Medical treatments for hair-loss, such as minoxidil lotion, finasteride 1 mg oral, or cyproterone acetate oral, may impede the development of baldness. In recent years, however, it has also been found that platelet-rich plasma (PRP) can also be injected into the scalp to reverse hair miniaturisation. This article will explore three main points: how growth factors interfere with the hair cycle, a review of the literature pertaining to treatments for hair loss (particularly the use of PRP), and a proposal of guidelines for future treatment evaluations.
Interest in the reversal of baldness has been enhanced by a precise multifactorial classification of each individual to effectively reverse male and female androgenic alopecia (AGA) in selected patients1. Dihydrotestosterone (DHT) is the specific hormone responsible for male and female pattern baldness as a result of changes in its metabolism.
In normal hair loss, less than 100 hairs fall each day and are replaced by new, thick hair. In the evolution of male and female pattern baldness, the new hair is fine and thin (intermediate hair or miniaturised hair). Male and female baldness usually progresses in a definitive pattern. Medical treatments for hair loss, such as minoxidil lotion, finasteride 1 mg oral, or cyproterone acetate oral, may impede the development of baldness. In recent years, however, it has also been found that platelet-rich plasma (PRP) can also be injected into the scalp to reverse hair miniaturisation.
A phototrichogram using a digital camera enables an objective measurement of hair-growth parameters2, such as density, number of miniaturised and/or terminal hairs, and hair growth rate on a selected and tattooed area.
The most researched and publicised medical treatment available for male pattern baldness is 5% minoxidil lotion, and 2% minoxidil for female baldness. The first signs of improvement generally appear after 3 months of therapy. The side-effects of minoxidil are minimal, but include itching, eczema and hypertrichosis (the latter is more common in female patients).
For male baldness, finasteride taken orally and daily (1 mg) works by inhibiting the 5α-reductase from forming DHT. The decreased DHT levels allow some intermediate follicles to enlarge and regrow normal terminal hairs. Side-effects may include decreased libido.
Cyproterone acetate (in Europe) can effectively block the increased levels of male hormones that cause hair-loss in some women. Spironolactone (in the US) appears to be a competitive inhibitor of DHT-receptor binding.
New interest in preventing hair-loss and baldness has been stimulated by cellular therapy with traumatising and then infusing PRP into the scalp, which normalises hair-loss after the first treatment, and reverses hair miniaturisation of male and female baldness after a second treatment.