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

Corticosteroids are a treatment that effectively reduces 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 of each patient and its severity.

The virtue 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 the pathology to avoid altering the local skin. 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 actually 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.

Androgen hormones are known as "male" hormones because they are predominant 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 leads to thinner hair and even hair loss. Multiple drugs with antiandrogen effects will halt and reverse this effect to allow hair to grow back with better quality. This is a highly effective treatment that aims to control the hormonal impact on hair follicles that causes hair to become progressively thinner. They can slow the progression of alopecia, and in many cases even improve it. These drugs are very safe, and their efficacy has been scientifically proven for many years. They are contraindicated in pregnancy. Different types exist, 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. The choice will depend on the patient's specific characteristics, and they can be used alone or in combination with other antiandrogens. Not all contraceptives are suitable, as some can even increase the effects of androgens.

 

Other antiandrogens:

Cyproterone acetate, spironolactone, bicalutamide... These drugs work to reduce the final effect of hormones on hair follicles. Like the others, pregnancy should be avoided while taking them. They will generally be associated with contraceptives.

 

Finasteride and Dutasteride:

These 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 the hair, causing few side effects in 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. 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 later (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 treatment method whose beneficial effects have been scientifically proven. Mesotherapy is used in hormonally influenced conditions and will achieve better growth, greater thickness and density, and overall better 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 requires no specific preparation, and after treatment, the patient can immediately return to their usual activities. This innovative treatment involves infiltrating dutasteride (antiandrogen) molecules directly into the scalp at the same depth as the hair follicle root where the growth cells are located. It usually takes 2-3 sessions to begin noticing the effects.

In some patients, alopecia must be treated surgically to achieve 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 hairs are placed one by one. The technology used is increasingly efficient, allowing for faster transplants with optimal results.

Its success is based on taking hair from a healthy area (donor area) and placing it in an area where there is 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 could be compared to transplanting other organs. It must be handled with the 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 anywhere on the body and also placing it in practically any area.

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

– STRIP transplant

The strip technique is based on the surgical removal of an area of scalp skin with all its hair follicles. Once extracted, the two ends of the skin are joined without leaving any 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 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 punctate scars. It is especially recommended for those who do not mind cutting or shaving their hair before the procedure. It is the choice for people who will wear their hair short after the procedure. The technology assisting FUE is evolving rapidly, as are increasingly effective robots.

The treatment for alopecia par excellence. Its history is curious because it was originally a treatment for hypertension. When high doses were administered, it was observed that patients experienced significant hair growth, and studies began to focus on its use solely for hair. Its usefulness 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 application, as it can leave residue and make hair look dirty.

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 effective and has 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 in other body areas, which is reversible by lowering the dose. Many of my patients are so happy with the 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 being performed, I usually combine it with vitamins or other components depending on the patient's characteristics.

Androgen hormones are known as "male" hormones because they are predominant 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 leads to thinner hair and even disappearance. Multiple antiandrogen drugs will slow down and reverse this effect to allow hair to grow with better quality. This is a highly effective treatment that aims to control the hormonal impact on hair follicles that causes hair to progressively thin. They can slow 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. 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 the hair, causing few side effects in the rest of the body. They can be taken orally, as well as applied topically or through microinjections (dutasteride mesotherapy). The form 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 patients 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 in the sexual sphere, which is very controversial scientifically, but 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 wound healing. When activated, they release growth factors, originally intended 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 it consists of the patient's own blood components, 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 (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 to make 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 minimize discomfort.

The patient can return to normal activities immediately afterward and requires no specific preparation. While the patient leaves the consultation a bit more disheveled than when they entered, they can even return to work immediately after. Its frequency will be assessed on a case-by-case basis, depending on whether it is used as an ongoing treatment for a pathology or as an aesthetic treatment to improve hair quality.