Alopecia medical therapy

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

Overview

Currently in the USA, there are two drug-based treatments that are FDA-approved and one product that has been cleared by the FDA for the treatment of androgenetic alopecia. These are finasteride (marketed for hair loss as Propecia) and minoxidil.

Medical Therapy

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

  • Topical minoxidil (Rogaine, generic):
    • Currently the treatment approved for both women and men
    • Increases duration of anagen and enlarges miniaturized follicles
    • Mechanism unclear
  • Efficacy:
    • Hair counts ~5x higher when compared to a 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 of treatment (men). Hence, treatment must continue indefinitely or regrown hair will be lost
    • Women: increased hair growth in 60% vs 40% with use of 2% solution vs. placebo
    • Decreased loss is usually seen within 2 months, growth w/in 4-8 months; stable at 1-1.5 yrs
    • Cosmetically notable growth occurs in only 30-40%
    • Best results if baldness present at vertex less than 5 years and less than 10 cm in diameter
    • Rarely, contact or irritant dermatitis may be seen as a side effect

Finasteride

Finasteride showed improvement in males with hair loss at a dose of 1mg. Over 83% of the 1,553 men experiencing male hair loss had actually maintained or increased their hair count from baseline. Also, based on visual assessments, it was concluded that more than 80% had improved appearances.

Minoxidil

Minoxidil was first used in tablet form as a medicine to treat high blood pressure, but after some patients experienced the side effect of excessive hair growth, further research was carried out into its use for the treatment of hair loss. FDA clinical trials showed that 65% of men with androgenetic alopecia maintained or increased their hair count by using 5% topical liquid minoxidil. 54% of these men experienced moderate to dense regrowth and 46% experienced hair loss stabilization and mild regrowth. When studied in women between the ages of 18-45 using controlled clinical studies, about 66% of the women with moderate degrees of hereditary hair loss reported hair re-growth after using 2% topical liquid 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.

Placebos

placebo treatments have shown in studies to frequently have reasonable success rates and even similar side effects as other tested products, although both efficacy and side effects are lesser when compared to the products being tested. 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 may keep androgen levels, especially free testosterone levels naturally lower while maintaining overall health, lowering stress and increasing SHBG.[2] [3] Weight training without incorporation of aerobic exercise into the trainin regimen may lead to an increase in testosterone levels.[4] [5] [6] [7] One study suggests that both a combination of heavy exercise and increased fat intake are required to produce an increase in free testosterone in strength trainers. While increased total or free testosterone would aid in the building and repair of muscle, it may also lead to hair loss in susceptible individuals. [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

While Immunosuppressants have been shown to temporarily reverse alopecia areata when applied to the scalp, the side effects of such medications make their use questionable.[10] [11]

Saw Palmetto

Saw Palmetto (Serenoa repens) is an herbal DHT inhibitor often claimed to be cheaper and has fewer side effects than finasteride and dutasteride. Unlike other 5-alpha-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. Polygonum Multiflorum contains stilbene glycosides similar to resveratrol.[16]

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 the 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 hair loss 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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