Thus it is inferred that reduced microcirculation in the affected tissues of the scalp may induce alopecia. [Rossi et.al]
Treatment for Alopecia (Cortisones and Anti-inflammatory and Immumotherapy drugs)
As yet, there is no complete cure for alopecia and hence all treatment rests in efficient management of the disease. There are many different types of pharmacological medications asides surgical procedures such as scalp reduction, scalp grafting, etc. While some drugs are effective as antiandrogenic agents others work by altering biological response mechanisms. Estrogen, progesterone and finasteride (Propecia)-5 alpha-reductase inhibitor are some examples of antiandrogen drugs and these are particularly suited for treating women. In men though, their use is very limited because of the potential for feminization. Cortisone injections directly into the scalp are used extensively for their anti-inflammatory properties. In some cases there is immediate arrest of hair fall and growth may be visible in a few weeks.
Topical Minoxidil is a standard treatment for androgenic alopecia and for patchy forms of alopecia areata. Clinical results have shown that minoxidil has the effect of reducing the telogen phase and promoting the anagen growth phase of the hair follicles. Anthralin is another topical anti-inflammatory drug found to be effective in the treatment of Alopecia. If effective, new hair will be visible in 8 to 12 weeks after starting the treatment. Topical immunotherapy is a widely used method for treating alopecia areata. It is believed that inducing mild dermatitis (inflammation on the skin) facilitates hair growth by triggering antigenic competition and interfering with the activities of the cytokines that trigger inflammations. Diphencyprone (DPCP) or squaric acid dibutyl ester (SADBE) are the commonly used chemicals for inducing dermatitis. [Kyle Kennedy]
Pharmacological interventions are effective only in some patients and also the results are temporary and require continuous use of the treatment, which is undesirable in view of the side effects. Hair transplantation by grafting and scalp reduction are two widely used surgical treatments for alopecia. In the Punch graft method, alopecic scalp area are covered by obtaining plugs of scalp tissue containing epidermis, dermis, subcutaneous tissue and live hair follicles from suitable donor sites. The obtained autografts are then transplanted into the affected scalp regions carefully maintaining the same orientation of the follicles as they were at the donor sites. It would take atleast 12 weeks for hair growth. Scalp reduction is another surgical method used for reducing bald surface. Scalp reduction helps to minimize hair grafts by surgically removing parts of the bald scalp region and extending the hair-bearing scalp in its place. The procedure can be repeated if necessary after sufficient gap (few months) to allow for the tissues to loosen up. Typically this procedure is effective in treating mild to moderate baldness in the crown area. For frontal baldness transposition flaps are effective. The elasticity of the scalp is the main factor, which determines the suitability and the effectiveness of the procedure. These surgical procedures thought effective carry the risk of infections, scarring and blood clots. [Kyle Kennedy]
There is no complete cure for alopecia as yet and treatment is primarily aimed at slowing down and containing the severity of the symptoms. Currently research is focused on identifying the main cause for the abnormal immune response in patients manifesting alopecia. The possible involvement of multiple genes as well as environmental factors makes the etiology even more complex. While there is moderate response for pharmacological treatment it is not effective for everybody and cosmetic surgeries like scalp reduction and hair transplantation may be recommended as alternative solutions. Providing care and support for patients is vital in managing the severe psychosocial trauma that accompanies hair loss and progressive baldness, and in particular young people affected by the disease may need counseling. Somatic gene therapy might soon be a reality and a cure for all types of alopecia. Much is yet to be uncovered as to the exact cause of alopecia and it is hoped that the current advances in genomic science and immunology will hasten our understanding of the disease and in the near future we might find cure for this psychologically distressing disorder.
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