Treating hair loss - 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 several 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 treatment. So ‘watchful waiting’ is sometimes best, particularly if you just have a few small patches of hair loss.

Some treatments for alopecia areata are outlined below.

Corticosteroid injections

Corticosteroids are medicines containing steroids, a type of powerful chemical called a 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 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.

They are usually prescribed for a three month period. 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 tablets are not recommended due to the risk of serious side effects, such as diabetes and stomach ulcers.

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 is not specifically licensed to treat alopecia areata. This means it has not undergone thorough medical testing for this purpose.

Minoxidil is not recommended for those under 18 years old. It is not available on the NHS, but it can be prescribed privately or bought over the counter.

Immunotherapy

Immunotherapy may be an effective form of treatment for extensive or total hair loss, although 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 eventually causes an allergic reaction and the skin develops mild eczema (dermatitis). In some cases, this results in hair regrowth 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.

However, it has not been proven that dithranol cream is significantly effective in the long term. 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.

The results of light therapy are often poor. The treatment can take up to a year to produce maximum results and responses vary, with 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

For many people, it is possible to replicate hair with a tattoo. This is known as dermatography, and it generally produces good long-term results, although it is usually expensive and can only be used to replicate very short hair.

This is usually carried out for eyebrows over a few hourly sessions and can even be used as a treatment for scalp hair loss caused by male-pattern baldness.

Wigs
Wigs can be a useful treatment for people with extensive hair loss.

Synthetic wigs

The cheapest wigs are made from acrylic, and can cost anywhere between £60 and £200. As of April 2012, an NHS stock acrylic wig costs £63.35.

Acrylic wigs last for six to nine months. They are easier to look after than wigs made of real hair (they do not need styling). However, acrylic wigs can be itchy and hot, and need to be replaced more often than wigs made from real hair.

Read about wigs and fabric supports costs for information on who is entitled to free wigs on the NHS and who can get help with costs.

Real-hair wigs
Some people prefer the look and feel of wigs made from real hair even though they are more expensive, costing anywhere between £200 and £2,000. As of April 2012, an NHS partial human hair wig costs £167.85 and an NHS full human hair wig that is made-to-order costs £245.40.

Real hair wigs last 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 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.