Diseases & Conditions

Hair loss

Your hair loss may have started with a few extra hairs in the sink or in your comb. But now you can't look in the mirror without seeing more of your scalp.

Baldness typically refers to excessive hair loss from your scalp and can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss.

Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications and surgical procedures that are available to treat hair loss. Before pursuing any of these treatment options, talk with your doctor about the cause of and best possible treatments for your hair loss.

Talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your hair. Sudden hair loss can signal an underlying medical condition and may require medical treatment.

No cure is available for permanent hair loss or baldness. However, you can talk to your doctor about medical treatments to slow the rate of hair loss or to hide hair loss.

Baldness, whether permanent or temporary, can't be cured. But hair loss treatments are available to help promote hair growth or hide hair loss. For some types of alopecia, hair may resume growth without any treatment.

Medication
The effectiveness of medications used to treat alopecia depends on the cause of hair loss, extent of the loss and individual response. Generally, treatment is less effective for more extensive cases of hair loss.

The types of drugs for treatment of alopecia that are approved by the Food and Drug Administration include:

• Minoxidil (Rogaine). This over-the-counter (nonprescription) medication is approved for the treatment of androgenetic alopecia and alopecia areata. Minoxidil is a liquid or foam that you rub into your scalp twice daily to grow hair and to prevent further loss. Some people experience some hair regrowth or a slower rate of hair loss or both. Minoxidil is available in a 2 percent solution and in a 5 percent solution.

  New hair resulting from minoxidil use may be thinner and shorter than previous hair. But there can be enough hair growth for some people to hide their bald spots and have them blend with existing hair. New hair stops growing soon after you discontinue the use of minoxidil. It may take 12 weeks for new hair to start growing. If you experience minimal results within six months, your doctor may recommend discontinuing use. Side effects can include irritation of the scalp.

• Finasteride (Propecia). This prescription medication to treat male-pattern baldness is taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. Positive results may take several months. Finasteride works by stopping the conversion of testosterone into dihydrotestosterone (DHT), a hormone that shrinks hair follicles and is an important factor in male hair loss. Rare side effects of finasteride include diminished sex drive and sexual function. As with minoxidil, the benefits of finasteride stop if you stop using it.

  Finasteride is not approved for use by women. In fact, it poses significant danger to women of childbearing age. If you're a pregnant woman, don't even handle crushed or broken finasteride tablets because absorption of the drug may cause serious birth defects in male fetuses.

• Corticosteroids. Injections of cortisone into the scalp can treat alopecia areata. Treatment is usually repeated monthly. Doctors sometimes prescribe corticosteroid pills for extensive hair loss due to alopecia areata. New hair may be visible four weeks after the injection. Ointments and creams also can be used, but they may be less effective than injections.
• Anthralin (Dritho-Scalp). Available as either a cream or an ointment, anthralin is a synthetic, tarry substance that you apply to your scalp and wash off daily. It's typically used to treat psoriasis, but doctors can prescribe it to treat other skin conditions. Anthralin may stimulate new hair growth for cases of alopecia areata. It may take up to 12 weeks for new hair to appear.

Surgery
Hair transplants and scalp reduction surgery are available to treat androgenetic alopecia when more conservative measures have failed. During transplantation a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of your scalp. The plugs are then implanted into the bald sections. Several transplant sessions may be needed, as hereditary hair loss progresses with time.

Scalp reduction, as the name implies, means decreasing the area of bald skin on your head. Your scalp and the top part of your head may seem to have a snug fit. But the skin can become flexible and stretched enough for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap. Scalp reduction can be combined with hair transplantation to fashion a natural-looking hairline in those with more extensive hair loss.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. It will take six to eight months before the quality of the new hair can be properly evaluated.

If you're interested in these procedures, consider only board-certified dermatologists, plastic surgeons or cosmetic surgeons, and check local and state medical boards for a record of patient complaints before choosing a doctor. Consult with this doctor to confirm the cause of your hair loss and review all treatment options, including nonsurgical ones, before proceeding with plans for surgery.

Wigs and hairpieces
If you would like an alternative to medical treatment for your baldness or if you don't respond to treatment, you may want to consider wearing a wig or hairpiece. They can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available.