Male and female pattern hair loss: Treatable and worth treating

Abstract

Pattern hair loss is the most common type of hair loss in both men and women. Scalp hair is typically affected in a characteristic distribution without other scalp or dermatologic fi ndings. Early recognition and treatment can help halt its progression to preserve as much hair as possible. Both pharmacologic and nonpharmacologic treatments have proven helpful.

Pharmacological Management of Pattern Hair Loss

“…Pharmacological management is necessary for all patients of PHL due to its progressive nature and that includes patients undergoing hair transplantation. 1,3,4,9,10 The hallmark of PHL is gradual reduction in hair shaft diameter, caused by reduced dermal papilla (DP) volume with reduced dermal papilla cells (DPCs). 11 The objective of pharmacological treatment in PHL is to reverse miniaturization to improve scalp coverage and prevent or slow further hair thinning and loss.…”

“…Currently, the pharmacological options with the best level of evidence from the efficacy and safety perspectives are topical minoxidil and oral finasteride for MPHL and topical minoxidil l for FPHL. [1][2][3][4] The cause of PHL is thought to be multifactorial, of which some of the elements are identified (androgens and genes) and some still under speculation (microscopic follicular inflammation, oxidative stress, prostaglandins, retinoid receptors and PPAR pathways, etc. ), leaving a wide scope of therapeutic intervention.…”

“…Finasteride usage in MPHL has shown to increase the duration of anagen with increase in hair count, improved scalp coverage, and increased hair mass. 1,56 Finasteride does not affect T levels or binding of DHT to AR and therefore does not possess androgenic, antiandrogenic, estrogenic or antiestrogenic, or progestational or steroid hormone-related properties. 56,57 Pharmacokinetics Finasteride when taken orally has a mean half-life of approximately 6 hours, mandating a daily dosage to maintain uniform blood levels.…”

“…102,103,105 Dutasteride Dutasteride, a potent type I and type II 5-α reductase inhibitor, and the logic of using this is that dual 5α-reductase inhibition could result in greater efficacy than is observed in selective type 2 inhibition, and this dual inhibition could prevent type 1-mediated synthesis of DHT 106 It is approved for BPH but is also prescribed as an off-label treatment for pattern hair loss. 1,107 It has a high level of evidence for safety and efficacy, as per the Japanese guidelines. 20 It is thought to be more potent than finasteride, as it can decrease serum DHT by more than 90%, while finasteride decreases serum DHT by 70%.…”

“…Prior to starting treatment, it is essential to get a thorough blood workup mentioned in1 Tests to be done before medical treatment of PHL…”