ARTICLE | hair research | Minoxidil lotions, the concentrations of which
ranged from 2–5%, were studied in more than 3000 patients, who all displayed an aGa. The number of hairs was assessed by counting on a round surface of 2.5 cm in diameter. results indicate an aesthetically satisfactory and statistically significant regrowth for 24–42% of all patients, over a 12-month period (6). a personal study of the author’s revealed an average density of 118 hairs/cm2 for 66 male patients displaying an androgenetic alopecia of types ii to iV on the hamilton scale (3, 5). The efficacy and the safety of 2% minoxidil lotion as a
form of treatment of female aGa was proved in a 32-week double-blind study conducted versus placebo (7). This study evaluated 550 female subjects displaying an aGa type i or ii, according to Ludwig’s classification (Figure 4). The study encompassed the counting of the hairs on a 1 cm2
tattooed surface using a Quantimet analyser. New
hair growth was indicated in 54% of all patients who had been taking minoxidil (vs 34% for those taking placebo). a computerised counting method confirmed an average density of 211 hairs per square centimetre, which had been observed on the frontoparietal area of 62 women. There was no increase in density for the remaining 488 women. From these results, it is possible to deduce that a 38% lost-hair regrowth (i.e. approximately one third of all hair lost) was obtained with minoxidil compared with only 16% in those treated with placebo. side-effects of minoxidil are minimal, but include itching, eczema, and hypertrichosis in females.
Finasteride Finasteride taken orally and daily (1 mg) works by inhibiting the 5α-reductase from forming DhT (8). The decreased DhT levels allow some intermediate follicles to enlarge and regrow normal terminal hairs (Figure 5). studies carried out on 1879 men showed a variety of improvements after photographic assessment: 5% great improvement; 31% moderate improvement; and 30% slight improvement. Finasteride’s side- effects were limited, with only 1.8% of the study gr o up expe r ienc ing decreased libido (erectile and ejaculation disorder), which is reversible. Persistant sexual side-effects have also been recently mentioned, but this requires further studies for
Finasteride taken orally and
daily (1 mg) works by inhibiting the 5α-reductase from forming dhT (8). The decreased dhT levels allow some intermediate follicles to enlarge and regrow normal terminal hairs.
48 ❚ May 2011 |
prime-journal.com
Figure 4 Female androgenetic alopecia (Ludwig II): before (a) and 19 months after 2% minoxidil lotion (b)
confirmation (9). recently, a warning with regard to a small risk of male breast cancer was included in the product information (10). Finasteride is not indicated for use in women, and dutasteride is not yet approved for the treatment of hair loss.
Anti-androgens cyproterone acetate (11) (in europe) can effectively block increased levels of male hormones that cause hair loss in some women. a 12-month randomised controlled trial compared the effects of 2% minoxidil versus cyproterone acetate (50 mg/day) in female aGa (11). after 6 months of treatment minoxidil was found to be more effective. The side-effects of cyproterone acetate are hepatotoxicity, nausea, headache and increased weight. spironolactone (12) (in the Us) is an aldosterone
antagonist which appears to be a competitive inhibitor of DhT-receptor binding. No controlled clinical trials have been published. With regard to the use of spironolactone in humans, there are no publications on teratogenicity as yet, but animal studies have revealed a feminisation of the male foetus after spironolactone treatment during the second trimester of pregnancy. it is of the author’s opinion, therefore,
that
spironolactone should not be used
d u r i n g pregnancy, and that contraceptives recommended
New treatments Platelet rich plasma
in a study by Greco and Brandt (13), traumatising and infusing platelet rich plasma (PrP) into the scalp
prescriptions of oral are
while administering this treatment.
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