Hair and Nail Conditions: Alopecia Management

The goals of management in patients with nonscarring and scarring alopecias are stabilization of hair loss and improvement in hair density. Management often is a lengthy process that requires months to years. Patients may present with more than one cause of alopecia, so management may need to address more than one process. Goals for alopecia management are diagnosis-specific. Physicians should set patient expectations early about the potential for hair regrowth with treatment. Patients should be counseled about hair care practices, personal care products, vitamins, and use of hairstyling devices. Management options such as topical and oral drugs and intralesional injections should be considered based on the diagnosis and the level of evidence supporting their use. Hair transplantation may be an option for select patients. There are more evidence-based guidelines for initial management of nonscarring alopecias than for scarring alopecias. Because of the relative rarity of scarring alopecias, there is a lack of large data sets on which to base guidelines.