National Scarring Alopecia Awareness Month (Day 20, Myth 5): Does popular equate to best?

Popular Treatments are Always Popular … but not Always Best

Everyone loves a new treatment. But what’s new is not always better - but it’s certainly sometimes more exciting and interesting. It’s a common theme in all of hair loss to turn one’s focus to something new. Many people love to use the newest and latest treatments! 

Is PRP, microneedling, and exosome treatments the way I treat scarring alopecia as a first step? Well that answer is no. This is seldom a good first step.

Scarring alopecias are treated in a somewhat logical and algorithmic manner.  Just like cooking, grilling or baking, there’s a logical order we do things.   

Treatments that have proven themselves to be consistently helpful in well designed studies are often the ones to be considered first - especially if they have good safety, affordability, and ease of administration. We call these first line treatments. First line treatments have a nice mix of safety and effectiveness. It might not be the absolute most effective treatment but when you take into account effectiveness with safety and affordability and feasibility- a first line treatment is a clear winner. 

Can a new popular treatment become a first line treatment? Sure it can provided good studies with a reasonable number of patients show that it is helpful. Only then can it be considered ahead of a current first line treatment. A new treatment can certainly bump an existing first line treatment down from first line to second line - but it has to be better in some way.

One does not become an award winning chef with creation of one exquisite dinner. Not even 2 of 3 such dinners will get you to that position. However, a repeated pattern of consistently good culinary skills will earn you a top spot.

A new treatment that comes out also does not automatically get rewarded the position as a first line treatment. No matter how good it is one needs good studies repeated demonstration of a beneficial effect for treating scarring alopecia along with good safety. Only then does the new treatment move up the ladder from a second or third line option to become a first line option.

I have patients who want to consider a variety of new and exciting treatments for their scarring alopecia. The decision on where to go for treatment and what treatments to use is always left to the patient (to some degree at least). 

If a patient really wants to use a popular treatment, a popular supplement, etc instead of a well established first line treatment, I am okay with that provided they know it might not work and they might lose more hair in the meantime. The patient is CEO of their health. My job, however, is to make sure they are well informed.