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Evaluation of efficacy and safety of finasteride 1 mg in 3177 Japanese men with androgenetic alopecia
Abstract
Before now, there has been no study of finasteride use exceeding 1 year in Japanese men with androgenetic alopecia (AGA) except the study subsequently conducted from the development phase. Since the launch of finasteride, no study in a larger population had been reported. Ethnic variation of the onset age, progressive nature and degree of hair loss of androgenetic alopecia are known. The therapeutic effect of oral finasteride (Propecia) was examined on androgenetic alopecia of Japanese men. The efficacy and safety of finasteride (1 mg tablet) was evaluated in Japanese men with AGA in the long term. The study enrolled 3177 men given finasteride 1 mg/day from January 2006 to June 2009 at our clinic. Efficacy was evaluated in 2561 men by the modified global photographic assessment; the photographs were assessed using the standardized 7-point rating scale. Safety data were assessed by interviews and laboratory tests in all men enrolled in the study. The overall effect of hair growth was seen in 2230 of 2561 men (87.1%), in whom hair greatly (11.1%), moderately (36.5%) and slightly (39.5%) increased. The response rate improved with increasing duration of treatment. Adverse reactions occurred in 0.7% (23/3177) of men; seven men discontinued treatment based on risk-benefit considerations. No specific safety problems associated with long-term use were observed. This study represents data collected at a single institution. Many patients did not receive follow-up examination. In Japanese men with AGA, oral finasteride used in the long-term study maintained progressive hair regrowth without recognized side-effect.
... 4,5 The authors have previously demonstrated three investigations of efficacy and safety of large-scale and long-term AGA treatment with finasteride (3,177 cases in 2.5 years, 801 cases in 5 years, and 532 cases in 10 years, respectively). [5][6][7] The objective of this article is to summarize the three investigations, and to consider them as a base for future studies over the next 20 to 30 years or more. ...
... The study period for each of the three investigations is as follows: The first investigation, "Evaluation of Efficacy and Safety of Finasteride 1mg in 3177 Japanese men with Androgenetic Alopecia," was evaluated from January 2006 to June 2009. 7 The second investigation, "Five-Year Efficacy of Finasteride in 801 Japanese Men with Androgenetic Alopecia," was evaluated from January 2000 to November 2008. 6 The third investigation, "Long-Term (10-Year) Efficacy of Finasteride in 523 Japanese Men with Androgenetic Alopecia," was evaluated from December 2005 to January 2009. ...
... Differences have been known to occur in the progression of AGA symptoms between Japanese and Caucasian men. 7,12 The superior response of Japanese men with AGA was reported to likely be attributable to their hair characteristics (greater diameter, black color, and lower density), which facilitated the detection of slight changes. 6,[13][14][15] Though many investigations have been recognized all over the world, most Japanese people still wrongly believe the following: "finasteride has only efficacy of prevention of AGA progression"; "finasteride decreases testosterone"; "finasteride has serious adverse reactions (decreased libido, male infertility, erectile dysfunction, liver dysfunction, etc.)." ...
Introduction: Finasteride has been the standard medical treatment for androgenetic alopecia (AGA) for over 20 years. We started AGA treatment with finasteride in 1999 in Japan, and have demonstrated 3 investigations as long-term and/or large-scale studies (3,177 cases in 2.5 years, 801 cases in 5 years, 532 cases in 10 years, respectively). The objective of this study is to summarize the three investigations, and to consider it as a base for future studies over the next 20 to 30 or more years.
Methods: Vertex photographs and/or forehead photographs were taken and recorded for every patient at each examination and used for evaluation for more than 20 years. Efficacy was assessed using the Norwood-Hamilton scale (N-H) and the modified global photographic assessment (MGPA) score, which is the standardized 7-point rating score using scalp photographs. Adverse reactions were assessed through self-reported evaluations by patients in two investigations
Results: All three of the investigations demonstrated high evaluations of improvement (MGPA≧5; 87.1%, 99.4%, and 91.5%, respectively), and higher evaluations of prevention of disease progression (MGPA≧4; 99.6%, 100%, and 99.1%, respectively). Furthermore, the early-stage AGA group (N-H I-III at first visit) and the younger group (less than 40 years of age at first visit) showed more improvement with long-term AGA treatment with finasteride than the other groups did. Two of the investigations showed safety of long-term AGA treatment with finasteride, revealing the low onset rates of adverse reactions (adverse reactions: 0.7% in 2.5 years and 6.8% in 10 years, respectively). Neither of the two investigations recognized Post Finasteride Syndrome adverse reaction at all.
Conclusion: Long-term (greater than 10 years) AGA treatment with finasteride 1 mg/day demonstrated a high efficacy and safety based on large-scale studies in Japanese men. For patients at the early stage of classification of AGA (within N-H I-III or earlier) and/or younger than 40 years of age, we recommend starting treatment with 1 mg/day finasteride.
... Dihydro-testosterone (DHT) has a key role in mediating progressive scalp hair loss in men with AGA, and finasteride blocks the conversion of testosterone to DHT as a selective type II 5α-reductase inhibitor, which justifies its use in AGA treatment [1][2][3]. Although the efficacy of AGA treatment with finasteride has been demonstrated by several large-scale and long-term studies, [4][5][6][7] no long-term investigation for up to 10 years has yet been conducted in Japanese subjects [8][9][10]. Therefore, the objective of this study was to evaluate the efficacy and safety of large-scale and long-term AGA treatment with finasteride, which, to our knowledge, is the first of such studies in Japan. ...
... A high objective efficacy was demonstrated by the MGPA, which revealed improvement and prevention of disease progression in 99.1% of the 532 Japanese men with AGA treated with 1 mg/day finasteride for 10 years. Furthermore, the outcome was similar to or better than that reported by other studies in Japan [8][9][10]13,17]. Differences have been known to occur in the progression of AGA symptoms between Japanese and Caucasian men [8,18]. ...
... Furthermore, the outcome was similar to or better than that reported by other studies in Japan [8][9][10]13,17]. Differences have been known to occur in the progression of AGA symptoms between Japanese and Caucasian men [8,18]. This efficacy of the investigated treatment in Japanese men exceeded that reported in other studies in Caucasians. ...
... A randomized, doubleblinded, placebo-controlled phase III study compared the efficacy, safety, and tolerability of a daily dose of 0.5 mg of dutasteride for six months vs. Placebo in patients with AGA, dutasteride was found to be significantly more effective than placebo in the aspects of hair count and selfassessment [16] . Though dutasteride was well tolerated in many studies, dutasteride-related sexual dysfunctions have been reported as well [17][18][19] . Three percent of the patients receiving dutasteride at a dose of 0.5 mg/d for 24 weeks complained of decreased libido and ejaculation disorder [15] . ...
... The incidence of sexual side effects in this study in the dutasteride group (15.6%) was similar to that reported by Jung et al. (17.1%) [10] . Dutasteride-related sexual dysfunction had been shown to decrease in frequency when treatment was continued for up to 4 years [19,20] . In this study, dutasteride was relatively well-tolerated with comparable sexual side effects which was consistent with previously reported data [16,5,6] . ...
This study evaluates the role of dutasteride in the treatment of androgenetic alopecia. A prospective, open-labeled interventional study conducted at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from April 2023 to March 2024. Men with Androgenetic alopecia (AGA) who did not show significant improvement when treated with finasteride at a dose of 1 mg/d for at least six months were enrolled. Ninety patients were recruited after taking informed consent. Patients were treated with dutasteride at a dose of 0.5 mg daily for 24 weeks. Clinical assessment was performed by dermatologists and subjective evaluation of overall assessment was done based onchanges in the size of the vertex spot, hair loss on top of the scalp, bitemporal recession, the amount of hair shedding and hair quality on a 3-point rating scale (increased, no change, or decreased). The mean age of study patients was 36.3±12 years and majority of the patients 30(33.3%) belonged to the age group 41- 50 years with followed by 27(30.0%) in the age group 31-40 years. Regarding subjective evaluation of overall assessment, in case of change in size of vertex spot, majority 77(85.6%) showed decreased, in case of hair loss from top of scalp, majority 83(92.2%) reported decreased, in case of bitemporal recession, majority 82(91.1%) showedno change, in case of hair shedding, majority 87(96.7%) showed decreased and in case of hair quality, 85(94.4%) reported increased and no patient reported of decreased. Regarding clinical assessment of investigator that majority of the patients 40(44.5%) was moderately improved (+2), followed by 30(33.3%) was greatly improved (score of +3), 18(20.0%) was slightly improved (+1) and only 2(2.2%) was unchanged (0). Among the ninety patients of androgenetic alopecia, 3(3.3%) showed decreased libido and 2(2.2%) showed erectile dysfunction. The study concluded that dutasteride is effective and safe in the treatment of androgenetic alopecia. This study will provide the therapeutic basis for dutasteride as an alternative treatment option for patients with AGA recalcitrant to finasteride over six months. Therefore, dutasteride will become a treatment of choice for androgenetic alopecia (AGA) in near future.
... In fact, finasteride represented a major breakthrough in the treatment of male pattern hair loss, based on an understanding of the underlying pathophysiology [29] and observations on the respective genetic defect of 5-alpha-reductase [30]. Clinical studies have demonstrated both a high efficacy of treatment and a very favorable safety profile [31][32][33][34][35][36][37][38], establishing the drug as first-line treatment of male pattern hair loss. In the most recent study published in 2012, Sato and Takeda [38] reported on the efficacy and safety of 1 mg oral finasteride for treatment of male pattern hair loss in the so far largest population study of 3,177 enrolled Japanese men. ...
... Clinical studies have demonstrated both a high efficacy of treatment and a very favorable safety profile [31][32][33][34][35][36][37][38], establishing the drug as first-line treatment of male pattern hair loss. In the most recent study published in 2012, Sato and Takeda [38] reported on the efficacy and safety of 1 mg oral finasteride for treatment of male pattern hair loss in the so far largest population study of 3,177 enrolled Japanese men. Efficacy was evaluated by global photographic assessment, and safety data were assessed by interviews and laboratory tests. ...
Post-finasteride syndrome (PFS) has been claimed to occur in men who have taken oral finasteride to treat either hair loss or benign prostatic hyperplasia, independent of age, dosage, or indication. By definition, the condition is characterized by sexual dysfunction, somatic symptoms, and psychological disorders that persist after cessation of finasteride treatment. As yet, the condition is not recognized by the medical community, although individuals who suffer from PFS present with relatively homogenous symptoms. The concept of PFS has emerged from reports of non-dermatologists, neuroendocrinological research and reflections, and uncontrolled studies of low quality and with a strong bias selection, while a significant nocebo effect among patients informed about possible side effects of finasteride is recognized. There are no predictive factors for the risk of development of PFS. Nevertheless, it has been suggested that a patient history of preexisting mental health disorder, particularly depression, may put patients at an increased risk. We report the first case of PFS in a long-standing (over 20 years) dermatotrichological practice with frequent finasteride prescription observed in a 25-year-old male following dutasteride treatment for male androgenetic alopecia. There was circumstantial evidence that PFS may represent a delusional disorder of the somatic type, possibly on a background of a histrionic personality disorder, which would explain the refractoriness of the condition and a high degree of suggestibility.
... The efficacy of finasteride has been rated as level of evidence 1 [23][24][25][26][27]. Based on clinical trials, the dose stracyjnymi, ale w większości przypadków opiera się to na dobrze udokumentowanej wiedzy medycznej. ...
... Dowody na efektywność terapii finasterydem oceniono na poziom pierwszy [23][24][25][26][27]. Na podstawie badań klinicznych wyznaczono dawkę 1 mg jako skuteczną w leczeniu łysienia androgenowego mężczyzn i w takiej dawce zarejestrowano lek w tym wskazaniu. ...
The main pathogenetic process in androgenetic alopecia is dihydrotestosterone-mediated follicular miniaturization in androgen-dependent scalp areas. Differential diagnosis is complex, especially in women, and covers a broad spectrum of non-cicatricial and cicatricial alopecias, particularly telogen effluvium and frontal fibrosing alopecia. The basic additional diagnostic procedure is trichoscopy. Currently there are two drugs approved for the treatment of androgenetic alopecia: minoxidil (in men and women) and finasteride (in men). However, medical literature indicates significantly more therapeutic options. The article presents algorithms recommended for the management of androgenetic alopecia in women and men.
... in temporal region, resulting in a gradual decrease in the hair diameter [1] . ...
... Exposure of skin to surfactants may induce irritation, but in our case this fact was also not observed. The type and degree surfactant irritancy can be related to the type and concentration and also some other factors such as skin type, color, and age [1,32,51] . ...
Background/aims:
Androgenetic alopecia is an extremely common dermatological disorder affecting both men and women. Oral finasteride (FNS), a synthetic 4-aza-3-oxosteroid compound with poor aqueous solubility, blocks the peripheral conversion of testosterone to dihydrotestosterone (DHT) in a significant reduction in DHT concentration, achieving satisfactory results in alopecia treatment. However, its oral intake generally causes severe side effects. Considering that there is currently no scientifically proven treatment, new drug delivery systems able to improve alopecia therapy are urgently required.
Methods:
In this study, polymeric nanoparticles have been proposed as a new carrier for topical delivery of FNS in hair follicles.
Results and conclusions:
Polymeric nanoparticles, prepared by using a modified method of the emulsification/solvent diffusion, showed a mean particle size around 300 nm, which may be sufficient for reaching the dermis and hair follicles and negative zeta potential values. Scanning electron microscope measurements showed that all the polymeric nanoparticles exhibited a spherical shape and a smooth surface regardless of their composition. A high encapsulation efficiency was achieved for FNS (79.49 ± 0.47%). In vitro release assays in physiological conditions demonstrated that nanoparticles yielded a prolonged release of FNS for 3 h. Skin assays through an in vitro permeation study demonstrated that nanoparticles had low levels of penetration of FNS, improving its time residence onto the skin. All excipients used in nanoparticle composition and in 3 different vehicles were safe. These results suggest that the proposed novel formulation presents several good characteristics indicating its suitability for dermal delivery of FNS for alopecia treatment.
... Minoxidil is associated with a number of adverse reactions, including pruritus, scalp irritation, irritant and allergic contact dermatitis, cardiovascular system symptoms/signs in a dose-dependent manner, and facial hypertrichosis [15][16][17]. Although primarily utilized in dermatologic applications, finasteride has been associated with hepatic dysfunction, unilateral breast enlargement and palpitations, libido reduction, head pain, fever, sexual dysfunction, and neuropsychiatric side effects [18][19][20]. In clinical practice, various medication treatments like progesterone, azelaic acid, zinc salts, flutamide, dutasteride, and spironolactone, as well as invasive techniques like platelet-rich plasma, scalp microneedling, and hair transplantation, are commonly employed, but they have not demonstrated conclusive outcomes or promising prospects [16]. ...
Background
Androgenetic alopecia (AGA) is the most prevalent cause of hair loss around the world.
Objective
The purpose of this study was to evaluate the efficacy of laser stimulation with a 675-nm wavelength for the treatment of AGA in male and female Indian patients.
Methods
A total of 20 Indian healthy patients aged 23-57 years who presented a grade of alopecia stage I to stage V underwent one single pass with a 675-nm laser to the scalp area twice a week for a total of 8 sessions, followed by once a week for 4 sessions and once in 2 weeks for 2 sessions. There are 14 laser treatments in total. Macro- and dermatoscopic images have been acquired at T0 (baseline) and T1 (4 months). The vertex, frontal, and parietal areas of the scalp were evaluated. Many parameters were analyzed including hair count and hair density of terminal; mean thickness; vellus follicles; total follicular units; units with 1 hair, 2 hairs, 3 hairs, 4 hairs, and >4 hairs; unit density; and average hair/unit.
Results
The macroimages and dermatoscopic evaluations showed good improvement over the entire treated area, with a clear increase in the number of hairs and hair thickness. General parameters such as hair count and hair density showed a percentage increase of around 17%. The hair mean thickness parameters showed a significant (P<.001) percentage increase of 13.91%. Similar results were obtained for terminal and vellus hair: terminal hair count and hair density significantly (P=.04 and P=.01, respectively) increased by 17.45%, vellus hair count increased by 16.67% (P=.06), and the density of vellus hair increased by 16.61% (P=.06).
Conclusions
The study findings demonstrate that the 675-nm laser system improved AGA in Indian patients, facilitating the anagen phase and improving hair density and other positive hair parameters.
... Thuốc có hiệu quả ở đỉnh đầu hơn là ở vùng trán, khuyến cáo sử dụng finasteride vô thời hạn để bảo tồn phần tóc còn lại sau lần điều trị ban đầu. Một nghiên cứu nổi tiếng của Nhật Bản trên 3000 nam giới mắc AGA đã cho thấy 11,1% đối tượng có biểu hiện mọc lại tóc đáng kể khi sử dụng finasteride; 36,5% có biểu hiện tăng trưởng vừa phải và 39,5% tăng trưởng tóc nhẹ trong khoảng thời gian 3 năm [10]. ...
Rụng tóc nội tiết tố nam (Androgenetic alopecia - AGA) là dạng rụng tóc phổ biến nhất, có thể ảnh hưởng đến chất lượng cuộc sống của cá nhân. Mặc dù có sẵn nhiều lựa chọn điều trị nội khoa, phẫu thuật, liệu pháp ánh sáng và dinh dưỡng để làm chậm hoặc đảo ngược sự tiến triển của AGA, nhưng việc lựa chọn liệu pháp thích hợp vẫn là một thách thức. Bài báo tổng quan các lựa chọn điều trị chứng AGA có tính đến hiệu quả, tác dụng không mong muốn, tính thực tiễn của việc tuân thủ điều trị và chi phí để giúp các bác sĩ đưa ra chế độ điều trị phù hợp (cả về mặt đạo đức) cho bệnh nhân.
... Its effects increase over time; therefore the therapeutic response is seen in the long term [8]. A large study involving more than 3,000 men with androgenetic alopecia showed that 11.1% of the patients experienced significant hair growth using finasteride, 36.5% had moderate growth, and 39.5% did not achieve satisfactory growth over a period of 3 years [9]. The results generated using oral finasteride are superior at the vertex of the scalp when compared to the frontal and centroparietal region. ...
Androgenetic alopecia, also known as male pattern hair loss or female pattern hair loss, is the most common form of alopecia worldwide and occurs due to an excessive response to androgens. Its etiology is chronic and influenced by genetic and environmental factors. For these reasons, this condition can be extremely difficult to treat. The main form of treatment currently involves the use of finasteride or dutasteride, which have the ability to inhibit the enzyme 5-alpha-reductase, responsible for the conversion of testosterone into DHT, and consequently prevent the progression of androgenetic alopecia. Concurrently with the dissemination of this treatment, various concerns have arisen regarding the potential side effects caused by this class of medication, particularly impairments in sexual function and possible psychological disorders observed in a portion of users. With the emergence of new methodologies aiming at the treatment of androgenetic alopecia, there is much debate in the scientific community about whether the use of finasteride and dutasteride is the best way to treat this condition. In this article, we will discuss how 5-alpha-reductase inhibitors act in the treatment of androgenetic alopecia, focusing on their risks and benefits.
... The effect of finasteride on androgenetic alopecia is confirmed in studies. A Japanese study involving 3,000 men with androgenetic alopecia showed over a three-year period significant hair regrowth in 11%, moderate hair regrowth in 36.5% and slight hair regrowth in 39.5% [56]. ...
Alopecia is a commonly occurring medical condition. Various types of alopecia are distinguished, with the most common being androgenetic alopecia affecting both men and women. Standard treatments do not always yield the expected results, hence the search for alternative forms of therapy for this condition. Platelet-rich plasma (PRP) has been used in medicine for a long time, but it has gained popularity in aesthetic medicine and dermatology in recent years. The action of PRP includes stimulating collagen formation. The therapeutic effects of PRP therapy in alopecia are achieved through the synergistic action of various types of growth factors. Aim: The aim of our study was to evaluate the effectiveness of platelet-rich plasma therapy for baldness, to compare its effectiveness with other treatment methods and to present this issue to the reader. Methods: Analysis of issues related to baldness and platelet-rich plasma therapy from PubMed sources and comparison of the effectiveness of this therapy with other methods. Conclusions: Treatment with PRP for androgenetic alopecia results in an increase in overall hair density. In chronic plaque alopecia, such therapy leads, among other things, to increased hair regrowth. Combined therapy of PRP with minoxidil in androgenetic alopecia yields better results than using these methods separately. The same applies to combined therapy of PRP with finasteride. However, minoxidil with PRP yields better results than finasteride with PRP.
... As such, pruritus, scalp irritation, irritant and allergic contact dermatitis, and facial hypertrichosis are observed with minoxidil [3][4][5]. Finasteride (1 mg) is mainly used in dermatological practice and has been found to be associated with erectile dysfunction and decreased libido [6], hepatic functional disorder, unilateral mammary hypertrophy and palpitations, febricula, and headache [6][7]. Moreover, low-level laser therapy is linked to acne, mild paresthesia such as burning sensation, dry skin, headache, pruritus, the temporary onset of telogen effluvium, and the presence of dysplastic or malignant lesions on the scalp [8]. ...
Background Androgenetic alopecia (AGA) is frequently encountered in dermatological practice; however, there is a lack of approved treatment. At present, only three therapies have been approved for on-label use in androgenetic alopecia: minoxidil, finasteride, and lower-level laser therapy. Micronutrients are primary elements in the normal hair follicle cycle, and their role in androgenetic alopecia is a growing matter of research nowadays. This study aims to investigate the clinical efficacy and safety of Dr. SKS Hair Booster Serum, a cocktail of micronutrients and multivitamins (copper, niacinamide, hyaluronic acid, thiamine, riboflavin, and biotin), in male and female patients with androgenetic alopecia. Methods We did an open-label, non-randomized, multicenter, prospective study across five hair clinic chains in India (Mumbai, Hyderabad, Jabalpur, Balaghat, and Nagpur). Eligible participants were patients with a confirmed diagnosis of androgenetic alopecia based on clinical examination and trichoscopic findings, age of 18 years or older, and any gender. Each patient received Dr. SKS Hair Booster Serum, 1 ml in volume, once a month by mesotherapy or derma roller/derma pen for up to six months. All patients were subjected to a 60-second hair count test (comb test), hair pull test, global photographic assessment (GPA), trichoscopy assessment, patient self-assessment questionnaire, and safety assessment at baseline and six months after the treatment. Results One thousand patients (500 males and females each) with androgenetic alopecia were analyzed. There was a significant reduction in hair fall with bulb (<0.0001) and without bulb (<0.0001) six months after the treatment versus baseline. There was a significant improvement in the number of hairs removed per pull (<0.0001), global photographic assessment score (<0.0001), hair growth rate (<0.0001), follicular hair density (<0.0001), vellus hair density (<0.0001), and terminal hair density (<0.0001) six months after the treatment versus baseline. The majority of patients (95%) were satisfied with six-month treatment of Dr. SKS Hair Booster Serum. No major adverse events were reported during the study. Conclusion Dr. SKS Hair Booster Serum was found to be a safe and effective treatment for androgenetic alopecia, with 95% patient self-assessment score.
... Finasteride, a strong inhibitor of 5αR, has been shown to modulate the progression of AGA to a certain extent by interfering with androgen metabolism. However, despite having reduced circulating DHT levels, a proportion of individuals (10-30%) still remained unresponsive to this therapy [3,4]. In addition, only 55% of male AGA patients with microin ammation of bald scalp had hair regrowth in response to topical minoxidil treatment, which was less than the 77% of patients with no signs of in ammation [5]. ...
Although Androgenetic Alopecia (AGA) is classified as a non-inflammatory alopecia, histological evidence of microinflammation has long been recognized. However, the changes in the immune microenvironment, the immune-related pathway and the expression of Immune-related genes (IRGs) involved in AGA remain unclear. The microarray gene expression data (GSE36169) from patients with male AGA were analyzed. Gene Set Enrichment Analysis (GSEA) among statistically changed genes was done. KEGG and GO analyses among differentially expressed genes (DEGs) were performed. DEGs were screened to identify IRGs based on the ImmPort database. The cytohubba-MCC plugin of Cytoscape was applied to screen hub immune genes. The infiltration levels of 28 immune cells were quantified adopting single-sample GSEA (ssGSEA) algorithm. The microarray gene expression data (GSE90594) of male AGA was analyzed to validate hub IRGs genes and differential infiltrated immune cells. The ssGSEA revealed γδT cell, central memory CD8+ T cell, mast cell, immature B cell, activated CD8+ T cell, effector memory CD4+ T cell, eosinophil and neutrophil were significantly increased infiltration in the bald scalp. GSEA showed statistically changed genes were most enriched in immune related pathways, including innate immune system, adaptive immune system, cytokine signaling, interferon-γ signaling, interferon signaling and interleukins signaling. The four hub IRGs, including MMP9, PTPRC, BMP2 and THBS1, were enriched in the pathways of allograft rejection, coagulation and interferon-γ response. In summary, we proposed that the increase in γδ T cells, central memory CD8+ T cells, activated CD8+ T cell as well as the infiltration of mast cells contributed to immune microenvironment changes in male AGA. The 4 hub IRGs may be involved in the development and progression of hair loss in male AGA through interferon-γ signal pathways.
... However, due to the associated adverse events, patient compliance for these drugs is poor. For example, finasteride can significantly reduce libido, cause erectile dysfunction, and abnormal sexual function (Arca et al., 2004;Sato and Takeda, 2012;Dou et al., 2022). Moreover, the pathological mechanism of hair loss is complex, making effective treatment with a single compound challenging. ...
Hair serves important physiological functions, including temperature regulation and scalp protection. However, excessive shedding not only impacts these functions but can also significantly affect mental health and quality of life. Tianma Gouteng decoction (TGD) is a traditional Chinese medicine used for the treatment of various conditions, including hair loss. However, the associated mechanism underlying its anti-alopecia effect remains unknown. Therefore, this study aims to elucidate these mechanisms by employing systematic biology approaches, as well as in vitro and in vivo experimental validation. The chemical constituents of Tianma Gouteng decoction were identified using UHPLC-MS/MS, from which 39 potential bioactive components were screened, while an additional 131 putative Tianma Gouteng decoction beneficial components were extracted from the Traditional Chinese Medicine Database and Analysis Platform (TCMSP) database. We then applied a dual-dimensional network pharmacology approach to analyze the data, followed by validation studies combining molecular docking techniques with in vivo and in vitro experiments. From the 39 bioactive components, including quercetin, luteolin, fisetin, wogonin, oroxylin A, boldine, tetrahydroalstonine, and galangin A, 782 corresponding targets were identified. In particular, GSK3β and β-catenin exhibited strong binding activity with the bioactive compounds. Hence, construction of a bioactive component-target network revealed that the mechanism underlying the anti-alopecia mechanism of Tianma Gouteng decoction primarily involved the Wnt/β-catenin signaling pathway. Moreover, C57BL/6J mice exhibited measurable improvements in hair follicle regeneration following treatment with Tianma Gouteng decoction. Additionally, β-catenin and p-GSK3β levels were upregulated, while GSK3β was downregulated in Tianma Gouteng decoction-treated animals and dermal papilla cells compared to control group. These in vivo and in vitro outcomes validated the targets and pathways predicted in the network pharmacology analysis of Tianma Gouteng decoction. This study provides a systematic analysis approach to identify the underlying anti-alopecia mechanisms of Tianma Gouteng decoction, further providing theoretical support for clinical assessment of Tianma Gouteng decoction.
... Hence, it cannot be administered to the scalp via traditional topical administration approaches. Therefore, a different mode of administration, such as changing oral administration to topical use, could reduce adverse reactions to DUT and provide good clinical effects (Rossi et al., 2011;Sato and Takeda, 2012). ...
Androgenic alopecia (AGA) is a common disease that negatively affects patients’ physical and mental health. AGA can be treated with drugs that improve the perifollicular microenvironment, such as 5α-reductase inhibitors (e.g., dutasteride [DUT]), androgen receptor blockers, and minoxidil. However, the efficacy of these treatments is limited. Therefore, this study aimed to show that nanoparticles are effective as stable carriers with high curative benefits and little adverse effects. The in vitro study showed that PLGA-DUT/siAR@DPCM NPs could deliver both DUT and siAR to dermal papilla cells. They could successfully suppress 5α-reductase and knock down androgen receptor, respectively, and thereby promote cell proliferation. In the in vivo study, PLGA-DUT/siAR@DPCM NPs showed a significant therapeutic effect in an AGA mouse model. They successfully penetrated the stratum corneum and showed a clear targeting effect on hair follicles and surrounding tissues. PLGA-DUT/siAR@DPCM NPs could enable the targeted delivery of DUT and siAR through percutaneous penetration, enhancing phagocytosis and decreasing adverse effects. Thus, they have great potential in the clinical treatment of AGA.
... Clinical studies have demonstrated both a high efficacy of treatment and a favorable safety profile [3][4][5][6][7][8][9][10], establishing the drug as the first-line treatment of MPHL. In 2012, Sato and Takeda [11] reported on efficacy and safety of 1 mg oral finasteride for treatment of MPHL in the so far largest population study of enrolled 3,177 Japanese men. The overall effect on hair growth was seen in 87.1%, in whom hair increased greatly in 11.1%, moderately in 36.5%, and slightly in 39.5%. ...
Oral finasteride represented a breakthrough for treatment of male pattern hair loss (MPHL), with clinical studies having demonstrated high efficacy of treatment and a favorable safety profile. And yet, fertility issues, malignancy, and postfinasteride syndrome have been concerns of users and prescribers of the drug. Pre-existing mental health disorder may put patients at an increased risk of nocebo, while the prevalence of personality disorders in subjects with MPHL is known to be higher than in the general population, specifically histrionic personality disorder. We devised a system for patient selection and risk assessment, including fertility issues, regular PSA determinations, and specific mental health assessment. For those who choose regular prostate cancer screening, the use of finasteride meaningfully reduces the risk of prostate cancer. While gynecomastia is a known, rare adverse effect of finasteride, so far, studies support the view that exposure to finasteride is not associated with male breast cancer risk. Patient understanding and involvement are central to optimal treatment selection and active patient role in treatment.
... Although treatment with oral finasteride offers temporary relief for hair loss in treating male AGA, the long-term use of finasteride, usually taking several months to a year or more, seems to be challenging for most patients due to its potential side effects. Hair regrowth can be lost again within 12 months after discontinued treatment [4]. Topical minoxidil has also been approved by the Food and Drug Administration (FDA) for the treatment of AGA, although the molecular mechanism(s) involved in the hair growth-promoting effect of minoxidil is still not fully understood [5]. ...
Introduction:
Although it has been reported that the anti-diabetic drug metformin has multiple extra-hypoglycemic activities, such as anti-oxidation, anti-aging and even anti-tumor, topical metformin also can induce hair regeneration, but the precise mechanism involved in that process is still unclear.
Objectives:
To assess the effect of metformin on hair growth in a mouse hair follicle reconstitution model generated by in vitro self-assembled three-dimensional aggregates of epidermal and dermal cells (3D aggregates).
Methods:
Epidermal cells and dermal cells were isolated and cultured from the mouse skin of fifty C57BL/6 mouse pups (1-day-old). For tracing the distribution of dermal cells during the self-assembly process of 3D aggregates, the dermal cells were labeled with Vybrant Dil cell-labelling solution and mixed with epidermal cells at 1:1 ratio. Formed 3D aggregates were treated with 10 mM metformin and then were grafted into recipient BALB/c nude mice. The biomarkers (HGF, CD133, ALP, β-catenin and SOX2) associated with the hair-inductive activity of dermal cells were detected in the grafted skin tissues and in cultured 3D aggregates treated with metformin using immunofluorescent staining, quantitative real-time RT-PCR (qRT-PCR), and western blotting. Furthermore, the expression levels of CD133 were also examined in dermal cells with different passage numbers using qRT-PCR and western blotting.
Results:
Metformin directly stimulates the activity of alkaline phosphatase (ALP) of cultured 3D aggregates, upregulates both the protein and mRNA expression levels of molecular markers (HGF, CD133, ALP, β-catenin and SOX2) and improves the survival rate of reconstituted hair follicles. Moreover, we also found that metformin increases the expression of CD133 in dermal cells thus maintaining their trichogenic capacity that would normally be lost by serial subculture.
Conclusions:
These results suggest that metformin can promote hair follicle regeneration in vitro through up-regulation of the hair inductive capability of dermal cells, warranting further evaluation in the clinical treatment of male or female pattern hair loss.
... 48 A well-known large Japanese study of over 3000 males with AGA demonstrated that 11.1% of subjects exhibited significant hair regrowth with finasteride use, 36.5% exhibited moderate growth, and 39.5% had only a slight increase in hair growth over a period of 3 years. 49 ...
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.
... In our experience, sexual side effects, such as decreased libido and erectile dysfunction, as well as testicular tenderness and (rarely) gynecomastia have been reversible upon cessation of oral finasteride treatment, and without any sequelae. This is consistent with the respective data on safety and efficacy of 1 mg oral finasteride in the so far largest study of 3,117 Japanese men treated for AGA published in 2012 [7]. ...
... Inhibition of this enzyme by finasteride [4] has found application in clinical practice-in the therapy of prostate cancer, benign prostatic hyperplasia (BPH), and androgenetic alopecia (AGA; prematurely balding young men) [5,6]. In the 1990s, finasteride was introduced to medical care and was considered a safe drug, without any "side effects" on male fertility, and this view is still maintained among dermatologists [7,8]. However, there are many studies documenting contrary findings [9,10], a decrease in semen parameters [5,11,12], difficulties in fertilization [5], psychological problems such as reduced libido, orgasms, and erectile disorders [13], melancholy, and even suicidal thoughts [14]. ...
(1) Background: Hormone-dependent events that occur throughout spermatogenesis during postnatal testis maturation are significant for adult male fertility. Any disturbances in the T/DHT ratio in male progeny born from females fertilized by finasteride-treated male rats (F0:Fin) can result in the impairment of testicular physiology. The goal of this work was to profile the testicular transcriptome in the male filial generation (F1:Fin) from paternal F0:Fin rats. (2) Methods: The subject material for the study were testis from immature and mature male rats born from females fertilized by finasteride-treated rats. Testicular tissues from the offspring were used in microarray analyses. (3) Results: The top 10 genes having the highest and lowest fold change values were mainly those that encoded odoriferous (Olfr: 31, 331, 365, 633, 774, 814, 890, 935, 1109, 1112, 1173, 1251, 1259, 1253, 1383) and vomeronasal (Vmn1r: 50, 103, 210, 211; Vmn2r: 3, 23, 99) receptors and RIKEN cDNA 5430402E10, also known as odorant-binding protein. (4) Conclusions: Finasteride treatment of male adult rats may cause changes in the testicular transcriptome of their male offspring, leading to a defective function of spermatozoa in response to odorant-like signals, which are recently more and more often noticed as significant players in male fertility.
... Accordingly, sexual dysfunction is the most commonly observed adverse events in clinical trials investigating finasteride for male pattern hair loss where ! 1% of patients reported decreased libido, erectile dysfunction, a reduction in the ejaculated semen volume, and impotence (Table 4) (8,9,(46)(47)(48)(49)(58)(59)(60)(61)(62)(63)(64)(65). ...
Background and objectives:
Finasteride 1 mg/day is indicated for androgen-dependent conditions such as male androgenetic alopecia (AGA).
Methods:
The literature is comprehensively summarized on the pharmacodynamics, pharmacokinetics, mechanism of action, and metabolism of finasteride. Pairwise and network meta-analyses were performed to assess the efficacy of finasteride reported in clinical trials. The adverse events profile is described along with the post-marketing reports.
Results and conclusion:
Finasteride 1 mg/day significantly increased total hair count compared to placebo after 24 weeks (mean difference =12.4 hairs/cm2, p < 0.05), and 48 weeks (mean difference =16.4 hairs/cm2, p < 0.05). The efficacy of the two doses of finasteride (5 mg/day and 1 mg/day) and topical finasteride (1% solution) were not significantly different. The most commonly reported sexual events include erectile dysfunction and decreased libido. Increasing patient complaints and analysis of the FAERS database led to the inclusion of depression in the FDA label in 2011, as men were found to be at a risk of suicide due to the persistent sexual side effects, commonly termed as post-finasteride syndrome. Finasteride is shown to be reasonably tolerated in both men and women; however, patients need to be educated about the possible short- and long-term side-effects.
... It is all around acknowledged that dihydrotestosterone (DHT) is answerable for androgenetic alopecia in people. DHT prompts scaling down of hair follicles by a few components including quickening the mitotic pace of the lattice, shortening of hair cycle, expanding telogen shedding, just as expanding the span of the slack stage or catagen [12]. ...
... Notably, combination therapy has been proposed to achieve the best efficacy expediently. However, oral medication requires long-term use and exhibit certain associated side effects, topical medication has limited and inaccurate efficacy, and invasive treatment carries surgical risks [19][20][21]. And hair loss is associated with considerable psychological and emotional distress and decreased quality of life. ...
Background:
Androgenetic alopecia (AGA) represents the most frequent clinical complaint encountered by dermatologists and is characterized by a progressive miniaturization of the hair follicle. However, the efficacy and safety of current medical treatment remain limited, and more personalized therapeutic approaches for AGA are needed. Therefore, the present study is aimed at investigating the efficacy and safety of botulinum toxin type A (BTA) in patients with AGA.
Methods:
63 patients with AGA meeting the inclusion criteria were included in this study and treated with BTA injection or BTA injection combined with oral finasteride (FNS). In the scalp, 30 sites were injected with 100 U of BTA in each site and patients received BTA after every 3 months for a total of 4 times. Hair counts, head photographs, evaluation scores, and self-assessment were assessed in patients with AGA.
Results:
Hair counts in both groups at all time points were significantly higher as compared with those before treatment. After 4 times of treatment, hair counts in the BTA+FNS group were higher than those in the BTA group. Hair growth and density were significantly augmented, and the area of hair loss was attenuated after each treatment as revealed by head photographs. The effective rates of BTA and BTA+FNS groups were 73.3% and 84.8%, respectively, following 4 times treatment.
Conclusion:
BTA is a safe and effective therapeutic strategy for the treatment of AGA without adverse effects, and BTA combined with FNS exhibited a superior therapeutic effect than BTA alone.
... Besides, a 3.5 years study was conducted among 3177 Japanese men with AGA and was administered with oral finasteride 1 mg. 40 The efficacy of oral finasteride is ranging from 81.0% to 91.3% among grade II to V hair loss, with 91.3% patients at stage IV responded highest to the treatment. In addition, two 5 years follow-up studies were conducted among the Asian populations. ...
... Moreover, treatment was discontinued due to sexual side effects only in 4% of patients [48]. Further, a study on 3177 Japanese patients treated with small doses of finasteride for 41 months failed to reveal any sexual side effects [49]. ...
Inhibitors of 5α-steroid reductase are drugs used to treat androgen-dependent conditions including prostate diseases and androgenic alopecia. Finasteride was the first on the market and is currently the most widely used inhibitor. Dutasteride was the second inhibitor to be approved and has a similar safety profile. Common adverse events of treatment consist of sexual disorders and a negative affect balance. It was described that the prolonged use of 5α-steroid reductase inhibitors in patients with alopecia can cause persistent side effects called a post-finasteride syndrome (PFS), that is not just a simple coexistence of events, but rather a definite syndrome with an iatrogenic background. PFS occurs in susceptible individuals even after small doses of the drug and can last for a long time after the discontinuation of treatment. A deterioration in the quality of life in affected individuals does not justify use of the drug. Wider recognition of PFS symptoms, its incidence, course, prevention, and treatment possibilities will allow the indications for drug use to be reconsidered and treatment to be more personalized. Knowledge about PFS will also help to provide the best treatment for affected individuals and to properly educate patients before obtaining an informed consent for therapy with 5α-steroid reductase inhibitors.
... Finasteride is widely used in AGA, which significantly improves hair growth and slows hair loss compared with placebo (11,29). However, finasteride is not recommended for use in women due to the risk of birth defects in women of childbearing age and its high transdermal absorption. ...
The use of finasteride for alleviating hair loss has been investigated, and it has been applied as an oral dose medication. However, due to the inconvenience of daily drug administration over long period of time, novel controllable finasteride delivery has been actively investigated. As a novel method of finasteride delivery, the development of finasteride‑loaded microspheres for subcutaneous administration is becoming increasingly pharmaceutically important. Therefore, the present study aimed to use finasteride‑loaded microspheres in a controlled manner in an attempt to overcome the limitations of the oral administration of finasteride and to cause fewer adverse effects. Finasteride‑loaded microspheres containing poly(lactic‑co‑glycolic acid) and finasteride at a ratio of 4:1 were prepared, and a testosterone‑induced androgenic alopecia mouse model was used. Following observation for 10 weeks, the percentage hair growth was 86.7% (total hair growth 60%, partial hair growth 26.7%) in the orally‑applied finasteride‑treated group as a positive control, and 93.3% (total hair growth 60%, partial hair growth 33.3%) in the finasteride‑loaded microspheres‑treated group. Serum dihydrotestosterone levels began to decrease at week 6 in the orally‑applied finasteride‑ and finasteride‑loaded microsphere‑treated groups. In addition, the finasteride‑loaded microspheres‑treated group exhibited similar follicular number, follicular length, anagen/telogen ratio and hair bulb diameter values to those of the orally‑applied finasteride‑treated group. Furthermore, the finasteride‑loaded microspheres increased the activities of phosphoinositide 3‑kinase/protein kinase B and Wnt/β‑catenin in relation to hair follicle cell growth signaling in mouse skin, and suppressed the apoptosis of hair follicle cells by reducing the expression of transforming growth factor‑β2 and caspase‑3, which are indicators of apoptosis. In conclusion, the administration of a single injection of finasteride‑loaded microspheres was effective in treating testosterone‑induced alopecia. Furthermore, it led to equivalent hair growth effects when compared with orally‑applied finasteride, thus revealing the possibility of effective treatment via different routes of administration.
... 5 Finasteride, an oral type 2 5-alpha reductase inhibitor (5ARI), has been approved by the US Food and Drug Administration for the treatment of AGA, significantly reversing the process of hair loss and increasing the length and density of the targeted hair. 6,7 Observing related literature on the effectiveness of finasteride in AGA, as many as 30%-45% of participants did not show relief of clinical symptoms which were eventually hard to control. 8 Although hair above the head is no longer shed after the treatment of finasteride, patient's target for treatment is not only to delay the progression of AGA, but also to increase the amount of the targeted hair and improve patients' quality of life. ...
Aim
We performed a meta-analysis to evaluate the efficacy and safety of dutasteride and finasteride in treating men with androgenetic alopecia (AGA) during a 24-week treatment cycle.
Methods
Randomized controlled trials of dutasteride and finasteride for treating AGA were searched using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The data were calculated using Rev Man v5.3.0. The reference lists of retrieved studies were also investigated.
Results
Three articles including 576 participants which compared dutasteride with finasteride were selected for our analysis. The mean change in total hair count (mean difference [MD], 28.57; 95% CI, 18.75–38.39; P<0.00001), investigator’s assessment of global photographs for the vertex (MD, 0.68; 95% CI, 0.13–1.23; P=0.02) and frontal (MD, 0.63; 95% CI, 0.13–1.13; P=0.01) views, panel global photographic assessment for the vertex (MD, 0.17; 95% CI, 0.09–0.24; P<0.00001) and frontal (MD, 0.25; 95% CI, 0.18–0.31; P<0.00001) views, and subjects’ assessment (MD, 0.56; 95% CI, 0.18–0.94; P=0.003) suggested that dutasteride provided a better efficacy in treating men with AGA compared with finasteride. With regard to the assessment of safety, altered libido (P=0.54), erectile dysfunction (P=0.07), and ejaculation disorders (P=0.58), dutasteride did not show a significant difference compared with finasteride.
Conclusion
Dutasteride seems to provide a better efficacy compared with finasteride in treating AGA. The two drugs appear to show similar rates of adverse reactions, especially in sexual dysfunction.
... Moreover, treatment was discontinued due to sexual side effects only in 4% of patients [48]. Further, a study on 3177 Japanese patients treated with small doses of finasteride for 41 months failed to reveal any sexual side effects [49]. ...
nhibitors of 5α-steroid reductase are drugs used to treat androgen-dependent conditions including prostate diseases and androgenic alopecia. Finasteride was the first on the market and is currently the most widely used inhibitor. Dutasteride was the second inhibitor to be approved and has a similar safety profile. Common adverse events of treatment consist of sexual disorders and a negative affect balance. It was described that the prolonged use of 5α-steroid reductase inhibitors in patients with alopecia can cause persistent side effects called a post-finasteride syndrome (PFS), that is not just a simple coexistence of events, but rather a definite syndrome with an iatrogenic background. PFS occurs in susceptible individuals even after small doses of the drug and can last for a long time after the discontinuation of treatment. A deterioration in the quality of life in affected individuals does not justify use of the drug. Wider recognition of PFS symptoms, its incidence, course, prevention, and treatment possibilities will allow the indications for drug use to be reconsidered and treatment to be more personalized. Knowledge about PFS will also help to provide the best treatment for affected individuals and to properly educate patients before obtaining an informed consent for therapy with 5α-steroid reductase inhibitors.
... Finasteride converts miniaturized hair follicles into terminal hairs and elongates the anagen phase of the hair follicle. It is most effective for treating vertex thinning, but also it works on the frontal area [1][2][3][4][5]. ...
The key change of androgenetic alopecia (AGA) is the thinning of hairs caused by miniaturization of hair follicles, not the shedding of hairs. As terminology implies, androgens (male sex hormones), especially dihydrotestosterone (DHT), play important roles in the pathogenesis of AGA, but no exact pathogenesis has been proven so far. However, several medications are successfully used for AGA through various mechanisms.
... Efficacymales Finasteride Twenty-five studies investigating the efficacy of finasteride in male patients with AGA met the inclusion criteria of the guideline. 34,35,38,41,44,[67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86] Thirteen studies obtained grade A2 evidence, nine grade B and three grade C. Fourteen studies were placebo-controlled. An EVIDENCE LEVEL 1 can be attributed. ...
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.
We aimed to determine the efficacy of the various available oral, topical, and procedural treatment options for hair loss in individuals with androgenic alopecia. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the National Library of Medicine was performed. Overall, 141 unique studies met our inclusion criteria. We demonstrate that many over the counter (e.g. topical minoxidil, supplements, low-level light treatment), prescription (e.g. oral minoxidil, finasteride, dutasteride), and procedural (e.g. platelet-rich plasma, fractionated lasers, hair transplantation) treatments successfully promote hair growth, highlighting the superiority of a multifaceted and individualized approach to management.
Although hair loss plays a vital physiological function in present society, their impact on shaping self-esteem is undeniable. Even though there are numerous synthetic drugs available, these days, there are issues with safety, efficiency, and unclear time settings for required outcomes with the current synthetic drug remedies available; therefore, there is growing attention to discovering alternative methods to fight hair loss, primarily through plant-derived formulations. While earlier reports mostly focused on screening compounds or plant extracts affecting 5α-reductase, our research takes a unique direction. We employed a biochemical and molecular biological approach by delving into the complicated biosynthetic pathways involving 17β-hydroxysteroid dehydrogenase (17β-HSD) and 3β-hydroxysteroid dehydrogenase (3β-HSD) in producing testosterone derived from cholesterol. This process conceded requiring experimental results, posing insights into the control of the testosterone/dihydrotestosterone (DHT) production pathway. Our study confirms a discovery platform for finding potential candidates as hair loss inhibitors, highlighting exploring various biochemical mechanisms involving 17β-HSD and 3β-HSD in combination with medicinal plant extracts.
Dutasteride 0.5 mg is a dual inhibitor of 5α‐reductase type I and II and was approved in Korea in 2009 for treating androgenetic alopecia (AGA) in men. We investigated the 5‐year efficacy and safety of dutasteride 0.5 mg in Korean men with AGA using the basic and specific (BASP) classification. This retrospective analysis included 99 male AGA patients aged ≥18 years who were treated with dutasteride 0.5 mg for at least 5 years from October 2009 to December 2016 at Kyung Hee University Hospital in Gangdong. Patient photographs were scored using the BASP classification, and the Investigator Global Assessment (IGA) was performed using a seven‐point scale. Patient improvement (IGA score ≥1) and prevention of disease progression (IGA score ≥0) were 89.9% (89/99) and 93.9% (93/99), respectively. According to the BASP classification, 52.5% (52/99) of the basic type, 75% (15/20) of the specific F type, and 82.2% (60/73) of the specific V type showed clinical improvement after 5 years of treatment. Dutasteride demonstrated long‐term safety and efficacy in Korean male patients with AGA over a period of at least 5 years, with results comparable to those of other long‐term efficacy studies of finasteride 1 mg in male patients with AGA.
Androgenetic alopecia (AGA) is a common type of hair loss, which is generally influenced by genetic factors and systemic androgens resulting in follicular miniaturization1. It can cause cosmetic problems leading to psychological distress among affected men and women. Effective standard medical treatments available are topical minoxidil 2-5%, oral finasteride, oral dutasteride, and hair transplantation.1 However, some patients do not achieve favorable results with standard treatments. For these reasons, other novel treatments have been developed, including new medications, regenerative medicines (autologous platelet-rich plasma (PRP), adipose derived stem cells, micrograft generation and exosome) and low-level laser therapy (LLLT).
The hair follicle (HF) is a multicellular complex structure of the skin that contains a reservoir of multipotent stem cells. Traditional hair repair methods such as drug therapies, hair transplantation, and stem cell therapy have limitations. Advances in nanotechnology offer new approaches for HF regeneration, including controlled drug release and HF-specific targeting. Until recently, embryogenesis was thought to be the only mechanism for forming hair follicles. However, in recent years, the phenomenon of wound-induced hair neogenesis (WIHN) or de novo HF regeneration has gained attention as it can occur under certain conditions in wound beds. This review covers HF-specific targeting strategies, with particular emphasis on currently used nanotechnology-based strategies for both hair loss-related diseases and HF regeneration. HF regeneration is discussed in several modalities: modulation of the hair cycle, stimulation of progenitor cells and signaling pathways, tissue engineering, WIHN, and gene therapy. The HF has been identified as an ideal target for nanotechnology-based strategies for hair regeneration. However, some regulatory challenges may delay the development of HF regeneration nanotechnology based-strategies, which will be lastly discussed.
Background
Although androgenetic alopecia (AGA) is classified as a non-inflammatory alopecia, histological evidence of microinflammation has long been recognized. However, changes in the immune microenvironment, immune-related pathways and the expression of immune-related genes (IRGs) involved in AGA remain unclear.
Methods
The microarray gene expression data (GSE36169) from patients with male AGA were analyzed. gene set enrichment analysis (GSEA) among statistically changed genes was done. Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analyses among differentially expressed genes were performed. differentially expressed genes were screened to identify IRGs based on the ImmPort database. The cytohubba-MCC plugin of Cytoscape was applied to screen hub immune genes. The infiltration levels of 28 immune cells were quantified adopting single-sample GSEA (ssGSEA) algorithm. The microarray gene expression data (GSE90594) of male AGA was analyzed to validate hub IRGs genes and differential infiltrated immune cells.
Results
The ssGSEA revealed γδT cell, central memory CD8 ⁺ T cell, mast cell, immature B cell, activated CD8 ⁺ T cell, effector memory CD4 ⁺ T cell, eosinophil and neutrophil were significantly increased infiltration in the bald scalp. GSEA showed statistically changed genes were most enriched in immune related pathways, including innate immune system, adaptive immune system, cytokine signaling, interferon-γ signaling, interferon signaling and interleukins signaling. The 4 hub IRGs, including matrix metallopeptidase 9, protein tyrosine phosphatase receptor type C, bone morphogenetic protein 2, and thrombospondin 1, were enriched in the pathways of allograft rejection, coagulation and interferon-γ response.
Conclusion
In summary, we proposed that the increase in γδ T cells, central memory CD8 ⁺ T cells, activated CD8 ⁺ T cell as well as the infiltration of mast cells contributed to immune microenvironment changes in male AGA. The 4 hub IRGs may be involved in the development and progression of hair loss in male AGA through interferon-γ signal pathways.
Finasteride is the result of a long-term research program by Merck & Co., dating back to 1950 when their R&D department got engaged in the study of androgen effects in Benign Prostatic Hyperplasia (BPH). BPH is defined as an increase in the prostate’s size caused by the growth of the prostatic periurethral transition zone, is due to androgen action, and occurs in 50% of men who are >50 years old [1]. BPH causes a partial obstruction of the endoprostatic part of the urethra and consequently increases urethral resistance, whereas BPH patients exhibit typical, progressive symptoms: difficulty initiating urination, decreased urinary flow pressure, intermittent urination, incomplete emptying of the bladder, faster bladder filling, urinary frequency, urinary urgency, and nocturia [2]. This group of clinical symptoms is referred to as “Lower Urinary Tract Symptoms (LUTS)” in the literature.
Ethnopharmacological relevance
alopecia is a hair disorder that can add a significant medical and psychological burden to patients. Currently, the FDA-approved drugs for the treatment of androgenetic alopecia (AGA) are minoxidil and finasteride and immunosuppressives are therapeutic options for alopecia areata (AA), but the objective adverse effects and high cost of these treatments reduce patient compliance and thus the effectiveness of the drugs. Traditional Chinese medicine (TCM) has good efficacy, a high safety profile and low treatment costs, but its mechanism of action is still not fully understood. The use of signaling pathways to modulate hair loss is a major direction in the study of the pathogenesis and pharmacology of alopecia.
Aim of the study
This review aims to collect the results of experimental studies related to alopecia, to screen previously documented combinations of herbs claimed to be effective based on the herbs and their constituent compounds used in the identified studies, and to uncover other useful information that we hope will better guide the clinical application and scientific research of drug combinations or individual herbs for the treatment of alopecia.
Materials and methods
We have reviewed experimental studies to determine the methods used and the mechanisms of action of the herbs and constituent compounds. The following keywords were searched in databases, including PubMed, EMBASE, CNKI and CSTJ.” Medicinal plants” “Chinese herbal medicine”, “hair loss”, " alopecia”, “androgenetic alopecia” and " alopecia areata ". We also collected combinations of drugs from books approved by various schools for screening.
Results
Using known combinations of compounds within herbal medicine to match the documented combinations, 34 topical combinations and 74 oral combinations were identified, and among the 108 herbal combinations screened Angelica, Rehmannia glutinosaLigusticum chuanxiong hort, Radix Rehmanniae, etc. The number of occurrences was very high, and the association with vascular drugs was also found to be very close.
Conclusions
This review further elucidates the therapeutic mechanisms of the compounds within the herbal components associated with alopecia and screens for other combinations that may be dominated by this component for the treatment of alopecia, uncovering compounds from other drugs that may be key factors in the treatment of alopecia. This improvement will provide a better quality of evidence for the effectiveness of herbs and compounds used to treat alopecia.
This article introduces the reader to the key components of hair transplantation, including evaluating the surgical patient, deciding whether to perform follicular unit transplantation (FUT) or follicular unit extraction (FUE), understanding the key components of these procedures, and establishing practical preoperative and postoperative protocols.
Abstract
Finasteride is a 5 alpha reductase inhibitor(5-α RI) that has been used for the treatment of benign prostatic hyperplasia (BPH) as well as androgenic alopecia for relatively young men for long. That a group of side effects not only develop following its use but persist following cessation of the drug with the syndrome coined as ‘’Post Finasteride Syndrome ‘’(PFS) has been realized for long. What is the reason that we as physicians refuse to appreciate this despite serious adverse effects like persistent sexual dysfunctions, suicidal ideation, and other metabolic effects like risk of developing type 2 diabetes mellitus (DM), lacrimal dysfunction, renal abnormalities we refuse to appreciate these drug induced syndrome. Infact when rimonabant (a CB1 receptor agonist)was being studied as an antiobesity syndrome and was shown to cause suicidal ideation immediately it was with drawn from trials. What pushes us not to use the same criteria for these 5-α RI including Finasteride and dutasteride knowing that how important they are in human physiology and how severe harm we might cause to then poor unknowing man who is not even told that he might develop erectile dysfunction, loss of pleasure in life a prize he has to pay to get his hair back. This comprehensive review has been done with an effort for our medical community who took hippocratic oath to serve the humanity why they cannot get up and protest against the side effects that in a subgroup of men might get irreversible side effects rather than label the poor men as psychotic or delusional. These symptoms have been emphasized by Traish along with other groups as men who have epigenetic susceptibility. Time has come that not only we start actually looking deep down into the pathophysiology and get an insight into this mysterious, elusive diagnosis that refuses to get accepted despite a lot of body of evidence.Hopefully a change in the attitude of our community will come.
Keywords: 5-α RI; ‘’Post Finasteride Syndrome ‘’(PFS); persistent sexual dysfunctions; suicidal ideation; BPH; metabolic dysfunctions
Background:
Androgenetic alopecia (AGA) is the most frequent form of alopecia. Telogen effluvium (TE) is a common form of diffuse hair loss mainly observed in women. The aim of our study was to evaluate the efficacy of a topical trichological treatment containing a new combination of molecules for the treatment of AGA and TE.
Methods:
In-vitro tests were performed analyzing different combinations and concentrations of arginine, zinc and a third enzymatically neutral substance called AA on human follicles dermal papillae cells. These tests evaluated the capability of inhibiting the 5α-reductase (5-AR) enzyme and the 5-AR gene expression. We also performed an in-vivo study. Forty individuals affected by AGA and TE were divided into two groups. One group was administered a combination of zinc and arginine (lotion A), whilst the other placebo (lotion B). Therapy duration was 23 consecutive weeks. Follow-up examinations and pull tests occurred at baseline, after 6 weeks and at the end of the therapy. On 20 randomly selected patients we also performed noninvasive phototrichograms.
Results:
In-vitro tests showed that the combination had a strong statistically significant inhibitory activity on 5-AR of dermal papillae cells. Number of hairs removed by pull-test significantly decreased at T0, T1 and T2 in patient treated with lotion A. We also observed an increase in the percentage of anagen hair and a decrease in telogen hairs. Concerning phototrichograms, all objective parameters evaluated showed better results in the lotion A group when compared with the placebo group.
Conclusions:
Based on our results, the combination of arginine and zinc tested in our study could represent a good therapeutic option for the treatment of AGA and TE and it might represent a valid alternative to finasteride.
If during development anything goes wrong at the time of development be it in fusion, or mullerian ducts getting resorbed as well as urogenital sinus might
end up in a variety of congenital malformations although similar, those of the body of the uterus, cervix, vagina as well as fallopian tubes. Although a variety of
classifications as well as definitions have been developed no uniformity exists in globally assessing and evaluating usefulness of surgical procedures for mullerian
anomalies, of these the most important one is septate uterus that has undergone varied classifications right from American Fertility Society (ASE) to European
Society of Human Reproduction and Embryology (ESHRE)/ European Society of Gynecological Endoscopy (ESGE) and American Society of Reproductive
Medicine (ASRM) classifications. Lot of discrepancy exists in the ESHRE/ESGE and ASRM classifications thus need for a modified ASRM classification is urgently
needed to bring in uniformity regarding management and evaluate criteria as well as results of surgery uniformly as per Ludwin A the group having done
maximum work on the subject. Further details of complicated malformations like Robert’s uterus, blind hemivagina, cervical atresia has been discussed in detail.
Zusammenfassung
Ein Patient wurde im Jahre 2013 mit Propecia 1 mg aufgrund einer androgenetischen Alopezie behandelt. Es traten bei ihm eine sexuelle Dysfunktion mit Erektionsschwäche und vermindertem sexuellen Verlangen auf, die auch nach Abbrechen der Therapie anhielt. Daraufhin machte der Patient gegenüber dem Facharzt einen Behandlungsfehler geltend aufgrund mangelhafter Aufklärung mit der Konsequenz einer fehlerhaften Behandlung. Der urologische Fachgutachter bejahte den Behandlungsfehler. Er war der Meinung, dass, auch wenn nur Einzelfälle mit geringer wissenschaftlicher Basis über das Post-Finasterid-Syndrom bekannt wären, der Facharzt über diese schwerwiegende Nebenwirkung den Patienten hätte aufklären müssen, dies insbesondere bei einer rein kosmetischen Indikation männlicher Glatzenbildung.
Der dermatologische Gutachter schloss sich nicht dieser Meinung an. Im Verordnungsjahr 2013 existierten lediglich 2 Publikationen über Einzelfälle des Post-Finasterid-Syndroms. Diese Publikationen in peripheren Zeitschriften fanden noch kein allgemeines wissenschaftliches Echo und führten auch nicht zur Änderung der Fachinformation. Erst im Verlauf der Folgejahre wurde in der Postmarketing-Phase das Syndrom öfters beschrieben und fand auch Eingang in die Fachinformation. Da für die Beurteilung das im Jahre der Verordnung geltende wissenschaftliche Wissen entscheidend ist, kann dem Facharzt kein Behandlungsfehler vorgeworfen werden.
Post-finasteride syndrome (PFS) is a constellation of serious adverse side effects manifested in clinical symptoms that develop and persist in patients during and/or after discontinuing finasteride treatment in men with pattern hair loss (androgenetic alopecia) or benign prostatic hyperplasia. These serious adverse side effects include persistent or irreversible sexual, neurological, physical and mental side effects. To date, there are no evidence-based effective treatments for PFS. Although increasing number of men report persistent side effects, the medical community has yet to recognize this syndrome nor are there any specific measures to address this serious and debilitating symptoms. Here we evaluate the scientific and clinical evidence in the contemporary medical literature to address the very fundamental question: Is PFS a real clinical condition caused by finasteride use or are the reported symptoms only incidentally associated with but not caused by finasteride use? One key indisputable clinical evidence noted in all reported studies with finasteride and dutasteride was that use of these drugs is associated with development of sexual dysfunction, which may persist in a subset of men, irrespective of age, drug dose or duration of study. Also, increased depression, anxiety and suicidal ideation in a subset of men treated with these drugs were commonly reported in a number of studies. It is important to note that many clinical studies suffer from incomplete or inadequate assessment of adverse events and often limited or inaccurate data reporting regarding harm. Based on the existing body of evidence in the contemporary clinical literature, the author believes that finasteride and dutasteride induce a constellation of persistent sexual, neurological and physical adverse side effects, in a subset of men. These constellations of symptoms constitute the basis for PFS in individuals predisposed to epigenetic susceptibility. Indeed, delineating the pathophysiological mechanisms underlying PFS will be of paramount importance to the understanding of this syndrome and to development of potential novel therapeutic modalities.
Androgenic alopecia (AGA) is an aesthetic condition with varying psycho-social implications, easily accepted by some patients and tolerated only with difficulty by others. Modern therapeutic options such as 5α-reductase inhibitors have significant outcomes, but also exert significant side effects in a subset of patients.
The literature describes three distinct situations regarding finasteride administration, a compound largely used for AGA. Some studies show finasteride to be very safe with minimal or no side effects. Other studies take a more cautious approach, recognizing such side effects but, at the same time, considering the putative relationship between finasteride and adverse effects to be disputable, given that placebo administration in AGA is associated with relatively similar or even more severe side effects. Finally, some authors/studies are concerned that, when compared to placebo, finasteride administration may result in side effects with greater frequency and severity, and sometimes that persist even after treatment cessation in the form of post-finasteride syndrome.
Several factors presented in this paper appear to explain finasteride inconsistency regarding its therapeutic and side effects. Such factors should be further investigated and used to categorize subjects into distinct subgroups, either predisposed to adverse reactions or more tolerant to the finasteride administration.
Background and Objectives: The most common type of hair loss is androgenetic alopecia. Mesotherapy is considered a controversial treatment for this condition. The aim of this study was to examine the safety and efficacy of mesotherapy in the treatment of androgenetic alopecia.
Methods: A systematic review was conducted to identify and evaluate relevant studies on mesotherapy for the treatment of androgenetic alopecia. The Cochrane Library, PubMed, Embase, Scopus, and Web of Science were searched until November 2017. The grey literature and references of key studies were also scanned for additional citations. In addition, quality assessment of studies was conducted using the Jadad scale.
Results: Five studies including 344 patients were considered eligible for the review. Of five studies included in this review, three were randomized controlled trials (RCTs) and two were non-RCTs. In previous studies, mesotherapy was performed using dutasteride, minoxidil, and finasteride. As the analysis revealed, quality of retrieved studies was poor. The results showed that mesotherapy leads to the improvement of efficacy outcomes. However, in one study, mesotherapy was not shown to be effective regarding some outcomes. No significant adverse effects were reported for mesotherapy.
Conclusions: Although the findings of previous studies suggest that mesotherapy is a safe and effective treatment for androgenetic alopecia, further research is needed to confirm this finding.
The post-Finasteride syndrome (PFS) has been claimed to occur in men who have taken oral finasteride to treat hair loss or benign prostatic hyperplasia. While the incidence of persistent sexual, mental, and physical side effects despite quitting finasteride is unknown, and the condition is not recognized by the scientific community, individuals who suffer from PFS do present with very distinctive and homogenous symptoms. The concept has emerged from reports of nondermatologists, neuroendocrinological research, case reports, and uncontrolled studies. These have been scrutinized by hair experts who found that persistent sexual side effects were only documented in low-quality studies with a strong bias selection and a significant nocebo effect. Others totally dispute the credibility of the PFS. In any case, the PFS is a problem that has to be dealt with. Low-quality studies neither confirm nor refute the condition as a valid nosologic entity. Therefore, it is as inappropriate to dismiss the condition, as it would be to demonize finasteride for the treatment of male pattern hair loss. Whether the PFS represents a nocebo reaction or a real drug adverse event is irrelevant, while the best way to alleviate the emotional distress related to hair loss is to effectively treat the condition causing the problem. It is not sufficient to only discuss the plausibility of the PFS. There is a need for practical recommendations to include such important issues as patient selection and risk assessment, appropriate patient information, how to react in case of drug-related adverse events, issues of fertility and malignancy, management of the PFS, and alternatives, specifically the use of topical finasteride. It is the aim of this commentary to provide the respective information. © 2019 International Journal of Trichology | Published by Wolters Kluwer - Medknow.
Testosterone (T) can act directly through neural androgen receptors (AR) to facilitate male sexual behavior; however, T's metabolites also can play complicated and interesting roles in the control of mating. One metabolite, dihydrotestosterone (DHT) binds to AR with significantly greater affinity than that of T. Is that important behaviorally? Another metabolite, estradiol (E), offers a potential alternative route of facilitating male mating behavior by acting through estradiol receptors (ER). In this review we explore the roles and relative importance of T as well as E and DHT at various levels of the neuroaxis for the activation of male sex behavior in common laboratory animals and, when relevant research findings are available, in man.
Background and aim:
Androgenetic alopecia (AGA) is undoubtedly the most common form of hair loss in males. It is a condition which may cause cosmetic and psychosocial problems in androgen-dependent cases. In this open, randomized and comparative study we evaluated the efficacy of oral finasteride and 5% topical minoxidil treatment for 12 months in 65 male patients with mild to severe AGA.
Methods:
We randomly assigned 40 (61.53%) patients to receive 1 mg/day oral finasteride for 12 months, and 25 (38.47%) patients applied 5% topical minoxidil solution twice daily for 12 months.
Results:
There were no significant differences between the 2 groups considering age, age of onset of hair loss, family history and type of hair loss (p > 0.05). In the clinical evaluation at the endpoint of treatment, the clinical cure rates (i.e. increased intensity of hair) were 80% (32/40) for the oral finasteride group and 52% (13/25) for the 5% topical minoxidil group. Encountered side effects were all mild, and there was no need to stop the treatment. In the group given oral finasteride, side effects were noted in 7 patients: 6 patients suffered from loss of libido, and 1 patient had an increase in other body hairs; irritation of the scalp was seen in 1 patient in the group administered 5% minoxidil. These adverse events disappeared as soon as the treatment was stopped. The laboratory data on both drug groups did not show any statistically or clinically significant intragroup changes from baseline values to the endpoint (p > 0.05), except the level of serum total testosterone which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were statistically decreased from baseline values to the endpoint (p < 0.05).
Conclusion:
In this comparative study of systemic finasteride and topical minoxidil, it was concluded that both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective (p < 0.05). Adverse events were not considered important either, and these side effects disappeared as soon as the treatment was stopped.
Finasteride is a type 2 5 alpha-reductase inhibitor that inhibits conversion of testosterone to dihydrotestosterone, a key mediator of male pattern hair loss (androgenetic alopecia). The objective of this study was to identify the optimal dosage of finasteride and to evaluate its efficacy and safety in the treatment of Japanese men with male pattern hair loss. In this double- blind randomized study, 414 Japanese men with male pattern hair loss received finasteride 1 mg (n = 139), finasteride 0.2 mg (n = 137), or placebo (n = 38) once daily for 48 weeks. Efficacy was evaluated by global photographic assessment, patient self-assessment, and investigator assessment. All efficacy endpoints showed significant improvement with finasteride therapy by 12 weeks (p < 0.05 versus placebo). At 48 weeks, 58%, 54%, and 6% of men in the finasteride 1 mg, finasteride 0.2 mg, and placebo groups, respectively, had improved based on assessments of global photographs. All efficacy endpoints were numerically superior for the 1 mg dose over the 0.2 mg dose at 48 weeks. Finasteride treatment was generally well tolerated. Finasteride 1 mg\day slows hair loss and improves hair growth in Japanese men with male pattern hair loss.
Hamilton (1951), in a frontier work, extensively studied the developing patterns of scalp hair in men and women from the prenatal period through the tenth decade. He divided the balding patterns into eight types with three sub-divisions, then compared the incidence of baldness between Caucasian and Chinese.
Background. Finasteride 1 mg (Propecia®) is indicated for the treatment of men with androgenetic alopecia (male pattern hair loss, MPHL). However, the long-term (> 2 years) efficacy and safety of finasteride in this population has not been previously reported. Objectives. To assess the efficacy and safety of finasteride in men with MPHL compared to treatment with placebo over five years. Methods. In two 1-year, Phase III trials, 1,553 men with MPHL were randomized to receive finasteride 1 mg/day or placebo, and 1,215 men continued in up to four 1-year, placebo-controlled extension studies. Efficacy was evaluated by hair counts, patient and investigator assessments, and panel review of clinical photographs. Results. Treatment with finasteride led to durable improvements in scalp hair over five years (p ≤ 0.001 versus placebo, all endpoints), while treatment with placebo led to progressive hair loss. Finasteride was generally well tolerated and no new safety concerns were identified during long-term use. Conclusions. In men with MPHL, long-term treatment with finasteride 1 mg/day over five years was well tolerated, led to durable improvements in scalp hair growth, and slowed the further progression of hair loss that occurred without treatment.
Background: Androgenetic alopecia (male pattern hair loss) is caused by androgen-dependent miniaturization of scalp hair follicles, with scalp dihydrotestosterone (DHT) implicated as a contributing cause. Finasteride, an inhibitor of type II 5α-reductase, decreases serum and scalp DHT by inhibiting conversion of testosterone to DHT. Objective: Our purpose was to determine whether finasteride treatment leads to clinical improvement in men with male pattern hair loss. Methods: In two 1-year trials, 1553 men (18 to 41 years of age) with male pattern hair loss received oral finasteride 1 mg/d or placebo, and 1215 men continued in blinded extension studies for a second year. Efficacy was evaluated by scalp hair counts, patient and investigator assessments, and review of photographs by an expert panel. Results: Finasteride treatment improved scalp hair by all evaluation techniques at 1 and 2 years (P < .001 vs placebo, all comparisons). Clinically significant increases in hair count (baseline = 876 hairs), measured in a 1-inch diameter circular area (5.1 cm2 ) of balding vertex scalp, were observed with finasteride treatment (107 and 138 hairs vs placebo at 1 and 2 years, respectively; P < .001). Treatment with placebo resulted in progressive hair loss. Patients’ self-assessment demonstrated that finasteride treatment slowed hair loss, increased hair growth, and improved appearance of hair. These improvements were corroborated by investigator assessments and assessments of photographs. Adverse effects were minimal. Conclusion: In men with male pattern hair loss, finasteride 1 mg/d slowed the progression of hair loss and increased hair growth in clinical trials over 2 years. (J Am Acad Dermatol 1998;39:578-89.)
The need for a widely accepted, accurate, and reproducible standard of classification for male pattern baldness has increased with the advent and increasing popularity of hair transplant surgery. This report establishes such a classification, and reports its use in determining the incidence of male pattern baldness at various ages in 1,000 white adult male subjects. The action of testosterone as an incitant in male pattern baldness is well known, but this study points out the continued effect of time, even in later years. Since most hair transplant surgery is peformed on subjects with male pattern baldness, and because the success of hair transplant surgery is largely dependent on proper patient selection, a complete understanding of male pattern baldness is essential for consistently good results with hair transplantation.
Androgenetic alopecia (male pattern hair loss) is caused by androgen-dependent miniaturization of scalp hair follicles, with scalp dihydrotestosterone (DHT) implicated as a contributing cause. Finasteride, an inhibitor of type II 5alpha-reductase, decreases serum and scalp DHT by inhibiting conversion of testosterone to DHT.
Our purpose was to determine whether finasteride treatment leads to clinical improvement in men with male pattern hair loss.
In two 1-year trials, 1553 men (18 to 41 years of age) with male pattern hair loss received oral finasteride 1 mg/d or placebo, and 1215 men continued in blinded extension studies for a second year. Efficacy was evaluated by scalp hair counts, patient and investigator assessments, and review of photographs by an expert panel.
Finasteride treatment improved scalp hair by all evaluation techniques at 1 and 2 years (P < .001 vs placebo, all comparisons). Clinically significant increases in hair count (baseline = 876 hairs), measured in a 1-inch diameter circular area (5.1 cm2) of balding vertex scalp, were observed with finasteride treatment (107 and 138 hairs vs placebo at 1 and 2 years, respectively; P < .001). Treatment with placebo resulted in progressive hair loss. Patients' self-assessment demonstrated that finasteride treatment slowed hair loss, increased hair growth, and improved appearance of hair. These improvements were corroborated by investigator assessments and assessments of photographs. Adverse effects were minimal.
In men with male pattern hair loss, finasteride 1 mg/d slowed the progression of hair loss and increased hair growth in clinical trials over 2 years.
A 24-month double-blind, randomized, placebo-controlled, parallel-group, multicenter study of 424 men was conducted to determine the efficacy and tolerability of finasteride 1 mg on hair growth/loss in men aged 41 to 60 years with mild-to-moderate, predominantly vertex male pattern hair loss. Efficacy was evaluated by review of global photographs of the vertex scalp taken at baseline and at Months 6, 12, 18, and 24 and by patient self-assessments and investigator clinical assessments of change from baseline in hair growth/loss collected at Months 6, 12, 18, and 24. Safety analyses included assessment of clinical and laboratory adverse experiences, including sexual adverse experiences. Analysis of global photographic assessment data showed significant improvement in hair growth for men in the finasteride group compared with those taking placebo beginning at Month 6 (p < 0.001) and maintained through Month 24 (p < 0.001). Results of the patient self-assessment and investigator assessments were consistent with those from the global photographic assessment. Finasteride 1 mg improved scalp hair growth in men aged 41 to 60 years with predominantly vertex male pattern hair loss compared with results seen with placebo. Improvement was evident by 6 months of treatment and continued through 24 months. Treatment with finasteride 1 mg was generally well tolerated.
This study collected qualitative and quantitative data about the morphology, structure, geometry, water swelling, and mechanical properties of hair fibers from subjects of different ethnic origins. X-ray analysis, cross-sectional measurements, tensile testing, and water swelling were performed on samples of hair collected from Caucasian, Asian, and African subjects. No differences in the intimate structures of fibers were observed among these 3 types of hairs, whereas geometry, mechanical properties, and water swelling differed according to ethnic origin. In addition, the behavior of hair fiber under mechanical stress was visualized with environmental scanning electron microscopy.
Pattern hair loss (PHL) can be classified into several patterns. Currently, the Hamilton-Norwood classification system for men and the Ludwig grade system for women are commonly used to describe patterns of hair loss. However, these pre-existing classifications have some limitations.
To establish an acceptable, universal, and accurate standard of both male and female pattern hair loss and to report its use in determining the incidence of PHL.
We developed a new classification system (BASP classification) and then applied this system to classify the types of PHL. The BASP classification was based on observed patterns of hair loss. The basic (BA) types represent the shape of the anterior hairline, and the specific types (SP) represent the density of hair on distinct areas (frontal and vertex). There are four basic types (L, M, C, and U) and two specific types (F and V). The final type is decided by the combination of the assigned basic and specific types. Between November 2004 and June 2005, 2213 Korean subjects, comprised of 1768 males and 445 females, were classified according to the BASP classification at 13 university dermatologic centers nationwide throughout South Korea, as a multicenter study of the Korean Hair Research Society.
For both sexes, the majority of patients enrolled in the study were in the third and fourth decade of life (65.1% of males and 56.68% of females). In males, the older group as well as the younger group in the study were more likely to have little recession of the frontal hairline (classified as type M1 approximately 2) and diffuse thinning over the top of scalp (type F1 approximately 2). The women in the study developed typical female PHL.
The subjects of our study were mostly outpatients and some inpatients who complained about hair loss, not the general population of Korea.
The BASP classification is a new stepwise, systematic, and universal classification system for PHL, regardless of sex.
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