If hair loss is caused by an infection or a condition such as anaemia, treating the infection or condition may prevent further hair loss. In some cases, including after cancer treatment, your hair may start to grow again.
There are two medicines that are known to be effective in treating male-pattern baldness: finasteride and minoxidil.
Finasteride works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size.
Although more research is needed, studies suggest that two-thirds of men who take finasteride, experience some hair regrowth. In the remaining third, there is no hair regrowth, but most do not experience any further hair loss. It normally takes at least four months of using finasteride before any effect is seen, and the balding process will normally resume if treatment is stopped.
Finasteride is not available on the NHS, but is available on private prescription from your GP. It comes as a tablet that you take every day. Side effects are uncommon, although about two in 100 men who use it experience a loss of sex drive.
Minoxidil is available as a lotion that you rub on your scalp every day. It is available from pharmacies without prescription. It is not clear how minoxidil works, but studies suggest that the balding process will slow in about half of those men who use it, and that about 15% of those who use it will experience hair regrowth. However, about a third of men who use minoxidil will not see any change in their hair loss.
Like finasteride, minoxidil normally needs at least four months of use before any effect is seen, and the balding process will normally resume if treatment is stopped. Any new hair that does regrow will fall out two months after treatment is stopped. Side effects are uncommon.
Currently, the only medicine available to treat female-pattern baldness is minoxidil. Minoxidil lotion may help hair to grow in 20-25% of women who use it, and in the majority it may slow or stop the loss of hair.
Other treatments for hair loss include wigs, hair transplants (taking hair from the sides and back of the head) and plastic surgery, such as scalp reduction, where the bald area is removed and the bit with hair on is stretched forward.
There is no completely effective treatment for alopecia areata.
However, in about eight out of 10 cases, the hair grows back after about a year without any treatment, so sometimes ‘watchful waiting’ is best, especially if you just have a few small patches.
When treatments are necessary, they tend to have variable results (see below).
Steroid injections appear to be the most effective treatment for small patches of alopecia. A steroid solution is injected several times into the bald areas of skin. This stops the immune system from attacking the hair follicles, and it can stimulate hair to grow again in those patches after about four weeks. Injections are repeated every few months. Alopecia may return when injections are stopped.
Topical steroids and steroid tablets
Topical steroids (creams and ointments) are widely prescribed for alopecia areata, but their long-term benefits are not known. There is some evidence that they can make hair regrow.
Steroids can also be taken as tablets, but alopecia often returns when the tablets are stopped, and after a while of taking them they can produce serious side effects, such as diabetes and stomach ulcers. Other possible side effects are itching or hair growth in other areas.
Minoxidil lotion is applied to the scalp and can stimulate hair regrowth after two to three months. It is not recommended for those under the age of 16 and is not available on the NHS, but can be prescribed privately or bought over the counter. It can take up to a year for a maximum response.
Immunotherapy appears to be the most effective treatment for extensive or total hair loss. A chemical solution called diphencyprone (DPCP) is applied to a small area of bald skin. This is repeated every week, using a stronger amount each time. Eventually, the DPCP causes an allergic reaction and the skin develops mild eczema (dermatitis). With many people, after about 12 weeks, hair then starts to regrow.
A possible side effect is a severe skin reaction, although 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, if treatment is stopped, the hair falls out again, therefore treatment needs to be maintained. Immunotherapy is only available in specialised centres.
Similar to immunotherapy, dithranol cream is applied regularly to the scalp and then washed off. It causes a skin reaction, followed by hair regrowth in some cases. It is not as effective as immunotherapy, it can cause itchiness and scaling of the skin, and it can stain the scalp and hair. For these reasons, dithranol is not widely used.
UV light treatment
Two to three sessions of light therapy are given every week in hospital, where the skin is exposed to UVA rays. It can take up to a year to produce maximum results. Responses vary and there is a high relapse rate. Side effects include nausea, pigment changes, and an increased risk of skin cancer, so it is often not a recommended treatment.
Eyebrows can be tattooed over a few hourly sessions. This is known as dermatography, and it generally produces good results.
The cheapest wigs are made from acrylic, and they cost anywhere between £60 and £200. An acrylic wig lasts for six to nine months and is easier to look after than a wig made of real hair (it does not need styling). However, it can be itchy and hot, and it needs to be replaced more often than a real-hair wig. You may be entitled to receive a free acrylic wig every six months on the NHS.
Some people prefer the look and feel of a real-hair wig, even though it is more expensive - it costs anywhere between £200 and £2,000. The wig lasts for three to four years, but is harder to maintain 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 have a skin condition made worse by acrylic. You may wish to buy your wig privately.
Aromatherapy, acupuncture and massage are often used for alopecia, but there is not enough evidence to support their use as an effective treatment.