Article

Use of topical minoxidil therapy for androgenetic alopecia in women

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Abstract

Androgenetic alopecia is the most common cause of hair loss in men and women. Androgenetic alopecia in women begins as a diffuse and progressive thinning of the frontoparietal area of the scalp. In women, hair loss at any age is socially unacceptable and may be the basis of psychiatric illness. A 32-week, double-blind, placebo-controlled trial was conducted in 10 European centers to assess the efficacy and safety of 2% topical minoxidil solution for the treatment of androgenetic alopecia in women. Two hundred ninety-four of the 346 women enrolled (85%) completed the 32-week trial. Photographic and computer imaging techniques were used at each visit to determine objectively the number of nonvellus hairs present in a 1-cm2 area selected as the target evaluation site. In the 2% minoxidil group, the mean increase in nonvellus hair count was 33 hairs, which was significantly greater than that of 19 hairs in the placebo group (P = 0.0001). The investigators observed that 44% of the patients in the 2% minoxidil group achieved new hair growth compared with 29% in the placebo group. When asked to evaluate their own hair growth, 55% of the women in the 2% minoxidil group compared to 41% of the women in the placebo group believed that they had achieved new hair growth. No clinically significant changes in vital signs were observed during the study and no serious or unexpected medical events were reported. Topical minoxidil solution was significantly more effective than placebo in the treatment of androgenetic alopecia in women.

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... Of the 334 references retrieved from the searches, only 22 studies met our inclusion criteria (see Table 2). A wide range of interventions was evaluated; 10 studies investigated minoxidil, [19][20][21][22][23][24][25][26][27][28] and four finasteride. [29][30][31][32] Two studies included cyproterone acetate in one treatment arm, 27,30 and two included flutamide. ...
... The treatment period ranged between 6 and 12 months. A majority of the studies included participant-assessed, in addition to investigator-assessed outcomes; however, only 11 of them evaluated 'hair regrowth', a [20][21][22][23][24][25][26]29,30,39,40 Only one study addressed the effectiveness of interventions on quality of life, 23 while a large proportion of the trials assessed treatment-associated adverse events. The secondary outcomes were assessed in several of the studies, but the methods of measurement and the timing of the assessments were not uniform across these studies. ...
... The overall risk of bias was also assessed for each study and 12 were categorized as 'high risk of bias' (plausible bias that seriously weakens confidence in the results) because one or more domain received a judgement of 'high risk'. [19][20][21][22][23]26,27,29,30,32,33,38 The remaining 10 studies were rated as 'unclear risk of bias' (plausible bias that raises some doubt about the result) because one or more criteria were assessed as unclear. Some of these assessments were based on the inadequate reporting of the criteria that are a prerequisite in the evaluation of methodological rigour, in terms of trial design and conduct. ...
Article
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Female pattern hair loss (FPHL) or androgenic alopecia is the most common type of hair loss affecting women with reduced hair density and can have a serious psychological impact. It is characterized by progressive replacement of slow cycling terminal hair follicles by miniaturized, rapidly cycling vellus hair follicles. The frontal hair line may or may not be preserved. The aim of this review was to assess the evidence for the effectiveness and safety of the treatments available for FPHL. Searches included: Cochrane Skin Group Specialised Register, Cochrane Central Register of Controlled Clinical Trials in The Cochrane Library, MEDLINE, EMBASE, AMED, PsycINFO, LILACS and several ongoing trials registries (October 2011). Randomized controlled trials in women with FPHL were identified. Twenty-two trials, comprising 2349 participants, were included. A range of interventions was evaluated, with 10 studies examining varying concentrations of minoxidil. Pooled data from four studies indicated that a greater proportion of participants treated with minoxidil reported a moderate increase in their hair regrowth compared with placebo (relative risk 1·86, 95% confidence interval 1·42-2·43). There was no difference between the number of adverse events experienced in the twice daily minoxidil and the placebo intervention groups, except for a reported increase with minoxidil 5% twice daily. Single studies accounted for most of the other comparisons, which were assessed as either having high risk of bias and/or they did not address the prespecified outcomes for this review and provided limited evidence of either the effectiveness or safety of these interventions. Further well-designed, adequately powered randomized controlled trials investigating other treatment options are still required.
... Minoxidil is FDA-approved as a treatment for androgenetic alopecia [2,44]. It has been shown that a mechanism of minoxidil inducing hair growth is via stimulation of vascular endothelial growth factor (VEGF), which plays a role in promoting angiogenesis as well as influencing cell survival and proliferation [45]. ...
... The mechanism of promoting hair growth of oleic acid was previously proposed to be due to the acceleration of hair follicles into the anagen and activation of the Wnt/β-catenin signal pathway [25]. Minoxidil is FDA-approved as a treatment for androgenetic alopecia [2,44]. It has been shown that a mechanism of minoxidil inducing hair growth is via stimulation of vascular endothelial growth factor (VEGF), which plays a role in promoting angiogenesis as well as influencing cell survival and proliferation [45]. ...
Article
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Synthetic drugs used to treat hair loss cause many side-effects. Natural tea seed oil possesses many activities that can suppress hair loss. However, it is oily and sticky in direct application. In this study, tea seed oil loaded nanostructured lipid carriers (NLC) using Tween 80 (NLC-T), Varisoft 442 (NLC-V), and a combination of both surfactants (NLC-C) was developed. The obtained nanoformulations showed spherical particles in the size range 130–430 nm. Particle size and size distribution of NLC-C and NLC-T after storage at 4, 25, and 40 °C for 90 days were unchanged, indicating their excellent stability. The pH of NLC-T, NLC-V, and NLC-C throughout 90 days remained at 3, 4, and 3.7, respectively. NLC-C showed significantly greater nontoxicity and growth-stimulating effect on human follicle dermal papilla (HFDP) cells than the intact oil. NLC-T and NLC-V could not stimulate cell growth and showed high cytotoxicity. NLC-C showed melting point at 52 ± 0.02 °C and its entrapment efficiency was 96.26 ± 2.26%. The prepared hair serum containing NLC-C showed better spreading throughout the formulation than that containing the intact oil. Using 5% NLC-C showed a 78.8% reduction in firmness of the hair serum while enhancing diffusion efficiency by reducing shear forces up to 81.4%. In conclusion, the developed NLC-C of tea seed oil is an effective alternative in stimulating hair growth. Hair serum containing NLC-C obviously reduces sticky, oily, and greasy feeling after use.
... Trials in female pattern hair loss using hair counts as a primary endpoint have shown a mean increase in hair growth of 15-33% in the minoxidil-treated groups com- pared with 9-14% in the vehicle control groups. [33][34][35] One small study using hair weight as the endpoint found an increase of 42.5% in hair weights in the minoxidil group compared to 1.9% in the controls. 36 In the investigator and subject assessments minoxidil was superior to the vehicle but about 40% of subjects appeared not to respond to minoxidil. ...
... 36 In the investigator and subject assessments minoxidil was superior to the vehicle but about 40% of subjects appeared not to respond to minoxidil. 34,35 None of the trials has been extended beyond 32 weeks and the long- term results of minoxidil treatment are uncertain. In men the beneficial effects on hair growth are lost rapidly on cessation of treatment and it is likely that the same is true in women. ...
Article
Zusammenfassung: Haarausfall vom weiblichen Typ ist hufig und durch eine Reduktion der Haardichte im Bereich des Scheitels und der vorderen Kopfhaut bei Erhalt des Haaransatzes gekennzeichnet. Mit höherem Lebensalter steigt die Prvalenz. Im Allgemeinen wird diese Form des Effluviums als weibliches Pendant der mnnlichen Glatzenbildung betrachtet und auch als weibliche androgenetische Alopezie bezeichnet. Allerdings ist die Bedeutung der Androgene nicht vollstndig geklrt. Ohne Zweifel kann der Verlust der Kopfhaare ein Merkmal von Hyperandrogenismus bei Frauen sein, doch findet man bei vielen Frauen mit einem Haarausfall vom weiblichen Typ keine anderen klinischen oder biochemischen Hinweise für einen Androgenüberschuss. Haarausfall vom weiblichen Typ ist wahrscheinlich ein multifaktorielles, genetisch determiniertes Geschehen, und es ist möglich, dass sowohl Androgen-abhngige und Androgen-unabhngige Mechanismen zum Phnotyp beitragen. Im Umgang mit Patientinnen, die unter Haarausfall vom weiblichen Typ leiden, muss der Arzt sich immer bewusst sein, dass die unerwünschten Wirkungen auf die Lebensqualitt als sehr gravierend empfunden werden können und nicht unbedingt mit dem tatschlichen Haarverlust korrelieren müssen. Die gegenwrtig verfügbaren Behandlungsoptionen sind im Prinzip unbefriedigend, bewirken aber bei einigen Frauen durchaus eine leichte Verbesserung der Haardichte.Summary: Female pattern hair loss is a common condition characterised by a diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. The prevalence increases with advancing age. It has been widely thought to be the female counterpart of male balding and is often referred to as female androgenetic alopecia. However, the role of androgens is not fully established. Scalp hair loss is undoubtedly a feature of hyperandrogenism in women but many women with female pattern hair loss have no other clinical or biochemical evidence of androgen excess. Female pattern hair loss is probably a multifactorial genetically determined trait and it is possible that both androgen-dependent and androgen-independent mechanisms contribute to the phenotype. In managing patients with female pattern hair loss the physician should be aware that the adverse effects on quality of life can be quite severe and do not necessarily correlate with the objective degree of hair loss. The treatment options are currently limited but modest improvements in hair density are achievable in some women.
... These preparations are used as topical or oral applications. In the field of pharmaceutical products, Finasterid and Minoxidil are the best known preparations [7,9,15,17]. Finasterid, a competitive inhibitor of type 2 5-alpha reductase inhibits the transformation of testosterone to dihydrotestosterone ...
Article
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Hair loss, hair thinning, poorly growing hair and powerless or dull hair are common complaints in clinical dermatology. There is a need for products, which support the hair growing process and control some of the disturbances in the hair cycle dynamics. In context of a randomised, placebo-controlled clinical trial efficacy of a fenugreek seeds containing food supplement against hair loss is evaluated. The results indicate a successful treatment of low to moderate hair loss in women and men. Additionally, positive effects on hair growth were demonstrated.
... The safety and efficacy of minoxidil 2% solution in a combined regimen Currently, topical minoxidil (2%-5%) is the only US Food and Drug Administration (FDA)-approved treatment for FPHL. [17][18][19] Minoxidil's mode of action is androgen independent, and believed to affect hair growth by promoting the production of vascular endothelial growth factor, increasing the production of anti-inflammatory prostaglandin E2 (PGE2), and lengthening the duration of the anagen phase. 20,21 Although oral finesteride (1 mg) is approved for male AGA, it is not approved for women, and nor does it does it demonstrate consistent efficacy in women since FPHL is not exclusively androgen-dependent. ...
Article
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Female pattern hair loss (FPHL), also known as female androgenic alopecia, affects over 21 million women in the United States with devastating effects on self-esteem and psychosocial functioning. Topical minoxidil 2% and 5% formulations are the only US Food and Drug Administration-approved treatments for FPHL. The length of time it typically takes to observe the benefits is a challenge for many patients, and may affect adherence to treatment. Herbal extracts, which are also believed to promote healthier-looking hair, have a long history of use in hair care formulations. The safety and efficacy of a twice-daily regimen of 2% minoxidil solution used in combination with the botanical hair solution for 12 weeks in 54 subjects was evaluated in a multicenter, single-arm, open-label study. Assessments included investigator and subject ratings of improvement and subject satisfaction. Investigator ratings indicated significant improvement in hair growth and overall treatment benefits in as early as 6 weeks (P<.001). Subject self-ratings indicated significant satisfaction with hair volume and quality improvement at week 6 (P<.001). Subjects also indicated an increase in self-confidence and attractiveness at week 12 (P<.001). The investigator and subject-assessed efficacy and subject satisfaction with this regimen provides clinicians with an effective treatment option for FPHL that also provides a high level of patient acceptance, which ultimately may help promote minoxidil treatment adherence. J Drugs Dermatol. 2016;15(4):398-404.
... The 2 percent solution of minoxidil was approved for this use by the FDA in 1991 after it was found to be effective in two doubleblind, placebo-controlled, 32-week studies of 550 women who were 18 to 45 years old. 56,57 The minoxidil-treated women had significantly higher hair counts than the women who received placebo. In a third 32-week study (of eight women), in which hair weight was the primary end point, the average total hair weight increased by 42.5 percent in the minoxidil group as compared with 1.9 percent in the placebo group. ...
... VEGF mRNA and papilla [34,35,40]. Clinical studies have demonstrated that minoxidil is more efficient in promoting hair growth than placebo and other hair growth promoting drugs [12,16,21,32]. However, undesirable adverse events such as acute telogen effluvium and scalp dermatitis affect patient compliance [27]. ...
Article
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Tofacitinib is a Janus kinase 3 (JAK3) inhibitor that promotes hair growth; however, the efficacy and mechanism of this effect are not yet understood. This study aimed to evaluate the efficacy and mechanism of topical tofacitinib on hair growth in mice. Eight-week-old male C57BL/6 mice were divided equally into four groups and treated topically with tofacitinib, minoxidil, or vehicle once daily for 21 days. Weekly photographs were taken to determine the area and rate of hair growth, and tissue samples were collected for histopathological evaluation. mRNA and protein expression of anagen-maintaining growth factors, including vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1), were determined via RT-PCR and ELISA, respectively. Tofacitinib-treated mice exhibited more hair regrowth than either minoxidil-treated or control mice did between day 7 and 21 (P < 0.05). Topical tofacitinib also promoted more rapid hair growth rate than topical minoxidil or control did (P < 0.001). Histopathology showed a distinct increase in the number of hair follicles, mostly in the anagen phase, in the tofacitinib-treated group. Hair follicles in the minoxidil- and vehicle-treated groups were more often classified as catagen and anagen. VEGF mRNA and protein expression in the tofacitinib-treated group was significantly greater than those in the other groups (P < 0.05). IGF-1 mRNA expression was not upregulated in tofacitinib-treated mice. Topical tofacitinib is effective in promoting hair growth, and the possible mechanism involves increased VEGF levels and lowered inflammation. This study will help develop a new therapeutic option for non-scarring alopecia.
... Nineteen studies investigating the efficacy of topical minoxidil in female patients suffering from AGA could be included in the evidence-based evaluation. 31,32,45,46,48,[52][53][54][55][56][57][58][59][60][61][62][63][64][65] Seven studies obtained grade A2 evidence, nine studies grade B evidence, three studies grade C evidence resulting in an EVIDENCE LEVEL 1. ...
Article
Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian men and 42% of women. Patients afflicted with androgenetic alopecia may undergo significant impairment of quality of life. The European Dermatology Forum (EDF) initiated a project to develop evidence-based guidelines for the treatment of androgenetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.
... 29 Several randomized controlled trials have proven the effectiveness of topical 2% minoxidil for FPHL. 30,31 However, the 5% concentration has demonstrated much superiority over the 2% in a double-blind, placebo-controlled, multicenter trial of 381 patients with FPHL who received minoxidil 5% solution, minoxidil 2% solution, or placebo ...
Article
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Hair loss is a commonly encountered problem in clinical practice, with men presenting with a distinctive pattern involving hairline recession and vertex balding (Norwood-Hamilton classification) and women exhibiting diffuse hair thinning over the crown (increased part width) and sparing of the frontal hairline (Ludwig classification). Female pattern hair loss has a strikingly overwhelming psychological effect; thus, successful treatments are necessary. Difficulty lies in successful treatment interventions, as only two medications - minoxidil and finasteride - are approved for the treatment of androgenetic alopecia, and these medications offer mediocre results, lack of a permanent cure, and potential complications. Hair transplantation is the only current successful permanent option, and it requires surgical procedures. Several other medical options, such as antiandrogens (eg, spironolactone, oral contraceptives, cyproterone, flutamide, dutasteride), prostaglandin analogs (eg, bimatoprost, latanoprost), and ketoconazole are reported to be beneficial. Laser and light therapies have also become popular despite the lack of a profound benefit. Management of expectations is crucial, and the aim of therapy, given the current therapeutic options, is to slow or stop disease progression with contentment despite patient expectations of permanent hair regrowth. This article reviews current perspectives on therapeutic options for female pattern hair loss.
... The overall growth was moderate in 13% of treated versus 6% in placebo, and minimal growth in 50% versus 33% in placebo group. [66] No serious medical adverse effects were reported. ...
Article
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Female pattern hair loss (FPHL) is a common cause of hair loss in women characterized by diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. Its prevalence increases with advancing age and is associated with significant psychological morbidity. The pathophysiology of FPHL is still not completely understood and seems to be multifactorial. Although androgens have been implicated, the involvement of androgen-independent mechanisms is evident from frequent lack of clinical or biochemical markers of hyperandrogenism in affected women. The role of genetic polymorphisms involving the androgen and estrogen receptors is being increasingly recognized in its causation and predicting treatment response to anti-androgens. There are different clinical patterns and classifications of FPHL, knowledge of which facilitates patient management and research. Chronic telogen effluvium remains as the most important differential diagnosis. Thorough history, clinical examination, and evaluation are essential to confirm diagnosis. Patients with clinical signs of androgen excess require assessment of biochemical parameters and imaging studies. It is prudent to screen the patients for metabolic syndrome and cardiovascular risk factors. The treatment comprises medical and/or surgical modalities. Medical treatment should be initiated early as it effectively arrests hair loss progression rather than stimulating regrowth. Minoxidil continues to be the first line therapy whereas anti-androgens form the second line of treatment. The progressive nature of FPHL mandates long-term treatment for sustained effect. Medical therapy may be supplemented with cosmetic concealment in those desirous of greater hair density. Surgery may be worthwhile in some carefully selected patients.
... None of the studies calculated power sample size within their protocols. Samples sizes of the studies in this systematic review were considerably lower than those used in pharmaceutical trials investigating hair loss treatments (31,34,36). Low statistical power may adversely affect the likelihood that statistically significant findings found within the LLLT studies reflect a true effect, and can cause an overestimation of effect size and low reproducibility of results. ...
Article
Alopecia is a common disorder affecting over half of the world’s population. Within this condition,androgenic alopecia (AA) is the most common type, affecting 50% of males over 40 and 75% of females over 65. Anecdotal paradoxical hypertrichosis noted during laser epilation has generated interest in thepossibility of using laser to stimulate hair growth. In this study, we aimed to critically appraise the application of low-level laser therapy for the treatment of AA in adults. A systematic review was performed on studies identified on Medline, EMBASE, Cochrane database, and clinicaltrials.org. Double-blinded randomized controlled trials were selected and analyzed quantitatively (meta-analysis) and qualitatively (quality of evidence, risk of bias). Low-level laser therapy appears to be a promising noninvasive treatment for AA in adults that is safe for self-administration in the home setting. Although shown to effectively stimulate hair growth when compared to sham devices, these results must be interpreted with caution. Further studies with larger samples, longer follow-up, and independent funding sources are necessary to determine the clinical effectiveness of this novel therapy.
... We have come across two studies of 2% minoxidil in females, by Whiting, Jacobson 1992 (7) and Jacobs, Szpunar, Warner 1993 (8). The duration of these studies was 32 weeks compared to the present study being 6 months or 24 weeks. ...
Article
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Abstract: Background: Reports dating 1932, (86 years prior) emphasise the role of iron deficiency in hair loss. However, blood tests sometimes show normal iron levels in these patients. Should we still include iron in our treatment or conclude that iron has no role in hair loss management? In an attempt to review the dilemma we have come across studies recommending intermittent iron therapy, which as a low dose supplement, can be utilized even in the absence of overt deficiencies. A clinical comparison of hair loss patients having normal haemoglobin is presented with standard 2% minoxidil treatment versus intermittent iron therapy once in three days and comprehensive iron therapy along with intermittent once in three days, inclusion of other hair nutrients, antioxidants, vitamins, calcium, aminoacids and omega 3. Objective: Review the role of iron in hair loss management. Understand why hair loss patients sometimes present with normal iron reports. Evaluate if intermittent iron therapy can help in hair loss management. Evaluate if by the same analogy, inclusion of other intermittent hair nutrients along with iron therapy can deliver better hair growth in addition to controlling hair loss. Method: Sixty women volunteers having hair loss despite normal haemoglobin, were enlisted for this prospective study. Three groups of twenty women each were created. Treatment group I, received standard hair loss treatment with 2% minoxidil. Iron therapy group II, received intermittent iron therapy and the nutrition group III, received intermittent iron with intermittent inclusion of antioxidants, vitamins, calcium, aminoacids and omega 3 which are known to benefit hair loss management. Results were evaluated with global photography, trichoscopy counts for hair density and hair calibre. Observations: Minoxidil 2% group I had reduction in hair fall after 10 weeks. This group at the end of 6 months had 9% improvement in density, with 17% non responders and 3% worsening of the condition. The intermittent iron therapy group II, had reduction of hair fall after 8 weeks and 16% improvement in density over 6 months. The group III, with Intermittent iron plus intermittent antioxidants, vitamins, calcium, aminoacids and omega 3 had the best benefit showing reduction in hair fall after 4 weeks and 21% improvement in density over 6 months. This group also showed 12% improvement in hair calibre over 6 months. There were no non responders or worsening of condition in group II & III. Conclusion: Iron is an integral part of hair loss management program. Compensation of low iron levels by autophagy or arrest of hair growth make iron available to maintain normal levels in circulation which may mislead to us believe that there is no iron deficiency. Other nutrients antioxidants, vitamins, calcium, aminoacids and omega 3 are required to ensure complete utilization of iron and also support active hair growth. We present clinical evidence that intermittent iron therapy once in three days along with comprehensive inclusion of other nutrients once in three days consistently results in control of hair loss along with new hair growth. The comprehensive intermittent therapy, can be a considered for management of hair loss without waiting for the evidence of detecting low nutrient levels through laboratory tests.
... Earlier to the present study, Jacobs et al. [9] found that topical minoxidil solution was significantly more effective than placebo in the treatment of FPHL and no serious side effects were reported during the study. ...
Article
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Background: Female pattern hair loss is a common cause of alopecia in women that predominately affects postmenopausal women and is characterized by a decrease in hair density over the crown and frontal scalp. The aim of this study was a clinical and trichoscopic evaluation of topical minoxidil 2% solution in treatment of female pattern hair loss. Methods: A clinical trial was done with twenty patients with female pattern hair loss. The studied patients were treated with minoxidil 2% topical solution twice daily for six months. A clinical and trichoscopic examination were done before starting treatment and every two months with photo-documentation, and scoring of disease severity using Ludwig Scale. Results: Regarding hair growth, a significant difference was detected between baseline and both 4 and 6 months. 55% of studied patients reported side effects. Conclusion: Minoxidil stimulates hair growth after 4 months of treatment but with side effects as dermatitis and hypertrichosis.
... However, even the patients who are fortunate enough to get noticed and receive medical care are frequently unsatisfied with the outcomes. Human trials have shown that more than 50% of women with FPHL do not respond to 2% topical minoxidil and are unsatisfied with this treatment [11].On the other hand, finasteride is no more effective than placebo in women with pattern hair loss [12]. Most patients participating in our study represent the non-respondent, difficult-to-treat patients that are in grave need for a novel and effective treatment. ...
... Minoxidil. Minoxidil ist die zweite Substanz, für die eine Wirksamkeit bei der AGA belegt ist [17,18] [18]. Auch die Lebensqua− lität unter der 5 %−igen Lösung verbesserte sich, obwohl subjektive, direkte Nebenwirkungen wie Pruritus in der Gruppe mit 5 %−iger Lösung stärker ausgeprägt waren als in der Gruppe mit 2 %−iger Lösung [18]. ...
Book
Hair disorders have become a central social and psychological issue with increasing demands and expectations from patients. Written by world-renowned experts, this lavishly illustrated textbook provides the latest scientific aspects of hair biology, up-to-date knowledge on hair diagnosis and treatment options as well as hair removal and restoration techniques. The well-structured content is divided into three sections: * Basic aspects of hair growth * Hair and scalp disorders * Fotoepilation, surgery and hair cosmetics It also contains unique sections on hair at different ages, in art and in forensic investigations as well as ethnic hair.
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Background Patterned hair loss (PHL) is a distressing common problem. It is associated with progressive reduction in hair density and hair fiber thickness, affecting mainly the frontovertical regions of the scalp. The available lines of treatment are not uniformly effective. Platelet-rich plasma and microneedling have been introduced recently to the armamentarium of treatment. Their comparative efficacy to topical minoxidil has not been evaluated. Objective To assess the efficacy of combined PRP mesotherapy and microneedling in the treatment of PHL compared with 5% topical minoxidil. Patients and methods Forty patients with clinically diagnosed PHL were recruited after exclusion of other causes of hair loss. They were divided into two equal age-matched, sex-matched, and severity-matched groups. The first group received 2ml of 5% topical minoxidil, whereas the other group received monthly sessions of combined platelet-rich plasma mesotherapy and scalp microneedling. The effect of the treatment was evaluated by a blinded investigator who graded the patient's alopecia and performed a nonvellus hair count in a target area after 12 and 28 weeks of treatment. Patients' satisfaction with treatment, their reported change in hair shedding rate, and side effects were recorded. Results Both treatment modalities were comparably effective in improving hair density and alopecia grade. Patients' satisfaction was comparable with both modalities. Both lines were well tolerated; however, the onset of action of minoxidil was significantly quicker. Conclusion Topical minoxidil remains the first-line of treatment for patients with PHL, given its efficacy, tolerability, and relatively low cost. Platelet-rich plasma with microneedling could be considered an effective second-line therapy for intolerant or unfit patients for minoxidil.
Article
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Female pattern hair loss, or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on people. To determine the effectiveness and safety of the available options for the treatment of female pattern hair loss in women. We searched the following databases up to October 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2011, Issue 4), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), Web of Science (from 1945), and reference lists of articles. We also searched several online trials registries for ongoing trials. Randomised controlled trials that assessed the effectiveness of interventions for female pattern hair loss in women. Two review authors independently assessed trial quality and extracted data. Twenty two trials, comprising 2349 participants, were included. A wide range of interventions were evaluated, with 10 studies investigating the different concentrations of minoxidil. Pooled data from 4 studies indicated that a greater proportion of participants (121/488) treated with minoxidil reported a moderate increase in their hair regrowth when compared with placebo (64/476) (risk ratio (RR) = 1.86, 95% confidence interval (CI) 1.42 to 2.43). In 7 studies, there was an important increase of 13.28 in total hair count per cm(2) in the minoxidil group compared to the placebo group (95% CI 10.89 to 15.68). There was no difference in the number of adverse events in the twice daily minoxidil and placebo intervention groups, with the exception of a reported increase of adverse events (additional hair growth on areas other than the scalp) with minoxidil (5%) twice daily. Most of the other comparisons consisted of single studies. These were assessed as high risk of bias: They did not address our prespecified outcomes and provided limited evidence of either the efficacy or safety of these interventions. Although more than half of the included studies were assessed as being at high risk of bias, and the rest at unclear, there was evidence to support the effectiveness and safety of topical minoxidil in the treatment of female pattern hair loss. Further direct comparison studies of minoxidil 5% applied once a day, which could improve adherence when compared to minoxidil 2% twice daily, are still required. Consideration should also be given to conducting additional well-designed, adequately-powered randomised controlled trials investigating several of the other treatment options.
Article
Female pattern hair loss, or female pattern androgenetic alopecia, is a nonscarring alopecia with a multi-factorial etiology that mostly affects postmenopausal women and is characterized by a reduction in hair density over the crown and frontal scalp. The clinical picture is characterized by a diffuse rarefaction of scalp hair over the mid-frontal scalp and a more-or-less intact frontal hairline without any signs of inflammation or scarring. Although the disease poses only a cosmetic concern, it is chronic and may have a significant negative psychological impact on the affected person. The aim of treating female pattern hair loss is to reduce hair loss and, to a certain extent, succeed in promoting hair regrowth. Various treatment methods are available, but it remains unclear which are the most effective. Early initiation of treatment and the combination of various modalities seem to be more efficacious than monotherapy.
Article
Zusammenfassung: Haarausfall vom weiblichen Typ ist häufig und durch eine Reduktion der Haardichte im Bereich des Scheitels und der vorderen Kopfhaut bei Erhalt des Haaransatzes gekennzeichnet. Mit höherem Lebensalter steigt die Prävalenz. Im Allgemeinen wird diese Form des Effluviums als weibliches Pendant der männlichen Glatzenbildung betrachtet und auch als weibliche androgenetische Alopezie bezeichnet. Allerdings ist die Bedeutung der Androgene nicht vollständig geklärt. Ohne Zweifel kann der Verlust der Kopfhaare ein Merkmal von Hyperandrogenismus bei Frauen sein, doch findet man bei vielen Frauen mit einem Haarausfall vom weiblichen Typ keine anderen klinischen oder biochemischen Hinweise für einen Androgenüberschuss. Haarausfall vom weiblichen Typ ist wahrscheinlich ein multifaktorielles, genetisch determiniertes Geschehen, und es ist möglich, dass sowohl Androgen-abhängige und Androgen-unabhängige Mechanismen zum Phänotyp beitragen. Im Umgang mit Patientinnen, die unter Haarausfall vom weiblichen Typ leiden, muss der Arzt sich immer bewusst sein, dass die unerwünschten Wirkungen auf die Lebensqualität als sehr gravierend empfunden werden können und nicht unbedingt mit dem tatsächlichen Haarverlust korrelieren müssen. Die gegenwärtig verfügbaren Behandlungsoptionen sind im Prinzip unbefriedigend, bewirken aber bei einigen Frauen durchaus eine leichte Verbesserung der Haardichte.
Chapter
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. It is typically characterized by hyperandrogenism, chronic anovulation, and the presence of polycystic ovaries. Dermatologic manifestations commonly encountered in women with PCOS include hirsutism, acne vulgaris, and androgenic alopecia or female hair loss. This chapter reviews the treatments for these clinical manifestations that are attributed to androgen excess in women with PCOS. © 2014 Springer Science+Business Media New York. All rights are reserved.
Article
• Decrease in hair density in the central (vertex, mid and frontal) scalp, bitemporal and parietal regions in women. • Miniaturization of affected hairs. • Two ages of onset: early (post-puberty to third decade) and late (age 40+ years). • Signs of hyperandrogenism (hirsutism, irregular periods) or hyperandrogenemia occur in a subset of women with female pattern hair loss (FPHL) but most women with FPHL have neither. • Many, but not all, affected women respond to antiandrogens or 5α-reductase inhibitors with increased hair growth indicating an androgen etiology in at least some cases of FPHL.
Article
Two percent topical minoxidil is the only US Food and Drug Administration-approved drug for the treatment of female androgenetic alopecia (AGA). Its success has been limited by the low percentage of responders. Meta-analysis of several studies reporting the number of responders to 2% minoxidil monotherapy indicates moderate hair regrowth in only 13–20% of female patients. Five percent minoxidil solution, when used off-label, may increase the percentage of responders to as much as 40%. As such, a biomarker for predicting treatment response would have significant clinical utility. In a previous study, Goren et al. reported an association between sulfotransferase activity in plucked hair follicles and minoxidil response in a mixed cohort of male and female patients. The aim of this study was to replicate these findings in a well-defined cohort of female patients with AGA treated with 5% minoxidil daily for a period of 6 months. Consistent with the prior study, we found that sulfotransferase activity in plucked hair follicles predicts treatment response with 93% sensitivity and 83% specificity. Our study further supports the importance of minoxidil sulfation in eliciting a therapeutic response and provides further insight into novel targets for increasing minoxidil efficacy.
Chapter
Prescribing topical treatment Formulation of topical treatment Topical treatments used in the management of skin disease References
Article
Young doctors want flexible career paths, not long term commitmentsYoung doctors are not choosing to train or settle in general practice as they did a decade ago, which has serious implications for training schemes and practices recruiting new partners. Changes in the NHS may partly explain this. Baker et al found that the four commonest reasons given by qualified general practitioners for not practising as principals were the commitment out of hours, difficulty combining work with family commitments, requirements of the general practice contract, and increasing demands from patients.1A broader shift in values and expectations of work may also be occurring, and we need to understand the social context in which young graduates have grown up. The old certainties of work and family life have …
Article
In the United States, an increasing number of individuals are identifying as transgender. Males at birth who identify as females are called male-to-female (MTF) transgender individuals or trans women, and females at birth who identify as males are called female-to-male (FTM) transgender individuals or trans men. The transgender patient population possess unique health concerns disparate from those of the general populace. Exogenous hormone therapy for transgender patients leads to changes in the distribution and pattern of hair growth. Exogenous testosterone can lead to male pattern hair loss and hirsutism, while estrogen therapy usually results in decreased facial and body hair growth and density. A thorough understanding of the hormonal treatments that may be used in transgender individuals as well the unique and complex biologic characteristics of the hair follicle is required for appropriate diagnosis, counseling and treatment of patients. The aim of this article is to provide a framework for understanding hair disorders in transgender individuals and effective treatment options.
Article
Background and objective: Various treatments exist for androgenetic alopecia (AGA); we determined the relative efficacies of non-surgical AGA monotherapies separately for men and women. Methods: Randomized controlled trials (RCTs) were systematically searched in PubMed, EMBASE, Scopus and clinicaltrials.gov. Separate networks were used for men and women; for each network, a Bayesian network meta-analysis (NMA) of mean change in hair count from baseline (in units of hairs per squared centimetre) was performed using a random effects model. Results: The networks for male and female AGA included 30 and 10 RCTs, respectively. We identified the following treatments for male AGA in decreasing rank of efficacy: platelet-rich plasma (PRP), low-level laser therapy (LLLT), 0.5mg dutasteride, 1mg finasteride, 5% minoxidil, 2% minoxidil, and bimatoprost. For female AGA the following were identified in decreasing rank of efficacy: LLLT, 5% minoxidil, and 2% minoxidil. The evidence quality of the highest ranked therapies, for male and female AGA, was judged to be low. Conclusions: While newer treatments like LLLT may be more efficacious than more traditional therapies like 5% minoxidil, the efficacy of the more recent treatment modalities needs to be further validated by future RCTs.
Article
Introduction This systematic review aims to examine surgical and non-surgical treatments and identify those procedures that are most effective in terms of patient satisfaction. Materials and Methods A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. The search was conducted in accordance with the PRISMA guidelines, the Cochrane handbook. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, and Cochrane databases was performed to identify studies on hair loss causes and hair loss treatment with different surgical and non-surgical techniques Results Our search generated a total of 781 articles; 646 studies were excluded based on the content of the abstracts, and an additional 105 studies were excluded based on the content of the complete article. We performed a review of the 30 remaining studies, which had sufficient data for inclusion, and met all the aforementioned inclusion criteria. Of the 30 studies, four were about minoxidil, four about finasteride, two about dutasteride, three about phototherapy, six about platelet-rich plasma injection, four about follicular unit transplantation technique, six about follicular unit extraction technique, and one about patient satisfaction following surgical treatment without a specified surgical technique. Only three studies used a patient-reported outcome measurement. Conclusions Our study is the first comprehensive systematic review of hair loss, looking at the problem from different points of view, and focusing on finding the best solution for the patient. In the literature, there is currently no algorithm for the management of patients who go to a plastic surgeon for a solution to the problem of hair loss. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Article
Background While dermatologists focus on practices to promote anti‐aging, thinning hair that frames a more rejuvenated face can affect age perception and cosmesis. Objectives To characterize the effects of age‐related hair changes on age determination and perceived attractiveness. Methods A search was conducted for articles on intrinsic and extrinsic aging as it relates to hair. Key studies on the hair aging process and its effects on self‐perception, confidence, and anti‐aging were reviewed. Results According to several studies, hair density peaks about 27 years of age or earlier and then decreases from the mid‐thirties onward. This serves as an opportunity to prevent or treat hair loss in a similar way we treat aging skin. Without optimizing appearance of hair, overall cosmesis to foster self‐perception can be curtailed despite multiple efforts to rejuvenate and restore the aging face. Conclusion The discrepancy between rejuvenated faces and thinner appearing hair that frames the face highlights the importance of a holistic approach to the anti‐aging consultation. To more comprehensively address the aesthetic patient, we need to promote awareness of the onset of these hair changes in order to incorporate prevention and therapeutic strategies to preserve hair to complement overall appearance.
Article
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Androgenetic alopecia (AGA) is characterized by non-scarring follicle miniaturization. Despite the success of approved therapies, commonly reported side effects and the need for continual use has led to the investigation of alternative therapies. The aim of this paper is to critically review the success of off-label, topical monotherapies for treatment of AGA in men. A literature search was conducted to obtain randomized, controlled and blinded studies that investigated off-label, topical, monotherapies in male patients. Hair density, hair diameter and hair growth were used to evaluate treatment success. Fourteen off-label topical therapies were investigated among the 16 studies that met inclusion criteria. Nine off-label therapies were reported to produce a significantly greater improvement in hair restoration parameters (e.g. mean change from hair count and hair diameter) as compared to placebo (p < 0.05 for all treatments). In two studies, procyanidin oligomers exhibited greater efficacy over vehicle with response to mean change in hair density (hairs/cm2) (ps < 0.0001 at Week 24). In conclusion, prostaglandin analogs and polyphenols, such as latanoprost and procyanidin oligomers, can improve hair restoration parameters in male AGA patients, possibly through targeting mechanisms proposed in the etiology of AGA. The current evidence suggests short-term (24 weeks) use may provide benefit for hair loss patients; however, long-term efficacy and safety data are required.
Article
Several studies have established that sulfotransferase enzyme activity in the outer root sheath of plucked hair follicles predicts response to topical minoxidil in the treatment of pattern hair loss. However, the prevalence of this enzyme activity among Indian patients has not been studied. Additionally, no reports in the literature characterize sulfotransferase activity based on sex, age, duration of hair loss, grade of hair loss, and family history. In this study we utilized a sulfotransferase activity assay first reported by Goren et al. We characterize the follicular sulfotransferase activity of 120 pattern hair loss patients visiting a dermatology outpatient clinic in India. Overall, 40.8% of patients with pattern hair loss had low levels of sulfotransferase. Surprisingly, 49.3% of men had low levels of sulfotransferase compared to 26.6% of women. No correlation was found between sulfotransferase activity and age, duration of hair loss, grade of hair loss, or family history. A sub‐analysis of patient reported outcomes (PRO) validated previous findings that sulfotransferase enzyme activity is a predictive marker for minoxidil response in pattern hair loss patients.
Article
Male‐pattern hair loss (MPHL, androgenetic alopecia) is a slowly progressive form of alopecia which begins after puberty. In 2010, we published the first Japanese edition of guidelines for the diagnosis and treatment of MPHL. It achieved the original goal of providing physicians and patients in Japan with evidence‐based information for choosing efficacious and safe therapy for MPHL. Subsequently, new therapeutic drugs and treatment methods have been developed, and women's perception of MPHL has undergone change and the term “female‐pattern hair loss (FPHL)” is becoming more common internationally. Thus, here we report a revised version of the 2010 guidelines aimed at both MPHL and FPHL. In these guidelines, finasteride 1 mg daily, dutasteride 0.5 mg daily and topical 5% minoxidil twice daily for MPHL, and topical 1% minoxidil twice daily for FPHL, are recommended as the first‐line treatments. Self‐hair transplantation, irradiation by light‐emitting diodes and low‐level lasers, and topical application of adenosine for MPHL are recommended, whereas prosthetic hair transplantation and oral administration of minoxidil should not be performed. Oral administration of finasteride or dutasteride are contraindicated for FPHL. In addition, we have evaluated the effectiveness of topical application of carpronium chloride, t‐flavanone, cytopurine, pentadecane and ketoconazole, and wearing a wig. Unapproved topical application of bimatoprost and latanoprost, and emerging hair regeneration treatments have also been addressed. We believe that the revised guidelines will improve further the diagnostic and treatment standards for MPHL add FPHL in Japan.
Article
Androgenetic alopecia, or male/female pattern baldness, is the most common type of progressive hair loss disorder. The aim of this paper is to review recent advances in non‐surgical treatments for androgenetic alopecia and identify the most effective treatments. A network meta‐analysis (NMA) was conducted of the available literature of the six most common non‐surgical treatment options for treating androgenetic alopecia in both men and women; dutasteride 0.5mg, finasteride 1mg, low level laser therapy (LLLT), minoxidil 2%, minoxidil 5% and platelet rich plasma (PRP). Seventy‐eight studies met the inclusion criteria and twenty‐two studies had the data necessary for a network meta‐analysis. Relative effects show LLLT as the superior treatment. Relative effects show PRP, finasteride 1 mg (male), finasteride 1 mg (female), minoxidil 5%, minoxidil 2% and dutasteride (male) are approximately equivalent in mean change hair count following treatment. Minoxidil 5% and minoxidil 2% reported the most drug‐related adverse events (n=45 and n=23, respectively). The quality of evidence of minoxidil 2% vs. minoxidil 5% was high; minoxidil 5% vs. placebo was moderate; dutasteride (male) vs. placebo, finasteride (female) vs placebo, minoxidil 2% vs. placebo, minoxidil 5% vs. LLLT was low and finasteride (male) vs. placebo, LLLT vs. sham, PRP vs. placebo, finasteride vs. minoxidil 2% was very low. Results of this NMA indicate the emergence of novel, non‐hormonal therapies as effective treatments for hair loss; however, the quality of evidence is generally low. High quality randomized controlled trials and head to head trials are required to support these findings and aid in the development of more standardized protocols, particularly for PRP. Regardless, this analysis may aid physicians in clinical decision making and highlight the variety of non‐surgical hair restoration options for patients. This article is protected by copyright. All rights reserved.
Article
Background: Androgenetic alopecia, or male pattern hair loss, is a hair loss disorder mediated by dihydrotestosterone, the potent form of testosterone. Currently, minoxidil and finasteride are Food and Drug Administration (FDA)-approved, and HairMax LaserComb, which is FDA-cleared, are the only treatments recognized by the FDA as treatments of androgenetic alopecia. Objective: This systematic review and meta-analysis assesses the efficacy of nonsurgical treatments of androgenetic alopecia in comparison to placebo for improving hair density, thickness, growth (defined by an increased anagen:telogen ratio), or subjective global assessments done by patients and investigators. Methods: A systematic review of randomized controlled trials was conducted. PubMed, Embase, and Cochrane were searched up to December 2016, with no lower limit on the year. We included only randomized controlled trials of good or fair quality based on the US Preventive Services Task Force quality assessment process. Results: A meta-analysis was conducted separately for 5 groups of studies that tested the following hair loss treatments: low-level laser light therapy in men, 5% minoxidil in men, 2% minoxidil in men, 1 mg finasteride in men, and 2% minoxidil in women. All treatments were superior to placebo (P < .00001) in the 5 meta-analyses. Other treatments were not included because the appropriate data were lacking. Limitations: High heterogeneity in most studies. Conclusions: This meta-analysis strongly suggests that minoxidil, finasteride, and low-level laser light therapy are effective for promoting hair growth in men with androgenetic alopecia and that minoxidil is effective in women with androgenetic alopecia.
Article
Female pattern hair loss typically presents with a history of gradual thinning of scalp hair and widening of the central parting. The prevalence and severity increase with age. Hair loss is due to a gradual decline in the production of hair by scalp hair follicles culminating in follicular miniaturization. Medical treatment can help to prevent progression of hair loss and may promote modest regrowth of hair but is probably unable to reverse follicular miniaturization.
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Dermatologists have the good fortune to work on the most accessible organ of the body. Many inflammatory and neoplastic conditions can be effectively managed using the wide range of locally applied physical or pharmacological modalities that are available. The latter are the subject of this chapter, which reviews the pharmacological treatments used topically, i.e. by application to the surface of the skin. Some of these are time-honoured treatments that have been used for a century or more, whilst others belong to the ever-expanding range of newer and increasingly potent agents constantly being developed and formulated for topical use. Topical treatment offers the potential to achieve high concentrations of a drug in the skin with minimal exposure of other organs. This can greatly increase efficacy and also safety relative to systemic administration. When side effects do occur, they are most likely to take the form of localized reactions.
Chapter
Formulation of topical treatmentTopical treatments used in the management of skin disease
Article
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Background: Female pattern hair loss (FPHL), or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on women. Objectives: To determine the efficacy and safety of the available options for the treatment of female pattern hair loss in women. Search methods: We updated our searches of the following databases to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (2015, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1872), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), and Web of Science (from 1945). We also searched five trial registries and checked the reference lists of included and excluded studies. Selection criteria: We included randomised controlled trials that assessed the efficacy of interventions for FPHL in women. Data collection and analysis: Two review authors independently assessed trial quality, extracted data and carried out analyses. Main results: We included 47 trials, with 5290 participants, of which 25 trials were new to this update. Only five trials were at 'low risk of bias', 26 were at 'unclear risk', and 16 were at 'high risk of bias'.The included trials evaluated a wide range of interventions, and 17 studies evaluated minoxidil. Pooled data from six studies indicated that a greater proportion of participants (157/593) treated with minoxidil (2% and one study with 1%) reported a moderate to marked increase in their hair regrowth when compared with placebo (77/555) (risk ratio (RR) = 1.93, 95% confidence interval (CI) 1.51 to 2.47; moderate quality evidence). These results were confirmed by the investigator-rated assessments in seven studies with 1181 participants (RR 2.35, 95% CI 1.68 to 3.28; moderate quality evidence). Only one study reported on quality of life (QoL) (260 participants), albeit inadequately (low quality evidence). There was an important increase of 13.18 in total hair count per cm² in the minoxidil group compared to the placebo group (95% CI 10.92 to 15.44; low quality evidence) in eight studies (1242 participants). There were 40/407 adverse events in the twice daily minoxidil 2% group versus 28/320 in the placebo group (RR 1.24, 95% CI 0.82 to 1.87; low quality evidence). There was also no statistically significant difference in adverse events between any of the individual concentrations against placebo.Four studies (1006 participants) evaluated minoxidil 2% versus 5%. In one study, 25/57 participants in the minoxidil 2% group experienced moderate to greatly increased hair regrowth versus 22/56 in the 5% group (RR 1.12, 95% CI 0.72 to 1.73). In another study, 209 participants experienced no difference based on a visual analogue scale (P = 0.062; low quality evidence). The assessments of the investigators based on three studies (586 participants) were in agreement with these findings (moderate quality evidence). One study assessed QoL (209 participants) and reported limited data (low quality evidence). Four trials (1006 participants) did not show a difference in number of adverse events between the two concentrations (RR 1.02, 95% CI 0.91 to 1.20; low quality evidence). Both concentrations did not show a difference in increase in total hair count at end of study in three trials with 631 participants (mean difference (MD) -2.12, 95% CI -5.47 to 1.23; low quality evidence).Three studies investigated finasteride 1 mg compared to placebo. In the finasteride group 30/67 participants experienced improvement compared to 33/70 in the placebo group (RR 0.95, 95% CI 0.66 to 1.37; low quality evidence). This was consistent with the investigators' assessments (RR 0.77, 95% CI 0.31 to 1.90; low quality evidence). QoL was not assessed. Only one study addressed adverse events (137 participants) (RR 1.03, 95% CI 0.45 to 2.34; low quality evidence). In two studies (219 participants) there was no clinically meaningful difference in change of hair count, whilst one study (12 participants) favoured finasteride (low quality evidence).Two studies (141 participants) evaluated low-level laser comb therapy compared to a sham device. According to the participants, the low-level laser comb was not more effective than the sham device (RR 1.54, 95% CI 0.96 to 2.49; and RR 1.18, 95% CI 0.74 to 1.89; moderate quality evidence). However, there was a difference in favour of low-level laser comb for change from baseline in hair count (MD 17.40, 95% CI 9.74 to 25.06; and MD 17.60, 95% CI 11.97 to 23.23; low quality evidence). These studies did not assess QoL and did not report adverse events per treatment arm and only in a generic way (low quality evidence). Low-level laser therapy against sham comparisons in two separate studies also showed an increase in total hair count but with limited further data.Single studies addressed the other comparisons and provided limited evidence of either the efficacy or safety of these interventions, or were unlikely to be examined in future trials. Authors' conclusions: Although there was a predominance of included studies at unclear to high risk of bias, there was evidence to support the efficacy and safety of topical minoxidil in the treatment of FPHL (mainly moderate to low quality evidence). Furthermore, there was no difference in effect between the minoxidil 2% and 5% with the quality of evidence rated moderate to low for most outcomes. Finasteride was no more effective than placebo (low quality evidence). There were inconsistent results in the studies that evaluated laser devices (moderate to low quality evidence), but there was an improvement in total hair count measured from baseline.Further randomised controlled trials of other widely-used treatments, such as spironolactone, finasteride (different dosages), dutasteride, cyproterone acetate, and laser-based therapy are needed.
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Clinical trichology should represent an integral part of medical training, and the dermatologist participates with the other medical disciplines in the diagnosis and treatment of all types of hair problems relating to systemic disease. On the other hand, hair loss is an important cause of discomfort and disability. The general physician is not always aware of the significance of hair loss and therefore may fail to refer patients with hair disorders to the dermatologist for appropriate management. Too often, the delay of correct diagnosis, and as a result the delay of appropriate therapy, leads to potentially irreversible loss of hair, prolongs the discomfort, and promotes the disfigurement. Knowledge of the main types of hair loss is prerequisite to providing appropriate patient care.
Article
Female pattern hair loss (FPHL), a type of hair disease common in pre- and postmenopausal women, is characterized by thinning of hair to O-type, mainly at the crown. Although a mouse model of this disease has recently been established, its details are still unknown, and thus, warrants further analysis. In this study, 3 week-old and 7- to 8 week-old C57BL/6 female mice were divided into two groups: one group underwent ovariectomy (OVX), while the other underwent sham surgery. In the 3 week-old mice, the dorsal skin was collected at seven weeks of age, while in the 7- to 8 week-old mice, it was collected at 12 and 24 weeks of age. In the former group, both the pore size of the hair follicles (HFs) and diameter of the hair shaft of telogen HFs decreased upon OVX; while in the latter group, these factors increased significantly. Notably, the thickness of the dermis and subcutis increased significantly in the OVX group. It needs to be further elucidated whether OVX mouse could serve as an ideal mouse model for FPHL, but our results upon evaluation of skin thickness indicate that it could be used to establish a novel treatment for non-hair-related diseases, such as post-menopause-related skin condition.
Article
Globally, hair loss negatively affects the lives of Asian women as it does women of other races [1,2]. In a study involving Caucasian women, those with highly visible hair loss reported a more negative impact on four dimensions (functioning, emotions, self-confidence, and stigmatization) compared with patients whose hair loss was only slightly visible [1]. This negative effect was similarly seen among Asian women in a study done in Singapore, which revealed that women with female pattern hair loss were socially embarrassed and unhappy about their condition [2]. For these aforementioned reasons, most patients in the Asian study sought treatment for their problem. Depending on the cause of hair loss, various treatment options are available. Although medical therapy is the treatment option for certain etiologies, for the other causes such as female pattern hair loss, hair transplatation may be a major consideration, especially with the newer techniques that lead to natural-looking results.
Article
Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80 % Caucasian men and 42 % of women. Patients diagnosed with androgenetic alopecia may undergo significant impairment of quality of life. Despite the high prevalence and the variety of therapeutic options available, there have been no national or international evidence-based guidelines for the treatment of androgenetic alopecia in men and women so far. Therefore, the European Dermatology Forum (EDF) initiated a project to develop an evidence-based S3 guideline for the treatment of andro-genetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists as well as general practitioners with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.
Article
Full-text available
The unit area trichogram was defined in the frontal and occipital areas of ten normal men and ten normal women and the results compared with the findings in ten male and fifteen female patients with androgenic alopecia. The epilation technique provided accurate data of normal hair density (higher than previously reported) and the phases of hair growth. The measurement of hair diameter showed that of 7603 hairs, 1241 were less than 40 microns in diameter, of which only 21 were more than 80 mm in length. Variation in the diameter of individual hair fibres was recorded. The number of hairs less than 40 microns diameter per cm2 of scalp was increased in both men and women with androgenic alopecia. It was concluded that the number of hairs greater than 40 microns in diameter per cm2 (meaningful density) reflected most closely the amount of hair usefully contributing to an individual's clinical appearance.
Article
This review outlines the findings associated with topical minoxidil use. Approximately one-third of the treated patients will obtain terminal hair growth using a 2 to 3% solution twice a day. Patients should receive treatment for a minimum of six months to evaluate the drug's efficacy. Factors associated with patients who obtained new hair growth include: a thinning versus absolute baldness, treatment initiated at a relatively younger age, and hair growth noted within three months. Following a positive growth response, there may be a reduction in new hair growth gained with minoxidil use for more than one year. Stopping the medication is associated with an exacerbation of hair loss. Currently, patients with hypertension, cardiovascular disease, or any serious systemic illness should be excluded from therapy. Patients should be monitored every four to six months, or sooner with any complaints. Initial evaluation should include monitoring of the blood pressure, pulse, electrocardiogram and serum lipid determinations.
Article
The efficacy and safety of topically applied 2% minoxidil solution were compared with those of an excipient placebo in the treatment of early male pattern alopecia in this 24-week, double-blind, randomized study conducted in The Netherlands. One hundred forty-four male patients were evaluable at week 24. They applied 1 ml of either the placebo or 2% minoxidil solution twice daily throughout the study. The 2% minoxidil solution was about three times more effective than the placebo solution in all primary efficacy parameters evaluated, (ie, hair count and investigator and patient subjective evaluation). Minoxidil did not appear to have an effect on systolic and diastolic blood pressures, pulse rate, or body weight. One placebo patient withdrew from the study when he developed a skin rash at week 8. This study supports previous findings on the safe and effective use of minoxidil solution in the treatment of early male pattern alopecia.
Article
Androgenetic alopecia in the female occurs much more frequently than is generally believed. The condition is still considered infrequent, for it differs, in its clinical picture and in the sequence of events leading to it, from common baldness in men. To facilitate an early diagnosis (desirable in view of the therapeutic possibilities by means of antiandrogens) a classification of the stages of the common form (female type) of androgenetic alopecia in women is presented. The exceptionally observed male type of androgenetic alopecia can be classified according to Hamilton or to the modification of this classification proposed by Ebling & Rook.
Article
Twenty-eight women with mild to moderate androgenetic alopecia were randomly assigned to apply either 2 percent topical minoxidil or placebo (vehicle) to their involved scalp areas twice daily. At the end of thirty-two weeks, there was a statistically significant increase of nonvellus target area hairs in the minoxidil-treated versus the vehicle-treated group (p = 0.006). Investigator assessment of moderate regrowth showed better results in subjects who used 2 percent topical minoxidil solution than those who used vehicle (p = 0.007), although subjects discerned no difference between treatment groups. Two percent topical minoxidil appears to be effective in the treatment of female androgenetic alopecia.
Article
Topical minoxidil (Rogaine) has recently been approved by the Food and Drug Administration for treatment of androgenetic alopecia. It has been approved for such use in many other countries. This paper is a review and summary of the reported efficacy and safety of topical minoxidil in the treatment of androgenetic alopecia. The results of anecdotal and controlled clinical trials are included. Realistic appraisal of the restorative and/or preventative potentials of topical minoxidil in androgenetic alopecia is needed.
Article
Twenty-five women fulfilling the criteria for female alopecia, of either the male pattern baldness type or female pattern baldness type, were evaluated for hormone markers to delineate the clinical baldness patterns. Women with a marked increase in the 3 alpha,17 beta-androstanediol glucuronide/sex hormone binding globulin ratio and low serum sex hormone binding globulin were noted to have female pattern baldness. This pattern of baldness may represent hair loss from the influence of minimal androgen excess on genetically sensitive hair bulbs in the absence of other signs of maximal androgen excess, including hirsutism, acne, or virilism.
Article
Our current knowledge of androgenetic alopecia and hair follicle metabolism and control has evolved from four phases of scientific evolution. In the first phase, which I have called the era of science, investigators made strides in understanding androgen metabolism in general and clarified the role of androgens in androgenetic alopecia in particular. This phase was followed by what I have labeled the era of antiandrogens when they were sought as the ideal and only treatment for androgenetic alopecia. Though valid, this approach has proved to be limited. The third phase of scientific progress, the era of biologic response modifiers, evolved when investigators discovered a group of unrelated drugs that promoted hair growth. These drugs have a variety of physiologic effects and may act synergistically to stimulate hair follicle growth. Finally, we are on the threshold of the fourth phase, the era of predictability, in which research efforts will focus on finding the active hair growth-promoting sites on these drug molecules, and on clarifying how these drugs, such as minoxidil, stimulate hair growth on physiologic, pharmacologic, biochemical, and molecular levels.
Article
Hypertrichosis occurs as an undesirable adverse reaction in the majority of hypertensive patients treated with minoxidil (Loniten tablets, Upjohn Company, Kalamazoo, MI).1–3 Nevertheless, its potential topical use for the treatment of alopecia4 has caused much publicity and interest in several topical formulations of minoxidil recently available to selected patient populations. First, patients have participated in sanctioned Investigational New Drug studies using unique investigational formulations of The Upjohn Company. Secondly, patients have received Upjohn's topical 2% minoxidil solution marketed in a country outside of the United States, such as Canada. Lastly, patients have had a local pharmacist prepare an extemporaneous minoxidil solution from Loniten tablets.5,6The pharmacodynamics of such extemporaneous preparations are variable and may not be directly comparable to Upjohn's unique marketed product. Consequently in 1985, the Food and Drug Administration (FDA) issued an order to halt the use of Loniten Tablets for preparing extemporaneous topical minoxidil solutions for alopecia5; however, such nonapproved usage constituted by far the major route of exposure to topical minoxidil.7
Article
This review outlines the findings associated with topical minoxidil use. Approximately one-third of the treated patients will obtain terminal hair growth using a 2 to 3% solution twice a day. Patients should receive treatment for a minimum of six months to evaluate the drug's efficacy. Factors associated with patients who obtained new hair growth include: a thinning versus absolute baldness, treatment initiated at a relatively younger age, and hair growth noted within three months. Following a positive growth response, there may be a reduction in new hair growth gained with minoxidil use for more than one year. Stopping the medication is associated with an exacerbation of hair loss. Currently, patients with hypertension, cardiovascular disease, or any serious systemic illness should be excluded from therapy. Patients should be monitored every four to six months, or sooner with any complaints. Initial evaluation should include monitoring of the blood pressure, pulse, electrocardiogram and serum lipid determinations.
Article
Androgenetic alopecia is the most common form of baldness observed in humans. It involves genetically predisposed individuals from puberty to senescence, with prominent central-pattern scalp alopecia induced by androgens. The many synonyms of androgenetic alopecia include androgenic alopecia, male-pattern baldness, female-pattern baldness, diffuse alopecia, common baldness, hereditary alopecia, and baldness.1–17
Article
Minoxidil solution 2.8 percent applied topically produced new hair growth in patients with male pattern alopecia. An open trial involving 777 male patients was conducted over thirty-two months. Of these patients, 133 were followed for six months or longer. Forty-five percent noted growth that varied from a few vellus hairs to terminal hair. Better response was seen in patients who underwent longer treatment and who had type I or type II alopecia. Subjective evaluations by the patients were better than objective evaluations. No serious systemic effects of minoxidil were encountered; however, in one patient allergic contact dermatitis occurred. The mechanism of this growth is presently unknown but may be related to a vasodilatory effect or direct cell stimulation.
Article
Cosmetically acceptable hair growth was achieved in 18 (32%) of 56 balding male subjects during a 12-month study using 2 or 3% topical minoxidil. The criteria for successful hair regrowth devised from those subjects were: (1) no baldness greater than a Hamilton pattern IV; (2) a balding vertex area smaller than 10 cm in diameter, and (3) a balding process of less than 5 years' duration. Frontotemporal hair loss did not respond to treatment and in fact progressed in severity, despite the twice-daily applications of minoxidil. In a subsequent study of 91 subjects who met these three criteria, 51 (56%) subjects achieved cosmetically acceptable hair growth after 1 year using 2% topical minoxidil (Regaine; registered trade mark of The Upjohn Company) twice daily.
Article
Endocrine profiles were established in nineteen women, aged 18–43 years, with common baldness. Reduced plasma levels were found in SHBG (68%), luteal phase progesterone (52%) indicating sub-fertility, LH (42%), oestradiol (37%) and FSH (21%), while plasma total testosterone was raised in only one patient. Three women with a history of diffuse loss of scalp hair of 2, 13 and 23 years duration and a familial history of premature balding in two, were treated with cyclical antiandrogen therapy (CAT) for 52 weeks. All showed an increase in hair density (hairs/cm2), and in the number of hairs greater than 40 um diameter/cm2 (meaningful density) after 24–28 weeks. The percentage of hairs in the anagen growth phase increased during therapy. Three control patients, left untreated for 26 weeks, showed no significant improvement in hair density, meaningful density or the percentage of hair in the anagen growth phase. During CAT, each patient showed an increase in plasma SHBG and a fall in plasma testosterone levels. One patient with severe depressive symptom related to hair loss prior to therapy, returned to a normal way of life without the need for psychotropic drugs.
Correspon-dence-reply
  • Olsen Ea
  • Sr
  • Weiner
  • Ms
Olsen EA, Pinnell SR, Weiner MS, et al. Correspon-dence-reply; J Am Acad Dermatol 1986; 14:850-851.
Academic Hospi-tal of the Free University Dermatologische Klinik und Po-liklinik
  • Rodney Dawher
  • M B B Ch
  • John Radcliffe Hospital
  • Oxford
  • Hugo Uk
  • M D Degreef
  • University
  • Leuven
  • Leuven
  • M D Hansted
  • Practice
  • Copenhagen
  • Ceef Denmark
  • M D Nieboer
  • Detlef
  • M D Petzoldt
  • Hautklinik
  • West Heidelberg
  • Germany
Rodney Dawher, M.B., Ch.B., John Radcliffe Hospital, Oxford, UK; Hugo DeGreef, M.D., University of Leuven, Leuven, Belgium; Birgitte Hansted, M.D., Private Practice, Copenhagen, Denmark; Ceef Nieboer, M.D., Academic Hospi-tal of the Free University, Amsterdam, Netherlands; Detlef Petzoldt, M.D., Universitats-Hautklinik, Heidelberg, West Germany; Theo Rufli, M.D., Dermatologische Klinik und Po-liklinik, Basel, Switzerland; Nicholas Simpson, M.D., Glasgow Royal Infirmary, Glasgow, UK; Ernst Stolz, M.D., Academic Hospital/Dijkzigt, Rotterdam, Netherlands; and Christopher Vickers, M.D., Liverpool Health Authority, Liverpool, UK. Address for correspondence: James P. Jacobs, M.D., 9153-298-214, The Upjohn Company, 7000 Portage Road, Kala-mazoo, MI 49001. REFERENCES
  • Olsen EA