INTRODUCTION
Nutraceuticals are an emerging category of beauty products and one of the fastest growing segments in the nutricosmetic market.1 This class of naturally derived therapeutics from food and botanicals contain phytochemicals - biologically active compounds that protect or promote health and occur at the intersection of food and medicine. Driving nutricosmetic sales is the growing acceptance of an inside-out-approach to health and beauty and the fact that these nutraceuticals are viewed as safe and natural. Nutritional alternatives and supplements to treat hair loss are among the most sought after nutricosmetics. Healthy hair requires more than just balanced nutrition so it follows that many patients who experience hair loss turn to nutraceuticals.2 This emerging category distinguishes itself by attributing efficacy to the isolation and standardization of specific phytochemicals that have clinically studied therapeutic effects. It is important to note that while nutritional supplements are regulated by the FDA and FTC, they are not subjected to the same rigorous standards as drugs.3 Nutraceuticals that lack standardized dosing, potent and pure ingredients, or contain phytoactives that are not bioavailable may be ineffective. For this reason, it is imperative that dermatologists are knowledgeable and able to guide their patients on nutraceutical selection.The most common form of hair loss, androgenetic alopecia (also termed female and male pattern hair loss), affects at least 40% of women and 50% of men and will progress without treatment.4 Patients who suffer with hair loss often develop depression and anxiety that is precipitated by the fact that there is no cure for hair loss and available medical treatments take months to produce variable results.5,6,7 Currently, there are only two drugs that have been FDA approved for treating hair loss.8 Topical minoxidil, now available over the counter in 2% and 5% solutions and 5% foam, is approved for use in both men and women.9 The exact mechanism of action of minoxidil is uncertain but it is known to prolong the anagen phase of hair growth and increase blood supply to the follicle.10 Finasteride is a type II 5-alpha reductase inhibitor that prevents conversion of testosterone to its active form 5-dihydrotestosterone (DHT).11 Finasteride slows the progress of hair loss and stimulates regrowth in patients with androgenetic alopecia. While both medications are supported by clinical studies and long-term clinical use, they are not without limitations. Topical minoxidil is objectionable to many who find the application process difficult to incorporate into a daily haircare routine. Women may suffer side effects particularly with higher dose minoxidil including the growth of facial hair.12 Irritant or allergic contact dermatitis can occur with minoxidil solution and is attributed to the propylene glycol used to solubilize minoxidil.13 The use of finasteride is limited to men and, off-label, post-menopausal women as ingestion of finasteride
