Advances in Alopecia: From Diagnosis to Treatment

Abstract Alopecia is the loss or absence of hair in anticipated areas, presenting a diverse spectrum of manifestations, spanning from localised to diffuse and temporary to permanent, affecting individuals of all genders and age brackets. Despite the lack of critical physiological function in scalp hair, its loss has a notable impact on self-confidence, reflected in the substantial annual expenditure of around $US1.5 billion by 60 million individuals in the US on diverse hair regrowth treatments. This prevalent and distressing medical concern reaches most individuals globally by middle age. Recognising the considerable emotional and physical burden associated with alopecia, clinicians must perceive it not merely as a cosmetic issue. Often serving as an indicator of underlying systemic conditions such as autoimmune disease, anaemia, nutritional deficiencies, and chronic infections, alopecia necessitates comprehensive clinical assessment and appropriate treatment. This approach is essential to prevent patient dissatisfaction and facilitate identifying and managing potentially significant medical conditions. Alopecia includes various subtypes, among which the nonscarring type has a higher incidence than the scarring type. Currently, there are very few approved drugs: minoxidil, finasteride and a very few JAK inhibitors for the treatment of various kinds, but most of the drugs are used off-label. This review provides a comprehensive overview of the pharmacotherapy of different alopecia types.