Evidence‑Based Management of Hair Loss in Adults

Androgenetic Alopecia (Male‑Pattern Hair Loss)

The American Academy of Dermatology recommends that the most likely cause of hair loss in a 29‑year‑old man is androgenetic alopecia, with topical or oral minoxidil as first‑line therapy and oral finasteride as an additional effective option. [1][2]
Minoxidil is the only treatment formally approved by the American Academy of Dermatology for androgenetic alopecia and is available in both topical and low‑dose oral formulations. [1][2]
Topical minoxidil 5 % should be applied once or twice daily; less than 5 % of the dose is systemically absorbed through the scalp. [2][7]
Topical minoxidil prolongs the anagen (growth) phase, promotes the telogen‑to‑anagen transition, and converts vellus hairs into terminal hairs, thereby increasing hair density. [2][8]
Oral low‑dose minoxidil (initial 1 mg daily, titratable to 2.5–5 mg) is preferred when the entire scalp is affected and shows efficacy comparable to topical minoxidil in controlled trials. [2][7]

The British Association of Dermatology states that alopecia areata is a chronic autoimmune inflammatory disease of the hair follicle that can appear at any age without sex predilection. [3][4]
Clinically it presents as well‑defined patches of hair loss with mildly erythematous but otherwise normal‑appearing skin. 4
Approximately 20 % of patients report a positive family history of the condition. [5][6]
Spontaneous remission within one year occurs in 34–50 % of cases seen in referral centers. 4
Oral and intralesional corticosteroids are standard for extensive or localized disease, respectively, and minoxidil has demonstrated additional benefit in promoting regrowth. [2][8]

The American Academy of Dermatology advises that the primary management of telogen effluvium is identification and removal of the precipitating factor (e.g., physiological stress, medication, nutritional deficiency); when treatment is required, minoxidil is the preferred pharmacologic option. 2

Systemic antifungal therapy is required for tinea capitis, a fungal scalp infection that can mimic other forms of alopecia. 5
Trichotillomania, an impulse‑control disorder characterized by compulsive hair pulling, should be considered in the differential diagnosis. 5
Traction alopecia results from excessive tension due to tight hairstyles and is managed by eliminating the mechanical stress. 2
The British Association of Dermatology emphasizes the importance of addressing the psychosocial impact of hair loss; moderate to severe hair loss is associated with increased anxiety, depression, and reduced quality of life, warranting psychological support. [5][9]
Unnecessary laboratory investigations are generally not indicated in typical cases of alopecia areata; targeted testing (e.g., fungal culture, skin biopsy, serology) should be reserved for atypical presentations. [5][9]
Differential diagnoses such as tinea capitis, lupus erythematosus, and secondary syphilis can mimic alopecia and must be excluded when clinical features are atypical. [5][6]
Dermoscopy aids diagnosis: yellow‑dot patterns are characteristic of alopecia areata, while other specific dermoscopic signs help identify alternative conditions. [4][5]