Among nonsurgical treatments for hair loss, nutraceuticals, platelet-rich plasma (PRP) and camouflage techniques work reliably for a variety of patients, said experts at The Cosmetic Bootcamp. Other hot trends range from low-level laser therapy (LLLT) to peroxide-free hair products.
With a wide range of high-quality botanical and micronutrient ingredients, Nutrafol (Nutraceutical Wellness Inc.) and Viviscal (Lifes2Good) exemplify the multidimensional approach necessary to succeed against the multifaceted pathology of hair loss, said Wendy E. Roberts, M.D. She is a Rancho Mirage, California-based dermatologist at Generational and Cosmetic Dermatology.
Nutrafol's saw palmetto slows production of 5-alpha reductase and prevents it from converting testosterone to DHT, said Jeanine B. Downie, M.D. "This inhibits 5-alpha reductase type 2 and promotes a stable hormonal balance via several anti-androgenetic and hormone rebalancing activities." The results can be life-changing for patients, said Dr. Downie, who is director of image Dermatology PC in Montclair, New Jersey.
"Nutrafol is very standardized. I explain to patients that the turmeric they're getting from CVS is not the same," she added. Impeccable ingredient quality and a standardized extraction technique make Nutrafol's turmeric 700% more bioavailable than traditional curcumin extracts, said Dr. Downie. Accordingly, Nutrafol significantly lowers the bioinflammatory markers (such as C-reactive protein and the erythrocyte sedimentation rate/ESR) that set the stage for hair loss, according to a November 2017 publication by Farris et al. in the Journal of Drugs in Dermatology.
"Many people come in, and the only thing they'll tell you is, 'I'm a little itchy.' Maybe it's the heat from the blowdryer or curling iron; maybe it's the overprocessing by perming the hair. But something is creating that microenvironment of microinflammation on your scalp," said Dr. Downie.
Nutrafol's standardized ashwaghandha addresses stress hormones, free radicals, thyroid function and estrogen levels. This ingredient decreases the typical chronically stressed adult's cortisol levels by an average of 35%, added Dr. Downie. "My patients comment after they've been on Nutrafol for six or eight months that they actually feel better."
Nutrafol's vitamin E component (tocotrienols and tocopherols) is 200% more bioavailable than over-the-counter vitamin E, said Dr. Downie. "It significantly increases hair counts, by 34% on average, by lowering the lipid peroxidation." Kelp battles oxidative stress and helps regulate thyroid and estrogen levels, according to Farris et al.
Viviscal's Amino-Mar complex is a proprietary blend of proteins, lipids and glycosaminoglycans derived from stable marine sources. The development of Amino-Mar stemmed from observations that the Scandinavian Inuit diet (which is high in protein from caribou and Arctic char) contributes to thick, black hair. In a pilot trial, subjects who took Viviscal for 10 weeks experienced an average 46% reduction in hair shedding.
Viviscal has even more studies behind it than does Nutrafol, said Dr. Downie, including a 2013 study involving 72 subjects who achieved an average of 7.4% increased vellus hair shaft thickness (versus placebo) with six months' use. In a 42-subject study, patients saw mean three-month and six-month hair-count increases of 57% and 80%, respectively.
Both Viviscal and Nutrafol work very well, said Dr. Downie. In fact, she puts many patients on both. "It depends on your own clinical judgment." Other nutraceutical leaders in hair loss include Mirage Anti-Hair Loss Shampoo (made by Mirage) and Vitalize (Vitalize Hair), added Dr. Roberts.
Like nutraceuticals, Dr. Roberts said, PRP works in all types of hair loss. "We're going to see with time, and we're seeing now, that PRP helps nearly everything and does very little harm."
Packing at least twice the platelet concentration of whole blood, PRP works via epidermal, fibroblast, vascular endothelial and transforming growth factors. A study published in Dermatologic Surgery in September 2018 reveals efficacy and an 82% satisfaction rate in androgenetic alopecia.
Dr. Roberts chose the Eclipse PRP HC kit (Eclipse Aesthetics) because it offers the largest yield available — approximately 11 mL. She typically performs four sessions at one-month intervals. Treatment can be performed with a syringe or microneedling pen and requires no anesthesia. PRP also complements hair transplantation, she said. She cautioned against using homemade Tiger Top (Becton, Dickinson and Company) tubes for PRP because these devices are not FDA-cleared for this purpose and can introduce harmful pathogens.
Dr. Downie said she remains cautious regarding PRP. "My colleagues who use PRP say it works with 20% of their patients."
Camouflage, hairpieces and fibers
In previous decades, development and marketing of hair-loss interventions focused almost exclusively on men. "But now women are starting to ask us increasingly about growing hair, hair extensions, devices and clip-ons. My tip is, fake it until you make it," Dr. Roberts said.
Approximately one in four women and one in two men worldwide suffer from hair loss. And research has shown that 89% of patients with hair loss feel depressed, she said. "Depression leads to other serious problems. And we're not going to grow hair overnight, no matter what the supplement or how strong the PRP." Therefore, Dr. Roberts said that physicians who offer hair restoration should also be knowledgeable about camouflage techniques such as hairpieces and fibers.
Keratin fibers are easy to work with because they intertwine magnetically with existing hair. "They can cover bald areas, but they also make thinner hair look thicker and give additional body." Conversely, she said, wig headbands create friction that can break hair and create traction alopecia and thinning at the hairline. Micro-pigmentation — tattooing tiny ink droplets to cover the scalp — is an up-and-coming urban camouflage technique, added Dr. Roberts.
Other noteworthy hair-treatment trends include the following:
- LLLT — "By itself," said Dr. Roberts, "it's not going to produce much hair growth. But it's great with our other treatments. I use it in my office, and encourage patients to use it at home, typically two 20-minute sessions per week."
- Systemic medications — Medicines that can improve hair loss include 5-alpha reductase inhibitors, thyroid replacement medications, antibiotics and antifungals. Among topical medications, the leaders are minoxidil and Redensyl (Induchem). Redensyl is believed to keep hairs in the anagen phase, thereby reducing shedding. Its active ingredients include the polyphenols green-tea derived epigallocatechin-gallate glucoside (EGCG2, which reduces inflammation) and dihydroquercetin-glucoside (DHQG), which is thought to activate hair bulge stem cells. "Very importantly, especially for aging hair," said Dr. Roberts, "it also protects against apoptosis, which occurs in the follicle just as it does in the epidermis."
- Anti-inflammatory and antibiotic medications — For central centrifugal cicatricial alopecia (CCCA), timely treatment with anti-inflammatory agents such as doxycycline can work wonders, said Dr. Roberts. When injecting steroids, she prefers intramuscular injections to avoid disrupting the landscape of the scalp. Other injectable agents include Kenalog-40 (triamcinolone acetonide, Bristol-Myers Squibb) and vitamin B12.
- Peroxide-free hair dyes — Peroxide in hair dyes weakens hair shafts, resulting in breakage and temporary alopecia. Dr. Downie added, "People should get their hair dyed by a professional. Dyeing your hair yourself can lead to significant hair breakage and hair loss."