In pathologies associated with inflammation, an indispensable part of their treatment is the elimination of that inflammation to allow hair to grow.

Corticosteroids are an effective treatment for reducing inflammation and are used to improve many conditions. They can be taken orally, applied to the skin as a cream (topical), or injected. The chosen route will be adapted to the type of disease and its severity in each patient.

The advantage of corticosteroid mesotherapy is that it allows us to apply a high dose of treatment only to the affected area, reducing the risks of sustained systemic corticosteroid use. The technique is performed in the clinic, causing only slight discomfort to the patient. The amount of corticosteroid and serum to be injected is chosen according to the area and pathology to prevent local skin alterations. The treatment will be repeated as often as necessary. It is usually combined with treatments such as platelet-rich plasma or vitamin mesotherapy to stimulate hair growth.

For it to be useful, the area of alopecia must be observed to know where it is really needed, as there is a maximum safe dose depending on the patient's weight. In other words, if an excessive dose is used, the body can absorb the corticosteroid, leading to subsequent alterations.

PRP is a treatment that stimulates hair growth and controls inflammation. Blood contains platelets, which are cells responsible for wound healing. When activated, they release growth factors, originally to heal the body. It began to be used in regenerative medicine many years ago. Since the hair follicle, which gives rise to hair, is a continuously growing structure, these locally applied growth factors will improve and stimulate its function. This stimulation of the hair root results in improved hair growth, hair shine, its consistency, and reduced hair loss.

As it consists of components from the patient's own blood, it is considered a natural treatment suitable for pregnant women, patients with oncological conditions, vegans, and vegetarians, etc.

The technique is practically painless and is performed in the clinic. Blood is drawn from the patient (similar to a blood test) to isolate the platelet-rich portion by specific and meticulous centrifugation and separation. This separated portion, which is the platelet-rich plasma itself, is activated with a substance to make the platelets release their growth factors. Once prepared and activated, it is injected into the scalp at 4mm beneath the skin, at the level of the hair roots. Local anesthesia can be applied to the scalp beforehand to make it less uncomfortable.

The patient can return to normal activities immediately afterward and does not require specific preparation. Although the patient leaves the consultation a bit more disheveled than they entered, they can even return to work immediately afterward. Its frequency will be assessed on a case-by-case basis, depending on whether it is used as a maintenance treatment for a condition or as an aesthetic treatment to improve hair quality without disease.

1. Oral corticosteroids: Recent research suggests the usefulness of pulsed regimens in oral corticosteroid treatment, which reduces side effects while achieving good results.

2. Immunosuppressants: cyclosporine, azathioprine, methotrexate... These will be chosen based on each patient's characteristics and the severity of their alopecia. They are usually not the first option, so they are used in patients who have not responded to other treatments.

3. Anti-JAK drugs: This is a therapy still under study, with good results in the United States but still difficult to prescribe in Spain.

When a wound occurs on the skin, the body sends all its arsenal to repair it. This is the idea behind this treatment, which seeks to create controlled micro-injuries to make the body send growth factors. Since we perform them in the scalp area and at a depth equivalent to the hair root, an effect is achieved on the hair cells. The result is an improvement in hair growth capacity and increased hair density. It is usually used in association with specific treatments for different pathologies or as an aesthetic treatment to improve hair quality without disease.

The technique is performed in the clinic with local anesthesia. It does not require specific patient preparation, and after its completion, one can return to normal daily activities. Discomfort only occurs during treatment and is completely tolerable. When performing the treatment, it can be combined with the topical application of active substances to improve the treatment's outcome. It must be repeated to observe the effects, ideally every 15 or 30 days.

This technique is based on trying to remove inflammatory cells from the hair follicle to allow it to grow. It involves sensitizing the patient to a substance (generally diphencyprone), and then applying it in very low doses to the treatment area. This causes a mild inflammatory reaction that can facilitate hair growth. Generally, we perform a tolerance test in the consultation and then prescribe the substance to patients at its minimum effective dose for home application.

The quintessential alopecia treatment. Its history is interesting, because it's a treatment for hypertension. When high doses were administered, it was observed that patients' hair grew significantly, and studies began to explore its use solely for hair. Its efficacy was described more than two decades ago, and it continues to be used with good results. This molecule is capable of stimulating hair growth, improving its vascularization. This prolongs the hair's growth phase, making it appear thicker and denser.

There are multiple application methods, including topical, oral, or repeated microinjections (minoxidil mesotherapy).

Topical application is associated with good results if applied daily. Since minoxidil contains an alcoholic excipient, it can sometimes cause mild irritation, which can be managed with appropriate shampoos or cosmetics. Its main problem is the inconvenience of its application, as it can leave residue and make hair appear dirty.

For several years now, oral treatment at low doses of 0.5-2.5mg (higher doses of 40-80mg daily are used to treat hypertension) has been available. This treatment has proven to be effective and have a good safety profile. It will not lower the patient's blood pressure if the dose is chosen correctly. The main adverse effect is hair growth on other body areas, which is reversible when the dose is lowered. Many of my patients are so happy with their hair growth that they prefer to wax unwanted hair rather than lower the dose, but that's a personal decision.

Minoxidil mesotherapy involves injecting the molecule into the scalp at the level of the hair roots, which are approximately 4mm deep. This treatment is performed in the clinic every 15 days. It is practically painless. Since injections are being performed, I usually combine it with vitamins or other components depending on the patient's characteristics.