If hair loss is caused by an infection or a condition, such as anaemia, treating the infection or condition may help to prevent further hair loss. In some cases, including after chemotherapy, your hair may start to grow back again.
Although there are some treatments available for hair loss, in most cases they cannot cure the problem and you will often have to pay for the treatment privately. Also, after the treatment has stopped, the hair loss often returns.
Telogen effluvium, a type of widespread hair loss that is caused by medication or stress, usually improves without treatment in around six months.
If you have scarring alopecia, a type of hair loss that is caused by another condition, the underlying cause should be treated first. The hair loss in scarring alopecia is usually permanent, so you may wish to consider wearing a wig or, in some cases, having surgery. See below for more information about these treatment options.
Male-pattern baldness
Two medicines are known to be effective in treating male-pattern baldness. They are:
These are described below.
Finasteride
Finasteride works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size.
Studies have suggested that finasteride can increase the number of hairs that people have (hair count) and can also improve how people think their hair looks. The effect increases the longer the treatment is used. Nearly a third of people see improvement if finasteride is used long-term (for several years). The hair count increased by nearly 10% for short-term treatment (up to a year) and by 24% for long-term treatment.
It usually takes three to six months of continuously using finasteride before any effect is seen. The balding process usually resumes within 6 to 12 months if treatment is stopped.
Finasteride is not available on the NHS, but is available on private prescription from your GP. It comes as a tablet that you take every day.
The side effects for finasteride are uncommon. Less than 1 in 100 men who take finasteride experience a loss of sex drive (libido) or erectile dysfunction (the inability to get or maintain an erection). If you are taking finasteride for several years, the risk of developing these side effects should reduce.
Minoxidil
Minoxidil is available as a lotion that you rub on your scalp every day. It is available from pharmacies without a prescription. It is not clear how minoxidil works, but evidence suggests that it can cause hair regrowth in some men.
The medication contains either 5% or 2% minoxidil. Some evidence suggests that the stronger version (5%) is more effective. Other evidence has shown that this is no more effective than the 2% version. However, the stronger version may cause more side effects, such as dryness or itchiness, where it is applied.
Like finasteride, minoxidil usually needs to be used for at least four months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. Any new hair that regrows will fall out two months after treatment is stopped. Side effects are uncommon.
Female-pattern baldness
Minoxidil is currently the only medicine available to treat female-pattern baldness.
Minoxidil lotion may help hair to grow in around 1 in 4 women who use it, and it may slow or stop hair loss in other women. In general, women respond better to minoxidil than men. As with men, you need to use minoxidil for at least four months to see any effect.
Other treatments for hair loss include wigs and surgery (see below).
Alopecia areata
There is no completely effective treatment for alopecia areata. However, in most cases, the hair grows back after about a year without any treatment. So ‘watchful waiting’ is sometimes best, particularly if you just have a few small patches of hair loss.
When treatments are necessary, they tend to have variable results (see below).
Corticosteroid injections
Corticosteroids are medicines that contain steroids, which are a type of hormone. They work by suppressing the immune system (the body’s natural defence against infection and illness). This is useful in alopecia areata because the condition is thought to be caused by the immune system damaging the hair follicle.
Corticosteroid injections appear to be the most effective treatment for small patches of alopecia. As well as your scalp, they can also be used in other areas, such as your eyebrows.
A corticosteroid solution is injected several times into the bald areas of skin. This stops your immune system from attacking the hair follicles. It can also stimulate hair to grow again in those areas after about four weeks. The injections are repeated every few weeks. Alopecia may return when the injections are stopped.
Side effects of corticosteroid injections include pain at the injection site and thinning of your skin (atrophy).
Topical corticosteroids
Topical corticosteroids (creams and ointments) are widely prescribed for treating alopecia areata, but their long-term benefits are not known. There are mixed opinions about the effectiveness of topical corticosteroids. Some experts prescribe them, but others consider them to be of no benefit.
You may be prescribed topical corticosteroids to use for three months. Possible corticosteroids include:
- betamethasone
- hydrocortisone
- mometasone
These are available as a lotion, gel or foam depending on which you find easiest to use. However, they cannot be used on your face – for example, on your beard or eyebrows.
Possible side effects of corticosteroids include thinning of your skin and acne (spots).
Corticosteroids are also available in tablet form, but due to the risk of serious side effects, such as diabetes and stomach ulcers, corticosteroid tablets are not recommended.
Minoxidil lotion
Minoxidil lotion is applied to the scalp and can stimulate hair regrowth after about 12 weeks. However, it can take up to a year for the medication to take full effect.
Minoxidil is licensed to treat both male- and female-pattern baldness, but it is not specifically licensed to treat alopecia areata. This means that it has not undergone thorough medical testing for this purpose.
Minoxidil is not recommended for those who are under 18 years old. It is not available on the NHS, but it can be prescribed privately or bought over the counter.
Immunotherapy
Immunotherapy appears to be the most effective form of treatment for extensive or total hair loss. But fewer than half of those who are treated will see worthwhile hair regrowth.
A chemical solution called diphencyprone (DPCP) is applied to a small area of bald skin. This is repeated every week, using a stronger dose of DPCP each time. The solution will eventually cause an allergic reaction and the skin will develop mild eczema (dermatitis). In many cases, a person’s hair will start to regrow after about 12 weeks.
A possible side effect of immunotherapy is a severe skin reaction. But this can be avoided by increasing the DPCP concentration gradually. Less common side effects include a rash and patchy-coloured skin (vitiligo). In many cases, the hair falls out again when treatment is stopped, therefore treatment needs to be maintained.
Immunotherapy is only available in specialised centres. You will need to visit the centre once a week for several months. After DPCP has been applied, you will need to wear a hat or scarf over the treated area for 24 hours because light can interact with the chemical.
Dithranol cream
Similar to immunotherapy, dithranol cream is applied regularly to the scalp before being washed off. It causes a skin reaction, followed by hair regrowth in some cases.
Dithranol cream is not as effective as immunotherapy. It can also cause itchiness and scaling of the skin and it can stain the scalp and hair. For these reasons, dithranol is not widely used.
Ultraviolet light treatment
Two to three sessions of light therapy (phototherapy) are given every week in hospital. The skin is exposed to ultraviolet (UVA or UVB) rays. In some cases, before your skin is exposed to UV light, you may be given a medicine called psoralen, which makes your skin more sensitive to the light.
Light therapy can take up to a year to produce maximum results. Responses vary, and there is a high relapse rate. It is often not a recommended treatment because side effects can include:
- nausea (feeling sick)
- pigment changes to the skin
- an increased risk of skin cancer
Tattooing
Eyebrows can be tattooed over a few hourly sessions. This is known as dermatography, and it generally produces good results.
Wigs
Wigs can be a useful treatment for people with extensive hair loss.
Synthetic wigs
The cheapest wigs are made from acrylic, and they can cost anywhere between £60 and £200. As of April 2011, an NHS stock acrylic wig costs £61.85.
Acrylic wigs last for six to nine months. They are easier to look after than wigs that are made of real hair (they do not need styling). However, acrylic wigs can be itchy and hot, and they need to be replaced more often than wigs made from real hair.
You may be entitled to receive a free acrylic wig every six months on the NHS (see box, left).
Real-hair wigs
Some people prefer the look and feel of wigs that are made from real hair even though they are more expensive, costing anywhere between £200 and £2,000. As of April 2011, an NHS partial human hair wig costs £163.80. An NHS full human hair wig that is made-to-order costs £239.65. The wig lasts for three to four years, but is harder to maintain than a synthetic wig because it may need to be set and styled by a hairdresser and professionally cleaned.
A human-hair wig is only available on the NHS if you are allergic to acrylic or if you have a skin condition that is made worse by acrylic. You may wish to buy your wig privately.
Alopecia UK has useful information about synthetic wigs and human hair wigs, including advice about choosing the right wig and how to care for it.
Complementary therapy
Aromatherapy, acupuncture and massage are often used for alopecia, but there is not enough evidence to support their use as effective treatments.
Hair loss surgery
Most men and women considering hair loss surgery have male-pattern or female-pattern baldness. However, surgery is sometimes suitable for a range of alopecia conditions.
Surgery for hair loss should only be considered after trying less invasive treatments, such as the medicines described above. These can often halt the hair loss process and sometimes help regrowth. But if that is not enough, then surgery is an option. However, surgery is not usually available on the NHS.
The success of hair loss surgery depends on the skill of the surgeon, as complications can arise. Before seeking out a surgeon in the private sector, get some advice from the NHS first. For example, by speaking to your GP.
Your GP may be able to advise you about your options and tell you about the advantages and disadvantages of various surgical treatments. They may also refer you to a dermatologist (a specialist in skin conditions) or a plastic surgeon with expertise in this area.
The main types of hair loss surgery are explained below, including information about how to get the best results for your condition and the risks associated with each technique.
Hair transplant
Under local anaesthetic (painkilling medication), a small piece of scalp (about 1cm wide and 30-35cm long) is removed from an area where there is plenty of hair, such as the back of the head. The piece of scalp is divided into single hairs or tiny groups of hairs, which are then grafted onto areas where there is no hair.
Stitches are not needed to attach the grafts because they are held in place by the clotting (thickening) action of the blood when the hairs are inserted. Fine hairs are placed at the front of the scalp and thicker hairs towards the back, in a process called grading. This helps to achieve a more natural result. Within six months, the hair should settle and start to regrow.
Hair transplantation is not provided by the NHS. It can be expensive and take a long time. Hair transplants are carried out over a number of sessions. There should be a break of nine to 12 months between procedures. As with any type of surgery, there is a risk of infection and bleeding, which can lead to hair loss and noticeable scarring.
Scalp reduction
Scalp reduction involves removing pieces of bald scalp from the crown and the top of the head. This can be done by cutting out loose skin and stitching the scalp back together, or it can be done by tissue expansion.
Tissue expansion is where a balloon is placed underneath the scalp and inflated over several weeks to expand the skin in stages. The balloon is then removed and the excess skin is cut out, bringing the areas with hair closer together.
Scalp reductions are not suitable for hair loss at the front of the scalp because it can cause unacceptable scarring. There is also the risk of infection in the area.
Scalp reduction is not usually used for male-pattern baldness, but it is available on the NHS to people with scarring alopecia. Scarring alopecia can be caused by an infection or by conditions such as lichen planus (a non-infectious itchy rash) and discoid lupus (a poorly understood condition that is caused by a faulty immune system). Surgery should only be carried out after these other conditions have cleared up.
Artificial hair
Artificial hair implantation is marketed as a treatment for male-pattern baldness. It involves implanting synthetic fibres into the scalp under local anaesthetic. The technique is not available on the NHS.
Artificial hair implantation carries serious risks of infection and scarring, but clinics may be reluctant to inform people of the possible complications to avoid losing potential clients.
Artificial hair implantation is not recommended by dermatologists due to the risk of complications such as:
- infection
- scarring
- the synthetic fibres falling out
People who are considering hair loss surgery should explore more established treatments, such as hair transplantation and scalp reduction, because the advantages and disadvantages of these techniques are better understood.
Cloning
The latest research into hair loss treatment is studying hair cell cloning. The technique involves taking small amounts of someone’s remaining hair cells, multiplying them, then injecting them into bald areas.
Cloning is intended to treat both male- and female-pattern baldness. However, the science behind the technique is very new and more trials are needed before it can be fully assessed.
