each day. Androgenetic hair loss is caused by androgen hormones and occurs in people with a genetic susceptibility. It is likely that around five separate genes determine the susceptibility to baldness. Some of these genes come from the mother’s side and some from the father’s side of the family. Hormonal imbalances, the contraceptive pill or the effects of corticosteroids can also be responsible for baldness in women.

Other possible causes of hair loss include alopecia areata (an autoimmune disorder characterised by inflammation of the hair root), cancer chemotherapy, burns or injuries, nervous habits such as continual hair pulling or scalp rubbing, ringworm of the scalp and rough handling. Long-term illness, major surgery and high fever may cause temporary hair loss.


Treatment options
Treatment aims to slow or reduce hair loss, stimulate partial regrowth or replace damaged hair. Surgical treatment involving hair transplantation is available from some specialist dermatologists and can be helpful for some men with advanced balding. Non-surgical treatments include lotions and tablets. In general, these must be used continuously to maintain regrowth. If treatment is stopped, regrowth ceases and hair loss will start again. Cosmetic options include wigs and hairpieces.

A number of other treatments have been suggested for hair loss including massage, vitamin supplements, herbal remedies (such as saw palmetto), zinc, amino acids, hair lotions and tonics. None of these has been shown to promote hair growth or prevent hair loss. There is also no scientific evidence that the use of lasers is effective. If unsure, consult with your doctor before commencing treatment.

Minoxidil
Minoxidil lotion has been available in Australia since the 1970s. A number of different brands are available over-the-counter from pharmacies without a prescription. Drops are applied to the scalp morning and night and rubbed in. Hair regrowth generally takes six months to appear. Patients considering taking minoxidil should tell their health care provider if they are taking any other medicines, especially high blood pressure medication. Minoxidil is not recommended for pregnant and breastfeeding women.

Finasteride
Finasteride is the active ingredient in the hair loss treatment Propecia. Propecia has been available in Australia since the late 1990s. One tablet a day will arrest further hair loss in over 90 per cent of men and stimulate partial hair regrowth in over two-thirds. Regrowth may be visible at six months, but can take up to two years to become apparent. Side effects are uncommon; however, Propecia does require a prescription from your doctor. Finasteride is not recommended for women.

Spironolactone
This tablet has been widely used to treat high blood pressure and fluid retention in Australia since the 1960s. It blocks the effect of androgen hormones. In women, androgens can cause oily skin, acne, unwanted facial and body hair, and scalp hair loss. Spironolactone can be used to treat all of these conditions but requires a prescription from your doctor. Spironolactone is not recommended for men. Pregnant and breastfeeding women or women with severe kidney disease, hyperkalaemia or Addison’s disease should not take minoxidil.

Cyproterone acetate
This tablet was also developed in the 1960s. It blocks the effect of androgen hormones. It is also a weak progestogen and is used as a component of some oral contraceptives. Cyproterone acetate can also be used to treat acne, unwanted facial and body hair, and hereditary hair loss in women. Cyproterone acetate requires a prescription from your doctor. Cyproterone acetate is not recommended as a treatment for hair loss in men.

Hair transplantation
Hair transplantation is a surgical procedure for the treatment of hair loss that first became popular in the 1950s. Originally, large plugs of hair were used, which sometimes led to unsatisfactory and unnatural results. Nowadays, very small mini- and micro-plugs of skin, containing one to five hairs, are used. Unlike the original large plugs, this modern technique does not produce very thick or dense hair growth. It appears more natural and, in many cases, is undetectable as a transplant.

Types of hair loss that respond best to hair transplantation include:

• Androgenetic hair loss in men – this is the most common type of baldness that can be helped by hair transplantation
• Hair loss due to accidents and operations.

Hair transplantation is a surgical procedure
Hair plugs are taken from the back or sides of the scalp where the hair is less likely to fall out. These plugs are transferred to the bald areas and placed in such a way that they receive adequate blood flow during the healing process. The transplant session may take several hours. One to three months later, more grafts can be added. Several treatments are required to give a progressive increase in the amount of hair. Hair will regrow in the area from which the hair plug was taken for transplantation.

A sedative is usually given prior to the procedure. Local anaesthetic is also used at the hair removal (donor) and recipient sites. As the anaesthetic wears off, you may notice some discomfort. This can be eased with simple pain-killing medications.

Possible complications of hair transplantation
Possible complications include:

• Infection – this can occur because the skin is broken to perform the procedure. It can be treated with antibiotics.
• Bleeding – this is usually controlled through careful postoperative care.
• Scarring – approximately 11 per cent of the population have a tendency to scar.
• Temporary, operation-induced hair loss – known as telogen effluvium, this can occur with hair transplantation as well as some other operations. It occurs in approximately five per cent of patients.
• Unacceptable cosmetic results – scarring and unacceptable cosmetic results are more common when hair transplants are carried out by inexperienced practitioners.

Seek advice from a specialist dermatologist
Many hair clinics offer hair transplantation. However, specialist dermatologists are best qualified to properly advise about this surgery, as they generally have the most knowledge about hair in health and disease.

What you can expect from treatment
Despite advances in our understanding of hair loss, there are limits to current treatment. In particular, age-related hair loss and inherited forms of hair loss are difficult to reverse, although treatment may prevent further loss. There are also limits to controlling alopecia areata. In many conditions, hair loss or thinning will stabilise and may not progress to baldness.

Where to get help

• Your doctor
• Australasian College of Dermatologists Tel. 1300 361 821
• Wigmaker
• Plastic surgeon

Things to remember

• Permanent hair loss is caused by genetic and hormonal factors.
• A number of options are available to treat hair loss.
• Hair transplantation is most effective for male pattern baldness.