PEER-REVIEW | HAIR LOSS | Minoxidil is mostly available in 2% and 5% and its use is


associated with increasing vasodilatation, enhanced cell proliferation and angiogenesis. The 5% solution was found to be more effective and the standard formulation, which contains propelyne glycol is preferred as the alternative preparations lack sufficient scientific evidence of their efficacy22


. Side-effects of minoxidil I II IIa III IIIa III-vertex


include hypertrichosis, contact dermatitis and transient shedding in the first four months, but the commercially available foam vehicle does not contain propelyne glycol, therefore, reducing the incidence of pruritus23 Studies in both animals and humans have shown that


.


the combination of minoxidil and oral finasteride are far superior than minoxidil and finasteride monotherapies24–25


. A recent double-blinded study


compared the efficacy and safety of 3% minoxidil (MNX) against combined 3% minoxidil/0.1% finasteride lotion (MFX). At 24 weeks, hair count was increased in both groups, but the MFX group showed significantly greater improvement in global photographic assessment than the MNX group26


. IV IVa V Va VI VII


Figure 1 Norwood-Hamilton male pattern baldness classification. Type I: minimal bi-temporal recession of hair. Type II: extension of type I. Type III: hair loss in tonsure area and recession of hair from the forehead. Type IV-VI: extension of type III. Type VII: severe pattern hair loss, with a confluence of the balding areas. Hair is preserved at the back and the sides of the head.


Oral finasteride, a 5-alpha reductase inhibitor at 1 mg


a day, is the recommended dose for AGA in men over 18 years of age and it is the treatment approach used most often17


. It is a synthetic drug that


reduces the conversion of testosterone to DHT. Its effect on hair count and thickness is often experienced at 6 months with the maximum effect at 12 months18


. Some rare but


important side-effects with oral finasteride include reduced libido, erectile dysfunction and gynecomastia.


It was also found that The prostaglandin F2 analogues bimatoprost and


latanoprost are used to treat glaucoma and ocular hypertension. One of their side-effects was found to be eyelash hair growth and thus bimatoprost is now available to promote eyelash hair growth27


. In a study,


latanoprost had been found to significantly increase hair density and encourage pigmentation when compared to baseline28


. Oral finasteride, a 5-alpha


reductase inhibitor at 1 mg a day, is the recommended dose for


finasteride decreases prostate specific antigen (PSA) levels and it is therefore recommended that PSA levels should be monitored in patients aged over 45 years19


. A large prospective study as part of The


Prostate Cancer Prevention Trial (PCPT) showed that participants who received 5 mg during a 7 year period experienced a minimal increase in sexual dysfunction and its impact diminished over time. The authors concluded that since the side- effects are minimal it should not limit physicians to prescribe oral finasteride20


. Dutasteride is more potent than finasteride,


working by inhibiting both type I and type II 5 reductase. Type II 5 reductase is more concentrated and therefore, the additional inhibitory effect could yield a greater clinical effect. Phase 1 and 2 trials in men have shown that dutasteride suppresses 100% of serum DHT (dose 2.5–5.0 mg/day), whereas finasteride suppresses only 70% (dose 5mg)21 lacking.


20 


AGA in men over 18 years of age and it is the treatment approach used most often.


Ketoconazole 2% shampoo, an imidazole anti-fungal agent, is commonly found over the counter and it is used for the treatment of dandruff and dermatitis.


associated follicular inflammation29–30 .


It could also help those with AGA- . Moreover,


it is also an anti-androgen and could improve hair growth in AGA through androgen dependent pathways31


Surgical treatment Hair transplantation is the most common hair


restoration surgery used for AGA. Its principle revolves around hair donor dominance, where androgenic insensitive hair follicles keep their properties when transplanted into scalp areas affected by AGA. This could be used in those who have sufficient donor hair sites. Studies have found that the combination of oral finasteride and hair transplantation yields the best results32–33


.


The safe donor area is a horizontal area in the occipital region.


There


must be at least 40 FUs/sq cm in the donor area. Hair is harvested by using either the follicular unit extraction or the strip method or a combination of the two. The grafting of follicular units is now considered the optimum method22


. . Despite this, sufficient evidence is still January/February 2016 | prime-journal.com


Local side-effects include post-operative bleeding, infection, swelling, facial oedema, scalp erythema, crusting, temporary headaches and


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