Over-the-Counter Hair Loss Treatments: Help or Hype?

This review of the current available OTC options is much appreciated in the December 2018 article by Bater and Rieder, however, most of the products mentioned have no current research or data in the past decade except for the supplements. In this field of alopecia, supplement data is expanding rapidly. Choosing patients wisely for these studies is imperative to the success of these clinical trials. As these products are trying to appeal to the broad category of hair loss that affects more than half the population, it is important to clarify if a study is specifically targeting androgenetic alopecia or not. I agree with the authors that having a board-certified dermatologist in patient selection is key, that is why I want to clarify that of the 5 studies referenced with me as the author (refs 37,38,39,41,42), I, a board-certified dermatologist with two recertifications under her belt, personally selected each candidate for participation. Only one of those studies was multi-site with half of the candidates chosen by a board certified facial-plastic surgeon. All study patients underwent thorough medical histories and physical exams, including evaluations of clinical presentations of alopecia. While full blood panels and punch biopsies were not performed due to budget constraints, patients were chosen that met each study's requirements. More studies need to continue with larger n population and a wide variety of treatments, including PRP, low level light lasers, stem cells, microneedling, and topical JAK inhibitors to name a few, as hair loss is a big issue and that is of great concern to many of our patients in dermatology as well as other specialties.Glynis Ablon MD FAACBoard-Certified Dermatologist, Associate Clinical Professor of Dermatology at UCLA, Manhattan Beach, CA

Bater KL, Rieder EA. Over-the-counter hair loss treatments: help or hype? J Drugs Dermatol. 2018;17(12):1317-1331.

We thank Dr. Ablon for her thoughtful response to our manuscript.¹ The use of supplements in the field of dermatology is pervasive, and their popularity for hair loss and other dermatologic conditions alike will continue to grow as they are made widely and easily accessible, especially through the virtual marketplace. Board certified dermatologists such as Dr. Ablon and colleagues have already made significant contributions to the evidence-based study of novel nutraceuticals for the treatment of hair loss.^2-7 As emphasized by Dr. Ablon, appropriate patient selection is central to the success and generalizability of these studies. We commend Dr. Ablon for her thoughtful consideration and comprehensive clinical evaluations when determining patient candidacy for inclusion in these trials. While the diagnosis of androgenetic alopecia is typically straightforward in men, other alopecic conditions can occur concomitantly, appear similar to, or unmask androgenetic alopecia in women, the majority of the subjects in the above nutraceutical trials.8 Such conditions include thyroid and iron deficiencies, hormonal disorders, alopecia areata, central centrifugal cicatricial alopecia, and telogen effluvium. While budgetary constraints may limit the extent to which laboratory and histopathological studies can be undertaken in research protocols, it is incumbent on the practicing dermatologist to ensure the accuracy of diagnosis before recommending expensive and potentially lifelong treatments for alopecia. Presently, there are limited data to suggest that supplementation in the nutrient-replete population serves to combat hair loss. The study of larger and more diverse patient populations will allow dermatologists to provide specific recommendations regarding the use of nutraceuticals for androgenetic alopecia, and head-to-head trials comparing these products to approved interventions may help guide data-driven conversations regarding outcomes and expectations for treatment.Evan Rieder MDThe Ronald O. Perelman Department of DermatologyNYU Langone Dermatology Associates, New York, NY