Challenging Cases of Hair Loss: Practical Tips When Nothing Seems to Help

What to do when a patient's hair loss refuses to improve? 

Every now and then there are some unusually challenging cases of hair loss that cause me to sit quietly at the end of the day and rethink the best means to treat me it. I'm talking about patients with alopecia unversalis who do not improve with any treatment, including the most potent of oral immunosuppressives. I'm talking about patients with scarring alopecia who continue to have symptoms and lose hair despite the most aggressive treatments. I'm talking about patients with early onset androgenetic alopecia who progress despite anti-androgens, minoxidil, laser and more. Is there anything we can do in these situations? Fortunately there usually is. Here are some practical tips.

Practical Tips

1. If the diagnosis is at all in question, a scalp biopsy should be done and possibly two. Blood tests should have been checked prior to the appointment but if not, basic screens are appropriate.

2. If a patient's diet is poor, one might look at ways to improve it. 

3. If stress and emotional issues are high, it might be worthwhile to address these. Stress is clearly relevant for some people.

4. Consideration needs to be given to whether a current treatment is actually causing the hair loss to worsen. Stopping treatment for a period may be useful in some situations.

5. A complete health check should be done by the patient's regular physician. Routine screening exams (mammograms, colonoscopies) should be up to date according to age appropriate screening.

6. One should always at least ask if patients are using their recommended treatment. Every now and then there are some incredible surprises.

7. If a different route of administration is possible this should be considered. Some oral drugs might be compounded topically. Some topicals may be available in oral form.
 

Conclusion

If a physician sees enough patients with hair loss, he or she will encounter cases of hair loss that don't seem to respond to anything. An organized approach in these situations is needed. Every so often some surprising improvements can finally occur!