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Androgenetic Alopecia: Clinical Treatment

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Hair and Scalp Treatments

Abstract

Androgenetic alopecia (AGA) affects predisposed men and women and is characterized by nonscarring progressive miniaturization of the hair follicle accompanied by shortening of the anagen phase, leading to a gradual conversion of terminal hairs into vellus hairs with a pattern distribution. The etiology of AGA is multifactorial and polygenetic. Male androgenetic alopecia, also known as male pattern hair loss (MPHL), is clearly an androgen-dependent condition, and although the mode of inheritance is uncertain, a genetic predisposition is observed. In female androgenetic alopecia, also known as female pattern hair loss (FPHL), the role of androgens is still uncertain. It is more frequent in Caucasians than in Asians and Africans, and the prevalence increases with age.

AGA is one of the most common causes of hair consultation, affecting quality of life and self-esteem of patients. Frequently, their expectations about therapy results are higher than reality. For this reason, it is important to clarify during the first consultation that the main treatment goal is to stop progression and prevent further thinning, highlighting that improvement and regrowth cannot always be achieved.

Although AGA is a very prevalent condition, approved therapeutic options are limited. The aim of this chapter is to review the efficacy and safety of current clinical therapeutic options in a practical manner.

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References

  1. Küster W, Happle R. The inheritance of common baldness: two B or not two B? J Am Acad Dermatol. 1984;11(5 Pt 1):921–6.

    PubMed  Google Scholar 

  2. Yip L, Rufaut N, Sinclair RD. Role of genetics and sex steroid hormones in male androgenetic alopecia and female pattern hair loss: an update of what we now know. Australas J Dermatol. 2011;52:81–8.

    PubMed  Google Scholar 

  3. Birch MP, Messenger AG. Genetic factors predispose to balding and non-balding in men. Eur J Dermatol. 2001;11:309–14.

    CAS  PubMed  Google Scholar 

  4. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Group. J Am Acad Dermatol. 1998;39:578–89.

    CAS  PubMed  Google Scholar 

  5. Olsen EA. Female pattern hair loss. J Am Acad Dermatol. 2001;45:S70–80.I.

    CAS  PubMed  Google Scholar 

  6. Torres F, Tosti A. Female pattern alopecia and telogen effluvium: figuring out diffuse alopecia. Semin Cutan Med Surg. 2015;34(2):67–71.

    PubMed  Google Scholar 

  7. Gan DC, Sinclair RD. Prevalence of male and female pattern hair loss in Maryborough. J Investig Dermatol Symp Proc. 2005;10:184–9.

    PubMed  Google Scholar 

  8. Lee WS, Lee HJ. Characteristics of androgenetic alopecia in Asian. Ann Dermatol. 2012;24(3):243–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Bas Y, Seckin HY, Kalkan G, Takci Z, Citil R, Önder Y, et al. Prevalence and types of androgenetic alopecia in north Anatolian population: a community-based study. J Pak Med Assoc. 2015;65(8):806–9.

    PubMed  Google Scholar 

  10. Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G. Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. Arch Dermatol. 2010;146:1141–50.

    PubMed  Google Scholar 

  11. Gupta AK, Charrette A. The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatolog Treat. 2014;25(2):156–61.

    CAS  PubMed  Google Scholar 

  12. Olsen EA, Whiting DA, Savin R, Rodgers A, Johnson-Levonas AO, Round E, et al. Global photographic assessment of men aged 18-60 years with male pattern hair loss receiving finasteride 1mg or placebo. J Am Acad Dermatol. 2012;67(3):379–86.

    PubMed  Google Scholar 

  13. Steiner JF. Clinical pharmacokinetics and pharmacodynamics of finasteride. Clin Pharmacokinet. 1996;30(1):16–27.

    CAS  PubMed  Google Scholar 

  14. Becker CD, Stichtenoth DO, Wichmann MG, Schaefer C, Szinicz L. Blood donors on medication - an approach to minimize drug burden for recipients of blood products and to limit deferral of donors. Transfus Med Hemother. 2009;36(2):107–13.

    PubMed  PubMed Central  Google Scholar 

  15. Propecia [package insert]. White House Station, NJ: Merck and Co, Inc; Oct 2004.

    Google Scholar 

  16. Fertig R, Shapiro J, Bergfeld W, Tosti A. Investigation of the plausibility of5-alpha-reductase inhibitor syndrome. Skin Appendage Disord. 2017;2(3–4):120–9.

    PubMed  Google Scholar 

  17. Ramot Y, Czarnowicki T, Zlotogorski A. Finasteride induced gynecomastia: case report and review of the literature. Int J Trichol. 2009;1(1):27–9.

    Google Scholar 

  18. Overstreet JW, Fuh VL, Gould J, Howard SS, Lieber MM, Hellstrom W, et al. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J Urol. 1999;162(4):1295–300.

    CAS  PubMed  Google Scholar 

  19. Yamazaki M, Miyakura T, Uchiyama M, Hobo A, Irisawa R, Tsuboi R. Oral finasteride improved quality of life of androgenetic alopecia patients. J Dermatol. 2011;38(8):773–7.

    CAS  PubMed  Google Scholar 

  20. D’Amico AV, Roehrborn CG. Effect of 1 mg/day finasteride on concentrations of serum prostate-specific antigen in men with androgenic alopecia: a randomized controlled trial. Lancet Oncol. 2007;8:21–5.

    PubMed  Google Scholar 

  21. Goodman PJ, Tangen CM, Darke AK, Lucia MS, Ford LG, Minasian LM. Long-term effects of finasteride on prostate cancer mortality. N Engl J Med. 2019;380(4):393–4. https://doi.org/10.1056/NEJMc1809961.

    Article  PubMed  Google Scholar 

  22. Hu AC, Chapman LW, Mesinkovska NA. The efficacy and use of finasteride in women: a systematic review. Int J Dermatol. 2019;58:759.

    PubMed  Google Scholar 

  23. van Zuuren EJ, Fedorowicz Z, Carter B. Evidence-based treatments for female pattern hair loss: a summary of a Cochrane systematic review. Br J Dermatol. 2012;167:995–1010.

    PubMed  Google Scholar 

  24. Bowman CJ, Barlow NJ, Turner KJ, Wallace DG, Foster PM. Effects of in utero exposure to finasteride on androgen-dependent reproductive development in the male rat. Toxicol Sci. 2003;74:393–406.

    CAS  PubMed  Google Scholar 

  25. Roussouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stafanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288:321–33.

    Google Scholar 

  26. Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5-alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004;89:2179–84.

    CAS  PubMed  Google Scholar 

  27. Gubelin Harcha W, Barboza Martínez J, Tsai TF, Katsuoka K, Kawashima M, Tsuboi R, et al. A randomized, active-and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. 2014;70(3):489–98.

    CAS  PubMed  Google Scholar 

  28. Boyapati A, Sinclair R. Combination therapy with finasteride and low-dose dutasteride in the treatment of androgenetic alopecia. Australas J Dermatol. 2013;54(1):49–51.

    PubMed  Google Scholar 

  29. Jung JY, Yeon JH, Choi JW, Kwon SH, Kim BJ, Youn SW, et al. Effect of dutasteride 0.5mg/d in men with androgenetic alopecia recalcitrant to finasteride. Int J Dermatol. 2014;53(11):1351–7.

    CAS  PubMed  Google Scholar 

  30. Olszewska M, Rudnicka L. Effective treatment of female androgenic alopecia with dutasteride. J Drugs Dermatol. 2005;4:637–40.

    PubMed  Google Scholar 

  31. Yip L, Sinclair R. Antiandrogen therapy for androgenetic alopecia. Expert Rev Dermatol. 2006;1(2):261–9.

    CAS  Google Scholar 

  32. Shaw JC. Antiandrogen therapy in dermatology. Int J Dermatol. 1996;35(11):770–8.

    CAS  PubMed  Google Scholar 

  33. Burke BM, Cunliffe WJ. Oral spironolactone therapy for female patients with acne, hirsutism or androgenic alopecia. Br J Dermatol. 1985;112:124–5.

    CAS  PubMed  Google Scholar 

  34. Rathnayake D, Sinclair R. Innovative use of spironolactone as an antiandrogen in the treatment of female pattern hair loss. Dermatol Clin. 2010;28(3):611–8.

    CAS  PubMed  Google Scholar 

  35. Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152:466–73.

    CAS  PubMed  Google Scholar 

  36. Peereboom-Wynia JD, van der Willigen AH, van Joost T, Stolz E. The effect of cyproterone acetate on hair roots and hair shaft diameter in androgenetic alopecia in females. Acta Derm Venereol. 1989;69:395–8.

    CAS  PubMed  Google Scholar 

  37. Vexiau P, Chaspoux C, Boudou P, et al. Effects of minoxidil 2% vs. cyproterone acetate treatment on female androgenetic alopecia: a controlled, 12-month randomized trial. Br J Dermatol. 2002;146:992–9.

    CAS  PubMed  Google Scholar 

  38. Rossi A, Cantisani C, Melis L, Iorio A, Scali E, Calvieri S. Minoxidil use in dermatology, side effects and recent patents. Recent Patents Inflamm Allergy Drug Discov. 2012;6:130–6.

    CAS  Google Scholar 

  39. Kvedar JC, Baden HP, Levine L. Selective inhibition by minoxidil of prostacyclin production by cells in culture. Biochem Pharmacol. 1988;37(5):867–74.

    CAS  PubMed  Google Scholar 

  40. Michelet JF, Commo S, Billoni N, Mahé YF, Bernard BA. Activation of cytoprotective prostaglandin synthase-1 by minoxidil as a possible explanation for its hair growth-stimulating effect. J Invest Dermatol. 1997;108(2):205–9.

    CAS  PubMed  Google Scholar 

  41. Buhl AE, Waldon DJ, Baker CA, Johnson GA. Minoxidil sulfate is the active metabolite that stimulates hair follicles. J Invest Dermatol. 1990;95:553–7.

    CAS  PubMed  Google Scholar 

  42. Buhl AE, Baker CA, Dietz AJ. Minoxidil sulfotransferase activity influences the efficacy of Rogaine topical solution (TS): enzyme studies using scalp and platelets. J Invest Dermatol. 1994;102:534.

    Google Scholar 

  43. Dias PCR, Miot HA, Trüeb RM, Ramos PM. Use of minoxidil sulfate versus minoxidil base in androgenetic alopecia treatment: friend or foe? Skin Appendage Disord. 2018;4(4):349–50.

    PubMed  PubMed Central  Google Scholar 

  44. Blume-Peytavi U, Hillmann K, Dietz E, Canfield D, Garcia Bartels N. A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. J Am Acad Dermat. 2011;65:1126–34 e2.

    CAS  Google Scholar 

  45. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776–89.

    Google Scholar 

  46. Blume-Peytavi U, Lonnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2012;66(5):794–800.

    CAS  PubMed  Google Scholar 

  47. Available from: https://clinicaltrials.gov/ct2/results?term=bimatoprost+alopecia&Search=Search. Last Accessed: 19 July 2018.

  48. Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2009;75:47–51.

    PubMed  Google Scholar 

  49. Caserini M, Radicioni M, Leuratti C, Annoni O, Palmieri R. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Int J Clin Pharmacol Ther. 2014;52(10):842–9.

    CAS  PubMed  Google Scholar 

  50. Caserini M, Radicioni M, Leuratti C, Terraqni E, Iorizzo M, Palmieri R. Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Int J Clin Pharmacol Ther. 2016;54(1):19–27.

    CAS  PubMed  Google Scholar 

  51. Saceda-Corralo D, Rodrigues-Barata AR, Vano-Galvan S, Jaen-Olasolo P. Mesotherapy with dutasteride in the treatment of androgenetic alopecia. Int J Trichol. 2017;9:143–5.

    Google Scholar 

  52. Sinclair RD. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018;57(1):104–9.

    CAS  PubMed  Google Scholar 

  53. Andrasfay A; Intrepid Therapeutics, Inc. A phase 2 study to evaluate the safety and efficacy of CB-03-01 solution, a comparator solution and vehicle solution in males with androgenetic alopecia. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2018 Jul 23]. Available from: https://clinicaltrials.gov/ct2/show/NCT02279823. NLM identifier: NCT02279823.

  54. Available from: www.cassiopea.com/activities/product-pipeline/breezula.aspx. Last accessed: 23 July 2018.

  55. Garza LA, Liu Y, Yang Z, Alagesan B, Lawson JA, Norberg SM, et al. Prostaglandin D2 inhibits hair growth and is elevated in bald scalp of men with androgenetic alopecia. Sci Transl Med. 2012;4:126):126–34.

    Google Scholar 

  56. Nieves A, Garza LA. Does prostaglandin D2 hold the cure to male pattern baldness? Exp Dermatol. 2014;23(4):224–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Lin J-E; Allergan. Phase 2A study of setipiprant tablets in androgenetic alopecia in males. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). [cited 2018 Jul 23]. Available from: https://www.clinicaltrials.gov/ct2/show/NCT02781311. NLM identifier: NCT02781311.

  58. Tosti A, Zaiac MN, Canazza A, Sanchis-Gomar F, Pareja-Galeano H, Alis R, et al. Topical application of the Wnt/β-catenin activator methyl vanillate increases hair count and hair mass index in women with androgenetic alopecia. J Cosmet Dermatol. 2016;15(4):469–74.

    PubMed  Google Scholar 

  59. Yazici Y, Smith SR, Swearingen CJ, Simsek I, DiFrancesco A, Hood JD. Safety and efficacy of a topical treatment (SM04554) for androgenetic alopecia (AGA): results from a phase 1 trial. Poster session presented at: 9th World Congress for Hair Research; 2015 Nov 18–21; Miami, FL, USA.

    Google Scholar 

  60. Yazici Y; Samumed LLC. A Phase 2, Multicenter, Randomized, Double-Blind, Vehicle- Controlled Study of the Safety, Tolerability, and Efficacy of 0.15% and 0.25% Concentrations of Topical SM04554 Solution in Male Subjects With Androgenetic Alopecia (AGA). In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2018 Jul 23]. Available from: http://clinicaltrials.gov/ct2/show/NCT02275351. NLM identifier: NCT02275351.

  61. Satino J, Markou M. Hair regrowth and increased hair tensile strength using the HairMax laser comb for low-level laser therapy. Int J Cosmet Surg Aesthet Dermatol. 2003;5(2):113–7.

    Google Scholar 

  62. Leavitt M, Charles G, Heyman E, Michaels D. HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: a randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Investig. 2009;29(5):283–92.

    PubMed  Google Scholar 

  63. Kim H, Woong Choi J, Young Kim J, Won Shin J, Lee S, Huh C. Low level light therapy for androgenetic alopecia: a 24-week, randomized, double-blind, sham device–controlled multicenter trial. Dermatol Surg. 2013;39(8):1177–83.

    CAS  PubMed  Google Scholar 

  64. Kim WS, Lee HI, Lim YY, Lee SJ, Kim BJ, Kim MN, et al. Fractional photothermolysis laser treatment of male pattern hair loss. Dermatol Surg. 2011;37(1):41–51.

    CAS  PubMed  Google Scholar 

  65. Lee GY, Lee SJ, Kim WS. The effect of a 1550 nm fractional erbium-glass laser in female pattern hair loss. J Eur Acad Dermatol Venereol. 2011;25(12):1450–4.

    PubMed  Google Scholar 

  66. Gkini MA, Kouskoukis AE, Tripsianis G, Rigopoulos D, Kouskoukis K. Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period. J Cutan Aesthet Surg. 2014;7(4):213–9.

    PubMed  PubMed Central  Google Scholar 

  67. Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014;40(9):1010–9.

    CAS  PubMed  Google Scholar 

  68. Gentile P, Garcovich S, Bielli A, Scioli MG, Orlandi A, Cervelli V. The effect of platelet-rich plasma in hair regrowth: a randomized placebo-controlled trial. Stem Cells Transl Med. 2015;4(11):1317–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Nusbaum AG, Tosti A. Commentary on a randomized placebo- controlled, double-blind, half-head study to assess the efficacy of platelet-rich plasma on the treatment of androgenetic alopecia. Dermatol Surg. 2016;42(4):498–9.

    CAS  PubMed  Google Scholar 

  70. Dhurat R, Sukesh MS, Avhad G, Dandale A, Pal A, Pund P. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. Int J Trichology. 2013;5(1):6–11.

    PubMed  PubMed Central  Google Scholar 

  71. Dhurat R, Mathapati S. Response to microneedling treatment in men with androgenetic alopecia who failed to respond to conventional therapy. Indian J Dermatol. 2015;60(3):260–3.

    PubMed  PubMed Central  Google Scholar 

  72. Shin H, Ryu HH, Kwon O, Park BS, Jo SJ. Clinical use of conditioned media of adipose tissue-derived stem cells in female pattern hair loss: a retrospective case series study. Int J Dermatol. 2015;54(6):730–5.

    PubMed  Google Scholar 

  73. Fukuoka H, Suga H. Hair regeneration treatment using adipose- derived stem cell conditioned medium: follow-up with trichograms. Eplasty. 2015;26(15):e10.

    Google Scholar 

  74. Kerastem. Product pipeline. http://kerastem.com/product-pipeline/. Accessed 16 July 2018.

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Kelly, Y., Tosti, A. (2020). Androgenetic Alopecia: Clinical Treatment. In: Tosti, A., Asz-Sigall, D., Pirmez, R. (eds) Hair and Scalp Treatments. Springer, Cham. https://doi.org/10.1007/978-3-030-21555-2_8

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