1
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Gao JL, Streed CG, Thompson J, Dommasch ED, Peebles JK. Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics. J Am Acad Dermatol 2023; 89:774-783. [PMID: 34756934 DOI: 10.1016/j.jaad.2021.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.
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Affiliation(s)
- Julia L Gao
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.
| | - Carl G Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts; Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts
| | | | - Erica D Dommasch
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jon Klinton Peebles
- Department of Dermatology, Kaiser-Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
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2
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Zari S. Assessment of Occipital Involvement Among a Large Population of Females with Pattern Hair Loss in Saudi Arabia. Clin Cosmet Investig Dermatol 2023; 16:2687-2696. [PMID: 37790906 PMCID: PMC10544099 DOI: 10.2147/ccid.s422283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/16/2023] [Indexed: 10/05/2023]
Abstract
Background Cumulative evidence suggests the involvement of the occipital region in female pattern hair loss (FPHL). However, most of the studies that have been published so far concerned relatively small samples of patients. Purpose To assess the occipital involvement in FPHL and analyze its correlation with disease severity among a large sample of patients. Patients and Methods A retrospective study involved 1000 adult women with FPHL, between January 2020 and August 2022. Occipital involvement was defined as more than 10% of thin hairs (<0.03 mm). Baseline trichometry parameters in the frontal and occipital regions were analyzed. Results Occipital involvement was observed in 32.4% of the patients. Positive correlations between frontal and occipital regions were observed for all trichometry parameters; the strongest concerned average hair shaft thickness (Pearson's coefficient r=0.708), cumulative hair thickness (r=0.673), and trichometry-derived Sinclair scale (r=0.656). The risk of occipital involvement increased independently with the disease severity in frontal region; however, the disease progression was slower in the occipital compared to frontal region. Conclusion One-third of females in our study with FPHL had occipital involvement. This has a major impact on the methods used to diagnose pattern hair loss in females and their treatment plan including hair restoration surgery.
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Affiliation(s)
- Shadi Zari
- Department of Dermatology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
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3
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Gao JL, Sanz J, Tan N, King DS, Modest AM, Dommasch ED. Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study. J Am Acad Dermatol 2023; 89:504-510. [PMID: 36780950 DOI: 10.1016/j.jaad.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. OBJECTIVE We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. METHODS Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. RESULTS TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). LIMITATIONS Inability to determine causation and limited generalizability. CONCLUSION TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.
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Affiliation(s)
- Julia L Gao
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Dartmouth Health, Lebanon, New Hampshire; George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Jessika Sanz
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; New York Institute College of Osteopathic Medicine, Jonesboro, Arkansas
| | - Nicholas Tan
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Case Western University School of Medicine, Cleveland, Ohio
| | - Dana S King
- Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Erica D Dommasch
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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4
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Aleissa M. The Efficacy and Safety of Oral Spironolactone in the Treatment of Female Pattern Hair Loss: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e43559. [PMID: 37719557 PMCID: PMC10502763 DOI: 10.7759/cureus.43559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Oral spironolactone has been proposed as a potential treatment for hair loss due to its antiandrogenic properties. However, the efficacy and safety of spironolactone for treating hair loss are not well-established. The objective of this study was to conduct a systematic review of the current literature on the use of oral spironolactone in female pattern hair loss. We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies that assessed the efficacy and safety of oral spironolactone for treating hair loss. We searched for eligible papers in PubMed, Web of Science (ISI), Embase, and Scopus. All analyses were done using R software version 4.2.3 (R Foundation for Statistical Computing, Vienna, Austria). The overall rate of improved hair loss was 56.60%, with a higher rate of improvement (65.80%) observed in the combined therapy group compared to the monotherapy group (43.21%). However, there was significant heterogeneity in the efficacy outcomes, and hair loss did not improve or showed a modest improvement in 37.80% of all patients. The rates of adverse events reported in at least two studies were scalp pruritus or increased scurf (18.92%), menstrual disorders (11.85%), facial hypertrichosis (6.93%), and drug discontinuation (2.79%). The overall adverse events rate was 3.69%, but there was significant heterogeneity in the rates of different adverse events. In conclusion, the present study suggests that spironolactone is an effective and safe treatment option for hair loss. However, further research is needed to fully understand the heterogeneity of treatment response and adverse events and identify factors that may predict treatment response.
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Affiliation(s)
- Majed Aleissa
- Department of Dermatology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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5
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Alavi SMK, Layegh P, Vahabi-Amlashi S, Sabeti V, Forouzanfar M, Darchini-Maragheh E. Therapeutic effects of topical cetirizine in the treatment of female pattern hair loss: a randomized controlled noninferiority trial. Expert Rev Clin Pharmacol 2023; 16:1009-1015. [PMID: 37552615 DOI: 10.1080/17512433.2023.2243813] [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: 02/25/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Female pattern hair loss (FPHL) is the most prevalent form of hair loss in women. It was aimed to evaluate the therapeutic effects of topical cetirizine 1%, versus topical minoxidil 2% in patients with FPHL. RESEARCH DESIGN AND METHODS Through a triple-blind randomized clinical trial, 60 women with FPHL were randomly divided into two groups of treatment with topical cetirizine 1% or topical minoxidil 2%. The endpoint was changing in hair loss severity as well as terminal hair density and diameter, according to trichoscopic evaluation. Intention-to-treat analysis was also performed for those who accomplished 3 months of treatment. RESULTS Both groups showed improvement in hair diameter and density after 6 months; however, the outcome was significant only in the minoxidil group. According to per-protocol analysis, minoxidil was significantly superior to cetirizine in hair density, but not in hair diameter. According to the hair loss severity scales, FPHL was significantly improved in both the cetirizine and minoxidil groups after 6 months of therapy. The dropout rate due to adverse effects was 10.0% and 6.6% in the cetirizine and minoxidil groups, respectively. CONCLUSION Although inferior to topical minoxidil, topical cetirizine can provide favorable therapeutic effects for FPHL, specifically when patient incompatibility with Minoxidil is observed. TRIAL REGISTRATION The study is registered in the Iranian Registry of Clinical Trials (IRCT) with the registration code IRCT20200521047536N1.
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Affiliation(s)
| | - Pouran Layegh
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sadegh Vahabi-Amlashi
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahideh Sabeti
- Department of Dermatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Forouzanfar
- Electronics Group, Engineering Faculty, Birjand University, Birjand, Iran
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6
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Sand J, Walen S. Noninvasive Hair Rejuvenation. Clin Plast Surg 2023; 50:509-520. [PMID: 37169416 DOI: 10.1016/j.cps.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Both nonsurgical and surgical modalities for the treatment of hair loss are being used by providers at an increasing rate worldwide. Men and woman are affected by hair loss, but the pathophysiology of the hair loss is thought to be different between sexes; therefore, gender must play a role in treatment decisions. Currently, there are 3 Food and Drug Administration-approved nonsurgical androgenetic alopecia treatments: minoxidil, finasteride, and low-light laser therapy. Platelet-rich plasma injections are showing promise as a single modality and as an adjunct to other nonsurgical and surgical treatments of androgenetic alopecia.
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Affiliation(s)
- Jordan Sand
- Spokane Center for Facial Plastic Surgery, 217 W. Cataldo Avenue, Spokane, WA 99201, USA
| | - Scott Walen
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive H-091, Hershey, PA 17033, USA.
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7
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Devjani S, Ezemma O, Kelley KJ, Stratton E, Senna M. Androgenetic Alopecia: Therapy Update. Drugs 2023; 83:701-715. [PMID: 37166619 PMCID: PMC10173235 DOI: 10.1007/s40265-023-01880-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
Androgenetic alopecia (AGA), also known as male pattern hair loss (MPHL) or female pattern hair loss (FPHL), is the most common form of alopecia worldwide, and arises from an excessive response to androgens. AGA presents itself in a characteristic distribution unique to both sexes. Despite its prevalence, AGA can be quite challenging to treat. The condition is chronic in nature and stems from an interplay of genetic and environmental factors. There are only two US Food and Drug Administration (FDA)-approved drugs for the condition: topical minoxidil and oral finasteride. However, numerous non-FDA-approved treatments have been shown to be effective in treating AGA in various studies. Some of these treatments are relatively new and still to be explored, thus emphasizing the need for an updated review of the literature. In this comprehensive review, we discuss the evaluation of AGA and the mechanisms of action, costs, efficacies, and safety profiles of existing, alternative, and upcoming therapeutics for this widespread condition.
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Affiliation(s)
- Shivali Devjani
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Ogechi Ezemma
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Kristen J Kelley
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Emma Stratton
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Maryanne Senna
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA.
- Harvard Medical School, Boston, MA, USA.
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8
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Kinoshita-Ise M, Fukuyama M, Ohyama M. Recent Advances in Understanding of the Etiopathogenesis, Diagnosis, and Management of Hair Loss Diseases. J Clin Med 2023; 12:jcm12093259. [PMID: 37176700 PMCID: PMC10179687 DOI: 10.3390/jcm12093259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Hair-loss diseases comprise heterogenous conditions with respective pathophysiology and clinicopathological characteristics. Major breakthroughs in hair follicle biology and immunology have led to the elucidation of etiopathogenesis of non-scarring alopecia (e.g., alopecia areata, AA) and cicatricial alopecia (e.g., lichen planopilaris, LPP). High-throughput genetic analyses revealed molecular mechanism underlying the disease susceptibility of hair loss conditions, such as androgenetic alopecia (AGA) and female pattern hair loss (FPHL). Hair loss attracted public interest during the COVID-19 pandemic. The knowledge of hair loss diseases is robustly expanding and thus requires timely updates. In this review, the diagnostic and measurement methodologies applied to hair loss diseases are updated. Of note, novel criteria and classification/scoring systems published in the last decade are reviewed, highlighting their advantages over conventional ones. Emerging diagnostic techniques are itemized with clinical pearls enabling efficient utilization. Recent advances in understanding the etiopathogenesis and management for representative hair diseases, namely AGA, FPHL, AA, and major primary cicatricial alopecia, including LPP, are comprehensively summarized, focusing on causative factors, genetic predisposition, new disease entity, and novel therapeutic options. Lastly, the association between COVID-19 and hair loss is discussed to delineate telogen effluvium as the predominating pathomechanism accounting for this sequela.
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Affiliation(s)
- Misaki Kinoshita-Ise
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
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9
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Müller Ramos P, Melo DF, Radwanski H, de Almeida RFC, Miot HA. Female pattern hair loss: therapeutic update. An Bras Dermatol 2023:S0365-0596(23)00053-3. [PMID: 37003900 DOI: 10.1016/j.abd.2022.09.006] [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: 08/11/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 04/03/2023] Open
Abstract
Female androgenetic alopecia or female-pattern hair loss (FPHL) is highly prevalent and has a great impact on the quality of life. The treatment is a routine challenge in dermatological practice, as many therapeutic options have a limited level of evidence and often do not meet patients expectations. Lack of knowledge of the pathogenesis of the hair miniaturization process and the factors that regulate follicular morphogenesis restricts the prospect of innovative therapies. There is also a lack of randomized, controlled studies with longitudinal follow-up, using objective outcomes and exploring the performance of the available treatments and their combinations. Topical minoxidil, which has been used to treat female pattern hair loss since the 1990s, is the only medication that has a high level of evidence and remains the first choice. However, about 40% of patients do not show improvement with this treatment. In this article, the authors critically discuss the main clinical and surgical therapeutic alternatives for FPHL, as well as present camouflage methods that can be used in more extensive or unresponsive cases.
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Affiliation(s)
- Paulo Müller Ramos
- Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Daniel Fernandes Melo
- Department of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Hélio Amante Miot
- Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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10
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Gomes TF, Soares RO. Pediatric androgenetic alopecia: an updated review. J Dtsch Dermatol Ges 2023; 21:19-25. [PMID: 36688435 DOI: 10.1111/ddg.14940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023]
Abstract
Pediatric androgenetic alopecia is an underrecognized disorder. A clinical evaluation with trichoscopy should be made in children and adolescents with hair loss and/or reduced hair density. Diagnosis is usually clinical, by observation of the hair loss pattern and performance of trichoscopy. In some cases, hyperandrogenism should be excluded. Although there is no approved therapy for androgenetic alopecia in pediatric age, topical minoxidil, oral minoxidil and topical finasteride may be very useful. Hair transplant may be an option for girls in selected cases. This article is a review of the current state of evidence concerning pediatric androgenetic alopecia.
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11
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Wang C, Du Y, Bi L, Lin X, Zhao M, Fan W. The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review. Clin Cosmet Investig Dermatol 2023; 16:603-612. [PMID: 36923692 PMCID: PMC10010138 DOI: 10.2147/ccid.s398950] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Introduction Androgenetic alopecia (AGA) has negative impacts on both men and women in terms of appearance and mental stress. Spironolactone is a synthetic aldosterone receptor antagonist known to stimulate hair growth and has been widely used by dermatologists to treat AGA. Objective To conduct a systematic review evaluating the efficacy and safety of topical and oral spironolactone in AGA treatment. Methods We searched PubMed, Embase, the Cochrane Library, and the Web of Science until October 23rd, 2022, for human studies evaluating the efficacy of spironolactone for the treatment of AGA, regardless of doses and routes. Results We retrieved 784 papers and ultimately 7 articles matched our inclusion criteria and comprised 618 AGA patients (65 men, 553 women), 414 of them received spironolactone treatment. Oral spironolactone doses ranged from 25mg to 200mg daily, with the vast majority between 80mg and 110 mg. Dosage forms for topical spironolactone use include gels of 1% and solutions of 5% twice daily. Both oral and topical spironolactone have been shown efficacy for alopecia recovery, but topical use has significantly fewer side effects and is suitable for any gender. It showed better efficacy in combination with other therapies such as oral or topical minoxidil compared with monotherapy. Conclusion Spironolactone is an effective and safe treatment of androgenic alopecia which can enhance the efficacy when combined with other conventional treatments such as minoxidil. Topical spironolactone is safer than oral administration and is suitable for both male and female patients, and is expected to become a common drug for those who do not have a good response to minoxidil. Furthermore, more high-quality clinical randomized controlled studies should be performed.
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Affiliation(s)
- Chaofan Wang
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yimei Du
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Lingbo Bi
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xuewen Lin
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Min Zhao
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Weixin Fan
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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12
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Gomes TF, Soares RO. Aktuelle Übersicht zur androgenetischen Alopezie bei Kindern und Jugendlichen. J Dtsch Dermatol Ges 2023; 21:19-26. [PMID: 36721944 DOI: 10.1111/ddg.14940_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023]
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13
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Jiang VS, Hawkins SD, McMichael A. Female pattern hair loss and polycystic ovarian syndrome: more than just hirsutism. Curr Opin Endocrinol Diabetes Obes 2022; 29:535-540. [PMID: 36226726 DOI: 10.1097/med.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To explore the recent updates in the diagnosis, management, and clinical implications of androgenic alopecia among patients diagnosed with polycystic ovarian syndrome (PCOS). RECENT FINDINGS PCOS diagnosis continues to be the most common cause of infertility among reproductively aged women, serving as the most common endocrinopathy among this population. Female pattern hair loss (FPHL) has been seen to be associated and more common among patients with PCOS, however, there are limited studies examining the impact of FPHL among PCOS patients. Although hyperandrogenism is associated with FPHL, the pathophysiology continues to be unclear as FPHL can be present with normal biochemical androgen markers. Treatment can be complex, as common treatments to promote hair growth can exacerbate undesired hirsutism, which can be overcome by cosmetic treatments. New second-line treatment options such as low level laser therapy and platelet rich plasma have been emerging, with limited data supporting efficacy. SUMMARY PCOS is a complex endocrinological disorder that has significant gynecologic, cutaneous, and metabolic implications that require multidisciplinary collaboration and care. Reproductive goals should be thoroughly discussed prior to starting any treatment, as PCOS is the most common cause of infertility among reproductively-aged women.
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Affiliation(s)
- Victoria S Jiang
- Division of Reproductive Endocrinology & Infertility, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Spencer D Hawkins
- Bosley Orlando, Hair Restoration Surgery Fellowship Program, Maitland, Florida
- Advanced Dermatology & Cosmetic Surgery, East Greenwich, Rhode Island
| | - Amy McMichael
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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14
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Chen X, Yan P, Zhang W, He X, Jiang R, Li Y, Sun J, Jiang J. Bioengineered polyester nanoparticles for the synergistic treatment of androgenic alopecia via the suppression of 5α-reductase and knockdown of androgen receptor. Front Bioeng Biotechnol 2022; 10:1033987. [DOI: 10.3389/fbioe.2022.1033987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
Androgenic alopecia (AGA) is a common disease that negatively affects patients’ physical and mental health. AGA can be treated with drugs that improve the perifollicular microenvironment, such as 5α-reductase inhibitors (e.g., dutasteride [DUT]), androgen receptor blockers, and minoxidil. However, the efficacy of these treatments is limited. Therefore, this study aimed to show that nanoparticles are effective as stable carriers with high curative benefits and little adverse effects. The in vitro study showed that PLGA-DUT/siAR@DPCM NPs could deliver both DUT and siAR to dermal papilla cells. They could successfully suppress 5α-reductase and knock down androgen receptor, respectively, and thereby promote cell proliferation. In the in vivo study, PLGA-DUT/siAR@DPCM NPs showed a significant therapeutic effect in an AGA mouse model. They successfully penetrated the stratum corneum and showed a clear targeting effect on hair follicles and surrounding tissues. PLGA-DUT/siAR@DPCM NPs could enable the targeted delivery of DUT and siAR through percutaneous penetration, enhancing phagocytosis and decreasing adverse effects. Thus, they have great potential in the clinical treatment of AGA.
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15
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Noninvasive Hair Rejuvenation. Facial Plast Surg Clin North Am 2022; 30:419-431. [DOI: 10.1016/j.fsc.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Abdallah HM, El-Megrab NA, Balata GF, Eissa NG. Niosomal and ethosomal gels: A comparative in vitro and ex vivo evaluation for repurposing of spironolactone. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Liang X, Chang Y, Wu H, Liu Y, Zhao J, Wang L, Zhuo F. Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female Pattern Hair Loss: A Prospective, Single-Center, Parallel-Group, Evaluator Blinded, Randomized Trial. Front Med (Lausanne) 2022; 9:905140. [PMID: 35899211 PMCID: PMC9309533 DOI: 10.3389/fmed.2022.905140] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background The efficacy of topical minoxidil (MX) alone on female pattern hair loss (FPHL) is limited. Combination therapy based on topical MX is currently expected to provide better outcomes. Objectives This study aimed to assess whether the combined therapies including MX plus oral spironolactone (SPT) and MX plus microneedling (MN) have advantages in efficacy and safety over topical MX alone on mild-to-moderate FPHL with normal hormone levels in the blood and regular menstrual cycle. Methods A prospective, single-center, parallel-group, evaluator blinded, randomized trial including 120 non-menopause women with proven FPHL (Sinclair class II-III) was performed in China. Patients were randomly assigned to three groups, namely, the MX group (5% topical MX alone, once daily), the MX + SPT group (MX plus SPT 80–100 mg daily), and the MX+MN group (MX plus MN every 2 weeks, 12 sessions). The change from the baseline to week 24 was assessed in hair growth (hair density and diameter under dermoscope), scalp tissue structure (epidermal thickness, dermis thickness, and average hair follicle diameter under ultrasound biomicroscopy), physician's global assessment (using a 7-point global-assessment scale and Sinclair's stage change), patient evaluation (Women's Androgenetic Alopecia Quality of Life Questionnaire and Sinclair's hair-shedding score) and side effects. Results In total, 115 participants completed the trial. At week 24, the hair density increased most in MX + MN group and increased least in MX group (p < 0.001 for MX + MN group vs. MX + SPT group; p = 0.009 for MX + SPT group vs. MX group). The hair shaft diameter significantly increased in all groups (p < 0.001, respectively), but there were no significant differences among the three groups (p = 0.905). The epidermal thickness and average hair follicle diameter only increased in MX + MN group. Dermis thickness increased in all groups, but there were no significant differences among the three groups. Both physician's and patient assessments showed improvement in all three groups. Scalp pruritus was the most common side effect. The MX + SPT group had the most reported adverse effects. Limitations The main limitations of this study are the relatively small sample size, the exclusion of severe FPHL patients, and the potential bias from unblinded treatments among the 3 groups. Conclusion Topical MX combined with MN is a better choice than either MX plus oral SPT or MX alone for the treatment of mild-to-moderate FPHL patients.
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Togo S, Imanishi H, Hayashi M, Koyama M, Kira Y, Sugawara K, Tsuruta D. Exploring the impact of ovariectomy on hair growth: can ovariectomized mouse serve as a model for investigating female pattern hair loss in humans? Med Mol Morphol 2022; 55:210-226. [PMID: 35486188 DOI: 10.1007/s00795-022-00320-1] [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: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
Female pattern hair loss (FPHL), a type of hair disease common in pre- and postmenopausal women, is characterized by thinning of hair to O-type, mainly at the crown. Although a mouse model of this disease has recently been established, its details are still unknown, and thus, warrants further analysis. In this study, 3 week-old and 7- to 8 week-old C57BL/6 female mice were divided into two groups: one group underwent ovariectomy (OVX), while the other underwent sham surgery. In the 3 week-old mice, the dorsal skin was collected at seven weeks of age, while in the 7- to 8 week-old mice, it was collected at 12 and 24 weeks of age. In the former group, both the pore size of the hair follicles (HFs) and diameter of the hair shaft of telogen HFs decreased upon OVX; while in the latter group, these factors increased significantly. Notably, the thickness of the dermis and subcutis increased significantly in the OVX group. It needs to be further elucidated whether OVX mouse could serve as an ideal mouse model for FPHL, but our results upon evaluation of skin thickness indicate that it could be used to establish a novel treatment for non-hair-related diseases, such as post-menopause-related skin condition.
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Affiliation(s)
- Sayaka Togo
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hisayoshi Imanishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Masami Hayashi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yukimi Kira
- Department of Research Support Platform, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Sugawara
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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19
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He F, Shen M, Zhao Z, Liu Y, Zhang S, Tang Y, Xie H, Chen X, Li J. Epidemiology and disease burden of androgenetic alopecia in college freshmen in China: A population-based study. PLoS One 2022; 17:e0263912. [PMID: 35171966 PMCID: PMC8849549 DOI: 10.1371/journal.pone.0263912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the epidemiology and disease burden of androgenetic alopecia (AGA) in college freshmen in China. Methods This population-based cross-sectional survey was carried out among 9227 freshmen of two comprehensive universities in two cities of China (Changsha and Xiamen) from September 2018 to October 2018. Questionnaires covering basic issues, surrounding demographic information, history of diseases, living habits, comorbidities, etc. were completed online in a self-reported manner Dermatological examination was performed by certified dermatologists. The disease burden of AGA, which includes health-related quality of life, symptoms of anxiety, symptoms of depression and quality of sleep, was measured by EQ-5D-3L, PHQ-2, GAD-2 and PSQI, respectively. Results The prevalence of AGA in college freshmen in China was 5.3/1000. Male was significantly associated with higher prevalence of AGA (7.9/1000, P<0.01) while female with lower risk of AGA (OR = 0.29, P = 0.002). There was no significant association between BMI and AGA, nor predilection of AGA in the Han nationality or the other ethnic minorities. Annual household income or parental highest educational level exerted no significant influence on the prevalence of AGA. Rosacea (OR = 3.22, P = 0.019) was significantly associated with higher prevalence of AGA while acne seemed not to be related to AGA. The scores of EQ-5D, GAD-2, PHQ-2 and PSQI were not significantly different between students with and without AGA. Conclusion The onset of AGA in Chinese college freshmen differ between genders and was significantly associated with rosacea.
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Affiliation(s)
- Fanping He
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhixiang Zhao
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
| | - Yicong Liu
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shuping Zhang
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- * E-mail: (XC); (JL)
| | - Ji Li
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
- * E-mail: (XC); (JL)
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20
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Butt AK, Patel J, Shirwany H, Mirza Q, Hoover J, Khouzam RN. Beneficial Extracardiac Effects of Cardiovascular Medications. Curr Cardiol Rev 2022; 18:e151021197270. [PMID: 34779371 PMCID: PMC9413730 DOI: 10.2174/1573403x17666211015145132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022] Open
Abstract
Cardiovascular diseases are the most common cause of death worldwide, with cardiovascular medications being amongst the most common medications prescribed. These medications have diverse effects on the heart, vascular system, as well as other tissues and organ systems. The extra cardiovascular effects have been found to be of use in the treatment of non-cardiovascular diseases and pathologies. Minoxidil is used to manage systemic hypertension with its well-known side effect of hirsutism used to treat alopecia and baldness. Sildenafil was originally investigated as a treatment option for systemic hypertension; however, its side effect of penile erection led to it being widely used for erectile dysfunction. Alpha-1 blockers such as terazosin are indicated to treat systemic hypertension but are more commonly used for benign prostatic hyperplasia and post-traumatic stress disorder. Beta blockers are the mainstay treatment for congestive heart failure and systemic hypertension but have been found useful to help in patients with intention tremors as well as prophylaxis of migraines. Similarly, calcium channel blockers are indicated in medical expulsion therapy for ureteric calculi in addition to their cardiovascular indications. Thiazides are commonly used for treating systemic hypertension and as diuretics. Thiazides can cause hypocalciuria and hypercalcemia. This side effect has led to thiazides being used to treat idiopathic hypercalciuria and associated nephrolithiasis. Spironolactone is commonly utilized in treating heart failure and as a diuretic for edema. It's well described anti-androgen side effects have been used for acne vulgaris and hirsutism in polycystic ovarian syndrome. This review article discusses how the various extracardiovascular effects of commonly used cardiovascular medications are put to use in managing non-cardiovascular conditions.
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Affiliation(s)
- Asra K Butt
- Department of Internal Medicine, Veteran Affairs Medical Center, Memphis, TN 38104, USA
| | - Jay Patel
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Hamid Shirwany
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Qasim Mirza
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jonathan Hoover
- Department of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Rami N Khouzam
- Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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21
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Nestor MS, Ablon G, Gade A, Han H, Fischer DL. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. J Cosmet Dermatol 2021; 20:3759-3781. [PMID: 34741573 PMCID: PMC9298335 DOI: 10.1111/jocd.14537] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 01/05/2023]
Abstract
Background Androgenetic alopecia (AGA) is the most common form of hair loss consisting of a characteristic receding frontal hairline in men and diffuse hair thinning in women, with frontal hairline retention, and can impact an individual's quality of life. The condition is primarily mediated by 5‐alpha‐reductase and dihydrotestosterone (DHT) which causes hair follicles to undergo miniaturization and shortening of successive anagen cycles. Although a variety of medical, surgical, light‐based and nutraceutical treatment options are available to slow or reverse the progression of AGA, it can be challenging to select appropriate therapies for this chronic condition. Aims To highlight treatment options for androgenetic alopecia taking into consideration the efficacy, side effect profiles, practicality of treatment (compliance), and costs to help clinicians offer ethically appropriate treatment regimens to their patients. Materials and Methods A literature search was conducted using electronic databases (Medline, PubMed, Embase, CINAHL, EBSCO) and textbooks, in addition to the authors' and other practitioners' clinical experiences in treating androgenetic alopecia, and the findings are presented here. Results Although topical minoxidil, oral finasteride, and low‐level light therapy are the only FDA‐approved therapies to treat AGA, they are just a fraction of the treatment options available, including other oral and topical modalities, hormonal therapies, nutraceuticals, PRP and exosome treatments, and hair transplantation. Discussion Androgenetic alopecia therapy remains challenging as treatment selection involves ethical, evidence‐based decision‐making and consideration of each individual patient's needs, compliance, budget, extent of hair loss, and aesthetic goals, independent of potential financial benefits to the practitioners.
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Affiliation(s)
- Mark S Nestor
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, Florida, USA.,Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Glynis Ablon
- Ablon Skin Institute & Research Center, Manhattan Beach, California, USA.,Department of Dermatology, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Anita Gade
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
| | - Haowei Han
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
| | - Daniel L Fischer
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
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22
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James JF, Jamerson TA, Aguh C. Efficacy and Safety Profile of Oral Spironolactone Use for Androgenic Alopecia-A Systematic Review. J Am Acad Dermatol 2021; 86:425-429. [PMID: 34352345 DOI: 10.1016/j.jaad.2021.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Crystal Aguh
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD.
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23
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Abstract
Significant androgenetic hair loss occurs in men older than 50 years, and in women it occurs in many who are perimenopausal, menopausal, and postmenopausal. By age 60 years, it is estimated that 80% of women experience hair loss. Other nonandrogenetic forms of hair loss occur due to various dermatologic disorders as well as systemic disorders. Children may also experience significant hair loss, often due to genetic abnormalities and incidences of trauma. In this article the author discusses a combination approach to hair loss for men, women, and children.
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24
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Alessandrini A, Bruni F, Piraccini B, Starace M. Common causes of hair loss – clinical manifestations, trichoscopy and therapy. J Eur Acad Dermatol Venereol 2021; 35:629-640. [DOI: 10.1111/jdv.17079] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Affiliation(s)
- A. Alessandrini
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - F. Bruni
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - B.M. Piraccini
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - M. Starace
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
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25
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Fagan N, Meah N, York K, Bokhari L, Fletcher G, Chen G, Tobin DJ, Messenger A, Irvine AD, Sinclair R, Wall D. Shedding light on therapeutics in alopecia and their relevance to COVID-19. Clin Dermatol 2020; 39:76-83. [PMID: 33972056 PMCID: PMC7738938 DOI: 10.1016/j.clindermatol.2020.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As of July 9, 2020, there were more than 12 million confirmed cases of coronavirus disease 2019 (COVID-19) across the globe, with more than 550,000 deaths. Many European countries, including Belgium, the United Kingdom, Italy, and Spain, have had the highest numbers of fatalities per capita. This indicates the potential for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus to overwhelm even the most advanced health care systems despite extreme societal interventions. Since its emergence, SARS-CoV-2 has disseminated across the globe, affecting the structure of global societies, infrastructure, and economies. Patients with alopecia are a diverse group who, for various indications, are prescribed a number of antimicrobials and antiandrogen treatments in addition to immunomodulatory therapies such as hydroxychloroquine, oral corticosteroids, and a range of broad immunosuppressants. These drugs are being scrutinized for their capacity to potentially affect SARS-CoV-2 outcomes. We examine these treatments and highlight the critical role that patient registries will play in generating real-world evidence to assess their impact on COVID-19 outcomes.
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Affiliation(s)
- Nicole Fagan
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Nekma Meah
- Sinclair Dermatology, Melbourne, Australia
| | - Katherine York
- Department of Dermatology, Netcare Greenacres Hospital, Port Elizabeth, South Africa
| | | | - Godfrey Fletcher
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Desmond J Tobin
- The Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Andrew Messenger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Alan D Irvine
- Department of Dermatology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Dmitri Wall
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland; Hair Restoration Blackrock, Dublin, Ireland
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26
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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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27
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Vargas-Mora P, Morgado-Carrasco D. Uso de la espironolactona en dermatología: acné, hidradenitis supurativa, alopecia femenina e hirsutismo. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:639-649. [DOI: 10.1016/j.ad.2020.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/02/2020] [Accepted: 03/07/2020] [Indexed: 01/18/2023] Open
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28
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Vargas-Mora P, Morgado-Carrasco D. Spironolactone in Dermatology: Uses in Acne, Hidradenitis Suppurativa, Female Pattern Hair Loss, and Hirsutism. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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29
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Kapoor R, Shome D, Doshi K, Patel G, Vadera S. Evaluation of efficacy of QR 678 and QR678 neo hair growth factor formulation for the treatment of female pattern alopecia in patients with PCOS-A prospective study. J Cosmet Dermatol 2020; 19:2637-2646. [PMID: 33460214 DOI: 10.1111/jocd.13673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hair is an essential identity of women. Femininity, sexuality, attractiveness, and personality are symbolically linked to a woman's hair. Female pattern hair loss is found in 20%-30% of patients with polycystic ovary syndrome (PCOS). AIM The aim of the present study was to evaluate the efficacy of QR678® and QR678 Neo® therapy in the treatment of female alopecia with PCOS. METHOD A total of 20 females diagnosed with PCOS in the age 25-50 years, with complaints of female pattern alopecia with Ludwig, grades I, and II were selected for the study. At each visit, 1.5 ml solution of QR678® was injected in the scalp skin of patients. A total of eight sessions were performed at an interval of 3 week each. All the patients were evaluated with standard global photography at baseline, 4th and 8th session, and 2 months after 8th session. RESULT Marked improvement was seen in the global photographic assessment score (mean = 8) which was maintained for over 1 year. In videomicroscopic assessment, after four sessions the patients had 8.07 fewer vellus hair, 6.07 more terminal hair, and average hair shaft diameter was 0.82 μm wider. After eight sessions, they had 11.66 fewer vellus hair, 13.77 more terminal hair, and hair shaft diameter was 2.86 μm wider than at baseline. CONCLUSION Intra-dermal injections of QR 678® hair growth factor formulation is an effective option for female pattern alopecia with PCOS. This is the first of its kind study using QR678® and QR678 Neo® in PCOS patients.
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Affiliation(s)
- Rinky Kapoor
- Department of Dermatology, Cosmetic Dermatology & Dermato-Surgery & Director, The Esthetic Clinics, Mumbai, India
| | - Debraj Shome
- Department of Facial Plastic Surgery & Facial Cosmetic Surgery & Director, The Esthetic Clinics, Mumbai, India
| | - Komal Doshi
- Fellow in Facial Plastic Surgery and Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | | | - Sapna Vadera
- Fellow Facial Plastic Surgery and Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
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30
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Salim S, Kamalasanan K. Controlled drug delivery for alopecia: A review. J Control Release 2020; 325:84-99. [DOI: 10.1016/j.jconrel.2020.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/21/2023]
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31
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Searle TN, Al-Niaimi F, Ali FR. Spironolactone in dermatology: uses in acne and beyond. Clin Exp Dermatol 2020; 45:986-993. [PMID: 32844462 DOI: 10.1111/ced.14340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2020] [Indexed: 11/28/2022]
Abstract
Spironolactone is a synthetic aldosterone receptor antagonist, with a role off-label in various dermatological conditions. Its antiandrogenic properties make it suitable for diseases in which excess androgen production results in unwanted and psychologically distressing manifestations in susceptible females. Treatment with spironolactone aims to attenuate androgen-mediated conditions including acne, hidradenitis suppurativa, female pattern hair loss and hirsutism. We discuss the emerging utility of spironolactone in dermatology, its potential adverse effects and considerations for monitoring.
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Affiliation(s)
- T N Searle
- University of Birmingham Medical School, Birmingham, UK
| | - F Al-Niaimi
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - F R Ali
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Vernova Healthcare Community Interest Company, Cheshire, UK
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32
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Bhat YJ, Saqib NU, Latif I, Hassan I. Female Pattern Hair Loss-An Update. Indian Dermatol Online J 2020; 11:493-501. [PMID: 32832434 PMCID: PMC7413422 DOI: 10.4103/idoj.idoj_334_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/18/2020] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
Female pattern hair loss (FPHL) is nonscarring progressive thinning of hair with gradual decrease in the number of hair, especially in the frontal, central, and parietal scalp, due to a process known as follicular miniaturization. The etiopathogenesis of FPHL is complex with multiple factors such as genetics, inflammation, hormones, and environment playing role in it. It usually manifests as slowly progressive hair thinning, mainly over the vertex and upper parietal scalp, the frontal hairline is often spared and the miniaturization is also not as severe as in men. A thorough history, clinical examination, hair loss evaluation tests, dermoscopy, and scalp biopsy can help in establishing the diagnosis. Various biochemical tests may be needed in patients with hyperandrogenism. The treatment includes medical and surgical modalities. Topical minoxidil is still considered the first line of treatment. Along with medical therapy, cosmetic camouflage may also be needed in some cases.
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Affiliation(s)
- Yasmeen Jabeen Bhat
- Postgraduate Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Najam-U- Saqib
- Postgraduate Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Insha Latif
- Postgraduate Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Iffat Hassan
- Postgraduate Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
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Yuan AR, Bian Q, Gao JQ. Current advances in stem cell-based therapies for hair regeneration. Eur J Pharmacol 2020; 881:173197. [DOI: 10.1016/j.ejphar.2020.173197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023]
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Burns LJ, De Souza B, Flynn E, Hagigeorges D, Senna MM. Spironolactone for treatment of female pattern hair loss. J Am Acad Dermatol 2020; 83:276-278. [DOI: 10.1016/j.jaad.2020.03.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/24/2020] [Accepted: 03/21/2020] [Indexed: 11/24/2022]
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Hu S, Li Z, Lutz H, Huang K, Su T, Cores J, Dinh PUC, Cheng K. Dermal exosomes containing miR-218-5p promote hair regeneration by regulating β-catenin signaling. SCIENCE ADVANCES 2020; 6:eaba1685. [PMID: 32832660 PMCID: PMC7439409 DOI: 10.1126/sciadv.aba1685] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/11/2020] [Indexed: 05/05/2023]
Abstract
The progression in the hair follicle cycle from the telogen to the anagen phase is the key to regulating hair regrowth. Dermal papilla (DP) cells support hair growth and regulate the hair cycle. However, they gradually lose key inductive properties upon culture. DP cells can partially restore their capacity to promote hair regrowth after being subjected to spheroid culture. In this study, results revealed that DP spheroids are effective at inducing the progression of the hair follicle cycle from telogen to anagen compared with just DP cell or minoxidil treatment. Because of the importance of paracrine signaling in this process, secretome and exosomes were isolated from DP cell culture, and their therapeutic efficacies were investigated. We demonstrated that miR-218-5p was notably up-regulated in DP spheroid-derived exosomes. Western blot and immunofluorescence imaging were used to demonstrate that DP spheroid-derived exosomes up-regulated β-catenin, promoting the development of hair follicles.
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Affiliation(s)
- Shiqi Hu
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, and North Carolina State University, Raleigh, NC 27606, USA
| | - Zhenhua Li
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, and North Carolina State University, Raleigh, NC 27606, USA
| | - Halle Lutz
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, and North Carolina State University, Raleigh, NC 27606, USA
| | - Ke Huang
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
| | - Teng Su
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, and North Carolina State University, Raleigh, NC 27606, USA
| | - Jhon Cores
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
| | - Phuong-Uyen Cao Dinh
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
| | - Ke Cheng
- Department of Molecular Biomedical Sciences and Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, and North Carolina State University, Raleigh, NC 27606, USA
- Corresponding author.
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Abstract
Androgenetic alopecia (AGA) is the most common hair loss disorder in men and women. The characteristic and reproducible balding pattern in AGA negatively affects self-image and the external perceptions of the balding patient. The phenotypical changes are driven by dihydrotestosterone (DHT) and its precursor testosterone. DHT induces follicle miniaturization and hair cycle changes until resulting hairs no longer extrude through the skin surface. AGA is inherited in a polygenetic pattern and is susceptible to epigenetic and environmental factors. Currently, minoxidil, finasteride, and photolaser therapy are the only Food and Drug Administration-approved medical treatments for AGA.
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Affiliation(s)
- Tymon Tai
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of USC, CHP 204M 1540 Alcazar Street, Los Angeles, CA 90033, USA
| | - Amit Kochhar
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of USC, CHP 204M 1540 Alcazar Street, Los Angeles, CA 90033, USA.
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Ismail FF, Meah N, Trindade de Carvalho L, Bhoyrul B, Wall D, Sinclair R. Safety of oral bicalutamide in female pattern hair loss: A retrospective review of 316 patients. J Am Acad Dermatol 2020; 83:1478-1479. [PMID: 32213304 DOI: 10.1016/j.jaad.2020.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/07/2020] [Accepted: 03/16/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nekma Meah
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | | | - Bevin Bhoyrul
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Dmitri Wall
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Rodney Sinclair
- Sinclair Dermatology, East Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Department of Dermatology, Epworth Healthcare, Melbourne, Victoria, Australia
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Broux E, Dewailly D, Catteau-Jonard S. [Spironolactone as a relay for cyproterone acetate in hyperandrogenic women]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:181-186. [PMID: 31926311 DOI: 10.1016/j.gofs.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Cyproterone acetate is actually the first-line anti-androgenic treatment for severe hyperandrogenism in women. However, as this treatment is currently controversial, the objective of the study was to evaluate the safety and efficacy of spironolactone as a relay for cyproterone acetate. METHODS This is a monocentric retrospective study conducted between December 2002 and January 2018 at the Jeanne de Flandre Hospital at the University Hospital Center of Lille. Patients with clinical hyperandrogenism who received treatment with cyproterone acetate and then spironolactone were included. A total of 37 patients were clinically and biologically evaluated before treatment, followed by cyproterone acetate and spironolactone. RESULTS Clinically, the vast majority of patients were satisfied with the relay by spironolactone and found no difference between the two treatments. Biologically, testosterone and delta-4 androstenedione levels were significantly decreased with cyproterone acetate and spironolactone compared to no treatment. No significant differences were found when comparing levels under cyproterone acetate and under spironolactone. In addition, 87,5% of patients were free of side effects. CONCLUSIONS The data collected show the clinical and biological efficacy of spironolactone as a relay for cyproterone acetate in the treatment of hyperandrogenism. This anti-androgen therefore appears as an effective and well-tolerated alternative, as a relay for cyproterone acetate in patients with hyperandrogenism.
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Affiliation(s)
- E Broux
- University Lille, CHU de Lille, service de gynécologie médicale, 59000 Lille, France; Service d'assistance médicale à la procréation, CH Calais, 1601, boulevard des Justes, 62100 Calais, France.
| | - D Dewailly
- University Lille, CHU de Lille, Inserm U1172, 59000 Lille, France.
| | - S Catteau-Jonard
- University Lille, CHU de Lille, service de gynécologie médicale, 59000 Lille, France; University Lille, CHU de Lille, Inserm U1172, 59000 Lille, France.
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Starace M, Orlando G, Alessandrini A, Piraccini BM. Female Androgenetic Alopecia: An Update on Diagnosis and Management. Am J Clin Dermatol 2020; 21:69-84. [PMID: 31677111 DOI: 10.1007/s40257-019-00479-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with age. Clinically, it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. FAGA can have a significant psychological impact, leading to anxiety and depression. For this reason, early diagnosis is very important to stop the progression of the disease. The sex hormonal milieu is the main pathogenetic mechanism studied in FAGA. The role of androgens is not clearly defined and only one-third of women with FAGA show abnormal androgen levels. Endocrinological diseases with hyperandrogenism associated with FAGA comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia and, rarely, ovarian and adrenal tumours. Usually the diagnosis of FAGA is made clinically. A complete clinical examination and a blood examination can reveal other signs of hyperandrogenism. Trichoscopy shows the typical hair miniaturization. A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecias with hair loss in the distribution of FAGA or alopecia areata are suspected. FAGA is a slowly progressive disease. The goal of therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth. The most important drugs are topical minoxidil and oral anti-androgens. The purpose of this review is to provide an update on FAGA and to create a guideline on diagnosis and management of this frequent hair disease, not always easily recognizable from cicatricial alopecias with a similar distribution.
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Affiliation(s)
- Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V. Massarenti 1, 40138, Bologna, Italy
| | - Gloria Orlando
- Unit of Dermatology, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Aurora Alessandrini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V. Massarenti 1, 40138, Bologna, Italy
| | - Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V. Massarenti 1, 40138, Bologna, Italy.
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Anti-androgen hormonal therapy for cancer and other diseases. Eur J Pharmacol 2020; 866:172783. [DOI: 10.1016/j.ejphar.2019.172783] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 01/27/2023]
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Griggs J, Burroway B, Tosti A. Pediatric androgenetic alopecia: A review. J Am Acad Dermatol 2019; 85:1267-1273. [DOI: 10.1016/j.jaad.2019.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/24/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
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Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, Lobo R, Olsen E. Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. J Clin Endocrinol Metab 2019; 104:2875-2891. [PMID: 30785992 DOI: 10.1210/jc.2018-02548] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/15/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the current state of knowledge and provide evidence-based recommendations that could be valid for all specialists taking care of female pattern hair loss (FPHL), a common form of hair loss in women that is characterized by the reduction of hair density in the central area of the scalp, whereas the frontal hairline is generally well conserved. PARTICIPANTS An expert task force appointed by the Androgen Excess and PCOS Society, which included specialists from dermatology, endocrinology, and reproductive endocrinology. DESIGN Levels of evidence were assessed and graded from A to D. Peer-reviewed studies evaluating FPHL published through December 2017 were reviewed. Criteria for inclusion/exclusion of the published papers were agreed on by at least two reviewers in each area and arbitrated by a third when necessary. CONCLUSIONS (i) The term "female pattern hair loss" should be used, avoiding the previous terms of alopecia or androgenetic alopecia. (ii) The two typical patterns of hair loss in FPHL are centrifugal expansion in the mid scalp, and a frontal accentuation or Christmas tree pattern. (iii) Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal. (iv) The assessment of patients with FPHL is primarily clinical. (v) In all patients with FPHL, assessment of a possible androgen excess is mandatory. Measurement of vitamin D, iron, zinc, thyroid hormones, and prolactin are optional but recommended. (vi) Treatment of FPHL should start with minoxidil (5%), adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism.
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Affiliation(s)
- Enrico Carmina
- Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Ricardo Azziz
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Wilma Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, Madrid Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | | | - Heather Huddleston
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California
| | - Rogerio Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Elise Olsen
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Ahluwalia J, Fabi SG. The psychological and aesthetic impact of age-related hair changes in females. J Cosmet Dermatol 2019; 18:1161-1169. [PMID: 31012988 DOI: 10.1111/jocd.12960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/14/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND While dermatologists focus on practices to promote anti-aging, thinning hair that frames a more rejuvenated face can affect age perception and cosmesis. OBJECTIVES To characterize the effects of age-related hair changes on age determination and perceived attractiveness. METHODS A search was conducted for articles on intrinsic and extrinsic aging as it relates to hair. Key studies on the hair aging process and its effects on self-perception, confidence, and anti-aging were reviewed. RESULTS According to several studies, hair density peaks about 27 years of age or earlier and then decreases from the mid-thirties onward. This serves as an opportunity to prevent or treat hair loss in a similar way we treat aging skin. Without optimizing appearance of hair, overall cosmesis to foster self-perception can be curtailed despite multiple efforts to rejuvenate and restore the aging face. CONCLUSION The discrepancy between rejuvenated faces and thinner appearing hair that frames the face highlights the importance of a holistic approach to the anti-aging consultation. To more comprehensively address the aesthetic patient, we need to promote awareness of the onset of these hair changes in order to incorporate prevention and therapeutic strategies to preserve hair to complement overall appearance.
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Affiliation(s)
- Jusleen Ahluwalia
- Department of Dermatology, San Diego School of Medicine, University of California, La Jolla, California
| | - Sabrina G Fabi
- Department of Dermatology, San Diego School of Medicine, University of California, La Jolla, California.,Cosmetic Laser Dermatology, San Diego, California
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Rozner RN, Freites-Martinez A, Shapiro J, Geer EB, Goldfarb S, Lacouture ME. Safety of 5α-reductase inhibitors and spironolactone in breast cancer patients receiving endocrine therapies. Breast Cancer Res Treat 2019; 174:15-26. [PMID: 30467659 PMCID: PMC6773272 DOI: 10.1007/s10549-018-4996-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/24/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To provide dermatologists and oncologists with a foundation for practical understanding and uses of 5α-reductase inhibitors and spironolactone for breast cancer patients and survivors receiving endocrine therapies (ETs), including the effect of these treatments on sex hormone levels, any reported drug interactions, and any risk of malignancy. METHODS All published studies from January 1978 through April 2018 were considered, using databases such as PubMed, Google Scholar, and Science Direct. Forty-seven studies were included in this review. RESULTS There is no evidence of interactions between 5α-reductase inhibitors and spironolactone with ETs used in breast cancer. Sex hormone alteration with 5α-reductase inhibitor or spironolactone use is variable. Three randomized controlled trials, 1 case-control study, and 6 retrospective cohort studies, including 284 female patients, studied the effects of 5α-reductase inhibitors on serum estrogen levels. Levels were increased in 97 of 284 (34%) patients, decreased in 15 of 284 (5.3%) patients, and unchanged in 162 of 284 (57%) patients. Four retrospective cohort studies, 1 case study, and 1 double-blinded crossover study, including 95 female patients, assessed the effect of spironolactone on estrogen levels. Levels were increased in 25 of 95 (26%) patients, decreased in 6 of 95 (6.3%) patients, and unchanged in 64 of 95 (67%) patients. Ultimately, most patients did not have a significant alteration in the level of estrogen when using 5α-reductase inhibitors or spironolactone. No consistent evidence of increased risk of female breast cancer while on spironolactone was reported in 3 studies including 49,298 patients; the risk of breast cancer with the use of 5α-reductase inhibitors has not been studied. CONCLUSIONS Most patients did not show increased estrogen levels with spironolactone and there were no data suggesting increased risk of breast cancer. Based on hormonal and pharmacological activity, spironolactone may be considered for further research on alopecia and hirsutism in breast cancer patients.
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Affiliation(s)
- Raquel N Rozner
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA
| | - Azael Freites-Martinez
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Eliza B Geer
- Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Shari Goldfarb
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Mario E Lacouture
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA.
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Azarchi S, Bienenfeld A, Lo Sicco K, Marchbein S, Shapiro J, Nagler AR. Androgens in women: Hormone-modulating therapies for skin disease. J Am Acad Dermatol 2018; 80:1509-1521. [PMID: 30312645 DOI: 10.1016/j.jaad.2018.08.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 11/28/2022]
Abstract
Androgen-mediated cutaneous disorders (AMCDs) in women, including acne, hirsutism, and female pattern hair loss, can be treated with hormone-modulating therapies. In the second article in this Continuing Medical Education series, we discuss the hormone-modulating therapies available to dermatologists for the treatment of AMCDs, including combined oral contraceptives, spironolactone, finasteride, dutasteride, and flutamide. Available hormone-modulating treatments used for each AMCDs are reviewed, along with mechanisms of androgen modulation, safety profile, contraindications, monitoring parameters, and evidence of efficacy. Medications discussed include those that are approved by the US Food and Drug Administration for certain AMCDs and some that are used off-label. Despite the ubiquity of hormone-modulating therapies used for AMCDs, this review highlights the need for more rigorous studies to evaluate these therapies for acne, hirsutism, and female pattern hair loss.
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Affiliation(s)
- Sarah Azarchi
- New York University School of Medicine, New York, New York
| | | | - Kristen Lo Sicco
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Shari Marchbein
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jerry Shapiro
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Arielle R Nagler
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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Biomedical applications of microemulsion through dermal and transdermal route. Biomed Pharmacother 2018; 108:1477-1494. [PMID: 30372850 DOI: 10.1016/j.biopha.2018.10.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/25/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022] Open
Abstract
Microemulsions are thermodynamically stable, transparent, colloidal drug carrier system extensively used by the scientists for effective drug delivery across the skin. It is a spontaneous isotropic mixture of lipophilic and hydrophilic substances stabilized by suitable surfactant and co-surfactant. The easy fabrication, long-term stability, enhanced solubilization, biocompatibility, skin-friendly appearance and affinity for both the hydrophilic and lipophilic drug substances make it superior for skin drug delivery over the other carrier systems. The topical administration of most of the active compounds is impaired by limited skin permeability due to the presence of skin barriers. In this sequence, the microemulsion represents a cost-effective and convenient drug carrier system which successfully delivers the drug to and across the skin. In the present review work, we compiled various attempts made in last 20 years, utilizing the microemulsion for dermal and transdermal delivery of various drugs. The review emphasizes the potency of microemulsion for topical and transdermal drug delivery and its effect on drug permeability.
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Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol 2018; 4:203-211. [PMID: 30627618 PMCID: PMC6322157 DOI: 10.1016/j.ijwd.2018.05.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 12/16/2022] Open
Abstract
Female pattern hair loss (FPHL) is the most common form of alopecia in women. Affected women may experience psychological distress and impaired social functioning. Early diagnosis and initiation of treatment are desirable because treatments are more effective to avoid the progression of hair loss than stimulating regrowth. Typically, a diagnosis of FPHL can be confirmed by review of a patient's medical history and a physical examination alone. Testing a scalp biopsy is diagnostic but usually not required. In women with signs of hyperandrogenism, an investigation for ovarian or adrenal disorders should be performed. Treatment for FPHL is obscured by myths. The aim of FPHL treatment could be two-fold: Reverse or stabilize the process of hair follicle miniaturization. Mild-to-moderate FPHL in women can be treated with oral antiandrogen therapies (cyproterone acetate and spironolactone) and/or topical minoxidil with good results in many cases. If used correctly, available medical treatments arrest the progression of the disease and reverse miniaturization in most patients with mild-to-moderate FPHL. Hair systems and surgery may be considered for selected cases of severe FPHL.
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Park HN, Lee JH, Park SK, Baek SY, Lee YM, Kang H. Development and validation of rapid and simultaneous method for determination of 12 hair-growth compounds in adulterated products by UHPLC-MS/MS. Forensic Sci Int 2018; 284:129-135. [PMID: 29408720 DOI: 10.1016/j.forsciint.2017.12.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/20/2017] [Accepted: 12/30/2017] [Indexed: 11/26/2022]
Abstract
Synthetic hair-growth compounds have been illegally used in diverse products to enhance the short-term efficacy of these products. In this study, a rapid and simultaneous method for the determination of hair-growth compounds in adulterated products based on ultra high pressure liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was developed and validated. The limit of detection (LOD) and limit of quantitation (LOQs) of the method were 0.08-43.6ng/mL and 0.27-145ng/mL for the solid-, liquid-, and cream-type samples, respectively. Good calibration linearity for all compounds was demonstrated with a correlation coefficient (r2) higher than 0.997. The intra- and inter-assay precisions were within 11%. The corresponding accuracies were 86-117% and 81-113%, respectively. The mean recoveries obtained for the solid-, liquid, and cream-type samples ranged from 87 to 114%, with a relative standard deviation (RSD) within 6%. The RSD of the stability evaluated at 4°C for 48h was less than 6%. The established method was used to screen 76 samples advertised as hair-growth treatments, from online and offline markets, over the course of two years. In 10% of the samples, four compounds, including triaminodil, minoxidil, finasteride, methyltestosterone, and testosterone-propionate were detected. The concentrations were in the range of 0.5-16.4mg/g. This technique provides a reliable platform for technical analysis for continuous monitoring of adulterated products to protect public health.
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Affiliation(s)
- Han Na Park
- Division of Advanced Analysis, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju-si, Chungcheongbuk-do 28159, Republic of Korea
| | - Ji Hyun Lee
- Division of Advanced Analysis, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju-si, Chungcheongbuk-do 28159, Republic of Korea
| | - Sung-Kwan Park
- Division of Advanced Analysis, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju-si, Chungcheongbuk-do 28159, Republic of Korea
| | - Sun Young Baek
- Division of Advanced Analysis, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju-si, Chungcheongbuk-do 28159, Republic of Korea; College of Pharmacy, Chungbuk National University, Cheongju-si, Chungcheongbuk-do 28159, Republic of Korea
| | - Yong-Moon Lee
- College of Pharmacy, Chungbuk National University, Cheongju-si, Chungcheongbuk-do 28159, Republic of Korea.
| | - Hoil Kang
- Division of Advanced Analysis, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju-si, Chungcheongbuk-do 28159, Republic of Korea.
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Sinclair RD. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol 2017; 57:104-109. [PMID: 29231239 DOI: 10.1111/ijd.13838] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/08/2017] [Accepted: 10/18/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Minoxidil and spironolactone are oral antihypertensives known to stimulate hair growth. OBJECTIVE To report on a case series of women with pattern hair loss (PHL) treated with once daily minoxidil 0.25 mg and spironolactone 25 mg. METHODS Women newly diagnosed with a Sinclair stage 2-5 PHL were scored for hair shedding and hair density before and after 12 months of treatment with oral minoxidil 0.25 mg and spironolactone 25 mg. RESULTS A total of 100 women were included in this observational pilot study. Mean age was 48.44 years (range 18-80). Mean hair loss severity at baseline was Sinclair 2.79 (range 2-5). Mean hair shedding score at baseline was 4.82. Mean duration of diagnosis was 6.5 years (range 0.5-30). Mean reduction in hair loss severity score was 0.85 at 6 months and 1.3 at 12 months. Mean reduction in hair shedding score was 2.3 at 6 months and 2.6 at 12 months. Mean change in blood pressure was -4.52 mmHg systolic and -6.48 mmHg diastolic. Side effects were seen in eight women but were generally mild. No patients developed hyperkalemia or any other blood test abnormality. Six of these women continued treatment, and two women who developed urticaria discontinued treatment. LIMITATIONS Prospective, uncontrolled, open-label observational study. DISCUSSION Once daily capsules containing minoxidil 0.25 mg and spironolactone 25 mg appear to be safe and effective in the treatment of FPHL. Placebo-controlled studies to investigate this further are warranted.
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Affiliation(s)
- Rodney D Sinclair
- Epworth Hospital, East Melbourne, Vic., Australia.,Sinclair Dermatology Clinical Trial Centre, East Melbourne, Vic., Australia
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50
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Lee JH, Park HN, Park HJ, Kim NS, Park SK, Lee J, Baek SY. Isolation and structural identification of a novel minoxidil analogue in an illegal dietary supplement: triaminodil. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2017; 35:2-9. [PMID: 29067865 DOI: 10.1080/19440049.2017.1397295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A new minoxidil analogue was detected in an illegal dietary supplement advertised as a hair-growth treatment. The analogue was identified using ultra-performance liquid chromatography (UPLC), high-resolution mass spectrometry (LC-HR-MS) and nuclear magnetic resonance (NMR) spectroscopy. The compound was structurally elucidated as a minoxidil analogue in which the piperidinyl group of minoxidil was replaced with a pyrrolidinyl group corresponding to a molecular formula of C8H13N5O. The new analogue has been named triaminodil. As this is the first report of the compound, there are no chemical, toxicology or pharmacological data available.
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Affiliation(s)
- Ji Hyun Lee
- a Division of Advanced Analysis, Toxicological Evaluation and Research Department , National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety , Cheongju-si , Chungcheongbuk-do , Republic of Korea
| | - Han Na Park
- a Division of Advanced Analysis, Toxicological Evaluation and Research Department , National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety , Cheongju-si , Chungcheongbuk-do , Republic of Korea
| | - Hyoung Joon Park
- a Division of Advanced Analysis, Toxicological Evaluation and Research Department , National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety , Cheongju-si , Chungcheongbuk-do , Republic of Korea
| | - Nam Sook Kim
- a Division of Advanced Analysis, Toxicological Evaluation and Research Department , National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety , Cheongju-si , Chungcheongbuk-do , Republic of Korea
| | - Sung-Kwan Park
- a Division of Advanced Analysis, Toxicological Evaluation and Research Department , National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety , Cheongju-si , Chungcheongbuk-do , Republic of Korea
| | - Jongkook Lee
- b College of Pharmacy , Kangwon National University , Chuncheon , Gangwon-do , Republic of Korea
| | - Sun Young Baek
- a Division of Advanced Analysis, Toxicological Evaluation and Research Department , National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety , Cheongju-si , Chungcheongbuk-do , Republic of Korea
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