Alopecia is the loss of hair. Hair loss can be caused by different factors, including damage to the hair shaft or follicles. Fungal infections can also cause hair loss. There are two main types of alopecia. Alopecia areata occurs when the body’s immune system attacks hair follicles and causes hair to fall out. Androgenetic alopecia, meanwhile, is an inherited form of hair loss. With alopecia areata, hair can fall out in patches all over the body. With androgenetic alopecia, hair on the head thins and falls out. In men, this is called male pattern hair loss; in women, it is called female diffuse hair loss. About 60% of people with androgenetic alopecia are men. Hair loss caused by androgenetic alopecia is permanent.

• Male pattern hair loss: Thinning or absence of hair at the hairline and top of the head.
• Female diffuse hair loss: A gradual thinning of hair, especially on the top of the head. The hairline generally remains the same.
• Alopecia areata: Broken hairs, or hairs easily removed; one or more round or oval bald patches.

• Aging
• Genetics
• Illness
• Some medications (such as chemotherapy)
• Malnutrition
• Autoimmune disorder (alopecia areata)

Usually your doctor can diagnose androgenetic alopecia by examining you and taking a medical history. If your doctor suspects alopecia areata, the doctor may order a fluorescent antinuclear antibody (FNA) test, which detects the presence of antibodies. If antibodies are present, it is a sign of an autoimmune disorder.

Treatment depends on the type of alopecia you have. In many temporary forms of alopecia, hair will grow back without treatment. For people with alopecia areata, medications may help reduce hair loss. Some men with male pattern hair loss may consider surgery, such as hair transplants, scalp reduction, and strip or flap grafts.

Drug Therapies

For male pattern hair loss:

• Minoxidil (Rogaine)
• Finasteride (Propecia)

Either drug must be used continually to maintain regrown hair. If you use these medications, your health care provider should monitor you for side effects.

For female diffuse hair loss:

• Minoxidil (Rogaine). Rogaine must be used indefinitely to maintain regrown hair.

For alopecia areata:

• Corticosteroids -- usually given by injection in the scalp each month. In severe cases, corticosteroids may be taken orally.

Surgical and Other Procedures

Surgical options include hair transplants, scalp reduction, and strip or flap grafts.

Complementary and Alternative Therapies

These therapies have limited success in treating male pattern baldness.

Nutrition And Supplements

For alopecia areata

• Biotin (300 mcg per day) and trace minerals, such as those found in blue-green algae (2 - 6 tablets per day), promote hair growth. Biotin and zinc aspartate have been used to treat alopecia areata in children. However, there is no evidence that biotin will help if you are already getting enough biotin in your diet.

For androgenetic alopecia

• Beta-sitosterol (50 mg two times per day) and saw palmetto (200 mg two times per day) appear to help hair growth in men with male pattern hair loss. In one study, men who took this combination had greater hair growth than men who took placebo.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

For androgenetic alopecia

• Saw palmetto (Serenoa repens), 200 mg and beta-sitosterol, 50 mg, two times per day.

For alopecia areata

• Aromatherapy -- One study found that massaging the scalp with a combination of several essential oils improved hair growth. The oils used were lavender, rosemary, thyme, and cedarwood. Because essential oils can be toxic, they are mixed with a “carrier” oil -- in this case, jojoba or grapeseed oil -- before applying to skin. Add 3 - 6 drops of essential oil to 1 tbs. of jojoba or grapeseed oil. Massage into scalp daily.

Massage

Therapeutic massage increases circulation (helping bring more blood to the scalp) and reduces stress. Scalp massage using essential oils of rosemary, lavender, thyme, and cedarwood may help increase circulation (see Herbs).

Some men using finasteride (Propecia) may have a decreased sex drive or trouble getting an erection.

If you are pregnant, postpone treatment until after your baby is born.

Camacho FM, Garcia-Hernandez MJ. Zinc aspartate, biotin, and clobetasol propionate in the treatment of alopecia areata in childhood. Pediatr Dermatol. 1999;16:336-8.

Fischer TW, Burmeister G, Schmidt HW, Elsner P. Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial. Br J Dermatol. 2004;150:341-5.

Foitzik K, Hoting E, Förster T, Pertile P, Paus R. L-carnitine-L-tartrate promotes human hair growth in vitro. Exp Dermatol. 2007 Nov;16(11):936-45.

Harada N, Okajima K, Arai M, Kurihara H, Nakagata N. Administration of capsaicin and isoflavone promotes hair growth by increasing insulin-like growth factor-I production in mice and in humans with alopecia. Growth Horm IGF Res. 2007 Oct;17(5):408-15.

Hay IC, Jamieson M, Ormerod AD. Randomized trial of aromatherapy: successful treatment for alopecia areata. Arch Dermatol. 1998;134:1349-1352.

Lebwohl M. New treatments for alopecia areata. Lancet. 1997;349:222-223.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Questions and Answers about Alopecia Areata. Pub. No. 03-5143

Prager N, Bicketee K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complent Med. 2002 Apr;8(2):143-52.