Alopecia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [7]

Overview

In the USA, there are only 2 drug-based treatments that have been approved by the FDA (Food and Drug Administration) and one product that has been cleared by the FDA for the treatment of androgenetic alopecia, otherwise known as male or female pattern hair loss. The two FDA approved treatments are finasteride (marketed for hair loss as Propecia) and minoxidil.

Medical Therapy

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

  • Topical minoxidil (Rogaine, generic):
    • Only Rx approved for women as well as men
    • Increases duration of anagen and enlarges miniaturized follicles
    • Mechanism unclear
  • Efficacy:
    • Hair counts ~5x higher than placebo with use of 5% solution (men)
    • Hair counts 45% higher with use of 5% solution compared with use of 2% solution (men)
    • Hair counts returned to those of placebo group within 24 weeks after discontinuation Rx (men)
    • Women: increased hair growth in 60% vs. 40% with use of 2% soln vs. placebo
    • Advice for patients:
      • 1 mL bid applied to dry scalp with spray or dropper; spread lightly w/finger
      • Expect decreased loss w/in 2 mos, growth w/in 4-8 mos; stable at 1-1.5 yrs
      • Best results if baldness present at vertex less than 5 years and less than 10 cm in diameter
      • Cosmetically notable growth occurs in only 30-40%
      • Rx must continue indefinitely or regrown hair will be lost
      • Side effects = rare contact or irritant dermatitis; no change blood pressure, heart rate or weight

Finasteride

A pharmaceutical company reportedly sought to find the smallest effective quantity of finasteride and test its long-term effects on 1,553 men between ages 18 and 41 with mild to moderate thinning hair. Based on their research, 1 mg daily was selected, and after 2 years of daily treatment, over 83% of the 1,553 men experiencing male hair loss had actually maintained or increased their hair count from baseline. Visual assessments concluded that over 80% had improved appearances.

Minoxidil

Minoxidil was first used in tablet form as a medicine to treat high blood pressure, but it was noticed that some patients being treated with Minoxidil experienced excessive hair growth (hypertrichosis) as a side-effect. Further research showed that by applying topical Minoxidil solution directly to the scalp, it could prove to be beneficial to those experiencing hair loss.

FDA clinical trials showed that 65% of men with androgenetic alopecia maintained or increased their hair count from the use of minoxidil 5% in liquid form. 54% of these men experienced moderate to dense regrowth and 46% experienced hair loss stabilisation and mild regrowth.

In controlled clinical studies of women aged 18-45, 2 out of 3 women with moderate degrees of hereditary hair loss reported re-growth after using 2% minoxidil. Initial results occur at 4 months with maximum results occurring at 8 months.

Ketoconazole

Topical application of ketoconazole, which is both an anti-fungal and a potent 5-alpha reductase inhibitor, is often used as a supplement to other approaches.1

Placebos

Interestingly, placebo treatments in studies often have reasonable success rates, though not as high as the products being tested, and even similar side-effects as the products. For example, in Finasteride (Propecia) studies, the percent of patients with any drug-related sexual adverse experience was 3.8% compared with 2.0% in the placebo group.[1]

Exercise

Regular aerobic exercise can help keep androgen levels (particularly free testosterone levels) naturally lower while maintaining overall health, lowering stress and increasing SHBG.[2] [3]

Weight training without aerobic exercise may increase testosterone.[4] [5] [6] [7] One study suggests that both heavy exercise and increased fat intake, in combination, are required for increased free testosterone in strength trainers. Increased total or free testosterone would help them build and repair muscle, but may cause susceptible individuals to lose hair. [8]

However, there is at least one study that indicates a decline in free testosterone combined with an increase in strength due to an (unspecified) strength training regime.[9]

Immunosuppressants

Immunosuppressants applied to the scalp have been shown to temporarily reverse alopecia areata, though the side effects of some of these drugs make such therapy questionable.[10] [11]

Saw Palmetto

Saw Palmetto (Serenoa repens) is an herbal DHT inhibitor often claimed to be cheaper and have fewer side effects than finasteride and dutasteride. Unlike other 5alpha-reductase inhibitors, Serenoa repens induces its effects without interfering with the cellular capacity to secrete PSA.[12] Saw palmetto extract has been demonstrated to inhibit both isoforms of 5-alpha-reductase unlike finasteride which only inhibits the (predominant) type 2 isoenzyme of 5-alpha-reductase.[13][14][15]

Polygonum Multiflorum

Polygonum Multiflorum is a traditional Chinese cure for hair loss. P. multiflorum contains stilbene glycosides similar to resveratrol.[16]

Beta Sitosterol

Beta sitosterol, which is a constituent in many seed oils, can help to treat BHP by lowering cholesterol. If used for this purpose, an extract is best. Consuming large amounts of oil to get at small quantities of beta sitosterol is likely to exacerbate male pattern baldness.

Anti-androgens

While drastic, broad spectrum anti-androgens such as flutamide are sometimes used topically. Flutamide is potent enough to have a feminizing effect in men, including growth of the breasts.

Hedgehog Agonists

Through 2006, a drug development company spent $1,000,000 on a hair growth program focused on the potential development of a topical hedgehog agonist for hair growth disorders, such as male pattern baldness and female hair loss. The hairloss research program was shut down in May 2007 because the process did not meet the proper safety standards.[17]

WNT Gene Related

In May 2007, US company Follica Inc, announced they have licensed technology from the University of Pennsylvania which can regenerate hair follicles by reawakening genes which were once active only in the embryo stage of human development.[18][19][20][21]


References

  1. Leyden J, Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D, Kraus S, Baldwin H, Shalita A, Draelos Z, Markou M, Thiboutot D, Rapaport M, Kang S, Kelly T, Pariser D, Webster G, Hordinsky M, Rietschel R, Katz H, Terranella L, Best S, Round E, Waldstreicher J (1999). "Finasteride in the treatment of men with frontal male pattern hair loss" (pdf). J Am Acad Dermatol. 40 (6 Pt 1): 930–7. PMID 10365924.
  2. Tworoger SS, Missmer SA, Eliassen AH, Barbieri RL, Dowsett M, Hankinson SE (2007). "Physical activity and inactivity in relation to sex hormone, prolactin, and insulin-like growth factor concentrations in premenopausal women - exercise and premenopausal hormones". Cancer Causes Control. 18 (7): 743–52. doi:10.1007/s10552-007-9017-5. PMID 17549594.
  3. Eliakim A, Nemet D (2006). "[Exercise and the male reproductive system]". Harefuah. 145 (9): 677–81, 702, 701. PMID 17078431.
  4. Tsolakis C, Xekouki P, Kaloupsis S, Karas D, Messinis D, Vagenas G; et al. (2003). "The influence of exercise on growth hormone and testosterone in prepubertal and early-pubertal boys". Hormones (Athens). 2 (2): 103–12. PMID 17003009.
  5. Ahtiainen JP, Pakarinen A, Kraemer WJ, Häkkinen K (2003). "Acute hormonal and neuromuscular responses and recovery to forced vs maximum repetitions multiple resistance exercises". Int J Sports Med. 24 (6): 410–8. doi:10.1055/s-2003-41171. PMID 12905088.
  6. Izquierdo M, Ibáñez J, Häkkinen K, Kraemer WJ, Ruesta M, Gorostiaga EM (2004). "Maximal strength and power, muscle mass, endurance and serum hormones in weightlifters and road cyclists". J Sports Sci. 22 (5): 465–78. doi:10.1080/02640410410001675342. PMID 15160600.
  7. Baker JR, Bemben MG, Anderson MA, Bemben DA (2006). "Effects of age on testosterone responses to resistance exercise and musculoskeletal variables in men". J Strength Cond Res. 20 (4): 874–81. doi:10.1519/R-18885.1. PMID 17194250.
  8. Sallinen J, Pakarinen A, Ahtiainen J, Kraemer WJ, Volek JS, Häkkinen K (2004). "Relationship between diet and serum anabolic hormone responses to heavy-resistance exercise in men". Int J Sports Med. 25 (8): 627–33. doi:10.1055/s-2004-815818. PMID 15532008.
  9. Ara, I.; Perez-Gomez, J.; Vicente-Rodriguez, G.; Chavarren, J.; Dorado, C.; Calbet, J. A. L. (2006). "Serum free testosterone, leptin and soluble leptin receptor changes in a 6-week strength-training programme". British Journal of Nutrition. 96 (6): 1053–9.
  10. Joly P (2006). "The use of methotrexate alone or in combination with low doses of oral corticosteroids in the treatment of alopecia totalis or universalis". J Am Acad Dermatol. 55 (4): 632–6. doi:10.1016/j.jaad.2005.09.010. PMID 17010743.
  11. Freyschmidt-Paul P, Ziegler A, McElwee KJ, Happle R, Kissling S, Sundberg JP; et al. (2001). "Treatment of alopecia areata in C3H/HeJ mice with the topical immunosuppressant FK506 (Tacrolimus)". Eur J Dermatol. 11 (5): 405–9. PMID 11525945.
  12. Habib F, Ross M, Ho C, Lyons V, Chapman K (2005). "Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression". Int J Cancer. 114 (2): 190–4. PMID 15543614.
  13. Prager N, Bickett K, French N, Marcovici G (2002). "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". J Altern Complement Med. 8 (2): 143–52. PMID 12006122.
  14. Marks L, Hess D, Dorey F, Luz Macairan M, Cruz Santos P, Tyler V (2001). "Tissue effects of saw palmetto and finasteride: use of biopsy cores for in situ quantification of prostatic androgens". Urology. 57 (5): 999–1005. PMID 11337315.
  15. Iehlé C, Délos S, Guirou O, Tate R, Raynaud J, Martin P (1995). "Human prostatic steroid 5 alpha-reductase isoforms — a comparative study of selective inhibitors". J Steroid Biochem Mol Biol. 54 (5–6): 273–9. PMID 7577710.
  16. Li-Shuang, L.V.; Gu, Xiaohong; Ho, Chi-Tang; Tang, Jian (2006). "STILBENE GLYCOSIDES FROM THE ROOTS OF POLYGONUM MULTIFLORUM THUNB AND THEIR IN VITRO ANTIOXIDANT ACTIVITIES". Journal of Food Lipids. 13 (2): 131–144. doi:10.1111/j.1745-4522.2006.00039.x. ISSN 1065-7258.
  17. "Curis and Procter & Gamble Enter into R&D Agreement for Hair Growth Program". 2005. Retrieved 2006-08-24. Unknown parameter |authro= ignored (help); Unknown parameter |month= ignored (help)
  18. [1]
  19. [2][3]
  20. [4][5]
  21. [6]



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