alopecia areata; telogen effluvium; traumatic alopecia and trichotillomania; androgenetic alopecia

Hair Loss - Treatments

ALOPECIA AREATA:

Although spontaneous re-growth of hair is common, the condition can recur and new patches may appear.

Treatment options include:

Observation (especially for younger children)
Topicals (steroids creams/ hairsprays and minoxidil hairspray)
Steroid injections (may be uncomfortable for some children)
Oral steroids for rapidly worsening AA
Topical immunotherapy using SADBE or DCP. This is used for chronic, severe AA. This is performed in the clinic at weekly intervals and may require treatment for many months.
Camouflage (eg. hair wigs and hats)
JAK inhibitors (e.g. tofacitinib) are a new class of medications that have shown some effect for severe AA.

TELOGEN EFFLUVIUM:

Telogen effluvium tends to resolve spontaneously as long as the cause is removed. Complete regrowth of hair occurs within a few months and there is no proven effective treatment.

TRAUMATIC ALOPECIA / TRICHOTILLOMANIA:

Treatment of traumatic alopecia is avoidance of the trauma, traction or pressure.

The management of trichotillomania is often difficult and requires a strong bond between the patient, doctor and parents. Treatment may involve identifying and reducing stress factors and changing of behaviour. More severe cases may require help from paediatric psychologists or psychiatrists. A medication called N-acetylcysteine has shown to help some patients with trichotillomania.

ANDROGENETIC ALOPECIA:

AGA will worsen without treatment, with the rate of worsening variable in different patients. The aim of treatment is to slow further thinning of the hair and to promote hair growth. Discontinuation of treatment will lead to continued hair loss after several months.

Topical minoxidil has been shown to promote hair growth and decrease hair loss in males and females. This is available in lotion or foam formulations. It should be applied on dry hair as using it on damp, moist hair may lead to dilution of the medication. Improvement is seen only after several months of use.

Oral finasteride has been shown to be useful in males, but is not approved for use under 18 years of age. It is not approved for use in females of child-bearing age.

Surgical treatment (eg. hair transplants) is reserved for more advanced cases in older adults.

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