Alopecia: evaluation and treatment

    Katherine Gordon, Antonella Tosti
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    TLDR The document concludes that proper diagnosis and FDA-approved treatments for different types of hair loss exist, but treatments for severe cases often fail and future improvements may focus on hair follicle stem cells.
    The document from July 2011 reviews the evaluation and treatment of various forms of alopecia, highlighting the importance of clinical history, examination, and diagnostic tests such as the pull test, wash test, and trichoscopy, as well as scalp biopsies for definitive diagnosis. It discusses FDA-approved treatments for androgenetic alopecia, including topical minoxidil and oral finasteride for men, and topical minoxidil for women, with hair transplantation as a surgical option. For alopecia areata, treatments include corticosteroids and topical immunotherapy, though the prognosis for severe forms is poor and few therapies have been rigorously tested. Telogen effluvium treatment involves addressing the underlying cause and may include iron supplementation. Cicatricial alopecia treatments include corticosteroids, cyclosporine, hydroxychloroquine, and others, with a new focus on targeting peroxisome proliferator-activated receptor pathways. However, treatment failure is common and no agents definitively halt the progression of cicatricial alopecia. The document suggests that future advancements may come from targeting hair follicle stem cells and other pathways. No conflicts of interest were reported.
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