Dermatologist explains over-the-counter hair loss treatments

Kimberly S. Salkey, M.D., shares answers to some of the most common questions she encounters from patients about OTC hair loss treatments.

People get desperate when they notice they’re losing their hair, and often turn to multiple over-the-counter remedies before visiting a dermatologist.

But dermatologists can potentially save patients’ money and limit permanent hair loss by educating patients about common over-the-counter options, says Kimberly S. Salkey, M.D., associate professor of dermatology and director of the dermatology residency program at Virginia Commonwealth University.

Dr. Salkey, who moderated the Alopecia and Hair Loss session, July 25 at the American Academy of Dermatology’s (AAD’s) 2019 Summer Meeting in New York City and presented “Common questions from patients with alopecia,” says she addresses patients concerns simply and scientifically.

Here are her answers to some of the most common questions she encounters on OTC hair loss treatments:

1. Can biotin supplementation help? Probably not. Here’s why:

Patients often ask about biotin supplementation for hair loss. Dr. Salkey explains that studies have shown that people who are profoundly deficient in biotin do have problems with hair production, but they also have a lot of other neurologic health problems.

“The likelihood that an otherwise healthy individual has a biotin deficiency that’s causing hair loss is slim,” she says. “Yet many patients take high doses of biotin supplements in an effort to try to help with their hair loss. There’s no evidence that taking high doses of it is going to have any impact on their hair growth whatsoever.”

2. If I start and stop minoxidil, I fear all my hair will fall out!

Dr. Salkey says patients regularly come in with this concern: They’ve heard that if they use minoxidil (Rogaine, Johnson and Johnson) and stop, all their hair will fall out.

“I tell them that’s not true and explain that they if they start and stop using Rogaine they will lose the hair they gain and maintain as a result of using it. But Rogaine doesn’t make all their hair come out,” she says.

Still other patients have heard that once you start using Rogaine, you have to use it forever.

“There may be a little more truth to that. If you get a good benefit from it, you do have to continue using it in order to maintain that benefit,” Dr. Salkey says.

Some also don’t realize other products that make hair loss treatment claims also tend to contain minoxidil. The very same patients that don’t want to use Rogaine because of hair loss fears ask Dr. Salkey about other products that claim to be scientifically proven hair loss treatments. Dr. Salkey says she points out the common active ingredient.

3. Is my medication causing hair loss?

Patients often hear from well-meaning friends or other sources that their medications might be causing their hair loss. This can be tricky and somewhat dangerous, according to Dr. Salkey.

“There are some medications that are associated with hair loss. But it can be a terrible situation, let’s say, when a patient stops taking their blood pressure medication because their friend told them that it could be the cause of their hair loss. Their blood pressure goes sky high and they still have hair loss,” she says .

She explains to patients that they should always see their doctor before stopping a prescribed medication and that medication might not be the culprit.

4. How about stress?

Patients sometimes come in with a long history of gradual, progressive hair loss, but they didn’t seek medical attention because they thought it was just due to stress. In the case of scarring alopecia, time lost equals permanent hair loss. 

It’s always good to relax, but that doesn’t mean their hair will regrow, Dr. Salkey explains. She also educates patients that they need to come in at the first signs of hair loss when it’s more likely to be treatable, rather than later when it’s not.

The take-home message for dermatologists is they need to better educate patients about the need to see a dermatologist about hair loss concerns, instead of trying to self-treat.

“People have wrong ideas about what they think is causing their hair loss, like stress or medications, and then they’re not getting the care they need in a timely manner when the care could have a big impact,” Dr. Salkey says.