Multimedialna platforma wiedzy medycznej Internetowa Księgarnia Medyczna Kalendarium Konferencji
Forum Dermatologicum
MENU
Shortcuts Submit an article Author Guidelines Ahead Of Print Reviewers 2023

open access

Vol 9, No 3 (2023)
Review paper
Published online: 2023-08-24
View PDF Download PDF file View HTML
Get Citation

The diagnosis and treatment of androgenetic alopecia: a review of the most current management

Karol Śliwa1, Daria Synia1, Waldemar Placek2, Agnieszka Owczarczyk-Saczonek2
DOI: 10.5603/fd.95391
·
Forum Dermatologicum 2023;9(3):99-111.
Affiliations
  1. Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
  2. Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland

open access

Vol 9, No 3 (2023)
REVIEW ARTICLES
Published online: 2023-08-24

Abstract

Androgenetic alopecia is a widespread problem in contemporary dermatology, as it may also affect many young patients, in particular males, making them more prone to anxiety and depression which may be caused by a distorted body image. These behavioural problems may occur in older individuals as well. That is why, there is an obvious need for further development in that area of dermatology, which should also include discovering new therapies. In men, the diagnosis of androgenetic alopecia is quite simple, and the treatment usually involves incorporating minoxidil and/or finasteride. Switching from topical minoxidil to its systemic form as well as from finasteride to dutasteride may give better results in some patients. In general, male pattern hair loss (MPHL) is a chronic disease that may demand pharmacological treatment in the long term, which is often unlimited. Therefore, and also considering the patients’ concerns involving the systemic usage of 5α-reductase inhibitors as well as the limitations of current therapies, some specialists use topical finasteride, dutasteride in mesotherapy and many other additional modalities. When it comes to female pattern hair loss (FPHL), in most cases it is also a chronic entity, which especially in younger women demands performing extended lab testing in the search for potential hyperandrogenism. It is necessary to remember that especially in women the condition may be triggered by many environmental and other additional factors, so taking that into consideration may be helpful in some patients.

Abstract

Androgenetic alopecia is a widespread problem in contemporary dermatology, as it may also affect many young patients, in particular males, making them more prone to anxiety and depression which may be caused by a distorted body image. These behavioural problems may occur in older individuals as well. That is why, there is an obvious need for further development in that area of dermatology, which should also include discovering new therapies. In men, the diagnosis of androgenetic alopecia is quite simple, and the treatment usually involves incorporating minoxidil and/or finasteride. Switching from topical minoxidil to its systemic form as well as from finasteride to dutasteride may give better results in some patients. In general, male pattern hair loss (MPHL) is a chronic disease that may demand pharmacological treatment in the long term, which is often unlimited. Therefore, and also considering the patients’ concerns involving the systemic usage of 5α-reductase inhibitors as well as the limitations of current therapies, some specialists use topical finasteride, dutasteride in mesotherapy and many other additional modalities. When it comes to female pattern hair loss (FPHL), in most cases it is also a chronic entity, which especially in younger women demands performing extended lab testing in the search for potential hyperandrogenism. It is necessary to remember that especially in women the condition may be triggered by many environmental and other additional factors, so taking that into consideration may be helpful in some patients.

Full Text:

View PDF Download PDF file View HTML
Get Citation

Keywords

androgenetic alopecia, hair loss, minoxidil, finasteride

About this article
Title

The diagnosis and treatment of androgenetic alopecia: a review of the most current management

Journal

Forum Dermatologicum

Issue

Vol 9, No 3 (2023)

Article type

Review paper

Pages

99-111

Published online

2023-08-24

Page views

742

Article views/downloads

737

DOI

10.5603/fd.95391

Bibliographic record

Forum Dermatologicum 2023;9(3):99-111.

Keywords

androgenetic alopecia
hair loss
minoxidil
finasteride

Authors

Karol Śliwa
Daria Synia
Waldemar Placek
Agnieszka Owczarczyk-Saczonek

References (74)
  1. Gupta AK, Talukder M, Venkataraman M, et al. Minoxidil: a comprehensive review. J Dermatolog Treat. 2022; 33(4): 1896–1906.
    CrossRefPubMed
  2. Nestor MS, Ablon G, Gade A, et al. Treatment options for androgenetic alopecia: efficacy, side effects, compliance, financial considerations, and ethics. J Cosmet Dermatol. 2021; 20(12): 3759–3781.
    CrossRefPubMed
  3. Rudnicka L, Kaczorowska A, Waśkiel-Burnat A, et al. Treatment of diseases associated with cicatricial alopecia. Dermatology Review. 2022; 109(1): 32–42.
    CrossRef
  4. Bhat YJ, Saqib NU, Latif I, et al. Female pattern hair loss-an update. Indian Dermatol Online J. 2020; 11(4): 493–501.
    CrossRefPubMed
  5. Starace M, Orlando G, Alessandrini A, et al. Female androgenetic alopecia: an update on diagnosis and management. Am J Clin Dermatol. 2020; 21(1): 69–84.
    CrossRefPubMed
  6. Liu Q, Tang Y, Huang Y, et al. Insights into male androgenetic alopecia using comparative transcriptome profiling: hypoxia-inducible factor-1 and Wnt/β-catenin signalling pathways. Br J Dermatol. 2022; 187(6): 936–947.
    CrossRefPubMed
  7. Guarrera M, Rebora A. Kenogen in female androgenetic alopecia. A longitudinal study. Dermatology. 2005; 210(1): 18–20.
    CrossRefPubMed
  8. Nirmal B, Somiah S, Sacchidanand SA, et al. Evaluation of perifollicular inflammation of donor area during hair transplantation in androgenetic alopecia and its comparison with controls. Int J Trichology. 2013; 5(2): 73–76.
    CrossRefPubMed
  9. Katzer T, Leite Junior A, Beck R, et al. Physiopathology and current treatments of androgenetic alopecia: going beyond androgens and anti-androgens. Dermatol Ther. 2019; 32(5): e13059.
    CrossRefPubMed
  10. Asfour L, Cranwell W, Sinclair R, et al. Male androgenetic alopecia. MBBS(Hons), BMedSc(Hons), and Rodney Sinclair, MBBS, MD, FACD, Male Androgenetic Alopecia; 2016.
  11. Brzezińska-Wcisło L, Rakowska A, Rudnicka L, et al. Androgenetic alopecia. Diagnostic and therapeutic recommendations of the Polish dermatological society. Dermatology Review. 2018; 105(1): 1–18.
    CrossRef
  12. Pietrauszka K, Bergler-Czop B. Sulfotransferase SULT1A1 activity in hair follicle, a prognostic marker of response to the minoxidil treatment in patients with androgenetic alopecia: a review. Postepy Dermatol Alergol. 2022; 39(3): 472–478.
    CrossRefPubMed
  13. Goren A, Shapiro J, Roberts J, et al. Clinical utility and validity of minoxidil response testing in androgenetic alopecia. Dermatol Ther. 2014; 28(1): 13–16.
    CrossRef
  14. Dhurat R, Daruwalla S, Pai S, et al. SULT1A1 (Minoxidil Sulfotransferase) enzyme booster significantly improves response to topical minoxidil for hair regrowth. J Cosmet Dermatol. 2022; 21(1): 343–346.
    CrossRefPubMed
  15. Sharma A, Goren A, Dhurat R, et al. Tretinoin enhances minoxidil response in androgenetic alopecia patients by upregulating follicular sulfotransferase enzymes. Dermatol Ther. 2019; 32(3): e12915.
    CrossRefPubMed
  16. Goldman BE, Fisher DM, Ringler SL. Transcutaneous PO2 of the scalp in male pattern baldness: a new piece to the puzzle. Plast Reconstr Surg. 1996; 97(6): 1109–16; discussion 1117.
    CrossRefPubMed
  17. Panchaprateep R, Lueangarun S. Efficacy and safety of oral minoxidil 5 mg once daily in the treatment of male patients with androgenetic alopecia: an open-label and global photographic assessment. Dermatol Ther (Heidelb). 2020; 10(6): 1345–1357.
    CrossRefPubMed
  18. Ramos PM, Gohad P, McCoy J, et al. Minoxidil sulfotransferase enzyme (SULT1A1) genetic variants predicts response to oral minoxidil treatment for female pattern hair loss. J Eur Acad Dermatol Venereol. 2021; 35(1): e24–e26.
    CrossRefPubMed
  19. Nestor MS, Ablon G, Gade A, et al. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. J Cosmet Dermatol. 2021; 20(12): 3759–3781.
    CrossRefPubMed
  20. Blume-Peytavi U, Hillmann K, Dietz E, et al. A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. J Am Acad Dermatol. 2011; 65(6): 1126–1134.
    CrossRefPubMed
  21. Ramírez-Marín HA, Tosti A. Role of oral minoxidil in patterned hair loss. Indian Dermatol Online J. 2022; 13(6): 729–733.
    CrossRefPubMed
  22. Ramos PM, Sinclair RD, Kasprzak M, et al. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. J Am Acad Dermatol. 2020; 82(1): 252–253.
    CrossRefPubMed
  23. Sinclair RD. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018; 57(1): 104–109.
    CrossRefPubMed
  24. Kaufman K, Olsen E, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. J Am Acad Dermatol. 1998; 39(4): 578–589.
    CrossRef
  25. Trueb R, Rezende H, Dias MR. A comment on the post-finasteride syndrome. Int J Trichology. 2018; 10(6): 255–261.
    CrossRefPubMed
  26. Caserini M, Radicioni M, Leuratti C, et al. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Int J Clin Pharmacol Ther. 2014; 52(10): 842–849.
    CrossRefPubMed
  27. Piraccini BM, Blume-Peytavi U, Scarci F, et al. Topical Finasteride Study Group. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol. 2022; 36(2): 286–294.
    CrossRefPubMed
  28. Mysore V, Shashikumar BM. Guidelines on the use of finasteride in androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2016; 82(2): 128–134.
    CrossRefPubMed
  29. Romero Pérez P. Post-Finasteride syndrome. Literature review. Arch Esp Urol. 2022; 75(5): 382–399.
    CrossRefPubMed
  30. Haber RS, Gupta AK, Epstein E, et al. Finasteride for androgenetic alopecia is not associated with sexual dysfunction: a survey-based, single-centre, controlled study. J Eur Acad Dermatol Venereol. 2019; 33(7): 1393–1397.
    CrossRefPubMed
  31. Arca E, Açikgöz G, Taştan HB, et al. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology. 2004; 209(2): 117–125.
    CrossRefPubMed
  32. Hu R, Xu F, Sheng Y, et al. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients. Dermatol Ther. 2015; 28(5): 303–308.
    CrossRefPubMed
  33. Suchonwanit P, Iamsumang W, Leerunyakul K. Topical finasteride for the treatment of male androgenetic alopecia and female pattern hair loss: a review of the current literature. J Dermatolog Treat. 2022; 33(2): 643–648.
    CrossRefPubMed
  34. Gupta AK, Talukder M, Williams G. Comparison of oral minoxidil, finasteride, and dutasteride for treating androgenetic alopecia. J Dermatolog Treat. 2022; 33(7): 2946–2962.
    CrossRefPubMed
  35. Gupta AK, Charrette A. The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatolog Treat. 2014; 25(2): 156–161.
    CrossRefPubMed
  36. Jung JY, Yeon JeHo, Choi JW, et al. Effect of dutasteride 0.5 mg/d in men with androgenetic alopecia recalcitrant to finasteride. Int J Dermatol. 2014; 53(11): 1351–1357.
    CrossRefPubMed
  37. Shanshanwal SJS, Dhurat RS. Superiority of dutasteride over finasteride in hair regrowth and reversal of miniaturization in men with androgenetic alopecia: A randomized controlled open-label, evaluator-blinded study. Indian J Dermatol Venereol Leprol. 2017; 83(1): 47–54.
    CrossRefPubMed
  38. Reguero-Del Cura L, Durán-Vian C, de Quintana-Sancho A. RF-Mesotherapy with dutasteride: a future alternative treatment for androgenetic alopecia. Actas Dermosifiliogr (Engl Ed). 2020; 111(5): 419–420.
    CrossRefPubMed
  39. Saceda-Corralo D, Moustafa F, Moreno-Arrones Ó, et al. Mesotherapy with dutasteride for androgenetic alopecia: a retrospective study in real clinical practice. J Drugs Dermatol. 2022; 21(7): 742–747.
    CrossRefPubMed
  40. Saceda-Corralo D, Rodrigues-Barata AR, Vañó-Galván S, et al. Mesotherapy with dutasteride in the treatment of androgenetic alopecia. Int J Trichology. 2017; 9(3): 143–145.
    CrossRefPubMed
  41. Hu AC, Chapman LW, Mesinkovska NA. The efficacy and use of finasteride in women: a systematic review. Int J Dermatol. 2019; 58(7): 759–776.
    CrossRefPubMed
  42. Saceda-Corralo D, Domínguez-Santas M, Vañó-Galván S, et al. What's new in therapy for male androgenetic alopecia? Am J Clin Dermatol. 2023; 24(1): 15–24.
    CrossRefPubMed
  43. Abdin R, Zhang Y, Jimenez JJ. Treatment of androgenetic alopecia using PRP to target dysregulated mechanisms and pathways. Front Med (Lausanne). 2022; 9: 843127.
    CrossRefPubMed
  44. Sharma A, Chouhan K, Bhatia S, et al. Platelet-Rich plasma in androgenetic alopecia. Indian Dermatol Online J. 2021; 12(Suppl 1): S31–S40.
    CrossRefPubMed
  45. de Oliveira AF, Arcanjo FP, Rodrigues MR, et al. Use of autologous platelet-rich plasma in androgenetic alopecia in women: a systematic review and meta-analysis. J Dermatolog Treat. 2023; 34(1): 2138692.
    CrossRefPubMed
  46. Shashank B, Bhushan M. Injectable platelet-rich fibrin (PRF): the newest biomaterial and its use in various dermatological conditions in our practice: a case series. J Cosmet Dermatol. 2021; 20(5): 1421–1426.
    CrossRefPubMed
  47. Pillai JK, Mysore V. Role of low-level light therapy (LLLT) in androgenetic alopecia. J Cutan Aesthet Surg. 2021; 14(4): 385–391.
    CrossRefPubMed
  48. Guo Y, Qu Q, Chen J, et al. Proposed mechanisms of low-level light therapy in the treatment of androgenetic alopecia. Lasers Med Sci. 2021; 36(4): 703–713.
    CrossRefPubMed
  49. Afifi L, Maranda EL, Zarei M, et al. Low-level laser therapy as a treatment for androgenetic alopecia. Lasers Surg Med. 2017; 49(1): 27–39.
    CrossRefPubMed
  50. Barikbin B, Khodamrdi Z, Kholoosi L, et al. Comparison of the effects of 665 nm low level diode Laser Hat versus and a combination of 665 nm and 808nm low level diode Laser Scanner of hair growth in androgenic alopecia. J Cosmet Laser Ther. 2017 [Epub ahead of print].
    CrossRefPubMed
  51. Jimenez JJ, Wikramanayake TC, Bergfeld W, et al. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study. Am J Clin Dermatol. 2014; 15(2): 115–127.
    CrossRefPubMed
  52. Suchonwanit P, Rojhirunsakool S, Khunkhet S. A randomized, investigator-blinded, controlled, split-scalp study of the efficacy and safety of a 1550-nm fractional erbium-glass laser, used in combination with topical 5% minoxidil versus 5% minoxidil alone, for the treatment of androgenetic alopecia. Lasers Med Sci. 2019; 34(9): 1857–1864.
    CrossRefPubMed
  53. Starace M, Orlando G, Alessandrini A, et al. Female androgenetic alopecia: an update on diagnosis and management. Am J Clin Dermatol. 2020; 21(1): 69–84.
    CrossRefPubMed
  54. Faghihi G, Nabavinejad S, Mokhtari F, et al. Microneedling in androgenetic alopecia; comparing two different depths of microneedles. J Cosmet Dermatol. 2021; 20(4): 1241–1247.
    CrossRefPubMed
  55. English RS, Ruiz S, DoAmaral P. Microneedling and its use in hair loss disorders: a systematic review. Dermatol Ther (Heidelb). 2022; 12(1): 41–60.
    CrossRefPubMed
  56. Gupta AK, Quinlan EM, Venkataraman M, et al. Microneedling for hair loss. J Cosmet Dermatol. 2022; 21(1): 108–117.
    CrossRefPubMed
  57. Dhurat R, Sukesh Ms, Avhad G, et al. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. Int J Trichology. 2013; 5(1): 6–11.
    CrossRefPubMed
  58. Vargas-Mora P, Morgado-Carrasco D. Spironolactone in dermatology: uses in acne, hidradenitis suppurativa, female pattern baldness, and hirsutism. Actas Dermosifiliogr (Engl Ed). 2020; 111(8): 639–649.
    CrossRefPubMed
  59. Searle TN, Al-Niaimi F, Ali FR. Spironolactone in dermatology: uses in acne and beyond. Clin Exp Dermatol. 2020; 45(8): 986–993.
    CrossRefPubMed
  60. Olamiju B, Craiglow BG. Combination oral minoxidil and spironolactone for the treatment of androgenetic alopecia in adolescent girls. J Am Acad Dermatol. 2021; 84(6): 1689–1691.
    CrossRefPubMed
  61. Abdel-Raouf H, Aly UF, Medhat W, et al. A novel topical combination of minoxidil and spironolactone for androgenetic alopecia: clinical, histopathological, and physicochemical study. Dermatol Ther. 2021; 34(1): e14678.
    CrossRefPubMed
  62. Faghihi G, Iraji F, Siadat AH, et al. Comparison between “5% minoxidil plus 2% flutamide” solution vs. “5% minoxidil” solution in the treatment of androgenetic alopecia. J Cosmet Dermatol. 2022; 21(10): 4447–4453.
    CrossRefPubMed
  63. Goodman NF, Cobin RH, Futterweit W, et al. American Association Of Clinical Endocrinologists, American College Of Endocrinology, And Androgen Excess And Pcos Society Disease State clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome — Part 1. Endocr Pract. 2015; 21(11): 1291–1300.
    CrossRefPubMed
  64. Rogers NE. Hair transplantation update. Semin Cutan Med Surg. 2015; 34(2): 89–94.
    CrossRefPubMed
  65. Rassman W, Pak J. Follicular unit extraction: evolution of a technology. J Transplant Technol Res. 2016; 06(02).
    CrossRef
  66. Collins K, Avram MR. Hair transplantation and follicular unit extraction. Dermatol Clin. 2021; 39(3): 463–478.
    CrossRefPubMed
  67. Gupta AK, Talukder M, Bamimore MA. Natural products for male androgenetic alopecia. Dermatol Ther. 2022; 35(4): e15323.
    CrossRefPubMed
  68. Zhou Y, Yu S, Zhao J, et al. Effectiveness and safety of botulinum toxin type a in the treatment of androgenetic alopecia. Biomed Res Int. 2020; 2020: 1501893.
    CrossRefPubMed
  69. Asfour L, Cranwell W, Sinclair R, et al. Male androgenetic alopecia. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc. 2000.
    PubMed
  70. Mao Y, Liu P, Wei J, et al. Cell therapy for androgenetic alopecia: elixir or trick? Stem Cell Rev Rep. 2023; 19(6): 1785–1799.
    CrossRefPubMed
  71. Gan Y, Du L, Wang H, et al. A clinical trial of treating androgenic alopecia with mesenchymal stem cell suspension derived from autologous hair follicle. Plast Reconstr Surg. 2023 [Epub ahead of print].
    CrossRefPubMed
  72. Gupta AK, Wang T, Rapaport JA. Systematic review of exosome treatment in hair restoration: Preliminary evidence, safety, and future directions. J Cosmet Dermatol. 2023 [Epub ahead of print].
    CrossRefPubMed
  73. Chen X, Xiang H, Yang M. Topical cetirizine for treating androgenetic alopecia: a systematic review. J Cosmet Dermatol. 2022; 21(11): 5519–5526.
    CrossRefPubMed
  74. Fu H, Li W, Weng Z, et al. Water extract of cacumen platycladi promotes hair growth through the Akt/GSK3β/β-catenin signaling pathway. Front Pharmacol. 2023; 14: 1038039.
    CrossRefPubMed

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
phone: +48 58 320 94 94, fax: +48 58 320 94 60, e-mail: viamedica@viamedica.pl