Introduction: Alopecia, encompassing non-scarring and scarring types, presents therapeutic challenges requiring individualized approaches based on pathophysiology and treatment responses. A comprehensive literature search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science (2015-2024) focused on randomized controlled trials, meta-analyses, and observational studies.
Areas covered: This review evaluates pharmacological strategies for androgenetic alopecia (AGA), alopecia areata (AA), and scarring alopecias, emphasizing efficacy and safety. Treatments for non-scarring alopecia include finasteride, minoxidil, JAK inhibitors, and antiandrogens like spironolactone. JAK inhibitors, such as baricitinib, show promise for AA but require monitoring due to immune suppression risks. Scarring alopecias, including lichen planopilaris and discoid lupus erythematosus, are managed with systemic agents like hydroxychloroquine and corticosteroids, alongside adjunctive topical and laser therapies.
Expert opinion: The future of alopecia treatment is poised for transformation, particularly for AA and AGA. Emerging targeted therapies, such as JAK inhibitors for AA, represent significant advancements. Additionally, innovations in regenerative medicine and delivery systems for AGA treatments, alongside nanotechnology and 3D bioprinting, promise enhanced efficacy and personalization. This shift toward mechanism-targeted and individualized therapy is expected to improve outcomes for various alopecia subtypes.
Keywords: 5-alpha-reductase inhibitors; Janus kinase inhibitors; alopecia areata; androgenetic alopecia; cicatricial alopecia; oral minoxidil; safety profile; scarring alopecia; steroid; topical minoxidil.
This review provides an overview of treatments for different types of hair loss, focusing on both non-scarring and scarring forms. Non-scarring hair loss conditions, such as androgenetic alopecia (common baldness), alopecia areata (patchy hair loss), and female pattern hair loss, are discussed along with various treatment options like finasteride, minoxidil, Janus Kinase inhibitors and antiandrogens (medications that block male hormones), including spironolactone, flutamide, and bicalutamide. The review highlights the need to customize treatments based on individual patient needs, considering possible side effects like sexual dysfunction and liver enzyme changes. On the other hand, scarring hair loss conditions, including lichen planopilaris, frontal fibrosing alopecia, discoid lupus erythematosus, folliculitis decalvans, and dissecting cellulitis, involve inflammation that damages hair follicles. Treatments for these conditions may include systemic medications like hydroxychloroquine and corticosteroids, as well as topical therapies and laser treatments that can help manage symptoms and promote hair regrowth. Overall, this review underscores the importance of personalized treatment strategies that consider the unique characteristics and responses of different types of hair loss to improve patient outcomes.