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Abstract

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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... female pattern hair loss, oral minoxidil, topical minoxidil, trichoscopy controversial results about PRP's efficacy in treating non-cicatricial alopecia. 3,7,8 There have been claims and studies about using mesotherapy to manage hair loss. Nevertheless, it is not entirely a safe technique and can cause serious adverse effects. ...
... Female pattern hair loss (FPHL) is the most common form of hair loss in women. [1][2][3] It occurs in a generally distinctive pattern characterized by a progressive decline in fiber production by scalp hair follicles and their eventual miniaturization. 1 It can damage a patient's self-esteem and may even cause some psychological problems. 4 Therefore, achieving a simple treatment that can be readily acceptable for different patients is essential. ...
... The most common treatment for FPHL, approved by the FDA in 1992, is a topical minoxidil solution. 3 It has been shown that minoxidil can arrest hair loss and induce mild to moderate hair regrowth in women with FPHL. 2 However, continued use of topical minoxidil twice a day for a long time can cause local irritation, itching, and alteration of hair texture, 5,6 which leads to low acceptance of many patients. ...
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Topical minoxidil solution is recommended treatment for female pattern hair loss. However, some complications, such as skin allergies, have prevented some patients from completely receiving this treatment. This study intends to evaluate the therapeutic and side effects of oral minoxidil 0.25 mg tablets treatment on FPHL and compare it with conventional treatment of 2% topical minoxidil. This study is a triple-blind randomized clinical trial in which seventy-two women with FPHL were treated as two separate groups. Group 1 was treated with oral minoxidil 0.25 mg tablets and topical placebo solution, while topical minoxidil solutions and oral placebo tablets were used to treat group2 patients. In the oral minoxidil group, the average hair diameter and hair density after the 9-month treatment reached from 0.044 mm and 102 per cm² to 0.048 mm and 115 per cm², respectively. In the topical minoxidil group, the average hair diameter and hair density from initial values of 0.044 mm and 107 per cm² increased to 0.047 mm and 113 per cm². In both groups, the changes of hair diameter and hair density were significant compared to initial values (p < 0.001), while the trend of changes was not statically different between the two groups((p = 0.077, p = 0.674 for hair diameter and hair density, respectively) and side effects were trivial. Oral minoxidil is an effective and new treatment for FPHL, even with a minimal dose, which can be used as an alternative treatment, especially for patients with poor compliance against topical minoxidil. This article is protected by copyright. All rights reserved.
... Levels of estrogen and progesterone decrease and that ensures the increase of androgens and male hormones. [40][41][42] Some treatment options are available for FPHL. [41] Firstly, there are two pharmacological options: ...
... A second option is surgical treatments such as hair transplantation, in which a thin strip of hair from one part of the patient's scalp is removed and is implanted in an area where the missing hair is, and scalp reduction which involves bringing hair-bearing skin closer together by removing the central scalp affected by the alopecia. [40][41][42][43][44] maLe PatterN Hair Loss ...
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Neurotransmitters are important in regulating the body's functions. They transmit messages between neurons and are a part of the nervous system. They have a variety of impacts on human behavior, psychology, and thought processes. Furthermore, they have roles in our skin which is important for stem cells. Hair stem cells are affected by many factors, including hormones and neurotransmitters. If the release of neurotransmitters or hormones is disrupted, the hair and stem cells are affected quickly. This dysfunction might cause hair loss. Hair loss is one of the most common problems experienced by people all over the world and can be caused by a variety of factors. Further research is needed in order to find a cure.
... The drug functions by inhibiting Type II 5-alpha-reductase enzyme thereby blocking the conversion of testosterone to DHT. 44 It is available in 1 mg and 5 mg tablets, of which the lower dose is indicated for male pattern baldness. It is not approved for use in women and is assigned to pregnancy category X due to risk of causing ambiguous genitalia in a male fetus. ...
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Background Androgenetic alopecia (AGA) is the most common form of hair loss consisting of a characteristic receding frontal hairline in men and diffuse hair thinning in women, with frontal hairline retention, and can impact an individual's quality of life. The condition is primarily mediated by 5-alpha-reductase and dihydrotestosterone (DHT) which causes hair follicles to undergo miniaturization and shortening of successive anagen cycles. Although a variety of medical, surgical, light-based and nutraceutical treatment options are available to slow or reverse the progression of AGA, it can be challenging to select appropriate therapies for this chronic condition. Aims To highlight treatment options for androgenetic alopecia taking into consideration the efficacy, side effect profiles, practicality of treatment (compliance), and costs to help clinicians offer ethically appropriate treatment regimens to their patients. Materials and Methods A literature search was conducted using electronic databases (Medline, PubMed, Embase, CINAHL, EBSCO) and textbooks, in addition to the authors' and other practitioners' clinical experiences in treating androgenetic alopecia, and the findings are presented here. Results Although topical minoxidil, oral finasteride, and low-level light therapy are the only FDA-approved therapies to treat AGA, they are just a fraction of the treatment options available, including other oral and topical modalities, hormonal therapies, nutraceuticals, PRP and exosome treatments, and hair transplantation. Discussion Androgenetic alopecia therapy remains challenging as treatment selection involves ethical, evidence-based decision-making and consideration of each individual patient's needs, compliance, budget, extent of hair loss, and aesthetic goals, independent of potential financial benefits to the practitioners.
... The efficacy of these two drugs is less than optimal in reducing progressive hair loss and stimulating hair growth. After one year and four months of topical 5% minoxidil administration, studies have shown that only about 38.6% of the subjects showed hair growth progression [25][26][27]. Scalp irritation that can occur due to topical minoxidil, in addition to suboptimal efficacy, are several reasons for patients to search for new alternative treatments using traditional plants [20,21,28,29]. Therefore, searching for and exploring new drugs to treat AGA is necessary. ...
Article
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Androgenetic Alopecia (AGA) occurs due to over-response to androgens causing severe hair loss on the scalp, and requires the development of new and efficient drugs to treat this condition. This study explores and identifies secondary metabolites from Sansevieriatrifasciata Prain using the LC-MS/MS and in-silico method. The inhibitory activity of bioactive compounds from S. trifasciata Prain against androgen receptors (PDB ID: 4K7A) was evaluated molecularly using docking and dynamics studies by comparing their binding energies, interactions, and stability with minoxidil. The results of the LC-MS/MS analysis identified Methyl pyrophaeophorbide A (1), Oliveramine (2), (2S)-3′, 4′-Methylenedioxy-5, 7-dimethoxyflavane (3), 1-Acetyl-β-carboline (4), Digiprolactone (5), Trichosanic acid (6) and Methyl gallate (7) from the leaves subfraction of this plant. Three alkaloid compounds (compounds 1, 3, and 4), and one flavonoid (compound 2), had lower docking scores of −7.0, −5.8, −5.2, and −6.3 kcal/mol, respectively. The prediction of binding energy using the MM-PBSA approach ensured that the potency of the four compounds was better than minoxidil, with energies of −66.13, −59.36, −40.39, and −40.25 kJ/mol for compounds 1, 3, 2, and 4, respectively. The dynamics simulation shows the stability of compound 1 based on the trajectory analysis for the 100 ns simulation. This research succeeded in identifying the compound and assessing the anti-alopecia activity of Sansevieria trifasciata Prain. Seven compounds were identified as new compounds never reported in Sansevieria trifasciata Prain. Four compounds were predicted to have better anti-alopecia activity than minoxidil in inhibiting androgen receptors through an in silico approach.
... The same pathological changes in pattern baldness are observed in both men and women. A shorter anagen phase and a longer telogen phase are observed [8]. However, as high androgen levels do not occur in all FPHL cases, the aforementioned hypothesis is yet to be confirmed [9]. ...
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BACKGROUND Female-pattern hair loss (FPHL) is a common disorder affecting women, and FPHL can cause psychological dysfunction and affect the social activities of patients. The disease-causing mechanisms are believed to be similar to those of male androgenetic alopecia (MAGA). Although genome-wide association studies (GWAS) have confirmed susceptibility genes/loci for MAGA, the associations between these genetic loci and FPHL are largely unknown. We investigated the associations between susceptibility loci for MAGA and FPHL in a Chinese Han population; a literature review of susceptibility loci associated with MAGA for FPHL was also performed. MATERIAL AND METHODS Twenty-two previously reported sites were analyzed with the Sequenom iPlex platform, and the genotype statistical analysis consisted of a trend test and conservative accounting. The samples comprised 82 patients diagnosed with FPHL by dermatoscopy and 381 healthy controls from the Chinese Han population. RESULTS No significantly associated variants were found in this FPHL study. The examined 22 tag SNPs in MAGA may not be associated with FPHL. The results of the current study in a Chinese Han population support the previous negative association obtained for a European population. CONCLUSIONS This was the first study exploring whether identified MAGA-associated loci confer susceptibility to FPHL in a Chinese Han population, and dermatoscopy was used to improve the diagnostic accuracy. However, there was no evidence of a relationship between susceptibility genes for MAGA and FPHL, and the results indicated that FPHL and MAGA are etiologically separate entities. Therefore, a systematic GWAS approach to FPHL may be required to clarify associated pathophysiological uncertainties.
Article
Background: Female Pattern Hair Loss (FPHL) is one of the most common types of hair loss in women. It is characterized by progressive follicular miniaturization leading to diffuse hair thinning over the midfrontal scalp with a negative impact on quality of life. Pharmacological treatments are commonly used, and hair follicle transplantation is an option for those cases with adequate donor area. Minimally invasive procedures, such as microneedling, mesotherapy, microinfusion of drugs into the scalp with tattoo machines (MMP®), and platelet-rich plasma (PRP) have been reported as adjuvant treatments. Aims: This study aims to summarize and discuss the efficacy of minimally invasive procedures described for the management of FPHL. Methods: Published articles indexed on the Pubmed database and Scopus that described minimally invasive procedures for the management of FPHL in humans were considered. Citations were reviewed and added for completeness. The search was for articles in English only. After excluding duplicate titles, 23 relevant articles were considered. Conclusion: Minimally invasive procedures are promising options and may play a role in FPHL treatment. They can be used as adjunctive therapy for FPHL, in case of poor response to clinical therapy, or when patients prefer other care than the standard. We reinforce that these methods should be performed by an experienced medical professional following strict aseptic techniques. However, microneedling, mesotherapy, MMP, and PRP lack standardization and are supported by a low level of evidence yet. For the future, larger randomized clinical trials are essential to determine the efficacy and optimal protocols for these treatments.
Article
Background One of the most common dermatological complaints among female is female pattern hair loss (FPHL). Serum vitamin D is a factor lately taken into consideration in approaching patients complaining of hair loss. Aim To evaluate the serum level of 25-hydroxy vitamin D in patients with FPHL and to evaluate the efficacy of vitamin D therapy alone or combined with minoxidil in the treatment of this disease. Methods 45 patients with FPHL and 15 controls to measure serum level of vitamin D were enrolled in the study. Patients then were subdivided into 3 groups: group I received topical minoxidil and oral vitamin D, group II received topical minoxidil, and group III received oral vitamin D for 6 months. Clinical and dermoscopic evaluation was done for the three groups before and after treatment. Results Vitamin D level was significantly decreased in patients compared to controls. After treatment, as regard Ludwig scale, there was statistically significant improvement in group I than II while no significant improvement was found in group III. Dermoscopy revealed that thin hair and single-hair unit were significantly improved in groups I and II, while it was not significantly improved in group III. Conclusion Oral vitamin D combination to topical minoxidil is recommended to treat patients with FPHL; they had better results than vitamin D or topical minoxidil alone.
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Medical professionals that treat patients with alopecia usually lack knowledge about hair cosmetics. Trichologists focus on hair cycling and growth problems and not on the hair shaft integrity. This may lead to abandon of the use of the prescribed treatment, such as topical minoxidil or to inadequate traumatic grooming habits that may jeopardize hair follicle health. Shampoos, hair dyes, and hair-straightening products may alter hair fiber structure, remove lipids, and elude protein. Hair procedures such as hair dying and straightening have side effects and health concerns, especially for pregnant women or sensitive hair and scalp patients. Hair breakage, follicle traction, frizz, contact dermatitis, and mutagenicity are possible side effects of hair cosmetics misuse. The proper use of hair care products may help to increase patients' adherence to alopecia treatments and avoid health problems related to inadequate application of hair cosmetics and procedures.
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PCOS is the commonest cause of anovulatory infertility. Many potential therapies are available and the mainstay of treatment centers around enhancing general health to achieve the best reproductive outcome for mother and baby. We describe the pathophysiology of anovulation in brief before an outline of pragmatic evidence-based algorithm for ovulation induction therapies.
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The influence of gelatin-cystine and serenoa repens on hair growth was studied through a long period application (50 weeks) of a new cosmeceutical lotion. On 48 volunteers (24 women and 24 men) aged between 21 and 38 years, affected by androgenetic alopecia (type III and IV according to Hamilton). 12 subjects also took a diet supplement (4 pills per day) based on gelatin- cystine. The solution and the diet supplement (placebo and active) were assigned in a randomized double-blind manner. Hair mass and the mean hair number were controlled according to Price et al. Exclusion criteria included use of topical or oral drug or diet supplement within the previous six months. The obtained results showed an increase of hair mass from 20 to 30% (p<0.005) together with a contemporary increase of hair number (from 17 to 27%) (p<0.005) compared to the placebo for subjects using the lotion only. With the diet supplement a further increase of 50% (p<0.005) in hair growth and a significant decrease of blood ROS (Reactive Oxigen Species) were obtained.
Poster
Background: Topical minoxidil has been used effectively for treatment of androgenetic alopecia in men and women. Recently, two phase 3, randomized, multicenter studies (one active-controlled and one vehicle-controlled) were conducted to evaluate the effectiveness of women’s 5% minoxidil topical foam (5% MTF) applied once a day for treatment of FPHL. Pooled data from common endpoints of the two studies are presented in this analysis. Individual publications for each study are in preparation. JAAD - May 2015 Volume 72, Issue 5, Supplement 1, Page AB112
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Application of an electrostatic field has been found to produce positive biological effects in many pathological situations; recently, Maddin reported regrowth or no further hair loss in 96.7% of 30 subjects with androgenic alopecia following regular application of a pulsed electrostatic field on the scalp for 36 weeks. Subsequently, we assessed the influence of application of a pulsed electrostatic field with variable polarities and intensities on the course of androgenic alopecia. The results of a 36-week controlled study conducted at the Unit of Cosmetic Dermatology at the Department of Dermatology of the University of Florence, are reported. The study involved 30 subjects (24 males and 6 females), 17 to 58 years of age, showing various stages of androgenic alopecia; the male subjects presented stage II, III or IV according to the Hamilton scale (modified by Norwood), and the females stage II or III according to the Ludwig scale. The patients were divided randomly into two groups, A (20 subjects) and B (10 subjects). In the control group B, the subjects were submitted to treatment sessions exactly as those in group A, but did not receive stimulation, as the electrostatic field was disactivated without the knowledge of the patient. Each subject underwent treatment for 36 weeks, with weekly sessions of 12 minutes each, except for the 1st, 2nd, 17th, 18th, 33rd and 34th weeks, in which 2 sessions were held per week. A pulsed electrostatic field generator with a computerized pulse level and frequency control was used. The polarity and intensity of the electrostatic field was varied according to a precise scheme, adopted empirically on the basis of previous experiments. Clinical assessment of the efficacy of the treatment was based on the technique of the average count of anagen hair by macrophotography, before beginning, at the 18th and 36th weeks. On these occasions, the patients were also asked to express their opinion on their clinical conditions, giving marks from 0 to 3. Six of the 30 patients did not complete the study: 5 of group A and 1 of group B. At the end of the treatment cycle 6 of the subjects considered their clinical conditions unchanged (40%), 7 (46.7%) claimed a slight improvement and 2 (13.3%) considerable improvement. The investigators, on the other hand, assessed no clinical changs in 5 subjects (33.3%) and slight improvement in 10 (66.7%). As for the 9 control subjects, 4 (44.4%) judged their conditions unchanged, and 5 (55.5%) found a slight improvement, whereas the investigators only detected a slight improvement in 3 subjects (33.3%). The hair count using macrophotography on patients who had undergone regular treatments showed an average 6.23% increase in the number of anagen hair per cm2; this increase was only 1.02% in the 9 control subjects. There were no significant differences in response between sexes, nor did any subject complain of negative side effects during the treatment period. Although the series was limited, these results confirm a positive effect of pulsed electrostatic fields on hair growth in subjects with androgenic alopecia.
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On the basis of literature data current status of finasteride treatment in androgenetic alopecia in men is presented.
Article
Sixty-three postmenopausal women, who had an excessive fall of hair as predominant symptom in this phase of their life, felt in our study. All patients have done routine diagnostic test, hormonal dosage, and trichogram. The patients have been randomized in three equal groups to which a different treatment had been administered: 1st group: Ethynilestradiol 0.02 mg/die from the 1st to the 25th day of each month. A daily dose of 10 mg medroxyprogesterone acetate (MPA) was added for the last 10 days of estrogen administration. 2nd group: Transdermal estradiol 0.05 mg associated with medroxyprogesterone acetate (MRA) for the last 10 days of estrogen administration. 3rd group: Ethynilestradiol 0.02 mg/die from the 1st to the 25th day of each month. A daily dose of 12.5 mg cyproterone acetate was added for the first 10 days of estrogen administration. The hormonal assays and the trichogram were repeated after one year of treatment. SHBG values increase singnificantly (p < 0.001) in patients belonging to the first and to the third group. On the contrary these values did not change in a statistically significant way in patients belonging to the second group. The per cent modifications of the hair diagrams were also significant in patients belonging to the first and third group. The results obtained from this study seem to suggest that the ethynilestradiol rather than the antiandrogens was responsible for the benefical outcome in the treatment of androgenetic alopecia in postmenopausal women.
Article
We carried out a 6-month, randomized, double-blind, placebo-controlled study of an oral combination product of millet seed extract, L-cystine and calcium pantothenate in women with androgenetic alopecia. The study endpoint was defined as change of anagen hair rate, as determined by phototrichogram, from abnormal (< 80%) at baseline to normal (> 85%) at the follow-up (after 3 months) and final visits (after 6 months). The active group, but not the placebo group, reached the study endpoint, thus establishing study product efficacy in female androgenetic alopecia.