Hair loss affects self-esteem and feelings of well-being, but exciting treatments are on the horizon.
August is Hair Loss Awareness Month, and Matt Leavitt, DO, FAOCD, board-certified dermatologist and founder of Advanced Dermatology and Cosmetic Surgery, as well as an industry leader on hair loss and hair restoration, joined Dermatology Times® to talk about the importance of bringing awareness to the condition of hair loss.
He emphasized the growing opportunities available for learning more about hair loss and treatments, as well as discussing some of the widely available methods for treating hair loss.
Matt Leavitt, MD: I'm Dr. Matt Leavitt, a board-certified dermatologist for over 30 years. I'm going to age myself too much here. And I am the former CEO and founder of Advanced Dermatology and now the chairman of the board for Advanced Dermatology. I built the largest live workshop in hair loss and hair surgery in the world ... 60 countries attending for 22 years and past president of the Hair Foundation and one of the founders of the Board of Hair Restoration, etc.
Dermatology Times: Why is it important for clinicians to be aware of hair loss and its impact on patients?
Leavitt: So, hair loss of any sort can be devastating to a patient, and it can affect their self-esteem. It can affect their feeling of healthiness or not healthiness. For example, often when women lose hair, they feel that it's a sign not only of aging, but an illness. And so it can really be devastating from that perspective. Obviously, people who are afflicted with things like alopecia areata, really often remove themselves from social situations completely just because of embarrassment. And so, it not only affects that person, but it affects the people that they work with, their friends, their family. It has a pretty devastating impact. And the message I give to everybody is not to judge how it affects somebody. Often in a busy day as a dermatologist, and it's not a skin cancer, people may not give it the same amount of time or energy. But they have to understand that to the patient walking in and seeking help, or asking questions, they want answers, and they want objective information. They're coming to a dermatologist to kind of sort through everything that's on the internet, or that's in the media, that's not really filtered by academically qualified people.
Dermatology Times: What are you excited about in hair loss treatment?
Leavitt: I think there's some very inexpensive treatments that work on most patients. And for example, oral Minoxidil is very inexpensive. It's about $6 a month, and it works on most hair loss very effectively. Men usually take a 2.5 milligram tablet daily. Women often will take a lesser dosage 1.25 milligrams, but it's a once-a-day pill, not a lot of side effects. With women, the biggest side effect would be hair in unwanted areas. And that's why we go with a 1.25 versus a 2.5. Because it greatly lessens that. So that's a really good answer. Also, dutasteride, which is off label for hair loss, but of course, mechanism of action is incredibly well-understood. Dutasteride [blocks type 1 and type 2 5 alpha reductase]. And it should not be taken in women of childbearing age, who is not on 2 types of birth control. But for all other hair loss patients it's very effective. But that's effective for things like frontal fibrosing alopecia. It's very effective for androgenetic alopecia and men, they don't have the same constraints, again, a very effective medication that can be bought as a generic and very inexpensive.
The combination of those 2, they work well. So, and again, we can go down to all the different types of hair loss, but trying to top line this, what works and what has data in those of us who treat hair loss every day that we see patients understand well, those are the 2 to begin with.
There are a lot of treatments and exciting things that are on the horizon or are there right now. So, some of the things that are talked about are PRP (platelet-rich plasma therapy). We're studying that, fine tuning a little bit on who should be getting PRP and what type of algorithm we should be using in terms of how often they should be injected, etc. There's a lot of discussion about exosomes. Exosomes are nanoparticles. They can be formed from different types of stem cells. They don't contain DNA, but control things like microsomal RNA and messenger RNA. And so they can affect the pathways that can regenerate hair and probably much more effectively than PRP.
I would caution everybody that the FDA has taken a really strong approach in terms of people not overusing this and injecting it into the scalp and things like that, because protocols have not been worked out and the INDs have to happen where this ultimately goes through an FDA process. But it's something to think about and be excited about. It is being delivered in topical preparations, which of course, probably might not work quite as well. But also, on the other hand, probably from an FDA perspective that claims aren't being made that are saying "guaranteed hair growth" or whatever.
They're also probably not going to take maybe the same sort of hard look at least that it could injure somebody in some way. It took a while for PRP to get approved, probably going to take a while for exosomes to be approved. And, but right now be just cautious that, FDA has not given the green light to this yet, but something to be excited about. Other things that we continue to use, we continue to use a low-level laser therapy. And that can be effective, people can wear a cap or a helmet, or they can go under a hood, but usually 3 times a week for about 10 to 15 minutes. And if somebody is really compliant, that has benefit.
There's a lot of other things depending on the type of hair loss that are much more specific, but probably the number one thing that I would want all the dermatologists to understand is, first of all, I'm going to tick off these off. 1. I started with this, you have to have empathy, and you have to make time for a hair loss patient, and you need to attend courses, read, but you need to become knowledgeable enough that you can give, first and foremost, an accurate diagnosis. Very often people make the wrong diagnosis.
Secondly, once you have the right diagnosis, you have to have different treatment options available and in hair loss most often it's not one treatment alone, unless it's very, very specific. For psoriasis, we can treat psoriasis. But most of the time for like female pattern, male pattern, you're going to use more than 1 modality. And they're going to synergize really, really well. So, 1 is not as effective as 2 or 3. And the most expensive treatments are not necessarily the better treatments.
I started off with probably 2 of the least expensive, that have the most science and work the best. It's not all about what they're spending. And then finally, I would say from a procedural standpoint, if somebody really is a good candidate and motivated, hair transplantation, in the right hands with somebody who's doing it all the time, that's a phenomenal option. My hair is all transplanted. And the viewer can't see this, but as somebody, I've been doing transplants for over 35 years and teaching them and, a good hair transplant, A: should be very natural, B: should never do patient harm. You need to have not only a short-term view, but a very long-term view of the dynamic nature of hair loss. When you transplant a hairline in say, somebody in their 20s, you have to remember that at some point, somebody's going to be 60 and 70. So you can't put in the hairline, like a 20-year-old and expect them to look good maybe in a 60-year-old. So again, there's a lot that goes into the type of knowledge and experience where you're going to consistently have a very happy patient.
So, I think hair loss month is an exciting time for awareness. There just, there truly needs to be more awareness on this subject. It really matters to patients. And as somebody who has treated every aspect of dermatology and a lot of aspects of cosmetic surgery, if you take the time with a hair loss patient and you give them really detailed explanations, and you listen and give them options, these are going to be really some of your most gratified patients. Because you're really changing what they see when they look in the mirror every day.
Dermatology Times: What are your top tips for clinicians seeing patients about hair loss?
Leavitt: I would just say that, continue to expand their knowledge. It's beyond the scope of what we could cover in one article and you're right, we would have to get specific disease by disease. I've had a fellowship for hair loss and hair surgery where for the last 20 years I've been training 2 to 3 people a year who spend a year just on these areas. And I would say that some of the changes in terms of what we're learning and how we're treating these are really evolving very rapidly. For example, the JAK inhibitors, not only for alopecia areata. And of course, now we have our first 2 approved drugs, including 1 that we can use in young adolescents can be game changers, because we've never had anything that worked on this severity of people. But some of those drugs even though it's off label right now, they can be also used for things like frontal fibrosing alopecia, most people don't know that. Where they may have tried 5, 6, 7 different things, and had no success. So stay tuned. I mean, it is really, it's an exciting time. I don't remember over the last 25-30 years, where there's been so much energy and focus on things that could potentially help these patients along with very different types of hair loss. So again, I would encourage people to attend conferences with speakers who are at the forefront of knowledge in these areas.
Dermatology Times: What should clinicians do to get the most up-to-date information on hair loss?
Leavitt: At most the major meetings right now, the curriculums are starting to have more focused hair sessions. For instance, at the Fall Clinical, I’m doing a 30-minute video for Fall Clinical in Vegas. We're doing something at the Winter Clinical, of course, the AAD has a couple of really, really great focused hair symposiums. So, I think,it’s easier now to get some of this knowledge. And then there's also some workshops that are popping up that people could attend in person where they can get procedural training. So again, I'm just encouraging the folks that are interested.
Dermatology Times: Is there anything you would like to add?
Leavitt: One more thing that I would say is, I think there should be especially more of a focus on female hair loss, I think, people have generally just treated the females much like their male patients, and kind of just put them in broad care categories, instead of really understanding the intricacies of the different types of hair loss in women. And sometimes it's not just loss, but it's actually the characteristics of the hair where the hair is there but the volume is not. So, it's a hair that's finer, it's not reflecting light as well. So, to the woman walking in the office, they may often, the doctor may look and say, “I don’t really see a lot of loss.” That doesn't mean that they're not struggling tremendously about what's happening to their hair. And again, they really have to understand the cause of that, some medical problem like thyroid disease, or there's a ferritin level or some medication is one thing, but a lot of times this is just a different variant of female pattern where they're not losing hair as much as they're losing the hair shaft diameter and they're losing the mass of their hair. So, again, this is treatable. So, I'd like to see a little bit more focus around women that are losing their hair.
[Leavitt reiterated that the use of exosomes in treating hair loss is not FDA-approved.]
[Transcript has been edited for clarity.]