In those pathologies that are 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 that reduces inflammation, being used to improve a multitude of conditions. They can be taken orally, applied topically to the skin in cream form, or injected. The chosen route will be adapted to the type of disease of each patient and its severity.

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 corticosteroid use systemically. The technique is performed in the clinic, causing only a 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 associated with treatments such as platelet-rich plasma or vitamin mesotherapy to stimulate hair growth.

For it to be useful, the alopecic area 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 with consequent alterations.

Androgen hormones are known as "male" hormones because they predominate in men, but they are present in both sexes. In predisposed individuals, when they come into contact with the hair root, they alter its growth, making it slower and less effective, so the hair ends up thinner and even disappears. The multiple drugs with antiandrogenic effect will slow down and reverse this effect to allow hair to grow with better quality. It is a very effective treatment that seeks to control the hormonal effect on hair follicles that causes hair to progressively thin. They can slow down the progression of alopecia, and in many cases even improve it. These are very safe drugs whose efficacy has been scientifically proven for many years. They are contraindicated in pregnancy. There are different types, each indicated for different types of patients.

 

Antiandrogenic Contraceptives

There are certain contraceptive pills with an antiandrogenic effect that can be useful in cases of incipient androgenetic alopecia in young women. They will be chosen based on specific patient characteristics and can be used alone or in association with other antiandrogens. Not all contraceptives are suitable as some may even increase the effects of androgens.

 

Other antiandrogens:

Cyproterone acetate, spironolactone, bicalutamide... They act to reduce the final effect of hormones on hair follicles. Like the rest, pregnancy should be avoided during their use. They will generally be associated with contraceptives.

 

Finasteride and Dutasteride:

They are called 5-alpha reductase inhibitors, which is the molecule that allows hormones to transmit their information to the hair follicle. That is why they act selectively on the hair causing few adverse effects on the rest of the body. They can be taken orally, as well as applied topically or by microinjections (dutasteride mesotherapy). The way they are taken will be chosen based on the patient's type of alopecia and other characteristics. These drugs have shown a good safety profile and the patient can lead a completely normal life during treatment. Dutasteride is more potent, reserved for more advanced cases. The results of this type of treatment usually begin to be visible after 6-8 months. During treatment with these drugs and up to 1 month (finasteride) or 6 months after (dutasteride), women should avoid pregnancy.

Antiandrogens are drugs that reduce the negative effect of certain hormones on hair growth. To administer higher doses without affecting the rest of the body, they began to be used locally, injecting them directly into the area where the hair roots are located (4mm deep in the scalp). This is an innovative form of treatment whose beneficial effects have been scientifically demonstrated. Mesotherapy is used in conditions influenced by hormones and will achieve better growth, greater thickness and density, and a better overall appearance, all without administering a systemic drug.

It is a treatment performed in the clinic, under local anesthesia with minimal discomfort. Depending on the patient, it can be done monthly or quarterly. It does not require specific preparation and after the treatment, the patient can immediately return to their usual activities. This innovative treatment involves the infiltration of dutasteride molecules (antiandrogen) directly into the scalp at the same depth as the hair follicle root where the growth cells are located. It usually takes between 2-3 sessions to start noticing the effects.

In some patients, alopecia must be treated surgically to obtain optimal results. When hair is no longer able to grow on its own, we will have to "place" it surgically. Transplant techniques are constantly evolving and improving. Currently, the micrograft technique is used, which allows for completely natural results in expert hands, as the hairs are placed one by one. The technology used is increasingly efficient, allowing transplants to be performed faster with optimal results.

Its success is based on taking hair from a healthy area (donor area) and placing it in an area with alopecia (recipient area). Hair does not grow in isolation but in the form of a hair follicle. This structure includes stem cells that give rise to hair but also the sebaceous gland. Therefore, when we remove it from the body, it can be compared to transplanting other organs. It must be treated with utmost care so that it is not damaged and placed in its final location as soon as possible. Then the stem cells adapt to their new location and begin to grow.
There are several transplant techniques for extracting hair from the posterior region of the scalp. Nowadays, there is also the option of transplanting hair from any part of the body and also placing it in almost any area.

The extraction options are the strip technique (or FUT) and the individual follicular unit extraction (FUE) technique.

– STRIP Transplant

The strip technique is based on the surgical removal of a strip of scalp skin with all its hair follicles. Once extracted, the two ends of the skin are joined together, leaving no trace other than a minimal linear scar. The follicular units from the strip are microscopically separated to be implanted one by one. The benefit of this technique is that it does not require shaving the donor area and many very healthy follicular units can be obtained for transplantation.

– FUE Transplant

In FUE, the follicular units are extracted individually, with a small circular scalpel called a punch. The recovery is much faster because the surgical extractions are microscopic and will leave minimal, almost invisible punctiform scars. It is especially recommended for those who do not mind cutting or shaving their hair before the intervention. It is the preferred choice for people who will wear their hair short after the intervention. The technology that assists FUE is evolving rapidly, as are increasingly efficient robots.

The quintessential treatment for alopecia. Its history is curious because it was originally a treatment for hypertension. When high doses were given, it was observed that patients experienced significant hair growth, and studies began to focus on its use solely for hair. Its usefulness was described over two decades ago, and it continues to be used with good results. This molecule is capable of stimulating hair growth by improving its vascularization. This extends the hair's growth phase, making it appear thicker and denser.

There are multiple administration routes, including topical, oral, or through 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 is controlled with appropriate shampoos or cosmetics. Its main problem is the inconvenience of application, as it can leave residue and make hair look greasy.

For several years now, oral treatment has been available at low doses of 0.5-2.5mg (higher doses of 40-80mg daily are used to treat hypertension). 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 side effect is hair growth in other body areas, which is reversible when the dose is reduced. Many of my patients are so pleased with their hair growth that they prefer to remove unwanted hair rather than lower the dose, but that is 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 performed, I usually combine it with vitamins or other components depending on the patient's characteristics.

Androgen hormones are called "male" hormones because they predominate in men, but they are present in both sexes. In predisposed individuals, when they come into contact with the hair root, they alter its growth, making it slower and less effective, which results in finer hair and even hair loss. Multiple drugs with antiandrogenic effects will slow down and reverse this effect to allow hair to grow back with better quality. It is a highly effective treatment that seeks to control the hormonal impact on hair follicles, which causes hair to become progressively thinner. They can slow down the progression of alopecia, and in many cases even improve it. These are very safe drugs whose effectiveness has been scientifically proven for many years. There are different types, each indicated for different types of patients.

 

Finasteride and Dutasteride:

They are called 5-alpha reductase inhibitors, which is the molecule that allows hormones to transmit their information to the hair follicle. This is why they act selectively on hair, causing few adverse effects on the rest of the body. They can be taken orally, as well as applied topically or through microinjections (dutasteride mesotherapy). The method of administration will be chosen based on the patient's type of alopecia and other characteristics.

These drugs have shown a good safety profile, and the patient can lead a completely normal life during treatment. Dutasteride is more potent, reserved for more advanced cases. There is talk of the possibility of adverse effects on sexual function, something highly controversial at a scientific level, but whatever the case, they appear in 1% of patients taking this medication and are reversible. The results of this type of treatment usually begin to be visible after 6-8 months.

PRP is a treatment that stimulates hair growth and controls inflammation. Blood contains platelets, which are cells responsible for healing wounds. 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 that produces 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.

Since they are components of the patient's own blood, it is considered a natural treatment suitable for pregnant women, patients with oncological pathology, vegans and vegetarians, etc.

The technique is practically painless and is performed in the clinic. Blood is drawn from the patient (just like for a blood test) to isolate the platelet-rich portion through specific and meticulous centrifugation and separation. This separated portion, which is the platelet-rich plasma itself, is activated with a substance so that the platelets release their growth factors. Once prepared and activated, it is injected into the scalp at 4mm under 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 requires no specific preparation. Although the patient leaves the clinic looking a bit more dishevelled than when 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 maintained treatment for a pathology or as a cosmetic treatment to improve hair quality.