eMedicine Specialties > Dermatology > Diseases of the Adnexa
Androgenetic Alopecia: Treatment & Medication
Updated: Jan 22, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Only 2 proven, food and drug administration (FDA)–approved medications are currently available for treatment of androgenetic alopecia: minoxidil and finasteride.
- Minoxidil10
- Although the method of action is essentially unknown, minoxidil appears to lengthen the duration of the anagen phase, and it may increase the blood supply to the follicle. Regrowth is more pronounced at the vertex than in the frontal areas and is not noted for at least 4 months. Continuing topical treatment with the drug is necessary indefinitely because discontinuation of treatment produces a rapid reversion to the pretreatment balding pattern.
- Patients who respond best to this drug are those who have a recent onset of androgenetic alopecia and small areas of hair loss. The drug is marketed as a 2% or a 5% solution, with the 5% solution being somewhat more effective. A 48-week study compared the 2 strengths in men.11 Findings indicated that 45% more regrowth occurred with the 5% compared with the 2% solution. In general, women respond better to topical minoxidil than men. The increase in effectiveness of the 5% solution was not evident for women in the FDA-controlled studies. Subsequent studies have shown at best a modest advantage to the higher concentration in women. In addition, the occurrence of facial hair growth appears to be increased with the use of the higher-concentration formulation.
- Finasteride12
- Finasteride is given orally and is a 5 alpha-reductase type 2 inhibitor. It is not an antiandrogen. The drug can be used only in men because it can produce ambiguous genitalia in a developing male fetus. Finasteride has been shown to diminish the progression of androgenetic alopecia in males who are treated, and, in many patients, it has stimulated new regrowth.
- Although it affects vertex balding more than frontal hair loss, the medication has been shown to increase regrowth in the frontal area as well. Finasteride must be continued indefinitely because discontinuation results in gradual progression of the disorder. A study in postmenopausal women indicated no beneficial effect of the medication in treating female androgenetic alopecia.
Some drugs are not approved by the FDA but are potentially helpful medications.13 In women with androgenetic alopecia, especially those with a component of hyperandrogenism, drugs that act as androgen suppressants or antagonists (eg, spironolactone, oral contraceptives) may be beneficial. Evidence exists of an association between androgenetic alopecia, hypertension, and hyperaldosteronism. Spironolactone could play a dual role in treatment.
Phase III US Food and Drug Administration (FDA) trials of dutasteride to treat androgenetic alopecia are currently on hold. This drug inhibits both type I and type II 5-a reductase isoenzymes and is felt to be 3 times as potent as finasteride in inhibiting the type II enzyme and 100 times as potent in inhibiting the type I enzyme.
Low-level laser light therapy, in particular a red light hairbrush-like device has been marketed as an over-the-counter technique for hair growth. Marketed as the HairMax LaserComb, it has obtained 510K FDA approval for use as a medical device. Note that this approval refers to safety rather than actual efficacy.
Androgenetic alopecia is very common; therefore, not surprisingly, it may accompany other forms of hair loss. Cases of telogen effluvium often occur in patients with underlying androgenetic alopecia. Therefore, a search for treatable causes of telogen effluvium (eg, anemia, hypothyroidism), especially in patients with an abrupt onset or a rapid progression of their disease, is indicated.
Surgical Care
Surgical treatment of androgenetic alopecia has been successfully performed for the past 4 decades. Although the cosmetic results are often satisfactory, the main problem is covering the bald area with donor plugs (or follicles) sufficient in number to be effective. Micrografting produces a more natural appearance than the old technique of transplanting plugs. Patients with less than 40 follicular units/cm2 in their donor areas are poor candidates for the procedure. Scalp reduction has been attempted to decrease the size of the scalp to be covered by transplanted hair. However, the scars produced by the reduction technique often spread and become more noticeable with time.
Hair weaving techniques are available, and, together with hairpieces, they offer the patient a prosthetic method of coverage.
Medication
Only 2 medications have been shown to be effective in the treatment of androgenetic alopecia: minoxidil and finasteride. Minoxidil is applied topically and available as 2% or 5% solutions. Finasteride is taken orally.
Vasodilators
This drug is indicated to improve hair growth by stimulating vasodilation.
Minoxidil (Rogaine)
Relaxes arteriolar smooth muscle, causing vasodilation. Hair growth effects are secondary to vasodilation.
Available as 2% and 5% solutions.
Adult
1 mL applied to affected area bid
Pediatric
Not established
Concurrent use with guanethidine, diuretics, or hypotensive agents may result in additive hypotension
Documented hypersensitivity; pheochromocytoma; women
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May exacerbate angina pectoris; caution in pulmonary hypertension, congestive heart failure, coronary artery disease, and significant renal failure
Antiandrogens
Finasteride is the agent in this category known to promote hair growth.
Finasteride (Propecia)
Inhibits conversion of testosterone to dihydrotestosterone, causing serum dihydrotestosterone levels to decrease. However, effects in hair growth are not clearly understood.
Adult
1 mg PO qd
Pediatric
Not established
None reported
Documented hypersensitivity; women of childbearing age
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in hepatic impairment; may cause a large residual urinary volume; avoid use in patients with severely diminished urinary flow
More on Androgenetic Alopecia |
| Overview: Androgenetic Alopecia |
| Differential Diagnoses & Workup: Androgenetic Alopecia |
 Treatment & Medication: Androgenetic Alopecia |
| Follow-up: Androgenetic Alopecia |
| References |
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References
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Further Reading
Keywords
androgenetic alopecia, common baldness, familial baldness, hereditary baldness, male pattern baldness, female pattern baldness, pattern baldness, hair loss, androgenic alopecia
