Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Androgenetic Alopecia Treatment & Management

  • Author: Robert P Feinstein, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
 
Updated: Jun 24, 2016
 

Medical Care

Only 2 drugs currently have US Food and Drug Administration (FDA)–approved indications for treatment of androgenetic alopecia: minoxidil and finasteride.

Minoxidil

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.[25] 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.[26] 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.

Central chorioretinopathy has been associated with the use of minoxidil 2% for androgenetic alopecia. A 37-year-old man developed this adverse effect consisting of a positive elative scotoma, metamorphopsia, and impaired dark adaptation of the right eye after 8 months use of minoxidil for androgenetic alopecia. However, 1 month after cessation of the drug, normal findings were found upon reexamination.[27]

Finasteride

Finasteride is given orally and is a 5-alpha reductase type 2 inhibitor.[28] 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.

A 10-year follow-up study of men using finasteride 1 mg daily for androgenetic alopecia reported that better improvements were noted in patients older than 30 years or men who had higher androgenetic alopecia grades. Interestingly, the efficacy of the medication was not reduced with time, and in some cases improved later on.[29]

A Japanese study of 3177 men noted the efficacy and safety of finasteride in the treatment of androgenetic alopecia. Photographs were assessed in 2561 men who completed the 42-month study. Of these men, 11.1% showed great regrowth, 36.5% moderate growth, and 39.5% had a slight increase in hair growth. Adverse effects occurred in 0.7% of the men, and there were no safety problems observed with long-term use. The authors concluded that in Japanese men with androgenetic alopecia, long-term use of oral finasteride maintained progressive hair regrowth without recognized adverse effects.[30]

Other drugs

Some drugs are not approved by the FDA but are potentially helpful medications.[31] 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.

Dutasteride is another possible treatment for androgenetic alopecia. This drug inhibits 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. A phase II study on the use of dutasteride in the treatment of alopecia was carried out in the United States, but no further trials are currently being conducted in the US. However, an ongoing trial is being conducted outside of the United States.

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. In a double blind, sham-device controlled, multicenter, 26-week trial, 110 patients in the active treatment group who completed the study showed a significantly greater improvement in overall hair regrowth than did the sham group.[32] 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 and that the data required for medical devices are quite different from those required to demonstrate the safety and efficacy of drugs.

Topical latanoprost 0.1%, a prostaglandin analogue used to treat glaucoma, has been noted to cause an increase in the number, length, and thickness of eyelashes. Blume-Peytavi et al conducted a 24-week topical treatment with this agent to note the effect on androgenetic alopecia. Sixteen young men with mild androgenetic alopecia were studied. They applied latanoprost 0.1% and placebo daily on 2 minizones on the scalp. Measurements of the hair growth, density, diameter, pigmentation, and anagen/telogen ratio were performed throughout the study. At 24 weeks, an increase in hair density was noted at the latanoprost-treated site compared with baseline and the placebo site. They concluded that this medication could be useful for stimulating hair follicle activity and treating hair loss.[33]

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.

Dawson et al, while discussing female androgenetic alopecia, list the following treatment options to arrest hair loss progression and stimulate partial hair regrowth in this disorder: the androgen receptor antagonists spironolactone and cyproterone acetate, the 5alpha-reductase inhibitor finasteride, and the androgen-independent hair growth stimulator minoxidil. These treatment are most effective when instituted early.[34]

A phase 1, double-blind clinical trial designed to evaluate the safety of a bioengineered, nonrecombinant, human cell–derived formulation containing follistatin, keratinocyte growth factor (KGF), and vascular endothelial growth factor (VEGF) was performed to assess the efficacy in stimulating hair growth. Twenty-six subjects were entered into the study and none showed an adverse reaction to the single intradermal injection. After 1 year, a statistically significant increase in total hair count continued to be seen.[35]

A 2015 study in Spain indicated that plasma rich in growth factors (PGRP) is effective in the treatment of androgenetic alopecia.[36] Over 100 patients were studied and were given two intradermal cycles of PGRF every 4 weeks. Anagen follicles significantly increased by 6.2% compared with baseline, and there was a decrease of 5.1% seen in telogen follicles. No adverse effects were noted in any of the patients.

Serena repens extract has been shown to inhibit both types of 5-α reductase and, when taken orally, has been shown to increase growth in androgenetic alopecia patients. A study by Wessagowit et al attempted to assess the efficacy of topical S repens in androgenetic alopecia.[37] Fifty male patients were studied and were treated with topical S repens products for 24 weeks. The result was that the average hair count increased at 12 and 24 weeks compared with baseline. They believe prolonged use of these products beyond 4 weeks is necessary for sustained efficacy.

Adipose-derived stem cells secrete various growth factors that promote hair growth. Using trichograms, Fukuoka and Suga evaluated the effects of adipose-derived stem cell‒conditioned medium on hair regeneration.[38] The studies were done on patients both on and off finasteride. It was their impression that combination therapy was preferable to single-agent treatment. They believe that using adipose-derived stem cell‒conditioned medium seems to represent a new avenue of therapy for hair regeneration, and they believe that long-term use (over a period of years) should be studied to note effects and histological changes.

Next

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.

A 2009 review of surgical procedures concluded that both patients and physicians alike are pleased with the results of contemporary hair transplantation.[32] 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.

A South Korean study noted the effect of a 1550-nm fractional erbium-glass laser in women with androgenetic alopecia. The patients received 10 treatments at 2-week intervals. Global photographs taken at baseline and at the end of laser treatment showed improvement in 24 (87.5%) of the 27 patients studied. However, 2 patients reported mild pruritus after treatment.[39]

Hair weaving techniques are available, and, together with hairpieces, they offer the patient a prosthetic method of coverage.

Also see the Medscape article Hair Transplantation.

Previous
 
 
Contributor Information and Disclosures
Author

Robert P Feinstein, MD Associate Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons

Robert P Feinstein, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Noah Worcester Dermatological Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Leonard Sperling, MD Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Manabu Ohyama. Hair Follicle Stem Cells-New Insights & Clinical Relevance. AccessMedicine. Available at http://www.accessmedicine.com/updatesContent.aspx?aID=1001537. Accessed: December 3 2009.

  2. Luderer HF, Demay MB. The vitamin D receptor, the skin and stem cells. J Steroid Biochem Mol Biol. 2010 Feb 6. [Medline].

  3. Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N. The role of inflammation and immunity in the pathogenesis of androgenetic alopecia. J Drugs Dermatol. 2011 Dec. 10(12):1404-11. [Medline].

  4. Brockschmidt FF, Heilmann S, Ellis JA, et al. Susceptibility variants on chromosome 7p21.1 suggest HDAC9 as a new candidate gene for male-pattern baldness. Br J Dermatol. 2011 Dec. 165(6):1293-302. [Medline].

  5. Kure K, Isago T, Hirayama T. Changes in the sebaceous gland in patients with male pattern hair loss (androgenic alopecia). J Cosmet Dermatol. 2015 Sep. 14 (3):178-84. [Medline].

  6. Wang TL, Zhou C, Shen YW, et al. Prevalence of androgenetic alopecia in China: a community-based study in six cities. Br J Dermatol. 2010 Jan 22. [Medline].

  7. Stough D, Stenn K, Haber R, et al. Psychological effect, pathophysiology, and management of androgenetic alopecia in men. Mayo Clin Proc. 2005 Oct. 80(10):1316-22. [Medline].

  8. Lesko SM, Rosenberg L, Shapiro S. A case-control study of baldness in relation to myocardial infarction in men. JAMA. 1993 Feb 24. 269(8):998-1003. [Medline].

  9. Oh BR, Kim SJ, Moon JD, et al. Association of benign prostatic hyperplasia with male pattern baldness. Urology. 1998 May. 51(5):744-8. [Medline].

  10. Arias-Santiago S, Arrabal-Polo MA, Buendía-Eisman A, et al. Androgenetic alopecia as an early marker of benign prostatic hyperplasia. J Am Acad Dermatol. 2012 Mar. 66(3):401-8. [Medline].

  11. Sanke S, Chander R, Jain A, Garg T, Yadav P. A Comparison of the Hormonal Profile of Early Androgenetic Alopecia in Men With the Phenotypic Equivalent of Polycystic Ovarian Syndrome in Women. JAMA Dermatol. 2016 Jun 15. [Medline].

  12. Polat EC, Ozcan L, Otunctemur A, Ozbek E. Relation of urinary stone disease with androgenetic alopecia and serum testosterone levels. Urolithiasis. 2016 May 7. [Medline].

  13. Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977 Sep. 97(3):247-54. [Medline].

  14. Hillmer AM, Flaquer A, Hanneken S, et al. Genome-wide scan and fine-mapping linkage study of androgenetic alopecia reveals a locus on chromosome 3q26. Am J Hum Genet. 2008 Mar. 82(3):737-43. [Medline]. [Full Text].

  15. Alsantali A, Shapiro J. Androgens and hair loss. Curr Opin Endocrinol Diabetes Obes. 2009 Jun. 16(3):246-53. [Medline].

  16. Krajcik RA, Vogelman JH, Malloy VL, Orentreich N. Transplants from balding and hairy androgenetic alopecia scalp regrow hair comparably well on immunodeficient mice. J Am Acad Dermatol. 2003 May. 48(5):752-9. [Medline].

  17. Cousen P, Messenger A. Female pattern hair loss in complete androgen insensitivity syndrome. Br J Dermatol. 2010 Feb 1. [Medline].

  18. Paladini RD, Saleh J, Qian C, Xu GX, Rubin LL. Modulation of hair growth with small molecule agonists of the hedgehog signaling pathway. J Invest Dermatol. 2005 Oct. 125(4):638-46. [Medline].

  19. Olsen EA, Reed KB, Cacchio PB, Caudill L. Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups. J Am Acad Dermatol. 2010 Dec. 63(6):991-9. [Medline].

  20. Lattouf C, Miteva M, Tosti A. Connubial androgenetic alopecia. Arch Dermatol. 2011 Nov. 147(11):1329-30. [Medline].

  21. Ahouansou S, Le Toumelin P, Crickx B, Descamps V. Association of androgenetic alopecia and hypertension. Eur J Dermatol. 2007 May-Jun. 17(3):220-2. [Medline].

  22. Su LH, Chen TH. Association of androgenetic alopecia with smoking and its prevalence among Asian men: a community-based survey. Arch Dermatol. 2007 Nov. 143(11):1401-6. [Medline].

  23. Schmidt, AN, Taylor BR, King LE, and Tourjee SM. The ProScope HR: A promising diagnostic tool. J Am Acad Dermatol. March, 2010. 62:AB64.

  24. Karadag Köse O, Güleç AT. Clinical evaluation of alopecias using a handheld dermatoscope. J Am Acad Dermatol. 2012 Aug. 67(2):206-14. [Medline].

  25. Headington JT, Novak E. Clinical and histological studies of male pattern baldness treated with topical minoxidil. Curr Ther Res Clin Exp. 1984. 36:1098-106.

  26. Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002 Sep. 47(3):377-85. [Medline].

  27. Scarinci F, Mezzana P, Pasquini P, Colletti M, Cacciamani A. Central chorioretinopathy associated with topical use of minoxidil 2% for treatment of baldness. Cutan Ocul Toxicol. 2011 Sep 23. [Medline].

  28. Rittmaster RS. Finasteride. N Engl J Med. 1994 Jan 13. 330(2):120-5. [Medline].

  29. Rossi A, Cantisani C, Scarnò M, Trucchia A, Fortuna MC, Calvieri S. Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up. Dermatol Ther. 2011 Jul. 24(4):455-61. [Medline].

  30. Sato A, Takeda A. Evaluation of efficacy and safety of finasteride 1 mg in 3177 Japanese men with androgenetic alopecia. J Dermatol. 2012 Jan. 39(1):27-32. [Medline].

  31. Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. 2008 Oct. 59(4):547-66; quiz 567-8. [Medline].

  32. Leavitt M, Charles G, Heyman E, Michaels D. HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: A randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Investig. 2009. 29(5):283-92. [Medline].

  33. Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2011 Aug 27. [Medline].

  34. Sinclair R, Patel M, Dawson TL Jr, et al. Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness. Br J Dermatol. 2011 Dec. 165 Suppl 3:12-8. [Medline].

  35. Zimber MP, Ziering C, Zeigler F, et al. Hair regrowth following a Wnt- and follistatin containing treatment: safety and efficacy in a first-in-man phase 1 clinical trial. J Drugs Dermatol. 2011 Nov. 10(11):1308-12. [Medline].

  36. Navarro MR, Asin M, Martinez AM, Molina C, Navarro V, Pino A, et al. Plasma rich in growth factors (PGRF) for the treatment of androgenetic alopecia. European Journal of Plastic Surgery. June 21, 2015; Accessed: June 25, 2015.

  37. Wessagowit V, Tangjaturonrusamee C, Kootiratrakarn T, Bunnag T, Pimonrat T, Muangdang N, et al. Treatment of male androgenetic alopecia with topical products containing Serenoa repens extract. Australas J Dermatol. 2015 May 25. (HTML)(/doi/10.1111/adj.12352/full). [Medline].

  38. Fukuoka H, Suga H. Hair Regeneration Treatment Using Adipose-Derived Stem Cell Conditioned Medium: Follow-up With Trichograms. Eplasty. 2015. 15:e10. [Medline].

  39. Lee GY, Lee SJ, Kim WS. The effect of a 1550 nm fractional erbium-glass laser in female pattern hair loss. J Eur Acad Dermatol Venereol. 2011 Dec. 25(12):1450-4. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.