Evaluating and treating hair loss (alopecia) is an important part of primary care, yet many physicians find it complex and confusing. Hair loss affects men and women of all ages and frequently has significant social and psychologic consequences. This article reviews the physiology of normal hair growth, common causes of hair loss, and treatments currently available for alopecia.

Triamcinolone acetonide (Kenalog), 0.1 mL diluted in sterile saline to 10 mg per mL, is injected intradermally at multiple sites within the area to a maximum dosage of 2 mL per visit.6 The main side effect, atrophy, can be minimized by not injecting too superficially and by limiting the volume per site and the frequency of injection (no more often than every four to six weeks).6 Because spontaneous resolution often occurs in patients with alopecia areata, assessing treatment response can be difficult. Intralesional steroids should be discontinued after six months if no improvement has been noted.
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In addition to diagnosing and treating any underlying disorder, treatments for alopecia areata include immunomodulating agents and biologic response modifiers (Table 5).6 Although topical and oral corticosteroids have been used, the treatment of choice in patients older than 10 years with patchy alopecia areata affecting less than 50 percent of the scalp is intralesional corticosteroid injections (Figure 8).6

I’m going to see an endocrinologist, a trichologist, a hematologist and a gastroenterologist and maybe this Dr. Redmond. I’m done with ‘hair loss experts’ pushing cosmetic surgery and trying the all around approach. My insurance is crap, but….Anyway, thanks all for your stories and knowing I’m not alone in hair loss and the fight against disinterested medical establishment. xxx
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