September/October 2013
Volume 11 • Issue 5
Core curriculum Virendra N. Sehgal, MD, Section Editor
Hair Biology and Its Comprehensive Sequence in Female Pattern Baldness: Treatment Modalities—Part III Virendra N. Sehgal, MD; Govind Srivastava, MD; Ashok K. Aggarwal, MD; Rashmi Midha, MBBS
Female pattern baldness is a major social concern for many women afflicted with hair loss. Parts I and II of this review discussed the types, sequence, and diagnosis of this condition. Part III will conclude the discussion by presenting treatment options for female pattern baldness.
Treatment Modalities
Medical Treatments Minoxidil Minoxidil is an ideal effective topical treatment for female pattern baldness (FPB), because it fulfills other requirements: (1) it stimulates a telogen to anagen transition, (2) it retards the onset of catagen/telogen, and/or (3) it enlarges the dermal papillae/matrix in order to produce a thicker diameter hair.1 Although there are many compounds that purport to do one or more of the preceding functions, the only compound that has been found effective in the treatment of female pattern hair loss (FPHL) in multicenter controlled trials is topical minoxidil. It is a piperidylpyrimidine derivative that causes hypertrichosis when given systemically for the treatment of hypertension.2,3 It also causes vasodilation through the potassium channel opening activity of its active metabolite, minoxidil sulfate. Although its precise mechanism of action in inducing hair growth is debatable, it appears to directly increase follicular proliferation.4 Topical minoxidil has been found to promote anagen growth and leads to an increase in the size of the affected hair follicle in both studies of the stump tail macaque and humans.4,5 It has a few side effects, including contact dermatitis. Its frequency is less than 8% and is more often used with 5% than 2% solution due to the higher concentration of propylene glycol, a frequent irritant.4 A newer
formulation of 5% topical minoxidil in a foam vehicle without propylene glycol has recently been approved by the US Food and Drug Administration and may lower the incidence of this potential side effect. Hypertrichosis may occur in 3% to 5% of women using 2% topical minoxidil solution, while it is likely to be higher in those using 5% solution.6
Anti-Androgens There are three anti-androgens that may be used in FPHL. They are approved for use in different countries for various indications. Spironolactone is an approved diuretic for treatment of hypertension in the United States,7 whereas it is recommended for use in hirsutism in Australia. Flutamide is approved as a treatment for prostate cancer in combination with luteinizing hormone. Releasing hormone and cyperoterone acetate are unavailable in the United States. Each has their own advantages and disadvantages in the treatment of FPB. All these drugs can cause feminization of a male fetus in pregnant women; therefore, they are contraindicated in pregnancy.8
Spironolactone Spironolactone, an anti-androgen, not only blocks the production of testosterone in the adrenal gland by decreasing the activity of cytochrome P450-dependent enzymes, but it is also a competitive inhibitor of the dihydrotestosterone receptor and
From the DermatoVenereology (Skin/VD) Center, Sehgal Nursing Home, Panchwati-Delhi, Skin Institute, School of Dermatology, Greater Kailash New-Delhi Address for Correspondence: Virendra N. Sehgal, MD, DermatoVenerology (Skin/VD) Center, Sehgal Nursing Home, A/6 Panchwati, Delhi-110 033, India • E-mail: drsehgal@ndf.vsnl.net.in
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