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Androgenetic alopecia in women and men: Italian guidelines adapted from European Dermatology Forum/European Academy of Dermatology and Venereology guidelines
Aurora ALESSANDRINI, Michela STARACE, Roberto D’OVIDIO, Lucia VILLA, Alfredo ROSSI, Teodora R. STAN, Piergiacomo CALZAVARA-PINTON, Bianca M. PIRACCI
Abstract
Androgenetic alopecia (AGA) is the most common form of alopecia, affecting up to 80% of men and 50% of women in the course of their life. AGA is caused by a progressive reduction in the diameter, length, and pigmentation of the hair, resulting from the effects of the testosterone metabolite dihydrotestosterone (DHT) on androgen-sensitive hair follicles. Clinical presentation is different in men and women. Trichoscopy is used routinely in patients with androgenetic alopecia, for diagnosis and differential diagnosis with other diseases, allowing staging of severity and monitoring the progress of the disease and the response to treatment. Medical treatment of AGA includes topical minoxidil, antiandrogen agents, 5-alpha reductase inhibitors, and many other options. This guideline for the treatment of androgenetic alopecia has been developed by an Italian group of experts taking into account the Italian pharmacological governance. The article is adapted from the original of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). It summarizes evidence-based and expert-based recommendations (S3 level).
Androgenetic alopecia (AGA) is the most common cause of non-scarring alopecia, affecting respectively up to 50% of women and 80% of men in the course of their life,1 with a frequency that increases with age after puberty. Androgenetic alopecia is characterized by a progressive miniaturization of hair follicles usually occurring in a pattern distribution. The term AGA was introduced to define a form of alopecia developing under the influence of androgens against a background of genetically determined susceptibility of the hair follicle. Hair loss represents a problem for the patient for cosmetic and psychological reasons because hair symbolizes an important mirror of our image and physical attractiveness to self-perception of beauty. The primary objective of this Italian guideline is to describe complete information about the disease and prescribing treatment for androgenetic alopecia. These guidelines are adapted from the original article under the guidance of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). This article summarizes evidence-based treatment for androgenetic alopecia according to Italian legislation (S3 level),2 associated also with expert-based recommendations and most frequently prescribed options (Table I).
1. General evaluation
Androgenetic alopecia is the progressive non-scarring miniaturization of hair follicles located in characteristic areas of the scalp, in genetically predisposed people. The clinical presentation of androgenetic alopecia can be different in men and women, sharing the same pathogenesis. A correct diagnosis is the first step to choose an efficacious therapy.
1.1 Objectives
1.2 Pathogenesis
1.3 Patient’s history
2. Clinical examination
2.1 Male
2.2 Female
2.3 Scale of severity
3. Laboratory/instrumental investigations
3.1 Pull test
3.2 Trichogram and phototrichogram
3.3 Trichoscopy
3.4 Biopsy
4. Therapeutic management
4.1 Objectives
4.2. Topical treatment
4.2.1 Minoxidil
4.2.1.1 Response to treatment
4.2.1.2 Useful instructions for the patient
4.2.1.3 Side effects of minoxidil
4.2.1.4 Pregnancy and lactation
4.2.2 Prostaglandin analogs
4.2.2.1 Response to treatment
4.2.2.2 Side effects
4.3 Systemic treatment
4.3.1 Alpha-reductase inhibitors
4.3.1.1 Finasteride in male
4.3.1.2 Finasteride in female
4.3.1.3 Dutasteride (Avodart®)
4.3.2 Hormones
4.3.2.1 Cyproterone acetate (Androcur®)
4.3.2.2 Spironolactone (Aldactone®)
4.3.2.3 Flutamide (Drogenil®, Eulexin®, Flutamide®)
5. Platelet-rich plasma
6. Surgery
7. Low-level laser (light) therapy (LLLT, laser hair comb)
Conclusions
Androgenetic alopecia is a progressive disease that, if left untreated, tends to worsen with time. Progression of the disease can be slow or very fast, especially in patients with a strong family history or with hormonal disturbances. Regular clinical, trichoscopical, and (photo) trichogram follow-ups are very important to monitor disease activity and treatment tolerance. If used correctly, in most cases available medical treatments for AGA arrest the progression of the disease and reverse miniaturization. In some advanced cases, hair replacement surgery is the only option.
Aurora ALESSANDRINI, Michela STARACE, Roberto D’OVIDIO, Lucia VILLA, Alfredo ROSSI, Teodora R. STAN, Piergiacomo CALZAVARA-PINTON, Bianca M. PIRACCI
Abstract
Androgenetic alopecia (AGA) is the most common form of alopecia, affecting up to 80% of men and 50% of women in the course of their life. AGA is caused by a progressive reduction in the diameter, length, and pigmentation of the hair, resulting from the effects of the testosterone metabolite dihydrotestosterone (DHT) on androgen-sensitive hair follicles. Clinical presentation is different in men and women. Trichoscopy is used routinely in patients with androgenetic alopecia, for diagnosis and differential diagnosis with other diseases, allowing staging of severity and monitoring the progress of the disease and the response to treatment. Medical treatment of AGA includes topical minoxidil, antiandrogen agents, 5-alpha reductase inhibitors, and many other options. This guideline for the treatment of androgenetic alopecia has been developed by an Italian group of experts taking into account the Italian pharmacological governance. The article is adapted from the original of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). It summarizes evidence-based and expert-based recommendations (S3 level).
Androgenetic alopecia (AGA) is the most common cause of non-scarring alopecia, affecting respectively up to 50% of women and 80% of men in the course of their life,1 with a frequency that increases with age after puberty. Androgenetic alopecia is characterized by a progressive miniaturization of hair follicles usually occurring in a pattern distribution. The term AGA was introduced to define a form of alopecia developing under the influence of androgens against a background of genetically determined susceptibility of the hair follicle. Hair loss represents a problem for the patient for cosmetic and psychological reasons because hair symbolizes an important mirror of our image and physical attractiveness to self-perception of beauty. The primary objective of this Italian guideline is to describe complete information about the disease and prescribing treatment for androgenetic alopecia. These guidelines are adapted from the original article under the guidance of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). This article summarizes evidence-based treatment for androgenetic alopecia according to Italian legislation (S3 level),2 associated also with expert-based recommendations and most frequently prescribed options (Table I).
1. General evaluation
Androgenetic alopecia is the progressive non-scarring miniaturization of hair follicles located in characteristic areas of the scalp, in genetically predisposed people. The clinical presentation of androgenetic alopecia can be different in men and women, sharing the same pathogenesis. A correct diagnosis is the first step to choose an efficacious therapy.
1.1 Objectives
1.2 Pathogenesis
1.3 Patient’s history
2. Clinical examination
2.1 Male
2.2 Female
2.3 Scale of severity
3. Laboratory/instrumental investigations
3.1 Pull test
3.2 Trichogram and phototrichogram
3.3 Trichoscopy
3.4 Biopsy
4. Therapeutic management
4.1 Objectives
4.2. Topical treatment
4.2.1 Minoxidil
4.2.1.1 Response to treatment
4.2.1.2 Useful instructions for the patient
4.2.1.3 Side effects of minoxidil
4.2.1.4 Pregnancy and lactation
4.2.2 Prostaglandin analogs
4.2.2.1 Response to treatment
4.2.2.2 Side effects
4.3 Systemic treatment
4.3.1 Alpha-reductase inhibitors
4.3.1.1 Finasteride in male
4.3.1.2 Finasteride in female
4.3.1.3 Dutasteride (Avodart®)
4.3.2 Hormones
4.3.2.1 Cyproterone acetate (Androcur®)
4.3.2.2 Spironolactone (Aldactone®)
4.3.2.3 Flutamide (Drogenil®, Eulexin®, Flutamide®)
5. Platelet-rich plasma
6. Surgery
7. Low-level laser (light) therapy (LLLT, laser hair comb)
Conclusions
Androgenetic alopecia is a progressive disease that, if left untreated, tends to worsen with time. Progression of the disease can be slow or very fast, especially in patients with a strong family history or with hormonal disturbances. Regular clinical, trichoscopical, and (photo) trichogram follow-ups are very important to monitor disease activity and treatment tolerance. If used correctly, in most cases available medical treatments for AGA arrest the progression of the disease and reverse miniaturization. In some advanced cases, hair replacement surgery is the only option.
