Alopecia or hair loss is a multifaceted disorder that results from influence of an array of different factors including heredity, androgenic hormones, micro-inflammation of hair follicles and scalp, infections, nutritional deficiency and harsh environmental conditions. The role of androgens and especially, the dihydrotestosterone (DHT) have been well-established as the most important players in
... [Show full abstract] pathophysiology of androgenetic alopecia (AGA); and elevated DHT levels have been associated with hair loss. Current treatment regimen approved by FDA includes minoxidil and finasteride. Minoxidil, administered as a topical solution is converted to minoxidil sulfate, the active metabolite by sulfotransferase enzyme at target site and hence, individual responses to treatment vary depending on the enzyme expression. Finasteride an effective 5α-reductase inhibitor which blocks conversion testosterone to DHT is administered orally and presents significant unwanted systemic exposure. In the present manuscript, we have presented an overview of recent advancements in our understanding of pathophysiology of AGA and have discussed underlying factors that contribute to the development/progression of the disease. Ideally due to complex nature of the disorder, a multilateral therapeutic approach addressing multiple pathophysiological pathways seems more sensible in comparison to a monophasic (single-drug) one. Moreover superior targeting of hair follicles the site of action, could be achieved with least undesired effects by if the treatments are solely administrated via topical compared with that via oral route. In later part of this review, we have focused the discussion on currently available therapeutic options for management of AGA and reviewed several emerging potential targets for development of advanced therapies.
