What treatments should I add next?

What is the next step in my treatment plan?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in the treatment of hair loss and why the next step is always to return to asking questions and listen rather than give statements and talk.

Question

I’m using PRP and topical minoxidil for female pattern hair loss and getting somewhat good results …. but not what I expected. What treatment is next for me? I’m 44, female, and done having kids and want to be more aggressive with my treatment. Can you recommend a good treatment?

Answer

Thanks for the question.

The answer is that the next step is to review your history again and examine the scalp properly and review all your blood tests. That’s really the only way this question can be answered.

The first, second and third line treatments for female pattern hair loss are shown below. It’s easy enough for me to say “use oral minoxidil” or “use spironolactone” but that may or may not be the next best step.

For example, a patient who is getting dizzy on topical minoxidil or getting excessive hair on the face with topical minoxidil is not going to be very happy with adding oral minoxidil to the plan. A patient who has low libido, depression and chronic fatigue issues should probably not go on oral spironolactone as the next step.

One really needs a full history and full examination.

Everyday I see consults “what’s next for my patient?” and every so often it’s discovered during the course of the appointment that the patient actually has a completely different condition like lichen planopilaris or frontal fibrosing alopecia or some other issue.

Nothing replaces a good history and good examination when deciding on next steps in treatment.

The next step in most clinical situations is to return to asking questions and listen rather than give statements and talk.