madman
Super Moderator
A review discusses various treatments for androgenetic alopecia (AGA), the most common cause of hair loss. Traditional methods like minoxidil and finasteride have mixed results. Newer treatments, such as low-level laser therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others, are explored. Oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy are alternative options. Combination therapies are being tested alongside emerging treatments. Evidence quality varies, prompting the need for randomized trials. While PRP and LLLT show promise, standardized protocols are necessary. Clinicians and patients must consider the benefits and risks of each treatment for AGA due to the increasing therapeutic options.
Key Takeaways:
Minoxidil for topical use
*Topical minoxidil was initially developed as an oral treatment for hypertension but was found to cause hypertrichosis, leading to the development of topical solutions for hair loss.
*Topical minoxidil works by vasodilation, reducing inflammation, and regulating gene signaling, ultimately increasing blood supply and nutrients to the hair follicles.
*Efficacy of topical minoxidil varies, with 5% solution generally more effective than 2% solution in men, while 5% is equivalent or superior to 2% in women.
*Positive effects on hair growth are typically observed after 6-8 weeks of continuous application, with maximal effect at 12-16 weeks.
*Around 60% of male patients may not respond to topical minoxidil due to lower levels of the enzyme sulfotransferase required to activate the drug.
*Adverse effects of topical minoxidil include irritant contact dermatitis, temporary increase in hair shedding, hypertrichosis, and headache.
Finasteride administered orally
*Oral finasteride (5mg/day) was approved by the FDA in 1992 for benign prostatic hyperplasia and later for androgenetic alopecia (AGA) at a dosage of 1mg/day.
*Finasteride inhibits 5α-reductase type II, which converts testosterone to dihydrotestosterone (DHT), the hormone responsible for miniaturization of hair follicles in AGA.
*Finasteride at a dosage of 1 mg/day can reduce the progression of AGA, improve hair regrowth, and increase hair count.
*Best results are seen in the vertex region of the scalp, while the frontal region shows minimal improvement.
*Long-term use of finasteride is required for sustained regrowth effect.
*Finasteride can be effective in female patients with AGA, with higher doses (2.5-5mg) showing better results than lower doses.
*Adverse effects of finasteride include sexual dysfunction, birth defects, and depression, with sexual side effects being the most common.
*There are conflicting data on the association between finasteride and prostate cancer, with some studies suggesting it may reduce the risk but increase the malignancy of prostate cancer.
*Patients should be informed of the risks and benefits of using finasteride and be monitored for prostate cancer development.
Minoxidil administered orally
*Oral minoxidil, originally used for hypertension, has been proposed as an alternative therapy for androgenetic alopecia (AGA).
*Low-dose oral minoxidil is easier to use than topical minoxidil and has good reported compliance.
*Oral minoxidil is converted to its active form in the liver, increasing its bioavailability and potential efficacy.
*Oral minoxidil is more convenient, cosmetically effective, and cost-effective compared to topical minoxidil.
*Studies show that oral minoxidil can increase hair density and total hair counts in both men and women with AGA.
*Adverse effects of oral minoxidil include hypertrichosis (excessive hair growth), hair shedding, and lower extremity edema.
*Adverse effects are dose-dependent, with higher doses associated with higher efficacy and more adverse effects.
*8% of patients discontinued treatment due to lack of efficacy, hypertrichosis, fear of drug interactions, intention to get pregnant, and hair shedding.
Finasteride for topical use
*Topical finasteride is a potential alternative to oral finasteride for treating hair loss.
*Topical finasteride inhibits DHT (dihydrotestosterone) locally in the hair follicle, reducing DHT production with fewer systemic effects.
*Studies have shown that topical finasteride is comparable to oral finasteride in promoting hair growth.
*Topical finasteride has minimal effects on plasma DHT levels, reducing adverse effects.
*The most common adverse effects of topical finasteride are skin irritation and itching at the application site.
*Further studies are needed to determine the optimal formulation and dosage for topical finasteride.
Topical Minoxidil and Finasteride combined
*Combination of topical minoxidil and topical finasteride has been explored to enhance the effectiveness of both treatments for androgenetic alopecia (AGA).
*Study by Suchonwanit et al. examined the combination of topical 0.25% finasteride with topical 3% minoxidil in 40 male patients with AGA.
*Both treatment groups showed a significant increase in hair density and hair diameter compared to baseline.
*Combined therapy resulted in a greater increase in hair density and hair diameter compared to monotherapy at 16 and 24 weeks.
*Plasma DHT (dihydrotestosterone) decreased by 5% with no significant adverse effects observed in any patients.
*Topical 5% minoxidil combined with topical 0.1% finasteride demonstrated maintenance of hair density and prevention of further hair loss.
*Several studies reported no adverse effects from the use of topical finasteride and minoxidil, which was preferred by some patients over oral finasteride due to fewer reported side effects.
Dutasteride for oral use
*Dutasteride inhibits both type I and type II 5α-reductase, which is vital for addressing androgenetic alopecia (AGA).
*Dutasteride showed a dose-dependent increase in hair count and width, with a minimum dose of 0.1 mg/d being effective.
*Compared to finasteride, dutasteride 0.5 mg/d was superior in improving hair count and thickness after 12 and 24 weeks.
*Dutasteride may be a viable option for patients who do not respond to oral finasteride, with clinical improvements seen in 80% of patients.
*Oral dutasteride can lead to sexual dysfunction side effects such as decreased libido, impotence, ejaculatory dysfunction, and gynecomastia.
*The long-term safety study of oral dutasteride found a 53% incidence of adverse effects, with erectile dysfunction being the most common drug-related adverse effect.
LLLT (Low Level Laser Therapy)
*Low-level laser therapy (LLLT) is a new and effective treatment for androgenetic alopecia (AGA).
*LLLT reduces inflammation, promotes wound healing, improves wrinkles and scars, and increases blood flow.
*LLLT stimulates hair regrowth by promoting anagen-phase reentry of telogen hair follicles, prolonging the anagen phase, and preventing premature conversion to catagen-phase hairs.
*LLLT has shown positive effects in AGA, including improved hair count, density, strength, and thickness.
*Treatment frequency and lower wavelengths (600-1100 nm) are more effective in LLLT therapy.
*The FDA has approved LLLT as a therapy for AGA, with Lasermax Haircomb being the only FDA-approved device.
*LLLT has minimal adverse effects, such as temporary hair shedding, pruritis, tenderness, and acne.
*Due to its low cost and minimal adverse effects, LLLT can be used as an adjunct therapy or an alternative option for patients intolerant to minoxidil and finasteride.
Topical Minoxidil and LLLT combination for hair loss
*Combining topical 5% minoxidil with low-level laser therapy (LLLT) resulted in high patient satisfaction and showed significant improvement in the number of follicles at 4 months.
*LLLT treatment provided an early therapeutic advantage while waiting for the delayed efficacy of minoxidil.
*Existing studies on the combination of LLLT and minoxidil therapy showed mixed results, with some favoring combination therapy and others showing no significant difference.
*These studies had limitations such as small sample sizes and lack of long-term follow-up.
*A meta-analysis found that the combination of LLLT and minoxidil demonstrated superior efficacy compared to minoxidil monotherapy.
*Combination therapy did not increase adverse effects.
*Further evaluation with larger sample sizes and a more consistent LLLT treatment regimen is needed.
PRP (Platelet Rich Plasma)
*Platelet Rich Plasma (PRP) is used in various medical fields for regenerative purposes.
*PRP is derived from the patient's own blood and contains chemokines, growth factors, and cytokines.
*PRP is used in dermatology for skin rejuvenation, treating acne scarring, and vitiligo.
*Alpha granules in PRP contain important growth factors for treating androgenetic alopecia (AGA) and promoting hair follicle growth.
*PRP has shown efficacy in promoting hair regrowth in AGA patients.
*Studies have demonstrated significant increases in hair growth and density with PRP treatment.
*PRP can be used as a monotherapy or compared to minoxidil therapy, showing favorable results.
*Standardization of PRP protocols is necessary for better characterization of treatment response.
*PRP is a minimally invasive treatment option with low risk of adverse effects, but infection and scalp sensitivity can occur.
*Not all patients are suitable candidates for PRP therapy due to certain medical conditions.
Skin treatment using microneedles
*Microneedling originated in the 1900s for scar treatment in plastic surgery.
*It is used for collagen induction therapy, acne treatment, hyperpigmentation, and androgenetic alopecia.
*Microneedling creates microchannels in the skin and can deliver molecules or nanoparticles.
*It promotes growth factors, activates stem cells, and increases gene expression associated with hair growth.
*Microneedling stimulates hair growth through Wnt/ß-catenin signaling and vascular endothelial growth factor.
*There are various microneedling devices with different parameters and customization options.
*Combination therapy of microneedling with topical minoxidil showed greater improvement in hair count compared to minoxidil alone.
*Microneedling, when used in an open-label study, showed increased hair density in both males and females.
*Microneedling can be considered as an adjunctive treatment for androgenetic alopecia, even in cases of treatment resistance.
*Side effects include pain, bleeding, erythema, lymph node enlargement, pruritis, seborrheic dermatitis, headache, and a low risk of serious adverse events.
PRP, minoxidil, LLLT, and microneedling used in combination for treatment
*Combination therapy using PRP, minoxidil, LLLT, and microneedling has been explored to treat AGA.
*Studies have shown that combining PRP with minoxidil leads to a significant increase in hair density and count compared to minoxidil alone.
*Combination therapy of PRP with minoxidil outperformed PRP monotherapy in terms of overall hair density.
*PRP and microneedling combination therapy have demonstrated improvements in hair growth.
*Combination therapy of PRP, microneedling, and minoxidil resulted in high patient satisfaction and improved hair growth.
*PRP and microneedling combination therapy showed significant improvement in hair growth in patients who did not respond to minoxidil or finasteride.
*Triple combination therapy of minoxidil, PRP, and microneedling yielded the best results in terms of negative hair pull tests, hair ratio, and hair growth improvement.
*Combination therapies generally outperform monotherapy options for AGA treatment.
*Combined therapy using LLLT, minoxidil, PRP, and microneedling is considered safe with favorable side effect profiles.
*Patients should be suitable candidates for PRP and be aware of the potential costs associated with all modalities.
Spironolactone for oral use
*Spironolactone is an aldosterone antagonist used primarily as an anti-hypertensive agent and potassium sparing diuretic.
*It can bind and inhibit androgen receptors, making it useful in treating hirsutism, acne, and female pattern hair loss (FPHL), particularly in patients with polycystic ovarian syndrome (PCOS).
*Oral spironolactone decreases circulating androgen levels, halting the progression of FPHL by inhibiting adrenal androgen production and their effects on the hair follicle.
*Patients with a Sinclair hair loss severity score greater than 2.5 experienced improvement in hair loss with spironolactone, while a dosage below 100 mg was ineffective.
*Long-term use (greater than 12 months) at a dosage between 100 mg and 200 mg was required to see clinical improvement in FPHL.
*Adverse effects of oral spironolactone include hypotension, hyperkalemia, and occasionally urticaria.
*The recommended treatment regimen for FPHL is starting at 50 mg daily, with the optimal dosage between 100 mg and 200 mg daily for at least 6 months to see clinical improvement.
Spironolactone for topical use
*Topical spironolactone offers local inhibition of androgens on the hair follicle.
*It does not have the systemic side effects of oral spironolactone.
*A study with 26 patients (16 males and 10 females) showed that 1% topical spironolactone led to clinical improvement in nearly 77% of patients.
*Comparing 5% topical spironolactone with 0.1% topical finasteride, spironolactone showed better improvement in hair density and diameter for both males and females.
*Combination therapy of 5% topical spironolactone and 5% topical minoxidil showed the greatest improvement in dermoscopic features, indicating its potential benefits for patients with androgenetic alopecia.
Botox
*Botulinum toxin, specifically botulinum toxin A, inhibits the release of acetylcholine into the neuromuscular junction, reducing scalp muscle tone.
*This reduction in muscle tone leads to vasodilation and enhanced local microcirculation, increasing hair follicle oxygen perfusion and removing accumulated DHT, potentially slowing hair loss.
*Botulinum toxin may also inhibit neuromodulators like substance P or CGRP that contribute to AGA.
*In the vertex area of the scalp, decreased blood perfusion due to muscle contraction can be alleviated by botulinum toxin relaxing the frontalis or occipitalis muscles.
*DHT-induced TGF-β1 in dermal papilla cells suppresses growth of follicular epithelial cells, and botulinum toxin inhibits TGF-β1 secretion, potentially mitigating this effect.
*Clinical studies have shown a 75% treatment response rate with botulinum toxin injections, resulting in a statistically significant increase in mean hair count.
*Adverse effects of botulinum toxin treatment for AGA are generally mild, including headache, injection site pain, erythema, madarosis, facial alopecia, and potentially worsening hairline regression.
*More rigorous clinical trials with control groups and larger sample sizes are needed before botulinum toxin can be recommended as a standard treatment for AGA.
Regenerative medical treatment using stem cells.
*Stem cell therapy has potential for treating AGA (androgenetic alopecia).
*Stem cells can reverse the effects of AGA and promote the growth of new hair follicles.
*Hair follicle stem cells interact with dermal papilla stem cells to regulate hair follicle growth and differentiation.
*Intradermal injection of autologous stem cells has shown significant improvement in hair growth in patients with AGA.
*Topical application of adipocyte-derived stem cells can also enhance hair growth.
*The long-term safety of stem cell therapy for AGA is uncertain.
*Stem cell therapy for AGA is expensive, invasive, and requires careful transportation of live stem cell cultures.
*Autonomous cellular micrografts (ACM) using autologous stem cells have shown promise in increasing hair density and thickness in AGA patients.
*The therapy is still in the early stages of development but could offer significant benefits to patients.
Nutritional Supplements and Dietary Options
*Nutritional supplements are being investigated for the treatment of AGA (Androgenetic Alopecia)
*Saw palmetto, pumpkin seed oil, and Forti5 combination supplement can inhibit 5-alpha reductase and potentially stabilize hair loss or stimulate hair growth in men with AGA
*Antioxidants like vitamin E and vitamin C can increase hair density and thickness in female AGA
*Protein-based supplements and probiotics like kimchi and cheonggukjang show clinical effectiveness by providing essential nutrients and improving blood flow to hair follicles
*These supplements may not have undergone FDA premarket approval and current studies have limitations in small sample size, lack of control group, and lack of head-to-head comparison with standard therapies.
Pipeline drugs
*Clascoterone is a unique therapeutic option for androgenetic alopecia (AGA) treatment.
*It functions as an androgen receptor antagonist, competing with DHT binding sites on androgen receptors.
*Clascoterone is approved by the FDA for treating acne vulgaris.
*It is being investigated as a topical treatment for AGA.
Currently, it is in Phase II clinical trials for AGA treatment.
AGA has novel therapeutic options, including combination therapy, topical and oral minoxidil, oral finasteride, LLLT, Platelet Rich Plasma, and microneedling. Topical minoxidil is effective but compliance can be challenging. Oral minoxidil and finasteride offer alternatives, with the former having promising early data. Topical finasteride is being evaluated. LLLT is FDA approved, noninvasive, and affordable. PRP is an option for patients who have failed other treatments. Microneedling can augment therapies. Overall, AGA patients and clinicians have a range of new treatment options to consider.
Key Takeaways:
Minoxidil for topical use
*Topical minoxidil was initially developed as an oral treatment for hypertension but was found to cause hypertrichosis, leading to the development of topical solutions for hair loss.
*Topical minoxidil works by vasodilation, reducing inflammation, and regulating gene signaling, ultimately increasing blood supply and nutrients to the hair follicles.
*Efficacy of topical minoxidil varies, with 5% solution generally more effective than 2% solution in men, while 5% is equivalent or superior to 2% in women.
*Positive effects on hair growth are typically observed after 6-8 weeks of continuous application, with maximal effect at 12-16 weeks.
*Around 60% of male patients may not respond to topical minoxidil due to lower levels of the enzyme sulfotransferase required to activate the drug.
*Adverse effects of topical minoxidil include irritant contact dermatitis, temporary increase in hair shedding, hypertrichosis, and headache.
Finasteride administered orally
*Oral finasteride (5mg/day) was approved by the FDA in 1992 for benign prostatic hyperplasia and later for androgenetic alopecia (AGA) at a dosage of 1mg/day.
*Finasteride inhibits 5α-reductase type II, which converts testosterone to dihydrotestosterone (DHT), the hormone responsible for miniaturization of hair follicles in AGA.
*Finasteride at a dosage of 1 mg/day can reduce the progression of AGA, improve hair regrowth, and increase hair count.
*Best results are seen in the vertex region of the scalp, while the frontal region shows minimal improvement.
*Long-term use of finasteride is required for sustained regrowth effect.
*Finasteride can be effective in female patients with AGA, with higher doses (2.5-5mg) showing better results than lower doses.
*Adverse effects of finasteride include sexual dysfunction, birth defects, and depression, with sexual side effects being the most common.
*There are conflicting data on the association between finasteride and prostate cancer, with some studies suggesting it may reduce the risk but increase the malignancy of prostate cancer.
*Patients should be informed of the risks and benefits of using finasteride and be monitored for prostate cancer development.
Minoxidil administered orally
*Oral minoxidil, originally used for hypertension, has been proposed as an alternative therapy for androgenetic alopecia (AGA).
*Low-dose oral minoxidil is easier to use than topical minoxidil and has good reported compliance.
*Oral minoxidil is converted to its active form in the liver, increasing its bioavailability and potential efficacy.
*Oral minoxidil is more convenient, cosmetically effective, and cost-effective compared to topical minoxidil.
*Studies show that oral minoxidil can increase hair density and total hair counts in both men and women with AGA.
*Adverse effects of oral minoxidil include hypertrichosis (excessive hair growth), hair shedding, and lower extremity edema.
*Adverse effects are dose-dependent, with higher doses associated with higher efficacy and more adverse effects.
*8% of patients discontinued treatment due to lack of efficacy, hypertrichosis, fear of drug interactions, intention to get pregnant, and hair shedding.
Finasteride for topical use
*Topical finasteride is a potential alternative to oral finasteride for treating hair loss.
*Topical finasteride inhibits DHT (dihydrotestosterone) locally in the hair follicle, reducing DHT production with fewer systemic effects.
*Studies have shown that topical finasteride is comparable to oral finasteride in promoting hair growth.
*Topical finasteride has minimal effects on plasma DHT levels, reducing adverse effects.
*The most common adverse effects of topical finasteride are skin irritation and itching at the application site.
*Further studies are needed to determine the optimal formulation and dosage for topical finasteride.
Topical Minoxidil and Finasteride combined
*Combination of topical minoxidil and topical finasteride has been explored to enhance the effectiveness of both treatments for androgenetic alopecia (AGA).
*Study by Suchonwanit et al. examined the combination of topical 0.25% finasteride with topical 3% minoxidil in 40 male patients with AGA.
*Both treatment groups showed a significant increase in hair density and hair diameter compared to baseline.
*Combined therapy resulted in a greater increase in hair density and hair diameter compared to monotherapy at 16 and 24 weeks.
*Plasma DHT (dihydrotestosterone) decreased by 5% with no significant adverse effects observed in any patients.
*Topical 5% minoxidil combined with topical 0.1% finasteride demonstrated maintenance of hair density and prevention of further hair loss.
*Several studies reported no adverse effects from the use of topical finasteride and minoxidil, which was preferred by some patients over oral finasteride due to fewer reported side effects.
Dutasteride for oral use
*Dutasteride inhibits both type I and type II 5α-reductase, which is vital for addressing androgenetic alopecia (AGA).
*Dutasteride showed a dose-dependent increase in hair count and width, with a minimum dose of 0.1 mg/d being effective.
*Compared to finasteride, dutasteride 0.5 mg/d was superior in improving hair count and thickness after 12 and 24 weeks.
*Dutasteride may be a viable option for patients who do not respond to oral finasteride, with clinical improvements seen in 80% of patients.
*Oral dutasteride can lead to sexual dysfunction side effects such as decreased libido, impotence, ejaculatory dysfunction, and gynecomastia.
*The long-term safety study of oral dutasteride found a 53% incidence of adverse effects, with erectile dysfunction being the most common drug-related adverse effect.
LLLT (Low Level Laser Therapy)
*Low-level laser therapy (LLLT) is a new and effective treatment for androgenetic alopecia (AGA).
*LLLT reduces inflammation, promotes wound healing, improves wrinkles and scars, and increases blood flow.
*LLLT stimulates hair regrowth by promoting anagen-phase reentry of telogen hair follicles, prolonging the anagen phase, and preventing premature conversion to catagen-phase hairs.
*LLLT has shown positive effects in AGA, including improved hair count, density, strength, and thickness.
*Treatment frequency and lower wavelengths (600-1100 nm) are more effective in LLLT therapy.
*The FDA has approved LLLT as a therapy for AGA, with Lasermax Haircomb being the only FDA-approved device.
*LLLT has minimal adverse effects, such as temporary hair shedding, pruritis, tenderness, and acne.
*Due to its low cost and minimal adverse effects, LLLT can be used as an adjunct therapy or an alternative option for patients intolerant to minoxidil and finasteride.
Topical Minoxidil and LLLT combination for hair loss
*Combining topical 5% minoxidil with low-level laser therapy (LLLT) resulted in high patient satisfaction and showed significant improvement in the number of follicles at 4 months.
*LLLT treatment provided an early therapeutic advantage while waiting for the delayed efficacy of minoxidil.
*Existing studies on the combination of LLLT and minoxidil therapy showed mixed results, with some favoring combination therapy and others showing no significant difference.
*These studies had limitations such as small sample sizes and lack of long-term follow-up.
*A meta-analysis found that the combination of LLLT and minoxidil demonstrated superior efficacy compared to minoxidil monotherapy.
*Combination therapy did not increase adverse effects.
*Further evaluation with larger sample sizes and a more consistent LLLT treatment regimen is needed.
PRP (Platelet Rich Plasma)
*Platelet Rich Plasma (PRP) is used in various medical fields for regenerative purposes.
*PRP is derived from the patient's own blood and contains chemokines, growth factors, and cytokines.
*PRP is used in dermatology for skin rejuvenation, treating acne scarring, and vitiligo.
*Alpha granules in PRP contain important growth factors for treating androgenetic alopecia (AGA) and promoting hair follicle growth.
*PRP has shown efficacy in promoting hair regrowth in AGA patients.
*Studies have demonstrated significant increases in hair growth and density with PRP treatment.
*PRP can be used as a monotherapy or compared to minoxidil therapy, showing favorable results.
*Standardization of PRP protocols is necessary for better characterization of treatment response.
*PRP is a minimally invasive treatment option with low risk of adverse effects, but infection and scalp sensitivity can occur.
*Not all patients are suitable candidates for PRP therapy due to certain medical conditions.
Skin treatment using microneedles
*Microneedling originated in the 1900s for scar treatment in plastic surgery.
*It is used for collagen induction therapy, acne treatment, hyperpigmentation, and androgenetic alopecia.
*Microneedling creates microchannels in the skin and can deliver molecules or nanoparticles.
*It promotes growth factors, activates stem cells, and increases gene expression associated with hair growth.
*Microneedling stimulates hair growth through Wnt/ß-catenin signaling and vascular endothelial growth factor.
*There are various microneedling devices with different parameters and customization options.
*Combination therapy of microneedling with topical minoxidil showed greater improvement in hair count compared to minoxidil alone.
*Microneedling, when used in an open-label study, showed increased hair density in both males and females.
*Microneedling can be considered as an adjunctive treatment for androgenetic alopecia, even in cases of treatment resistance.
*Side effects include pain, bleeding, erythema, lymph node enlargement, pruritis, seborrheic dermatitis, headache, and a low risk of serious adverse events.
PRP, minoxidil, LLLT, and microneedling used in combination for treatment
*Combination therapy using PRP, minoxidil, LLLT, and microneedling has been explored to treat AGA.
*Studies have shown that combining PRP with minoxidil leads to a significant increase in hair density and count compared to minoxidil alone.
*Combination therapy of PRP with minoxidil outperformed PRP monotherapy in terms of overall hair density.
*PRP and microneedling combination therapy have demonstrated improvements in hair growth.
*Combination therapy of PRP, microneedling, and minoxidil resulted in high patient satisfaction and improved hair growth.
*PRP and microneedling combination therapy showed significant improvement in hair growth in patients who did not respond to minoxidil or finasteride.
*Triple combination therapy of minoxidil, PRP, and microneedling yielded the best results in terms of negative hair pull tests, hair ratio, and hair growth improvement.
*Combination therapies generally outperform monotherapy options for AGA treatment.
*Combined therapy using LLLT, minoxidil, PRP, and microneedling is considered safe with favorable side effect profiles.
*Patients should be suitable candidates for PRP and be aware of the potential costs associated with all modalities.
Spironolactone for oral use
*Spironolactone is an aldosterone antagonist used primarily as an anti-hypertensive agent and potassium sparing diuretic.
*It can bind and inhibit androgen receptors, making it useful in treating hirsutism, acne, and female pattern hair loss (FPHL), particularly in patients with polycystic ovarian syndrome (PCOS).
*Oral spironolactone decreases circulating androgen levels, halting the progression of FPHL by inhibiting adrenal androgen production and their effects on the hair follicle.
*Patients with a Sinclair hair loss severity score greater than 2.5 experienced improvement in hair loss with spironolactone, while a dosage below 100 mg was ineffective.
*Long-term use (greater than 12 months) at a dosage between 100 mg and 200 mg was required to see clinical improvement in FPHL.
*Adverse effects of oral spironolactone include hypotension, hyperkalemia, and occasionally urticaria.
*The recommended treatment regimen for FPHL is starting at 50 mg daily, with the optimal dosage between 100 mg and 200 mg daily for at least 6 months to see clinical improvement.
Spironolactone for topical use
*Topical spironolactone offers local inhibition of androgens on the hair follicle.
*It does not have the systemic side effects of oral spironolactone.
*A study with 26 patients (16 males and 10 females) showed that 1% topical spironolactone led to clinical improvement in nearly 77% of patients.
*Comparing 5% topical spironolactone with 0.1% topical finasteride, spironolactone showed better improvement in hair density and diameter for both males and females.
*Combination therapy of 5% topical spironolactone and 5% topical minoxidil showed the greatest improvement in dermoscopic features, indicating its potential benefits for patients with androgenetic alopecia.
Botox
*Botulinum toxin, specifically botulinum toxin A, inhibits the release of acetylcholine into the neuromuscular junction, reducing scalp muscle tone.
*This reduction in muscle tone leads to vasodilation and enhanced local microcirculation, increasing hair follicle oxygen perfusion and removing accumulated DHT, potentially slowing hair loss.
*Botulinum toxin may also inhibit neuromodulators like substance P or CGRP that contribute to AGA.
*In the vertex area of the scalp, decreased blood perfusion due to muscle contraction can be alleviated by botulinum toxin relaxing the frontalis or occipitalis muscles.
*DHT-induced TGF-β1 in dermal papilla cells suppresses growth of follicular epithelial cells, and botulinum toxin inhibits TGF-β1 secretion, potentially mitigating this effect.
*Clinical studies have shown a 75% treatment response rate with botulinum toxin injections, resulting in a statistically significant increase in mean hair count.
*Adverse effects of botulinum toxin treatment for AGA are generally mild, including headache, injection site pain, erythema, madarosis, facial alopecia, and potentially worsening hairline regression.
*More rigorous clinical trials with control groups and larger sample sizes are needed before botulinum toxin can be recommended as a standard treatment for AGA.
Regenerative medical treatment using stem cells.
*Stem cell therapy has potential for treating AGA (androgenetic alopecia).
*Stem cells can reverse the effects of AGA and promote the growth of new hair follicles.
*Hair follicle stem cells interact with dermal papilla stem cells to regulate hair follicle growth and differentiation.
*Intradermal injection of autologous stem cells has shown significant improvement in hair growth in patients with AGA.
*Topical application of adipocyte-derived stem cells can also enhance hair growth.
*The long-term safety of stem cell therapy for AGA is uncertain.
*Stem cell therapy for AGA is expensive, invasive, and requires careful transportation of live stem cell cultures.
*Autonomous cellular micrografts (ACM) using autologous stem cells have shown promise in increasing hair density and thickness in AGA patients.
*The therapy is still in the early stages of development but could offer significant benefits to patients.
Nutritional Supplements and Dietary Options
*Nutritional supplements are being investigated for the treatment of AGA (Androgenetic Alopecia)
*Saw palmetto, pumpkin seed oil, and Forti5 combination supplement can inhibit 5-alpha reductase and potentially stabilize hair loss or stimulate hair growth in men with AGA
*Antioxidants like vitamin E and vitamin C can increase hair density and thickness in female AGA
*Protein-based supplements and probiotics like kimchi and cheonggukjang show clinical effectiveness by providing essential nutrients and improving blood flow to hair follicles
*These supplements may not have undergone FDA premarket approval and current studies have limitations in small sample size, lack of control group, and lack of head-to-head comparison with standard therapies.
Pipeline drugs
*Clascoterone is a unique therapeutic option for androgenetic alopecia (AGA) treatment.
*It functions as an androgen receptor antagonist, competing with DHT binding sites on androgen receptors.
*Clascoterone is approved by the FDA for treating acne vulgaris.
*It is being investigated as a topical treatment for AGA.
Currently, it is in Phase II clinical trials for AGA treatment.
AGA has novel therapeutic options, including combination therapy, topical and oral minoxidil, oral finasteride, LLLT, Platelet Rich Plasma, and microneedling. Topical minoxidil is effective but compliance can be challenging. Oral minoxidil and finasteride offer alternatives, with the former having promising early data. Topical finasteride is being evaluated. LLLT is FDA approved, noninvasive, and affordable. PRP is an option for patients who have failed other treatments. Microneedling can augment therapies. Overall, AGA patients and clinicians have a range of new treatment options to consider.
