Hair loss is often stressful for those affected – and not always easy to explain. In our overview you will find all information regarding possible causes and therapies.
It is normal to lose up to 100 hairs a day. If there are more, panic quickly breaks out. In the case of permanent hair loss, there are light spots on parts of the body that were once hairy, a alopecia. The most common type of hair loss is the Androgenic alopecia (AGA). A receding hairline in the temple area (receding hairline) is typical in men and diffuse thinning of the hair in women. The cause is believed to be opposed to the hair follicles Dihydrotestosterone (DHT) overly sensitive. As a result, the hair follicles shrink and the growth phase of the hair is shortened.
In the Alopecia areata (AA) is caused by an autoimmune reaction. Stress factors, infections and environmental influences might trigger hair loss with the appropriate disposition. There are circular hairless spots on the head or other hairy parts of the body.
Diffuse alopecia is when the hair falls off evenly all over the head. This type affects women more often. The causes are hormonal changes, metabolic diseases such as Diabetes mellitus or thyroid dysfunction, deficiencies such as iron deficiency, infections, stress or taking some medications such as hormonal contraceptives, chemotherapy drugs, beta blockers, Retinoide, Thyrostatika or Statins in question. External influences can also cause the hair to fall out, such as physical or mechanical influences such as tight hair bands or certain ingredients in hair care products. The good news is that if the cause of diffuse alopecia is eliminated or treated, the hair loss problem usually goes away as well.
Treatment: A challenge
Hair loss cannot be reversed. Whether and how hair can be saved depends on the type of hair loss. In the most common type, the AGA, stand for the pharmacotherapy topical Minoxidiloral Finasteride and topical Alpharadiol available.
Topical minoxidil can be used by women and men to stimulate hair growth and can be bought in pharmacies without a prescription. In a Study from 2004 with 904 men, AGA-affected scalp areas decreased in 62% of patients when treated with topical minoxidil 5% twice daily. Further studies confirmed that minoxidil can improve AGA and increase hair density. Oral minoxidil was in several studies studied and confirmed to be effective. However, it has not yet been approved for the treatment of male and female patients with AGA. When used orally, more systemic side effects such as increased heart rate, weight gain, Hirsutismus, Hypertrichose and lower extremity edema occur than with topical minoxidil.
Finasteride can do that
While the mechanism of action of Minoxidil has not yet been precisely clarified, it is at hand 5-alpha reductase inhibitors Finasteride on hand: The active ingredient inhibits the enzyme that converts testosterone into the more potent DHT. Finasteride is used in both topical and oral forms and is only suitable for men. Both formulations might in studies reduce DHT levels in the plasma and on the scalp. It is also true that this has a positive effect on hair growth through studies proven. Gel and tablets turned out to be comparably effective. Oral therapies are easier to administer, but carry more potential side effects than topical agents. These include sexual Problems as a erectile dysfunction, ejaculation disorders and decreased libido. In Germany, commercial preparations with oral finasteride are available in pharmacies once morest prescription.
Placed ahead of finasteride in the effectiveness ranking current study another 5-alpha reductase inhibitor viz Dutasters in oral form. However, the active ingredient is only available in Germany for the treatment of benign prostatic hypertrophy authorized.
Another option is Alpharadiol, a stereoisomer of the female sex hormone 17β-estradiol. It has negligible hormonal effects and is available over the counter for use on the scalp for mild AGA in men and women 18 years and older. Alfatradiol also inhibits 5-alpha reductase. In 2007, scientists compared the effects of a 0.025% alfatradiol solution and a 2% minoxidil solution in women with AGA. It was foundthat treatment with minoxidil can cause an increase in hair density and thickness, while alfatradiol slowed down or stabilized hair loss.
Outlook and last resort
A future therapy option might be clascoterone. The compound received FDA approval in August 2020 as the first topical antiandrogen agent for the treatment of hormonal Acne. In Germany and the USA, clinical studies are being carried out with a solution of the active substance for the treatment of AGA. There was already a significant improvement in hair loss compared to placebo to be shown.
The prostaglandin analogue known from ophthalmology Latanoprost can increase growth, thickness and pigmentation of eyelashes as a side effect. In a double-blind, placebo-controlled clinical study, 16 men with mild AGA were treated with latanoprost 0.1%. There was an increase in hair density established. There are also Hintsthat latanoprost might help with AA.
Spironolactone is used off-label for hair loss in women. The active ingredient has anti-androgenic properties and influences androgen-stimulated hair growth. In 2005, Sinclair et al. the results of their clinical studyin 80 women with hair loss either spironolactone (200 mg daily) or Cyproteronacetat (either 50 mg daily or 100 mg). There was no significant difference between the two treatment groups.
Non-drug options include low-level laser therapy (LLLT). Light with a wavelength of 650 to 680 nm is said to stimulate hair growth. In 2016, Afifi et al. conducted a systematic literature review to examine the effect of LLLT on AGA. The majority of in this review paper The studies treated showed an overall improvement in hair growth, hair thickness and patient satisfaction.
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If medication does not help or very large bald areas are visible on the head, patients can opt for a hair transplant. Hair is removed from the neck area under local anesthetic and implanted on the head. There are different procedures that are associated with more or less visible scars in the donor area. The costs are usually not covered by statutory health insurance companies. However, the chances of success are good for most patients.
Alopecia areata: JAK inhibitors approved
There are currently only limited pharmacotherapeutic options for the treatment of AA. Many patients are treated with glucocorticoids to shut down the excessive immune response. Treatment with the contact allergen diphenylcyclopropenone (DCP) triggers an allergic reaction on the scalp, designed to distract the immune system. Therapy can be promising, however not for every patient. DCP is not approved for this indication in Germany, these are individual healing attempts.
A new option is Janus kinase inhibitors (JAK inhibitors). Since July 2022 Baricitinib used in severe AA. Baricitinib regulates the immune response and is said to reduce the induction of pro-inflammatory cytokines in the hair follicle. It may be able to help more people with AA than previous treatment options.
Honest advice and courage to go bald
When advising all alopecia patients, it is important to be honest regarding the possibilities and limitations of the individual treatments and the associated costs. The aim is to find the best solution for the individual person. Hair loss is usually a chronic disease and treatment lasts for life, with the exception of hair transplantation. If patients discontinue therapy, the hair recedes and the hair loss continues. For men in particular, the decision to have a well-groomed bald head can not only be the cheapest, but also the simplest and socially acceptable solution.
Image source: Miha Rekar, unsplash