Complementary and Alternative Treatments for Alopecia: A Comprehensive Review

The treatment of alopecia is limited by a lack of therapies that induce and sustain disease remission. Given the negative psychosocial impact of hair loss, patients that do not see significant hair restoration with conventional therapies often turn to complementary and alternative medicine (CAM). Although there are a variety of CAM treatment options on the market for alopecia, only a few are backed by multiple randomized controlled trials. Further, these modalities are not regulated by the Food and Drug Administration and there is a lack of standardization of bioactive in gredients in over-the-counter vitamins, herbs, and supplements. In this article, we provide a comprehensive review of the efficacy, safety, and tolerability of CAM, including natural products and mind and body practices, in the treatment of hair loss. Overall, there is a need for additional studies investigating CAM for alopecia with more robust clinical design and standardized, quantitative outcomes.

[1]  L. Celleno,et al.  Efficacy of a cosmetic phyto-caffeine shampoo in female androgenetic alopecia. , 2018, Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia.

[2]  T. D'arrigo FDA warns that biotin may interfere with lab tests , 2018 .

[3]  E. Novellino,et al.  Annurca Apple Nutraceutical Formulation Enhances Keratin Expression in a Human Model of Skin and Promotes Hair Growth and Tropism in a Randomized Clinical Trial , 2017, Journal of medicinal food.

[4]  Tsung-Yu Tsai,et al.  Vitamin D deficiency in patients with alopecia areata: A systematic review and meta‐analysis , 2018, Journal of the American Academy of Dermatology.

[5]  K. Ingkaninan,et al.  Germacrone and sesquiterpene-enriched extracts from Curcuma aeruginosa Roxb. increase skin penetration of minoxidil, a hair growth promoter , 2018, Drug Delivery and Translational Research.

[6]  R. Dhurat,et al.  An Open-Label Randomized Multicenter Study Assessing the Noninferiority of a Caffeine-Based Topical Liquid 0.2% versus Minoxidil 5% Solution in Male Androgenetic Alopecia , 2017, Skin Pharmacology and Physiology.

[7]  J. Hodges,et al.  Association of Biotin Ingestion With Performance of Hormone and Nonhormone Assays in Healthy Adults , 2017, JAMA.

[8]  A. Nast,et al.  Efficacy of topical caffeine in male androgenetic alopecia , 2017, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[9]  J. Shapiro,et al.  The Infatuation With Biotin Supplementation: Is There Truth Behind Its Rising Popularity? A Comparative Analysis of Clinical Efficacy versus Social Popularity. , 2017, Journal of drugs in dermatology : JDD.

[10]  T. Narang,et al.  Efficacy and safety of topical calcipotriol in management of alopecia areata: A pilot study , 2017, Dermatologic therapy.

[11]  L. Castelo-Soccio,et al.  A Review of the Use of Biotin for Hair Loss , 2017, Skin Appendage Disorders.

[12]  F. Mokhtari,et al.  Comparing the Effects of Zinc Sulfate, Calcium Pantothenate, Their Combination and Minoxidil Solution Regimens on Controlling Hair Loss in Women: A Randomized Controlled Trial , 2017, Journal of research in pharmacy practice.

[13]  H. Lynch,et al.  Curcumin: An age-old anti-inflammatory and anti-neoplastic agent , 2016, Journal of traditional and complementary medicine.

[14]  D. Murphy Counselling Psychology A Textbook for Study and Practice , 2017 .

[15]  D. Camfield Nutritional-Based Nutraceuticals in the Treatment of Anxiety , 2017 .

[16]  G. Ablon A 6‐month, randomized, double‐blind, placebo‐controlled study evaluating the ability of a marine complex supplement to promote hair growth in men with thinning hair , 2016, Journal of cosmetic dermatology.

[17]  F. Distelmaier,et al.  Biotin Treatment Mimicking Graves' Disease. , 2016, The New England journal of medicine.

[18]  V. Wessagowit,et al.  Treatment of male androgenetic alopecia with topical products containing Serenoa repens extract , 2016, The Australasian journal of dermatology.

[19]  Mark S. George,et al.  The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder , 2016, Brain Stimulation.

[20]  R. Trüeb Serum Biotin Levels in Women Complaining of Hair Loss , 2016, International journal of trichology.

[21]  G. Ablon,et al.  A Randomized, Double-blind, Placebo-controlled, Multi-center, Extension Trial Evaluating the Efficacy of a New Oral Supplement in Women with Self-perceived Thinning Hair. , 2015, The Journal of clinical and aesthetic dermatology.

[22]  W. Bergfeld,et al.  Prevalence of Comorbid Conditions and Sun-Induced Skin Cancers in Patients with Alopecia Areata. , 2015, The journal of investigative dermatology. Symposium proceedings.

[23]  F. Ramos,et al.  A novel insight on an ancient aromatic plant: The rosemary (Rosmarinus officinalis L.) , 2015 .

[24]  James R Murphy,et al.  A Marine Protein-based Dietary Supplement for Subclinical Hair Thinning/Loss: Results of a Multisite, Double-blind, Placebo-controlled Clinical Trial , 2015, International journal of trichology.

[25]  Myeong Soo Lee,et al.  Acupuncture for treating alopecia areata: a protocol of systematic review of randomised clinical trials , 2015, BMJ Open.

[26]  Mark B. Holland,et al.  The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. , 2015, Journal of Drugs in Dermatology.

[27]  I. Altunay,et al.  Topical Calcipotriol Therapy for Mild-to-Moderate Alopecia Areata: A Retrospective Study. , 2015, Journal of drugs in dermatology : JDD.

[28]  L. Carrera-Quintanar,et al.  Immunomodulation and Anti-Inflammatory Effects of Garlic Compounds , 2015, Journal of immunology research.

[29]  G. Ablon A 3-Month, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Ability of an Extra-Strength Marine Protein Supplement to Promote Hair Growth and Decrease Shedding in Women with Self-Perceived Thinning Hair , 2015, Dermatology research and practice.

[30]  M. Gershwin,et al.  The autoimmune basis of alopecia areata: a comprehensive review. , 2015, Autoimmunity reviews.

[31]  M. Taghizadeh,et al.  Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial. , 2015, Skinmed.

[32]  H. Levy,et al.  Homocystinuria Caused by Cystathionine Beta-Synthase Deficiency , 2014 .

[33]  D. Zillikens,et al.  Differential effects of caffeine on hair shaft elongation, matrix and outer root sheath keratinocyte proliferation, and transforming growth factor‐β2/insulin‐like growth factor‐1‐mediated regulation of the hair cycle in male and female human hair follicles in vitro , 2014, The British journal of dermatology.

[34]  H. Yoon A Case Study of Androgenetic Alopecia in woman Improved by Pharmacopuncture Therapy and Needle-embedding Therapy , 2014 .

[35]  Y. Cho,et al.  Effect of Pumpkin Seed Oil on Hair Growth in Men with Androgenetic Alopecia: A Randomized, Double-Blind, Placebo-Controlled Trial , 2014, Evidence-based complementary and alternative medicine : eCAM.

[36]  S. Calvieri,et al.  Treatment of alopecia , 2014, Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia.

[37]  K. Sharquie,et al.  Oral Zinc Sulphate in Treatment of Alopecia Areata (Double Blind; Cross- Over Study) , 2014 .

[38]  F. Azizi,et al.  Comparing the Effectiveness of Local Solution of Minoxidil and Caffeine 2.5% with Local Solution of Minoxidil 2.5% in Treatment of Androgenetic Alopecia , 2013 .

[39]  C. Kim,et al.  Analysis of Serum Zinc and Copper Concentrations in Hair Loss , 2013, Annals of dermatology.

[40]  M. Taniguchi,et al.  Anti-Inflammatory Effect of Electroacupuncture in the C3H/Hej Mouse Model of Alopecia Areata , 2013, Acupuncture in Medicine.

[41]  P. Enticott,et al.  Deep Transcranial Magnetic Stimulation as a Treatment for Psychiatric Disorders: A Comprehensive Review , 2013, European Psychiatry.

[42]  Ablon Glynis A Double-blind, Placebo-controlled Study Evaluating the Efficacy of an Oral Supplement in Women with Self-perceived Thinning Hair. , 2012, The Journal of clinical and aesthetic dermatology.

[43]  C. Maxia,et al.  Comparitive Effectiveness and Finasteride Vs Serenoa Repens in Male Androgenetic Alopecia: A Two-Year Study , 2012 .

[44]  P. Elsner,et al.  Topical Melatonin for Treatment of Androgenetic Alopecia , 2012, International journal of trichology.

[45]  K. Ingkaninan,et al.  Curcuma aeruginosa, a novel botanically derived 5α-reductase inhibitor in the treatment of male-pattern baldness: a multicenter, randomized, double-blind, placebo-controlled study , 2012, The Journal of dermatological treatment.

[46]  Hyeong Mi Kim,et al.  Successful Treatment of Alopecia Areata with Topical Calcipotriol , 2012, Annals of dermatology.

[47]  J. D. Rosso,et al.  Use of complementary and alternative medicine among adults with skin disease: Updated results from a national survey , 2012 .

[48]  E. Dietz,et al.  A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. , 2011, Journal of the American Academy of Dermatology.

[49]  P. Hu,et al.  Zinc Pyrithione Inhibits Yeast Growth through Copper Influx and Inactivation of Iron-Sulfur Proteins , 2011, Antimicrobial Agents and Chemotherapy.

[50]  Qiyu Zhu,et al.  Clinical observation on acupuncture treatment of alopecia areata , 2011 .

[51]  J. Manson,et al.  Does vitamin D affect risk of developing autoimmune disease?: a systematic review. , 2011, Seminars in arthritis and rheumatism.

[52]  Y. K. Hay,et al.  Effects of tocotrienol supplementation on hair growth in human volunteers. , 2010, Tropical life sciences research.

[53]  Gordon Guyatt,et al.  Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. , 2010, Archives of dermatology.

[54]  P. Haentjens,et al.  Hypnosis in refractory alopecia areata significantly improves depression, anxiety, and life quality but not hair regrowth. , 2010, Journal of American Academy of Dermatology.

[55]  L. Celleno,et al.  Use of a Caffeine Shampoo for the Treatment of Male Androgenetic Alopecia , 2010 .

[56]  A. Ehsani,et al.  Capsaicin vs. clobetasol for the treatment of localized alopecia areata , 2009, Journal of the European Academy of Dermatology and Venereology : JEADV.

[57]  H Decker,et al.  Senile hair graying: H2O2‐mediated oxidative stress affects human hair color by blunting methionine sulfoxide repair , 2009, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[58]  G. Millington,et al.  Acupuncture in dermatology: an historical perspective , 2009, International journal of dermatology.

[59]  C. Park,et al.  The therapeutic effect and the changed serum zinc level after zinc supplementation in alopecia areata patients who had a low serum zinc level. , 2009, Annals of dermatology.

[60]  R. Saper,et al.  Zinc: an essential micronutrient. , 2009, American family physician.

[61]  J. Mao,et al.  Use of complementary and alternative medicine among adults with skin disease: results from a national survey. , 2009, Journal of the American Academy of Dermatology.

[62]  J. Zempleni,et al.  Biotin and biotinidase deficiency , 2008, Expert review of endocrinology & metabolism.

[63]  Nicole E Rogers,et al.  Medical treatments for male and female pattern hair loss. , 2008, Journal of the American Academy of Dermatology.

[64]  H. Kurihara,et al.  Effect of topical application of raspberry ketone on dermal production of insulin-like growth factor-I in mice and on hair growth and skin elasticity in humans. , 2008, Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society.

[65]  K. Kraemer,et al.  Trichothiodystrophy: a systematic review of 112 published cases characterises a wide spectrum of clinical manifestations , 2008, Journal of Medical Genetics.

[66]  J. Leonardi-Bee,et al.  Interventions for alopecia areata. , 2008, The Cochrane database of systematic reviews.

[67]  D. Tobin,et al.  Melatonin and the hair follicle , 2007, Journal of pineal research.

[68]  H. Kurihara,et al.  Administration of capsaicin and isoflavone promotes hair growth by increasing insulin-like growth factor-I production in mice and in humans with alopecia. , 2007, Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society.

[69]  E. Alhaj,et al.  Diffuse alopecia in a child due to dietary zinc deficiency. , 2007, Skinmed.

[70]  R. Itamura Effect of homeopathic treatment of 60 Japanese patients with chronic skin disease. , 2007, Complementary Therapies in Medicine.

[71]  P. Elsner,et al.  Effect of caffeine and testosterone on the proliferation of human hair follicles in vitro , 2007, International journal of dermatology.

[72]  B. Seifert,et al.  Dietary supplement increases anagen hair rate in women with telogen effluvium: results of a double-blind, placebo-controlled trial , 2007 .

[73]  J. Akbari,et al.  Combination of topical garlic gel and betamethasone valerate cream in the treatment of localized alopecia areata: a double-blind randomized controlled study. , 2007, Indian journal of dermatology, venereology and leprology.

[74]  M. Morohashi,et al.  Procyanidin Oligomers Counteract TGF-β1- and TGF-β2-Induced Apoptosis in Hair Epithelial Cells: An Insight into Their Mechanisms , 2006, Skin Pharmacology and Physiology.

[75]  R. Willemsen,et al.  Hypnotherapeutic management of alopecia areata. , 2006, Journal of the American Academy of Dermatology.

[76]  V. Randall,et al.  Inhibitory autocrine factors produced by the mesenchyme‐derived hair follicle dermal papilla may be a key to male pattern baldness , 2006, The British journal of dermatology.

[77]  R. Sinclair,et al.  Prevalence of male and female pattern hair loss in Maryborough. , 2005, The journal of investigative dermatology. Symposium proceedings.

[78]  M. Morohashi,et al.  Investigation of the topical application of procyanidin oligomers from apples to identify their potential use as a hair‐growing agent , 2005, Journal of cosmetic dermatology.

[79]  Xie Shaoqiong Three typical dermatological cases treated by Dr. Li Yueping. , 2005, Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan.

[80]  M. Ino,et al.  Effects of arginine on hair damage via oxidative coloring process. , 2005, Journal of the Society of Cosmetic Chemists.

[81]  J. Rundegren,et al.  Minoxidil: mechanisms of action on hair growth , 2004, The British journal of dermatology.

[82]  Maria Hordinsky,et al.  Autoimmunity: alopecia areata. , 2004, The journal of investigative dermatology. Symposium proceedings.

[83]  T. F I S C H,et al.  Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia : results of a pilot randomized controlled trial , 2004 .

[84]  S. Agrawala,et al.  Saw palmetto (Serenoa repens) in androgenic alopecia An effective phytotherapy , 2003 .

[85]  K. Lammers,et al.  The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial , 2003, The British journal of dermatology.

[86]  J. Guilbaud,et al.  Essential oils and low-intensity electromagnetic pulses in the treatment of androgen-dependent alopecia , 2003, Advances in therapy.

[87]  Ayako Kamimura,et al.  Procyanidin B‐3, isolated from barley and identified as a hair‐growth stimulant, has the potential to counteract inhibitory regulation by TGF‐β1 , 2002, Experimental dermatology.

[88]  S. Harrap,et al.  Androgenetic alopecia: pathogenesis and potential for therapy , 2002, Expert Reviews in Molecular Medicine.

[89]  N. Groves Capsaicin Bats .500 , 2002 .

[90]  D. Madey,et al.  Evidence supporting zinc as an important antioxidant for skin , 2002, International journal of dermatology.

[91]  K. Sharquie,et al.  Onion Juice (Allium cepa L.), A New Topical Treatment for Alopecia Areata , 2002, The Journal of dermatology.

[92]  N. Prager,et al.  A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. , 2002, Journal of alternative and complementary medicine.

[93]  R. Dover,et al.  Causes of hair loss and the developments in hair rejuvenation , 2002, International journal of cosmetic science.

[94]  S. Kato,et al.  Lack of the vitamin D receptor is associated with reduced epidermal differentiation and hair follicle growth. , 2002, The Journal of investigative dermatology.

[95]  G. Karikas,et al.  Low Serum Biotinidase Activity in Children with Valproic Acid Monotherapy , 2001, Epilepsia.

[96]  A. Kamimura,et al.  The first clinical trial of topical application of procyanidin B‐2 to investigate its potential as a hair growing agent , 2001, Phytotherapy research : PTR.

[97]  E. Thom Efficacy and Tolerability of Hairgain® in Individuals with Hair Loss: A Placebo-Controlled, Double-Blind Study , 2001, The Journal of international medical research.

[98]  A. Kamimura,et al.  Investigation of topical application of procyanidin B-2 from apple to identify its potential use as a hair growing agent. , 2000, Phytomedicine : international journal of phytotherapy and phytopharmacology.

[99]  G. Karikas,et al.  The Effect of Isotretinoin on Biotinidase Activity , 1999, Skin Pharmacology and Physiology.

[100]  A. Hasegawa,et al.  Procyanidin oligomers selectively and intensively promote proliferation of mouse hair epithelial cells in vitro and activate hair follicle growth in vivo. , 1999, The Journal of investigative dermatology.

[101]  A. Ormerod,et al.  Randomized trial of aromatherapy. Successful treatment for alopecia areata. , 1998, Archives of dermatology.

[102]  P. Morganti,et al.  EFFECT OF GELATIN-CYSTINE AND SERENOA REPENS EXTRACT ON FREE RADICALS LEVEL AND HAIR GROWTH , 1998 .

[103]  D. Walsh Using aromatherapy in the management of psoriasis. , 1996, Nursing Standard.

[104]  pierre-Marie Martin,et al.  Human prostatic steroid 5α-reductase isoforms—A comparative study of selective inhibitors , 1995, The Journal of Steroid Biochemistry and Molecular Biology.

[105]  L. Melton,et al.  Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. , 1995, Mayo Clinic proceedings.

[106]  G. Rocchetti,et al.  Topical use of calcipotriol does not potentiate squaric acid dibutylester effectiveness in the treatment of alopecia areata , 1995 .

[107]  D. Schmitt,et al.  Protective effect of zinc on keratinocyte activation markers induced by interferon or nickel. , 1995, Acta Dermato-Venereologica.

[108]  M. Dzindolet,et al.  A Case Study: Massage, Relaxation, and Reward for Treatment of Alopecia Areata , 1994, Psychological Reports.

[109]  T. F. Cash,et al.  Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects. , 1993, Journal of the American Academy of Dermatology.

[110]  A. Lassus,et al.  A Comparative Study of a New Food Supplement, ViviScal®, with Fish Extract for the Treatment of Hereditary Androgenic Alopecia in Young Males , 1992, The Journal of international medical research.

[111]  P. Harrison,et al.  Hypnotherapy for alopecia areata , 1991, British Journal of Dermatology.

[112]  B. Wolf,et al.  Biotinidase Deficiency a , 1985, Advances in pediatrics.

[113]  P. Hutchinson,et al.  Alopecia totalis does not respond to the vitamin-D analogue calcipotriol , 1991 .

[114]  L. Packer,et al.  Free radical recycling and intramembrane mobility in the antioxidant properties of alpha-tocopherol and alpha-tocotrienol. , 1991, Free radical biology & medicine.

[115]  H. Sogawa,et al.  Application of psychoimmunotherapy in patients with alopecia universalis. , 1991, Psychotherapy and Psychosomatics.

[116]  O. Lindahl,et al.  Treatment of benign prostatic hyperplasia with phytosterols. , 1990, British journal of urology.

[117]  S. Ge Treatment of alopecia areata with acupuncture. , 1990, Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan.

[118]  H. Gollnick,et al.  [Low dosage retinol and L-cystine combination improve alopecia of the diffuse type following long-term oral administration]. , 1989, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.

[119]  I. Mowszowicz,et al.  Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid. , 1988, The British journal of dermatology.

[120]  T. Oppé,et al.  Vitamin D deficiency. , 1979, British medical journal.

[121]  E. Ludwig,et al.  Androgenetic alopecia. , 1977, Archives of dermatology.

[122]  D. Opdyke,et al.  Antimicrobial properties of the pyrithione salts. VII. In vitro methods for comparing pyrithiones to standard antimicrobials. , 1969, Food and Cosmetics Toxicology.

[123]  M. Neil The absorption of cystine and cysteine from rat small intestine. , 1959, The Biochemical journal.