NEW YORK — Of the adjunctive treatments available for alopecia, the list of those supported by data is fairly short, but clinicians are inevitably asked about others, and it can be helpful to distinguish those that are at least benign when faced with patients ready to try anything, according to two experts.

Outlining over-the-counter therapies for alopecia, Maryanne Makredes Senna, MD, said that while she relies on data on these treatments, she does not necessarily object to those that patients pursue on their own.

“There might be no evidence, but patients can add what they want if it will not interfere with what is evidence-based,” said Senna, director of Lahey Hospital and Medical Center’s Hair Loss Center of Excellence, Burlington, Massachusetts, and associate professor of clinical dermatology at Harvard Medical School, Boston. She reviewed proven and unproven adjunctive therapies for hair loss in a presentation on October 5 at the Skin of Color Update (SOCU) 2025.

Who Doesn’t Want a Scalp Massage?

Among many examples, she cited scalp massage, scalp scrubbers, and scalp serums. Although there is no evidence that any of these improve hair regrowth, Senna distinguished between treatments that might provide comfort, such as a scalp massage, and those that might cause unhelpful inflammation, such as certain scalp serums.

At the same meeting, Victoria Barbosa, MD, MPH, director of the Hair Loss Program and associate professor of medicine in the section of dermatology at the University of Chicago, Chicago, provided an overview of therapeutic options to reverse nonscarring alopecias, such as alopecia areata.

Adjunctive therapies were not part of her review, but when asked to comment on this topic by Medscape Medical News, she said that she agreed that it is appropriate to help patients understand which treatments are or are not supported by evidence, leaving them to make their own choices.

“I only recommend therapies supported by evidence,” Barbosa said. Yet, she acknowledged that patients commonly ask about employing a range of unproven adjunctive treatments recommended by friends or found on the internet.

Many “really involve patient preference, so I am fine with them if they pose a low risk of harm,” she said. “But I do suggest that if they add these kinds of treatments, they do so methodically,” she added. “If they add them one at a time, they can at least judge what works.”

Patients urgently seeking hair regrowth, particularly when many approved pharmacologic options offer gradual hair regrowth, often hope to boost the response in any way they can. Both Senna and Barbosa are empathetic and do not typically discourage patients from anything unlikely to interfere with prescribed therapies for which there is evidence.

Indeed, even the short list of adjunctive treatments backed by clinical evidence tends to offer only modest, if still clinically meaningful, benefit. Senna listed proper nutrition, over-the-counter topical minoxidil, antidandruff shampoos, and low-level laser light therapy (LLLT) devices.

For nutrition, Senna emphasized the importance of adequate intake of iron and vitamin D. In general, she counsels patients to alter their diet if necessary to achieve adequate levels of these nutrients rather than take a supplement. She recommended baseline labs to identify those who are deficient and prescribed supplements in only select cases.

Iron and Vitamin D Are Hair Regrowth Nutrients

Barbosa also considers adequate levels of both iron and vitamin D to be important. However, she is only likely to screen for these if there are no values in the chart and she suspects that these might be low.

Senna does not recommend biotin supplements for hair regrowth. She cited data suggesting these are still commonly recommended despite an FDA warning issued in 2017 and updated in 2019 about the potential for biotin to interfere with certain laboratory tests, such as those for thyroid function. In patients being treated for hair loss, she is particularly concerned about interactions with turmeric and ashwagandha and the potential for systemic harm, including liver injury, from botanicals included in some hair and nail supplements.

Topical minoxidil, according to Senna, can be helpful even if hair regrowth on the topical therapies available over the counter is generally modest. Typically, she recommends the 5% foam or solution but only once rather than twice daily to avoid the scalp irritation that can be bothersome.

Over-the-counter LLLT devices for hair regrowth have been cleared by the FDA for male and female pattern loss, but Senna warned that the light must reach the scalp to be effective. Dramatic responses are uncommon, she said, and a 6-month trial is appropriate to judge benefit.

However, she said the benefit cannot be ruled out. She recounted a story of a patient who insisted on trying LLLT even though Senna warned her that the benefit would likely be modest. Even though the benefit was modest, there was hair regrowth, and the patient was satisfied.

This is an apt example of why Senna is willing to allow patients to pursue adjunctive therapies when she sees no risks. In addition to the fact that patients may derive some level of satisfaction in participating in their own care, their own perception of benefit is meaningful.

Barbosa made the same point, and both she and Senna acknowledged the psychological burden of alopecia that might make adjunctive therapies appealing to patients when hair regrowth is achieved gradually with evidence-based therapies.

Senna reported having financial relationships with AbbVie, CorEvitas, Inmagene, Kintor Pharmaceutical Limited, Lilly, L’Oreal, Pfizer, Sun Pharma, and Veradermics. Barbosa reported having financial relationships with Beiersdorf, CeraVe, Johnson & Johnson, Lilly, L’Oreal, Pfizer, Veradermics, and Vichy.