Hair Disorders and Treatments
Hair treatments have proliferated in the past several years. While prior treatment options were limited to topical minoxidil and oral finasteride for androgenetic alopecia (AGA), novel options have emerged. Topical minoxidil is typically considered the benchmark by which other treatments are compared. In the clinical setting, tweaks are often made based on theoretical data. A prominent example is the addition of topical finasteride to topical minoxidil, which is largely practiced but not widely studied. To address this, Asad et al compared 5% topical minoxidil to the combination of 5% minoxidil with 0.25% finasteride. While a SALT score was used to assess, which is not the traditional scale for AGA, they still had fascinating results. Another practice that is becoming more mainstream in clinical practice for the treatment of AGA is using platelet-rich plasma (PRP) injections and microinjections. Asim et al compared these monthly PRP injections to 5% topical minoxidil BID, assessing hair density as well as with the clinical hair pull test. This study was meaningful, as it provides tangible data and was conducted as a randomized clinical trial. The authors also stratified results based on age as well as other demographic information. An emerging treatment in the United States that has been performed abroad with regularity is mesotherapy, or injectable treatments. One of the main mesotherapy options is dutasteride. Historically, dutasteride mesotherapy has been confined to case reports and case series; however, Saceda-Corralo et al provided a retrospective study to examine its efficacy as well as adverse effects. They studied over 500 patients treated at 3-month intervals. Their findings indicate a new modality to treat AGA.
AGA is the most common cause of hair loss, but it is far from the only cause. Alopecia areata (AA) is the most common cause of immunologic hair loss, with treatments constantly evolving based on our understanding of the disease process. For severe AA, the FDA-approved treatments are JAK inhibitors, with one of the most well-studied being baricitinib. Singh et al provide an in-depth review of baricitinib in AA, including dosing, efficacy, and adverse effects to help dermatologists familiarize themselves with the medication class. Pham et al pivot from classic treatments in AA to examine the role of the Th2 immune system in AA. They examine the role of antihistamines in treating AA as well as alopecia treated and caused by dupilumab. Other causes of immunologic hair loss can be difficult to treat, with lichen planopilaris (LPP) one of the types most refractory to treatment. As such, Klein et al present a case of regrowth in an LPP patient with low-dose naltrexone as well as PRP injection. This regimen could present a novel modality when conventional treatments fail.
Finally, traction alopecia represents an intricate process whereby hairstyles can cause a non-scarring or scarring process. This pathology is often difficult to treat and requires early detection, cultural competence, and knowledge of the underlying pathophysiology. Akintilo et al detail treatments throughout the course of traction alopecia. They also describe how to address styling practices with patients and the underlying cause. Uwakwe et al furthers the discussion by providing clinical pearls for using intralesional Kenalog to treat traction alopecia before it can progress further.
Patients with hair loss are often quite desperate. With the proliferation of misinformation and treatments without data, it is crucial for clinicians to follow emerging data on different hair pathologies closely as opposed to seeking out trends.
Intralesional Triamcinolone Acetonide in the Treatment of Traction Alopecia
The Role of Antihistamines and Dupilumab in the Management of Alopecia Areata: A Systematic Review
