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Villani A, Ferrillo M, Fabbrocini G, Ocampo-Garza SS, Scalvenzi M, Ruggiero A. Hair Aging and Hair Disorders in Elderly Patients. Int J Trichology 2022; 14:191-196. [PMID: 37034552 PMCID: PMC10075351 DOI: 10.4103/ijt.ijt_90_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 03/16/2023] Open
Abstract
Hair loss in elderly patients is a common complaint. It can be related to different conditions that affect patients' quality of life and represents a challenge for dermatologists. It affects both men and women during the aging process with an estimated percentage of balding after 65 years of age of 53% and 37%, respectively. Androgenetic alopecia, frontal fibrosing alopecia, senile alopecia, and erosive pustular dermatosis of the scalp are the hair diseases most frequently described in this age group. The objective of this review is to summarize the current knowledge about alopecia affecting elderly patients, differentiating between chronological hair aging signs and pathological changes, to help clinicians, offer an adequate management of these disorders to their patients.
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Affiliation(s)
- Alessia Villani
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maria Ferrillo
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Sonia Sofía Ocampo-Garza
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
- Department of Dermatology, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Massimiliano Scalvenzi
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
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Comparative Efficacy Study Combination of Oral Methotrexate and Prednisolone versus Oral Methotrexate in Patients with Lichen Planopilaris. Dermatol Res Pract 2022; 2022:3792489. [PMID: 36254319 PMCID: PMC9569223 DOI: 10.1155/2022/3792489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Lichen planopilaris (LPP) is a rare inflammatory disorder of the scalp that causes cicatricial alopecia. No therapeutic approach has been approved for this disease due to the rare frequency. Methotrexate and corticosteroid are commonly considered second- or third-line therapy. The efficacy of a combination of methotrexate and corticosteroid has been reported in some dermatological and immunological diseases. However, the efficacy of this combination in LPP is not clear. Therefore, this study aimed to compare the impact of methotrexate alone and in combination with corticosteroid on LPP. Materials and Methods This randomized clinical trial was performed on 28 patients who referred to the dermatology clinic affiliated with Isfahan University of Medical Sciences, Isfahan, Iran during February 2015-December 2016, and 24 of them completed the trials. Fourteen patients received 15 mg methotrexate per week alone and the other fourteen subjects received 200 mg prednisolone plus 15 mg methotrexate per week. The primary outcome was Lichen planopilaris activity index (LPPAI) score. Moreover, we evaluated photographic changes and symptoms during the study. Results The mean of LPPAI in both groups decreased during the follow-up with a similar pattern of LPPAI changes in both groups. No statistically significant difference was found between the two intervention groups regarding the LPPAI score. We found no difference in the symptoms and photographic assessments in methotrexate and combination therapy groups during follow-up. In both groups, exclusively one adverse effect was reported. Conclusions Our results showed that methotrexate therapy with and without corticosteroids had similar efficacy and safety.
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Alessandrini A, Starace M, D'''''Ovidio R, Villa L, Rossi A, Stan TR, Calzavara-Pinton P, Piraccini BM. Androgenetic alopecia in women and men: Italian guidelines adapted from European Dermatology Forum/European Academy of Dermatology and Venereology guidelines. GIORN ITAL DERMAT V 2020; 155:622-631. [PMID: 33295740 DOI: 10.23736/s0392-0488.19.06399-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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).
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Affiliation(s)
- Aurora Alessandrini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Lucia Villa
- Private Practitioner, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Alfredo Rossi
- Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | | | | | - Bianca M Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
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Comparison of low-level light therapy and combination therapy of 5% minoxidil in the treatment of female pattern hair loss. Lasers Med Sci 2020; 36:1085-1093. [PMID: 33068178 DOI: 10.1007/s10103-020-03157-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
Abstract
This study was conducted in order to compare the safety and efficacy of LLLT, 5% minoxidil, and combination therapy in the treatment of FPHL. A randomized controlled trial was developed to study the effect of LLLT on FPHL using a device called iHelmet®, which is equipped with 200 5mW laser diode source (650 nm) arrays. Ninety Ludwig's types II-III FPHL patients were randomly divided into 3 groups: LLLT group (A), 5% minoxidil group (B), and combination group(C). Hair density, hair diameter, and scalp oil-secretion were detected to evaluate the treatment effect. Significant improvement of hair density and hair diameter was observed in all stages of FPHL after treatment. Oil-secretion of the three groups was decreased after treatment. The effectiveness of reducing oil-secretion in LLLT group and combination group was higher than minoxidil group (P < 0.05). For improving hair diameter and hair density, combination group was better than LLLT and minoxidil groups. No side effects were reported. Our study illustrated that LLLT is a safe and effective treatment for FPHL. Besides, LLLT can significantly improve its efficacy when used in combination with 5% minoxidil.
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Traish AM. Post-finasteride syndrome: a surmountable challenge for clinicians. Fertil Steril 2020; 113:21-50. [PMID: 32033719 DOI: 10.1016/j.fertnstert.2019.11.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
Post-finasteride syndrome (PFS) is a constellation of serious adverse side effects manifested in clinical symptoms that develop and persist in patients during and/or after discontinuing finasteride treatment in men with pattern hair loss (androgenetic alopecia) or benign prostatic hyperplasia. These serious adverse side effects include persistent or irreversible sexual, neurological, physical and mental side effects. To date, there are no evidence-based effective treatments for PFS. Although increasing number of men report persistent side effects, the medical community has yet to recognize this syndrome nor are there any specific measures to address this serious and debilitating symptoms. Here we evaluate the scientific and clinical evidence in the contemporary medical literature to address the very fundamental question: Is PFS a real clinical condition caused by finasteride use or are the reported symptoms only incidentally associated with but not caused by finasteride use? One key indisputable clinical evidence noted in all reported studies with finasteride and dutasteride was that use of these drugs is associated with development of sexual dysfunction, which may persist in a subset of men, irrespective of age, drug dose or duration of study. Also, increased depression, anxiety and suicidal ideation in a subset of men treated with these drugs were commonly reported in a number of studies. It is important to note that many clinical studies suffer from incomplete or inadequate assessment of adverse events and often limited or inaccurate data reporting regarding harm. Based on the existing body of evidence in the contemporary clinical literature, the author believes that finasteride and dutasteride induce a constellation of persistent sexual, neurological and physical adverse side effects, in a subset of men. These constellations of symptoms constitute the basis for PFS in individuals predisposed to epigenetic susceptibility. Indeed, delineating the pathophysiological mechanisms underlying PFS will be of paramount importance to the understanding of this syndrome and to development of potential novel therapeutic modalities.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts.
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Cyclosporine or methotrexate, which one is more promising in the treatment of lichen planopilaris?; A comparative clinical trial. Int Immunopharmacol 2020; 86:106765. [PMID: 32674048 DOI: 10.1016/j.intimp.2020.106765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Lichen Planopilaris (LPP) is a primary scarring alopecia with unknown etiology and its management is a challenge for dermatologists. We aimed to compare the safety and efficacy of methotrexate and cyclosporine in LPP patients. METHODS In a randomized clinical trials, 33 patients were randomly allocated to receive either 15-mg oral methotrexate per week or 3-5-mg/kg/day cyclosporine for six months. During the treatment course, side effects, signs/symptoms and laboratory test were assessed periodically. Lichen planopilaris activity index (LPPAI) was measured at baseline and 2, 4, and 6 months after the intervention. Score of both photography and patient's opinion were also obtained. The collected data were analyzed in SPSS software (Ver.25.0. Armonk, NY: IBM Corp). RESULTS Both medications had positive effects on the signs and symptoms of LPP with a significant difference between the variables (p < 0.05), and the results showed similar efficacy at the end of 6th months of the therapy with both cyclosporine and methotrexate (p > 0.05). CONCLUSIONS Regarding the results of the present study, both cyclosporine and methotrexate are effective in treating refractory lichen planopilaris and we propose methotrexate as a possible earlier choice over cyclosporine. This study was registered in Iranian Registry of Clinical Trials (IRCT20190717044256N1).
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Kim D, Park S. Pharmacological therapeutics in androgenetic alopecia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.5.277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Androgenetic alopecia (AGA) is the most common type of hair loss and affects both men and women. Male pattern hair loss shows characteristic frontal recession and vertex baldness, whereas female pattern hair loss produces diffuse alopecia over the mid-frontal scalp. AGA is mediated by increased androgen susceptibility in affected scalp hairs. 5α-Reductase converts testosterone into dihydrotestosterone, a potent androgen, in the scalp. Both androgen receptors and 5α-reductase have higher expression levels in the balding scalp than in non-affected regions. Increased androgen susceptibility induces hair follicle miniaturization, which leads to the progressive loss of thicker terminal hairs in the balding scalp. Currently, topical minoxidil and oral 5α-reductase inhibitors, such as finasteride and dutasteride, are approved options for the pharmacological treatment of AGA. Topical minoxidil remains the mainstay of therapy for mild to moderate AGA in both men and women. The daily intake of 1-mg finasteride or 0.5-mg dutasteride shows better efficacy than topical minoxidil in regard to hair regrowth in male AGA. Anti-androgens can be used in female AGA wit clinical and biochemical evidence of hyperandrogenism. Patients may be overwhelmed and confused by the variety of treatment options for AGA management, including over-the-count drugs with low evidence quality. Therefore, physicians must be aware of the current guidelines for the management of AGA based on evidence-based approaches to select better options for patients.
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5α-Reductase inhibitors in men aged 50 years or older with androgenetic alopecia: A retrospective study. J Am Acad Dermatol 2020; 84:172-173. [PMID: 32320771 DOI: 10.1016/j.jaad.2020.04.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/22/2022]
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9
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Eichenfield LF, Del Rosso JQ, Tan JKL, Hebert AA, Webster GF, Harper J, Baldwin HE, Kircik LH, Stein-Gold L, Kaoukhov A, Alvandi N. Use of an alternative method to evaluate erythema severity in a clinical trial: difference in vehicle response with evaluation of baseline and postdose photographs for effect of oxymetazoline cream 1·0% for persistent erythema of rosacea in a phase IV study. Br J Dermatol 2019; 180:1050-1057. [PMID: 30500065 PMCID: PMC6850476 DOI: 10.1111/bjd.17462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 12/01/2022]
Abstract
Background Once‐daily topical oxymetazoline cream 1·0% significantly reduced persistent facial erythema of rosacea in trials requiring live, static patient assessments. Objectives To evaluate critically the methodology of clinical trials that require live, static patient assessments by determining whether assessment of erythema is different when reference to the baseline photograph is allowed. Methods In two identically designed, randomized, phase III trials, adults with persistent facial erythema of rosacea applied oxymetazoline or vehicle once daily. This phase IV study evaluated standardized digital facial photographs from the phase III trials to record ≥ 1‐grade Clinician Erythema Assessment (CEA) improvement at 1, 3, 6, 9 and 12 h postdose. Results Among 835 patients (oxymetazoline n = 415, vehicle n = 420), significantly greater proportions of patients treated with oxymetazoline vs. vehicle achieved ≥ 1‐grade CEA improvement. For the comparison between phase IV study results and the original phase III analysis, when reference to baseline photographs was allowed while evaluating post‐treatment photographs, the results for oxymetazoline were similar to results of the phase III trials (up to 85.7%), but a significantly lower proportion of vehicle recipients achieved ≥ 1‐grade CEA improvement (up to 29.7% [phase 4] vs. 52.3% [phase 3]; P<0.001). In the phase IV study, up to 80·2% of patients treated with oxymetazoline achieved at least moderate erythema improvement vs. up to 22·9% of patients treated with vehicle. The association between patients’ satisfaction with facial skin redness and percentage of erythema improvement was statistically significant. Conclusions Assessment of study photographs, with comparison to baseline, confirmed significant erythema reduction with oxymetazoline on the first day of application. Compared with the phase III trial results, significantly fewer vehicle recipients attained ≥ 1‐grade CEA improvement, suggesting a mitigated vehicle effect. This methodology may improve the accuracy of clinical trials evaluating erythema severity. What's already known about this topic? Phase III studies that evaluate the effects of medications on persistent facial erythema associated with rosacea require investigator assessments without allowing comparison with baseline images.
What does this study add? Grading of facial erythema of rosacea that utilized baseline photographs compared with post‐treatment photographs enhanced the accuracy of persistent facial erythema assessments. Furthermore, this method more accurately differentiated active treatment with oxymetazoline cream 1·0% from vehicle compared with live, static assessments. Methodology that allows for comparison to baseline photographs may improve the accuracy of clinical trials that evaluate erythema severity.
Linked Comment: https://doi.org/10.1111/bjd.17725. https://www.bjdonline.com/article/
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Affiliation(s)
- L F Eichenfield
- University of California, San Diego, CA, U.S.A.,Rady Children's Hospital, San Diego, CA, U.S.A
| | - J Q Del Rosso
- JDR Dermatology Research/Thomas Dermatology, Las Vegas, NV, U.S.A
| | - J K L Tan
- Windsor Clinical Research Inc., Windsor, ON, Canada
| | - A A Hebert
- UTHealth McGovern Medical School, Department of Dermatology, Houston, TX, U.S.A
| | - G F Webster
- Webster Dermatology, P.A., Hockessin, DE, U.S.A
| | - J Harper
- Dermatology and Skin Care Center of Birmingham, Birmingham, AL, U.S.A
| | - H E Baldwin
- The Acne Treatment and Research Center, Morristown, NJ, U.S.A
| | - L H Kircik
- DermResearch, PLLC, Louisville, KY, U.S.A.,Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
| | - L Stein-Gold
- Henry Ford Health System, West Bloomfield, MI, U.S.A
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Olsen EA, Roberts J, Sperling L, Tosti A, Shapiro J, McMichael A, Bergfeld W, Callender V, Mirmirani P, Washenik K, Whiting D, Cotsarelis G, Hordinsky M. Objective outcome measures: Collecting meaningful data on alopecia areata. J Am Acad Dermatol 2018; 79:470-478.e3. [PMID: 29128463 PMCID: PMC7450487 DOI: 10.1016/j.jaad.2017.10.048] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although alopecia areata is a common disorder, it has no US Food and Drug Administration-approved treatment and evidence-based therapeutic data are lacking. OBJECTIVE To develop guidelines for the diagnosis, evaluation, assessment, response criteria, and end points for alopecia areata. METHODS Literature review and expert opinion of a group of dermatologists specializing in hair disorders. RESULTS Standardized methods of assessing and tracking hair loss and growth, including new scoring techniques, response criteria, and end points in alopecia areata are presented. LIMITATIONS The additional time to perform the assessments is the primary limitation to use of the methodology in clinical practice. CONCLUSION Use of these measures will facilitate collection of standardized outcome data on therapeutic agents used in alopecia areata both in clinical practice and in clinical trials.
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Affiliation(s)
- Elise A Olsen
- Duke University Medical Center, Durham, North Carolina.
| | - Janet Roberts
- Northwest Dermatology and Research Center, Portland, Oregon
| | | | | | | | - Amy McMichael
- Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina
| | | | | | | | - Ken Washenik
- New York University, New York, New York; Bosley Medical Group, Beverly Hills, California
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Suchonwanit P, Srisuwanwattana P, Chalermroj N, Khunkhet S. A randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in the treatment of male androgenetic alopecia. J Eur Acad Dermatol Venereol 2018; 32:2257-2263. [PMID: 29972712 DOI: 10.1111/jdv.15171] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 06/20/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The synergism of combined use between oral finasteride and topical minoxidil has been established in treating androgenetic alopecia among men. However, the concern regarding adverse effects of finasteride use has been rising. OBJECTIVE To compare the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in men with androgenetic alopecia. METHODS Forty men aged 18-60 years with androgenetic alopecia were randomized to 24 weeks of treatment with a finasteride/minoxidil or minoxidil solution twice daily. Primary efficacy endpoint was the change from baseline in hair density and hair diameter at week 24. Secondary endpoints included global photographic assessment by treatment-blinded investigators and subjects. Changes in plasma dihydrotestosterone levels and adverse events were recorded. RESULTS At week 24, the combined solution of finasteride and minoxidil was significantly superior to minoxidil alone in improvements of hair density, hair diameter and global photographic assessment (all P < 0.05). About 90% of patients treated with the combined solution experienced moderate to marked improvement. The combined solution also had minimal effect on plasma dihydrotestosterone levels, approximately 5% reduction. There were also no systemic adverse events reported by patients in both groups. CONCLUSION Treatment with topical solution of 0.25% finasteride admixed with 3% minoxidil was significantly superior to 3% minoxidil solution for promoting hair growth in male androgenetic alopecia, and well tolerated.
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Affiliation(s)
- P Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - P Srisuwanwattana
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - N Chalermroj
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Khunkhet
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Gupta AK, Mays RR, Dotzert MS, Versteeg SG, Shear NH, Piguet V. Efficacy of non-surgical treatments for androgenetic alopecia: a systematic review and network meta-analysis. J Eur Acad Dermatol Venereol 2018; 32:2112-2125. [PMID: 29797431 DOI: 10.1111/jdv.15081] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/13/2018] [Indexed: 01/03/2023]
Abstract
Androgenetic alopecia, or male/female pattern baldness, is the most common type of progressive hair loss disorder. The aim of this study was to review recent advances in non-surgical treatments for androgenetic alopecia and identify the most effective treatments. A network meta-analysis (NMA) was conducted of the available literature of the six most common non-surgical treatment options for treating androgenetic alopecia in both men and women; dutasteride 0.5 mg, finasteride 1 mg, low-level laser therapy (LLLT), minoxidil 2%, minoxidil 5% and platelet-rich plasma (PRP). Seventy-eight studies met the inclusion criteria, and 22 studies had the data necessary for a network meta-analysis. Relative effects show LLLT as the superior treatment. Relative effects show PRP, finasteride 1 mg (male), finasteride 1 mg (female), minoxidil 5%, minoxidil 2% and dutasteride (male) are approximately equivalent in mean change hair count following treatment. Minoxidil 5% and minoxidil 2% reported the most drug-related adverse events (n = 45 and n = 23, respectively). The quality of evidence of minoxidil 2% vs. minoxidil 5% was high; minoxidil 5% vs. placebo was moderate; dutasteride (male) vs. placebo, finasteride (female) vs. placebo, minoxidil 2% vs. placebo and minoxidil 5% vs. LLLT was low; and finasteride (male) vs. placebo, LLLT vs. sham, PRP vs. placebo and finasteride vs. minoxidil 2% was very low. Results of this NMA indicate the emergence of novel, non-hormonal therapies as effective treatments for hair loss; however, the quality of evidence is generally low. High-quality randomized controlled trials and head-to-head trials are required to support these findings and aid in the development of more standardized protocols, particularly for PRP. Regardless, this analysis may aid physicians in clinical decision-making and highlight the variety of non-surgical hair restoration options for patients.
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Affiliation(s)
- A K Gupta
- Mediprobe Research Inc., London, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - R R Mays
- Mediprobe Research Inc., London, Canada
| | | | | | - N H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - V Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom.,Division of Dermatology, Women's College Hospital, Toronto, Canada
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14
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Treat androgenetic alopecia with antiandrogens, as well as other pharmacological and non-pharmacological interventions. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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A genomic approach to susceptibility and pathogenesis leads to identifying potential novel therapeutic targets in androgenetic alopecia. Genomics 2017; 109:165-176. [DOI: 10.1016/j.ygeno.2017.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 02/03/2017] [Accepted: 02/25/2017] [Indexed: 02/07/2023]
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Naeini FF, Saber M, Asilian A, Hosseini SM. Clinical Efficacy and Safety of Methotrexate versus Hydroxychloroquine in Preventing Lichen Planopilaris Progress: A Randomized Clinical Trial. Int J Prev Med 2017; 8:37. [PMID: 28584619 PMCID: PMC5450502 DOI: 10.4103/ijpvm.ijpvm_156_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/22/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Lichen planopilaris is an inflammatory cicatricial alopecia, and its management is a challenge for dermatologists. We aimed to compare the efficacy of methotrexate and hydroxychloroquine on refractory lichen planopilaris. METHODS In a randomized clinical trial, 29 patients were randomly allocated to receive either 15 mg methotrexate/week or 200 mg hydroxychloroquine twice a day for 6 months. Side effects, symptoms/signs, and laboratory tests were assessed periodically. Lichen Planopilaris Activity Index (LPPAI) was measured before intervention and at 2, 4, and 6 months after. The changes from baseline to the end of the study were analyzed within each group and between the two groups by per-protocol and intention-to-treat analysis. RESULTS After 2 months, mean (standard deviation [SD]) decrease in LPPAI in methotrexate group was significantly more than that in hydroxychloroquine group (1.68 [1.24] vs. 0.8 [0.71], respectively, P = 0.047). Furthermore, after 6 months, mean (SD) decrease in LPPAI in methotrexate group was significantly higher than that in hydroxychloroquine group (3.3 [2.09] vs. 1.51 [0.91], respectively, P = 0.01). The following symptoms/signs showed significant improvements in frequency and/or severity in methotrexate group after intervention: pruritus (P = 0.007), erythema (P = 0.01), perifollicular erythema (P = 0.01), perifollicular scaling (P = 0.08), spreading (P = 0.001), and follicular keratosis (P = 0.04). In hydroxychloroquine group, only erythema (P = 0.004) showed significant improvement. CONCLUSIONS Methotrexate was more effective than hydroxychloroquine in treating refractory lichen planopilaris.
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Affiliation(s)
- Farahnaz Fatemi Naeini
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Saber
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asilian
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mohsen Hosseini
- Department of Biostatics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Abstract
Androgenetic alopecia (AGA) is characterized by a non-scarring progressive miniaturization of the hair follicle in predisposed men and women with a pattern distribution. Although AGA is a very prevalent condition, approved therapeutic options are limited. This article discusses the current treatment alternatives including their efficacy, safety profile, and quality of evidence. Finasteride and minoxidil for male androgenetic alopecia and minoxidil for female androgenetic alopecia still are the therapeutic options with the highest level evidence. The role of antiandrogens for female patients, the importance of adjuvant therapies, as well as new drugs and procedures are also addressed.
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Affiliation(s)
- Yanna Kelly
- Department of Dermatology, Universidade de São Paulo, São Paulo, SP, Brazil. .,Department of Dermatology, Hospital do Servidor Publico Municipal de São Paulo, São Paulo, SP, Brazil. .,, 1364, Oscar Freire Street, São Paulo, SP, 05409-010, Brazil.
| | - Aline Blanco
- Department of Dermatology, Universidade Federal do Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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18
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Hu R, Xu F, Sheng Y, Qi S, Han Y, Miao Y, Rui W, Yang Q. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients. Dermatol Ther 2015; 28:303-8. [PMID: 26031764 DOI: 10.1111/dth.12246] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ruiming Hu
- Department of Dermatology, Huashan Hospital; Fudan University; Shanghai 200040 China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital; Fudan University; Shanghai 200040 China
| | - Youyu Sheng
- Department of Dermatology, Huashan Hospital; Fudan University; Shanghai 200040 China
| | - Sisi Qi
- Department of Dermatology, Huashan Hospital; Fudan University; Shanghai 200040 China
| | - Yumei Han
- Department of Dermatology, Huashan Hospital; Fudan University; Shanghai 200040 China
| | - Ying Miao
- Department of Dermatology, Huashan Hospital; Fudan University; Shanghai 200040 China
| | - Wenlong Rui
- Department of Dermatology, Huashan Hospital; Fudan University; Shanghai 200040 China
| | - Qinping Yang
- Department of Dermatology, Huashan Hospital; Fudan University; Shanghai 200040 China
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19
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Yoshitake T, Takeda A, Ohki K, Inoue Y, Yamawaki T, Otsuka S, Akimoto M, Nemoto M, Shimakura Y, Sato A. Five-year efficacy of finasteride in 801 Japanese men with androgenetic alopecia. J Dermatol 2015; 42:735-8. [DOI: 10.1111/1346-8138.12890] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/04/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Toshihiro Yoshitake
- Department of Regenerative Plastic Surgery; Kitasato University School of Medicine; Kanagawa Japan
- Department of Plastic and Aesthetic Surgery; Kitasato University School of Medicine; Kanagawa Japan
- Tokyo Memorial Clinic Hirayama; Tokyo Japan
| | - Akira Takeda
- Department of Plastic and Aesthetic Surgery; Kitasato University School of Medicine; Kanagawa Japan
- Tokyo Memorial Clinic Hirayama; Tokyo Japan
| | | | - Yuko Inoue
- Tokyo Memorial Clinic Hirayama; Tokyo Japan
| | | | - Saori Otsuka
- Department of Regenerative Plastic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Minekatsu Akimoto
- Department of Plastic and Aesthetic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Mitsuru Nemoto
- Department of Plastic and Aesthetic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Yasuhito Shimakura
- Department of Plastic and Aesthetic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Akio Sato
- Department of Regenerative Plastic Surgery; Kitasato University School of Medicine; Kanagawa Japan
- Tokyo Memorial Clinic Hirayama; Tokyo Japan
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20
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Abstract
PURPOSE OF REVIEW The authors will review the current literature on efficacy and safety of 5-alpha reductase inhibitors (5αRIs) for androgenetic alopecia (AGA). RECENT FINDINGS The 5αRI finasteride and dutasteride are effective in treating AGA and promoting hair regrowth. 5αRI can be given orally, topically and more recently through mesotherapy. However, there has been an increasing concern about permanent sexual adverse events such as impotence and infertility. Most of these reports are published as case reports, and two studies reporting persistent sexual side-effects after discontinuation of finasteride had serious method limitations, as patients were recruited from a website. To our knowledge, permanent sexual adverse events have yet to be published in higher quality studies, such as randomized controlled trials. Although patients treated with 5αRIs have an increased incidence of sexual adverse events, these events decrease if discontinued or over time with continued therapy. SUMMARY Sexual side-effects are uncommon and resolve spontaneously in most patients even without discontinuing therapy. Significant effort is underway to find delivery systems that optimize delivery and reduce systemic absorption of topical 5αRs including hydroxypropyl chitosan and liposomal and nanoparticulate systems.
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Affiliation(s)
- Elizabeth Yim
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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21
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Millum J, Grady C. The ethics of placebo-controlled trials: methodological justifications. Contemp Clin Trials 2013; 36:510-4. [PMID: 24035802 DOI: 10.1016/j.cct.2013.09.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 11/26/2022]
Abstract
The use of placebo controls in clinical trials remains controversial. Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study; (2) when withholding treatment poses negligible risks to participants; (3) when there are compelling methodological reasons for using placebo, and withholding treatment does not pose a risk of serious harm to participants; and, more controversially, (4) when there are compelling methodological reasons for using placebo, and the research is intended to develop interventions that can be implemented in the population from which trial participants are drawn, and the trial does not require participants to forgo treatment they would otherwise receive. The concept of methodological reasons is essential to assessing the ethics of placebo controls in these controversial last two cases. This article sets out key considerations relevant to considering whether methodological reasons for a placebo control are compelling.
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Affiliation(s)
- Joseph Millum
- Department of Bioethics, Clinical Center, National Institutes of Health, 10/1C118, 10 Center Drive, Bethesda, MD 20892, United States; Fogarty International Center, National Institutes of Health, 16/210, Stone House, Bethesda, MD 20892, United States.
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22
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Chin EY. Androgenetic alopecia (male pattern hair loss) in the United States: what treatments should primary care providers recommend? J Am Assoc Nurse Pract 2013; 25:395-401. [PMID: 24170634 DOI: 10.1111/1745-7599.12030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Androgenetic alopecia (AGA), or male pattern hair loss, affects up to 96% of Caucasian men. Characterized by gradual thinning and eventual loss of hair along frontotemporal, parietal, and vertex areas of the scalp, AGA is associated with low self-esteem, depression, and dissatisfaction with body appearance. DATA SOURCES In this systematic review of the literature, six primary research studies conducted in the United States are evaluated for their clinical application to primary care provider practice. CONCLUSIONS Topical minoxidil 2%-5% 1 mL twice daily or finasteride 1 mg daily are recommended as first line treatments, followed by the use of Food and Drug Administration-cleared HairMax LaserComb® in patients who do not respond to first line modalities. IMPLICATIONS FOR PRACTICE Further research in novel and established treatments is recommended, along with an evidence-based clinical practice guideline for practitioners in the United States.
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Affiliation(s)
- Evelyn Y Chin
- Family Health Nurse Practitioner Program, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Rossi A, Mari E, Scarnò M, Garelli V, Maxia C, Scali E, Iorio A, Carlesimo M. Comparitive Effectiveness and Finasteride Vs Serenoa Repens in Male Androgenetic Alopecia: A Two-Year Study. Int J Immunopathol Pharmacol 2012; 25:1167-73. [DOI: 10.1177/039463201202500435] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this open label study is to determine the effectiveness of Serenoa repens in treating male androgenetic alopecia (AGA), by comparing its results with finasteride. For this purpose, we enrolled 100 male patients with clinically diagnosed mild to moderate AGA. One group received Serenoa repens 320 mg every day for 24 months, while the other received finasteride 1 mg every day for the same period. In order to assess the efficacy of the treatments, a score index based on the comparison of the global photos taken at the beginning (T0) and at the end (T24) of the treatment, was used. The results showed that only 38% of patients treated with Serenoa repens had an increase in hair growth, while 68% of those treated with finasteride noted an improvement. Moreover finasteride was more effective for more than half of the patients (33 of 50, i.e. 66%), with level II and III alopecia. We can summarize our results by observing that Serenoa repens could lead to an improvement of androgenetic alopecia, while finasteride confirmed its efficacy. We also clinically observed, that finasteride acts in both the front area and the vertex, while Serenoa repens prevalently in the vertex. Obviously other studies will be necessary to clarify the mechanisms that cause the different responses of these two treatments.
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Affiliation(s)
- A. Rossi
- Department of Dermatology and Plastic Surgery, University of Rome “Sapienza” I School, Rome, Italy
| | - E. Mari
- Department of Dermatology and Plastic Surgery, University of Rome “Sapienza” I School, Rome, Italy
| | - M. Scarnò
- CASPUR (Inter-University Consortium for Supercomputing), Rome, Italy
| | - V. Garelli
- Department of Dermatology and Plastic Surgery, University of Rome “Sapienza” I School, Rome, Italy
| | - C. Maxia
- Department of Dermatology and Plastic Surgery, University of Rome “Sapienza” I School, Rome, Italy
| | - E. Scali
- Department of Dermatology and Plastic Surgery, University of Rome “Sapienza” I School, Rome, Italy
| | - A. Iorio
- Department of Dermatology and Plastic Surgery, University of Rome “Sapienza” I School, Rome, Italy
| | - M. Carlesimo
- Dermatology University of Rome “Sapienza” of Rome II School, Rome, Italy
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