Depending upon your specific type of hair loss, age and sex, Dr. Dubow may discuss a variety of treatments. These include both FDA approved medications (Minoxidil and Finasteride for men and Minoxidil for women) as well as “off-label” use of others (Dutasteride, Spironolactone, Finasteride (women), oral contraceptives & Latisse).
Topically applied Minoxidil was the first medication approved by the FDA for male and female pattern hair loss. It is available over the counter in 2% and 5% strengths. The original studies on Rogaine were performed on the crown, so there is a misconception that it only works in this area. Although minoxidil usually works best in the crown, it also works to a lesser degree in other areas, such as the front of the scalp, as long as there is some fine (miniaturized) hair in the area. It does not work when the area is totally bald. The greatest benefit from the medication is seen from 5 months to 2 years, with a gradual decrease in effectiveness after that. Those using minoxidil long-term will continue to lose hair, but at a somewhat slower rate.
Oral finasteride is FDA approved for use in male pattern baldness. This drug is a 5 alpha reductase inhibitor that reduced the formation of dihydrotestosterone (DHT), a testosterone metabolite that has been shown to promote androgenetic alopecia (pattern hair loss). In some cases, finasteride may also be prescribed (off label) for women with evidence of female pattern hair loss. Although usually prescribed for post menopausal or women who are no longer of child bearing potential, finasteride may occasionally be prescribed to pre-menopausal women. In these instances pregnancy MUST be avoided while taking finasteride as well as for a period of time following finasteride therapy.
Dutasteride is similar in its mechanism of action to finasteride although because it is a stronger inhibitor of 5 alpha reductase it may have greater efficacy than finasteride in retaining and regrowing hair. However, the incidence of side effects, primarily sexual, are higher with use of this medication. The use of dutasteride for male and female patten hair loss is not FDA approved for this use and is considered “off-label.” Dutasteride will sometimes be discussed as a treatment option for patients who have continued to lose hair after an adequate trial of finasteride therapy.
Spironolactone is a medication that is primarily used to treat high blood pressure. However, because of its anti-androgenic effects this medication has been used off label in women who suffer from hormonal acne, hirsutism (body and facial hair growth) and female hair loss. Spironolactone inhibits the binding of androgens to their cellular receptors and decreases testosterone synthesis. Since the medication is a diuretic and is potassium sparing it is important to avoid supplemental or excessive potassium intake and to have periodic monitoring of potassium blood levels. Because of sexual side effects due to testosterone inhibition spironolactone is not an option for treatment of hair loss in men.
Latisse is FDA approved for treatment of eyelashes to promote thickening and growth. This medication is also used off label to promote thickening of eyebrows. A similar version of this drug is currently being studied for use in scalp hair loss.
This is a cortisone type medication that is injected locally into scalp skin for some forms of hair loss. In addition, triamcinolone may be injected in dilute concentrations into scalp skin for patients who have pattern hair loss in combination with seborrheic dermatitis, an associated condition that results is a dry, itchy and flaky scalp that can contribute to additional hair loss. Injections are most often performed at 6 to 12 week intervals.
Micro-needling involves using small sterile needles or a rolling device to create dozens of microscopic scalp wounds that theoretically act to promote local blood flow and the healing cascade with recruitment of associated platelet derived growth factors. Recent studies have shown some efficacy of micro needling as a technique in the treatment of hair loss. (reference available upon request) In addition, micro-needling can be combined with application of topical or locally injected appropriate medications to enhance penetration through the skin.
PLATELET RICH PLASMA (PRP):
PRP is a relatively new technique that has found widespread application in orthopedics for injury rehabilitation as well as plastic surgery and rejuvenative medicine. The technique involves harvesting and then concentrating blood plasma to achieve platelet concentrations of 3 to 6 times that found in normal circulating blood. The platelet rich plasma is then injected into balding areas of the scalp. The theory of platelet derived growth factors promoting hair growth is similar to the proposed mechanism of the micro needling treatment described above. A limited number of published studies have shown mixed results of PRP injections however the preparation techniques as well as other added ingredients may have significant impact on PRP results. This practice uses the EmCyte Pure PRP system which is a double centrifuge technique that achieves much higher platelet concentrations than most conventional PRP preparation systems. We do NOT add A-Cell or other additives which may increase inflammation after injection and paradoxically exacerbate hair loss. PLEASE CLICK HERE FOR PRP INSTRUCTIONS