Treatment of Alopecias

The alopecia treatment par excellence. Its history is curious, because it is a treatment for hypertension. When high doses were administered, it was observed that patients experienced significant hair growth, and it began to be studied for hair use alone. 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 routes of application, including topical, oral, or repeated microinjections (minoxidil mesotherapy).

Topical application is associated with good results if applied daily. As minoxidil contains an alcoholic excipient, it can sometimes cause mild irritation, which can be controlled with appropriate shampoos or cosmetics. Its main problem is the inconvenience of its application, as it can leave residue and make the hair look 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 been shown 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 in other body areas, which is reversible by lowering the dose. Many of my patients are so pleased 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. When performing the injections, I usually combine it with vitamins or other components depending on the patient's characteristics.

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

Corticosteroids are an effective treatment that reduces inflammation and are used to improve a multitude of conditions. They can be taken orally, applied topically to the skin as a cream, or injected. The chosen route will be adapted to each patient's type of disease 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 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 prevent local skin alteration. 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 alopecia 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.

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 that has demonstrated its beneficial effects scientifically. Mesotherapy is used in hormonally influenced conditions and will achieve better growth, greater thickness and density, and an overall better appearance, all without administering a drug systemically.

This treatment is 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 the treatment, the patient can immediately return to their normal activities. This innovative treatment involves the infiltration of 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 between 2-3 sessions to begin to notice the effects.

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 causes the hair to become progressively finer and even disappear. The multiple drugs with antiandrogen effects will slow down and reverse this effect to allow hair to grow with better quality. It is a highly effective treatment that aims to control hormonal involvement in 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 efficacy has been scientifically proven for many years. There are different types, each indicated for different types of patients.

 

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 adverse effects on the rest of the body. They can be taken orally, 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 completely normal lives during treatment. Dutasteride is more potent, reserved for more advanced cases. There is talk of the possibility of sexual side effects, which is highly controversial scientifically, but in any 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 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 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 an improvement in hair growth, shine, consistency, and reduced hair loss.

Since these are 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 (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 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. Although the patient may leave the clinic with slightly disheveled hair, they can even return to work immediately afterward. Its frequency will be evaluated on a case-by-case basis, depending on whether it is used as a maintenance treatment for a pathology or as a cosmetic treatment to improve hair quality without disease.

Just as skin is cared for internally to improve its appearance, hair can also be treated in depth to enhance it. Vitamins, antioxidants, minerals, and hyaluronic acid have shown the ability to stimulate hair growth. The hair root is a highly active mini-organ that requires many nutrients to function correctly and also generates many free radicals.

When these substances are given orally, the amount that reaches the hair is unknown and probably less effective. However, when we inject them directly onto the roots, we achieve optimal stimulation. Improvements in hair shine and quality as well as a reduction in hair loss are described. It should be noted that when we want to regenerate cells, the effects are not seen immediately, but with sustained treatment over several months.

It is a practically painless treatment performed in the clinic, after which the patient can return to their daily life. Depending on the condition and the type of patient, the infiltration protocol will be chosen, which can be weekly, bi-weekly, or monthly. It is often associated with other treatments for specific conditions.

When a wound is made on the skin, the body sends all its artillery to repair it. This is the idea behind this treatment, which aims to create micro-wounds in a controlled manner so that the body sends growth factors. As we perform them in the scalp area and at a depth equivalent to the hair root, an effect on hair cells is achieved. The result is an improvement in hair growth capacity and increased hair density. It is often used in association with specific treatments for different pathologies or as a cosmetic 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, the patient can return to their normal daily activities. Discomfort only appears during the treatment and is completely tolerable. When the treatment is performed, it can be combined with the topical application of active substances to improve the treatment's results. It must be repeated to observe the effects, ideally every 15 or 30 days.

Androgen hormones are known as "male" hormones as 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 results in thinner hair or even hair loss. Multiple drugs with antiandrogen effects will curb and reverse this effect to allow hair to grow back healthier. It is a highly effective treatment that aims to control the hormonal impact on hair follicles, which 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 effectiveness has been scientifically proven for many years. They are contraindicated during 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. The choice will depend on the specific characteristics of the patient, 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 during their use. They are generally 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. That 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 type of alopecia the patient has 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 (dutasteride) afterward, women must avoid pregnancy.