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Medical Treatment

Management of androgenic alopecia in male

Medical Management

Cyclic Treatment

Cyclic Treatment

  1. Protiens
  2. Calcium
  3. Iron
  4. Multivitamins
  5. Brahmi
  6. Finesteriods
  7. Minoxidil solution 2% for local application
  8. Ketaconazole shampoo for dandruff
  9. Routine shampoo for daily hair wash and condition

Finesteride

FDA approved Finesteride for treatment of AGA in 1997.

Finesteride is most common treatment approach for male AGA.

It is synthetic 4-azasteriod compound that is specific inhibitor of type II 5µ-reductase inhibitor and responsible to reduced serum and tissue level of DHT.

Finesteride does not have any hormonal properties in itself and has no estrogenic, antiestrogenic, or progestational effects.

1 mg/daily dose is optimum dose for treatment of AGA.

It can be taken with food or without food.

Finesteride is well tolerated and side effects occur in less than 2% of patients.

Side effects include

  1. Decreased lobido-1.8%
  2. Erectile disfunction-0.8%
  3. Decreases ejaculate volume 0.4%

                          But

Side effect subsides spontaneously in those who want to continue treatment in 59% and are reversible on cession of treatment.

The effect on prostate size and serum prostate-specific antigen(PSA) in this young population without BHP was small and reversible on discontinuation.

There are no evidences on casual link between finasteride and persistent sexual dysfunction.

Minoxidil 

Minoxidil is piperidinopyrimidine derivative originally used as an oral antihypertensive  as a smooth muscle vasodilator.

Mechanism of Action:

It have mitogenic , nonhormonal effect on epidermal cells leading to prolonged survival time as well the capacity to induce increased proliferation on hair follicle in vitro.

A change in intracellular calcium homeostasis has been suggested because minoxidil is converted to minoxidil sulfate, a potassium channel antagonist that increases potassium channel permeability, leading to the entry of calcium into the cell. This active metabolite is believed to be responsible for hair growth stimulation.

The sulfotransferase enzyme (SULT1A1) activity in the hair follicle correlate with minoxidil response.

Minoxidil 5% solution or Foam twice (Two times a day)daily is approved for  the treatment of AGA in Men.

Side Effects

  1. Contact dermatitis
  2. Transient shedding during first two months of use.

Dutesteride

Mechanism of action: Dutesteride is dual inhibitor of both types I and II 5µ-reductase that inhibits the conversion of testosterone to DHT.

It is not approved by FDA for treatment of AGA

Only in Korea has Dutesteride at a dose of 0.5 mg daily been approved for treatment of AGA.

Side effects

  1. Breast enlargement and tenderness.
  2. Reduced sperm count.
  3. Decreases libido
  4. Erectile dysfunction
  5. Decreased ejaculate volume

Prostaglandin Analogs

The prostaglandin F2a analogs Latanoprost and Bimatoprost  are in used in treating ocular hypertension and Glaucoma.

A noted side effect in increased eyelash hair growth ,a feature that has been investigated in several stdies. Bimaprost is now available as a treatment for eyelash growth.

Latanoprost can be used for treatment of AGA.

Ketoconazole

Ketoconazole is an imidazole antifungal agent: it is effective for the treatment of dermatitis and dandruff.

It’s action on scalp microflora may benefit those with AGA- associated follicular inflammation.

Ketoconazole is also an antiandrogen and has been suggested to improve hair growth in AGA through androgen-dependent pathways.

Ketoconazole shampoo 2% on MPHL showed increased hair density in addition to increased size and proportion of anagen follicle compared to those using non-medicated shampoo.

Ketoconazole shampoo is used in conjunction with other AGA treatment.

ACell MartiStem

 Acell MatriStem is an extracellular matrix derived from porcein urinary bladder.

It contains anetwork of collagens and proteins.

It contains growth factor and is known to recruit progenitor cells.

Possible help in tissue regeneration and follicle regeneration.

Cell Therapy and Cloning 

Still under experimental stage.