Hair loss manifests itself in many forms, and it is becoming an increasingly common complaint of patients in dermatological clinics. Some forms of scarring are also becoming more common in dermatological practice. However, today androgenetic alopecia is widespread among men. Its frequency varies among different ethnic groups, but in general, up to 70% of men in their lives encounter it to one degree or another. The negative perception of their appearance makes the affected persons look for promising methods of treatment of androgenic alopecia.
Androgenetic baldness
Clinical manifestations
In most men, androgenic alopecia develops with a characteristic “pattern” of the hair loss zone. In women, the manifestations may be less pronounced. progressive thinning of the hair, As a rule, diffuse thinning of the hair is observed in women, which is observed primarily in the frontal, parietal areas, the upper part of the scalp, although the frontal hairline is preserved. Sometimes women with excessive androgen production may develop male-type baldness. It should also be noted that frontal fibrosing alopecia in women is often misdiagnosed as androgenic alopecia. Diffuse androgenic alopecia can be difficult to distinguish from telogen baldness. Indeed, increased telogenic hair loss may be characteristic of the early phase. If the diagnosis is in doubt, a biopsy is indicated.
Genetics and diagnostic tests
The tendency to androgenic alopecia is largely determined by genetics, although the environment may also play a minor role. The polymorphism of androgen receptors probably determines their sensitivity to androgens, but genes associated with 5a reductase, aromatase and sex hormone binding globulin (SHBG) also have a noticeable effect. While the full genetic picture is not clear, at least one company claims to be working on creating a diagnostic test to determine the polymorphism of genes that will be able to predict the chances of further development of the disease. For young patients concerned about hair loss, this test can help determine the value of early treatment initiation. Perhaps of more immediate practical importance is a test that is able to predict the response to treatment with finasteride used in women. The level of thyroid-stimulating hormone helps to eliminate thyroid dysfunction. Free testosterone is evaluated if an excess of androgens is suspected. To determine the iron deficiency in serum, a test can be used to determine the level of serum ferritin. If there is not enough ferritin in the serum, iron preparations are indicated as stimulators of the response to other types of treatment.
Methods of treatment of androgenic alopecia
The drug therapy recommended for treatment is limited to minoxidil and finasteride. Both drugs can be used in combination. Some other drugs are also used to treat androgenic alopecia, but they do not have sufficient evidence base and do not exclude claims to hair growth from patients. Promising methods for the treatment of androgenic alopecia – an analysis and development of scientifically based recommendations for treatment in men and women that can help in making treatment decisions has recently been published.
Finasteride – methods of treatment of androgenic alopecia
Finasteride (Propecia®) is the most common treatment for androgenic alopecia. It is a synthetic type II 5α reductase that reduces the conversion of testosterone to DHT. An increase in hair growth and thickness can be observed for 6 months – 1 year at a daily dose of 1 mg. Adverse sexual events have been reported more frequently with Finasteride having an adverse effect on sexual function. Finasteride has significant and adverse effects on the development of male embryos and is not officially approved for use in women. However, it can be used in case of illness in combination with effective oral contraceptives. Narrow-scale studies suggest that it may be effective in women with increased androgen activity.
Laser treatment
The use of laser radiation for the treatment of hair loss has become a very promising method of treating androgenic alopecia. It is also used as a preventive measure against baldness. Several different manufacturers provide lasers and light sources of different wavelengths and with different ways of use. While some laser installations are designed for daily use at home, others are only available in clinic settings for weekly or monthly use. While there is evidence that a laser beam can stimulate hair growth at certain wavelengths, the biological mechanism by which it occurs has not been determined. There is also a lack of large-scale clinical studies. Despite some positive results in androgenic alopecia, laser technology has not yet become an essential approach to treatment in most dermatological clinics.
In general, there are currently a number of treatment options for people with androgenic alopecia, although clinical evidence supports their use is often very limited. Finasteride and minoxidil are still the most common therapeutic agents intended for treatment. New approaches to treatment are the subject of active study. You can learn more about all the methods of treatment in the article by McElwee K, Shapiro J. Promising from the University of Vancouver.