Management of Androgenetic Alopecia and Other Causes of Hair Loss

Diagnosis and Classification

The pattern of hair loss should be determined to guide diagnosis and treatment, according to Praxis Medical Insights 1
Androgenetic alopecia presents with characteristic patterns, including preferential affection of temples, vertex, and mid-frontal scalp in men, and central region thinning with preserved frontal hairline in women, as described in Periodontology 2000 2
The Hamilton-Norwood classification for males and Ludwig system for females should be used to describe patterns, as recommended by Periodontology 2000 2
Dermoscopy can be used to identify diagnostic features of different types of alopecia, according to Praxis Medical Insights 1

Platelet-Rich Plasma (PRP) is a non-pharmacological option with some clinical trials showing improvement in hair count, as noted in Periodontology 2000 2

Intralesional corticosteroid injections (triamcinolone acetonide 5-10 mg/mL) can be used to stimulate hair regrowth at the site, with effects lasting about 9 months, as reported in the British Journal of Dermatology 3 and Praxis Medical Insights 1
Contact immunotherapy can be used for extensive patchy hair loss, though availability is limited, as described in the British Journal of Dermatology 4 and Praxis Medical Insights 1
Potent topical corticosteroids can be used, though evidence for effectiveness is limited, as noted in the British Journal of Dermatology 4 and Praxis Medical Insights 1
Observation without active treatment is appropriate for many cases, especially with limited patchy hair loss, as reported in the British Journal of Dermatology 5
Spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of short duration, as described in the British Journal of Dermatology 5

Avoid aggressive treatments in young children, including contact immunotherapy and systemic corticosteroids, as recommended by Praxis Medical Insights 6
Mild potent topical corticosteroids or minoxidil solution may be considered for extensive cases in children, according to Praxis Medical Insights 6
Regular monitoring every 3-6 months is necessary to assess disease progression and psychological impact in children, as suggested by Praxis Medical Insights 6

Hazardous treatments with unproven efficacy should be avoided, as warned by Praxis Medical Insights 1
Continuous or pulsed systemic corticosteroids and PUVA therapy should be used with caution due to potential serious side effects, as noted by Praxis Medical Insights 1
Treatment response may be poor in longstanding extensive alopecia, as reported by Praxis Medical Insights 1
Intralesional corticosteroids may be poorly tolerated in children, as described by Praxis Medical Insights 1

The psychological impact of hair loss should be addressed, which can be significant, as reported by Praxis Medical Insights 1
Consider referral for psychological support for patients experiencing significant distress, as recommended by Praxis Medical Insights 1
Discuss cosmetic options such as wigs or hairpieces, particularly for extensive hair loss, as suggested by Praxis Medical Insights 1

Schedule follow-up at 3 months to assess treatment response, as recommended by Praxis Medical Insights 1
Provide written instructions for self-monitoring, as suggested by Praxis Medical Insights 1
Consider longer follow-up for patients with extensive, persistent, or atypical disease, as noted by Praxis Medical Insights 1