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Management of hair loss diseases
Manabu Ohyama
DERMATOLOGICA SINICA 28 (2010) 139–145

The treatment of hair loss diseases is sometimes difficult because of insufficient efficacy
and limited options. However, recent advances in understanding of the pathophysiology
and development of new remedies have improved the treatment of refractory hair
loss conditions. In this article, an update on the management of hair loss diseases is
provided, especially focusing on recently reported therapeutic approaches for alopecia
areata (AA). An accurate diagnosis is indispensable to optimize treatment. Dry dermoscopy
represents new diagnostic techniques, which could enable the differentiation of
barely indistinguishable alopecias, e.g. AA and trichotillomania. An organized scalp
biopsy adopting both vertical and transverse sectioning approaches also provides a
deep insight into the pathophysiology of ongoing alopecias. Among various treatments
for AA, intraregional corticosteroid and contact immunotherapy have been recognized
as first-line therapies. However, some AA cases are refractory to both treatments. Recent
studies have demonstrated the efficacy of pulse corticosteroid therapy or the combination
of oral psoralen ultraviolet A therapy and systemic corticosteroids for severe AA.
Previous clinical observations have suggested the potential role of antihistamines as
supportive medications for AA. Experimental evaluation using AA model mice further
supports their effectiveness in AA treatment. Finasteride opens up new possibilities for
the treatment of androgenetic alopecia. For androgenetic alopecia patients refractory to
finasteride, the combination of finasteride with topical minoxidil or the administration
of dutasteride, another 5 alpha-reductase inhibitor, may provide better outcomes.
Scarring alopecia is the most difficult form of hair loss disorder to treat. The bulge stem
cell area is destroyed by unnecessary immune reactions with resultant permanent loss
of hair follicle structures in scarring alopecia. Currently, treatment options for this hair
loss disorder are extremely limited. The development of effective therapies for this form
of intractable alopecia represents an important issue to be resolved.

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