Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 3/2000

01-05-2000 | Disease Management

Management of Androgenetic Alopecia

Authors: Chantal Bolduc, Dr Jerry Shapiro

Published in: American Journal of Clinical Dermatology | Issue 3/2000

Login to get access

Abstract

Androgenetic alopecia is by far the most common cause of hair loss. It affects approximately 50% of men by the age of 50 and 20 to 53% of women by the age 50. Although it is a medically benign condition, it is a significant psychosocial issue for many patients. Various different treatment options are now available for androgenetic alopecia.
The best treatment option for women with androgenetic alopecia Ludwig stage I and II is minoxidil 5% solution. If it is not effective after 1 year, antiandrogens can be tried, but there are no large studies showing their efficacy and they have considerable adverse effects. Also, for patients with alopecia that is unresponsive to treatment or with Ludwig stage III, hair transplantation can be offered if the occipital donor area is sufficient. For men, we always offer minoxidil or finasteride therapy and leave the choice of therapy to the patient. Some patients may prefer a systemic agent, whereas others may favor a topical agent. If the condition is not stabilized after 1 year or if the patient wants greater hair density, hair transplantation can be discussed.
There have been tremendous advances in the treatment of hair loss in recent years and the future is very encouraging. As our knowledge of androgenetic alopecia pathophysiology increases, novel targeted treatments will potentially be developed.
Literature
1.
Price V.H. Treatment of hair loss. N Engl J Med 1999; 23: 341 (13): 964–1773
2.
Hamilton J.B. Patterned loss of hair in man: types and incidence. Ann N Y Acad Sci 1951; 53: 708–728PubMedCrossRef
3.
Olsen E. Androgenetic alopecia. In: Olsen E., editor. Disorders of hair growth. New York: McGraw-Hill, 1994: 257
4.
Whiting D.A. The diagnosis of alopecia. Current concepts. Kalamazoo (MO); Upjohn Company, 1990
5.
Rhodes T., Girman C.J., Savin R.C., et al. Prevalence of male pattern hair loss in 18–49 year old men. Dermatol Surg 1988: Dec; 24 (12): 1330–1332
6.
Cash T.F. The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol 1999 Sep; 141 (3): 398–405PubMedCrossRef
7.
Randall V. The use of dermal papilla cells in studies of normal and abnormal hair follicle biology. Dermatol Clin 1996; 14 (4): 585–594PubMedCrossRef
8.
Ziller C. Pattern formation in neural crest derivatives. In: Van Neste D., Randall V., editors. Hair research for the next millenium. Amsterdam: Elsevier Science, 1996: 1
9.
Uno H., Cappas A., Schlagel C. Cyclic dynamics of hair follicles and the effect of minoxidil on the bald scalps of the stumptailed macaques. Am J Dermatopathol1985; 7(3): 283–297CrossRef
10.
11.
Bergfeld W.F. Androgenetic alopecia: an autosomal dominant disorder. Am J Med 1995; 98 (1A Suppl.): 95S–98SPubMedCrossRef
12.
Kuster W., Happle R. The inheritance of common baldness: two B or not two B? J Am Acad Dermatol 1984: 11 (5 Pt 1): 921–926PubMedCrossRef
13.
Norwood O.T. Male pattern baldness: classification and incidence. South Med J 1975; 68: 1359–1365PubMedCrossRef
14.
Chen W., Zouboulis C., Orfanos C. The 5 alpha-reductase system and its inhibitors. Recent development and its perspective in treating androgen-dependent skin disorders.Dermatology 1996; 193: 177–184PubMedCrossRef
15.
Sawaya M.E., Price V.H. Different levels of 5 alpha reductase type I and II, aromatase, and androgen receptor in hair follicles of women and men with androgenetic alopecia. J Invest Dermatol 1997; 109: 296–300PubMedCrossRef
16.
Bingham K., Shaw D. The metabolism of testosterone by human male scalp skin.J Endocrinol 1973; 57: 111–121PubMedCrossRef
17.
Itami S., Kurata S., Sonoda T., et al. Mechanism of action of androgen in dermal papilla cells. Ann N Y Acad Sci 1991; 642: 385–395PubMedCrossRef
18.
Itami S., Kurata S., Sonoda T., et al. Characterization of 5 alpha reductase in cultured human dermal papilla cells from beard and occipital hair. J Invest Dermatol 1991; 96: 57–60PubMedCrossRef
19.
Imperato-McGinley J., Guerrero L., Gautier T., et al. Steroid 5 alpha reductase deficiency in man: an inherited form of male pseudohermaphroditism. Science 1974; 186: 1213PubMedCrossRef
20.
Imperato-McGinley J. 5 alpha reductase deficiency. Curr Ther Endocrinol Metab1994; 5: 351–354
21.
Price V.H. Testosterone metabolism in the skin: a review of its function in androgenetic alopecia, acne vulgaris, and idiopathic hirsutism including recent studies with antiandrogens. Arch Dermatol 1975; 111: 1496–1502PubMedCrossRef
22.
Sawaya M.E., Price V.H., Harris K. Human hair follicle aromatase activity in females with androgenetic alopecia [abstract]. J Invest Dermatol 1990; 94: 575
23.
Randall V.A., Thornton M.J., Messenger A. Cultured dermal papilla cells from androgen-dependent human hair follicles contain more androgen receptors than those from non-balding areas of scalp. J Endocrinol 1992; 133: 141PubMedCrossRef
24.
Sawaya M.E. Purification of androgen receptors in human sebocytes and hair. J Invest Dermatol 1992; 98 (6 Suppl.): 92S–96SPubMedCrossRef
25.
Price V.H., Menefee E. Quantitative estimation of hair growth: comparative changes in weight and hair count with 5% and 2% minoxidil, placebo and no treatment.In: Van Neste D., Randall V., editors. Hair research for the next millenium. Amsterdam: Elsevier Science, 1996: 67
26.
Sawaya M.E. Novel agents for the treatment of Alopecia. Seminars in Cutaneous Medicine and Surgery 1998; 17 (4): 276–283PubMedCrossRef
27.
Baden H., Kubilus J. Effect of minoxidil on cultured keratinocytes. J Invest Dermatol 1983; 81: 558–560PubMedCrossRef
28.
Kiesewetter F., Langer P., Schell H. Minoxidil stimulates mouse vibrissae follicles in organ culture [letter]. J Invest Dermatol 1991; 96: 295–296PubMedCrossRef
29.
Ohtsuyama M., Morhashi M. Minoxidil sulfate effect of internal calcium of cell in the epidermis and epidermal appendages. In: Van neste D., Randall V., editors. Hair research a for the next millenium. Amsterdam: Elsevier Science, 1996: 481
30.
31.
Buhl A., Waldon D., Kawabe T., et al. Minoxidil stimulates mouse vibrissae follicles in organ culture. J Invest Dermatol 1985; 84: 358–420
32.
33.
Price V.H., Menefee E., Strauss P.C. Changes in hair weight and hair count in men with androgenetic alopecia, after application of 5% and 2% topical minoxidil, placebo, or no treatment. J Am Acad Dermatol 1999; 41 (5): 717–721PubMedCrossRef
34.
Olsen E. Treatment of androgenetic alopecia with topical minoxidil. Resid Staff Physician 1989; 35: 53
35.
Olsen E., Weiner M.S., Amara I., et al. Five year follow of men with androgenetic alopecia treated with topical minoxidil. J Am Acad Dermatol 1990; 22: 643–646PubMedCrossRef
36.
Olsen E., DeLong E., Weiner M. Long-term follow-up of men with male pattern baldness treated with topical minoxidil. J Am Acad Dermatol 1987; 16: 688–695PubMedCrossRef
37.
Olsen E., Weiner M.S. Topical minoxidil in male pattern hair loss: effects of discontinuation of treatment. J Am Acad Dermatol 1987; 17: 97–101PubMedCrossRef
38.
Price V.H., Menefee E. Quantitative estimation of hair growth. I. Androgenetic alopecia in women: effect of minoxidil. J Invest Dermatol 1990; 95: 683–687PubMedCrossRef
39.
Diani A., Mulholland M.J., Shull K.L., et al. Hair growth effects of oral administration of finasteride, a steroid 5 alpha reductase inhibitor, alone and in combination with topical minoxidil in the balding stump-tailed macaque. J Clin Endocrinol Metab1992; 74: 345–350CrossRef
40.
Canadian Pharmacists Association. Monography. Compendium of pharmaceuticals and specialties (CPS). 34th Ed. Ottawa, Canada: Canadian Pharmacists Association, 1999
41.
Katz H.I., Hien N.T., Prawer S.E. Long-term efficacy of topical minoxidil in male pattern baldness. J Am Acad Dermatol 1987; 16 (3): 711–718PubMedCrossRef
42.
Ebsser H., Muller E. Allergic contact dermatitis from minoxidil. Contact Dermatitis1995; 32: 316–317CrossRef
43.
Kaufman K. Androgen metabolism as it affects hair growth in androgenetic alopecia.Dermatol Clin 1996; 14: 697–711PubMedCrossRef
44.
Kaufman K. Clinical studies on the effects of oral finasteride, a type II 5 alpha reductase inhibitor, on scalp hair in men with male pattern baldness. In: Van Neste D., Randall V., editors. Hair research for the next millenium. Amsterdam: Elsevier Science, 1996: 363
45.
Gormley G., Stoner E., Bruskewitz R., et al. The effect of finasteride in men with benign prostatic hyperplasia. N Engl J Med 1992; 327: 1185–1191PubMedCrossRef
46.
Stoner E. The clinical development of 5 alpha reductase inhibitor, finasteride. J Steroid Biochem Mol Biol 1990; 37: 375–378PubMedCrossRef
47.
Dallob A., Sadick N., Unger W., et al. The effects of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and dihydroterstosterone concentrations in patients with male pattern baldness. J Clin Endocrinol Metab 1994; 79: 703–706PubMedCrossRef
48.
Drake L., Hordinsky M., Fiedler V., et al. The effects of finasteride on scalp skin and serum androgen levels in male with androgenetic alopecia. J Am Acad Dermatol1999; 41 (4): 550–554
49.
Leyden J., Dunlop F., Miller B., et al. Finasteride in the treatment of male with frontal male pattern hair loss. J Am Acad Dermatol 1999; 40 (6): 930–937PubMedCrossRef
50.
Kaurman K. Treatment with finasteride 1 mg per day in men with male pattern hair loss. Australas J Dermatol 1997; 38: 20
51.
Waldstreicher J. The effects of finasteride in men with frontal male pattern hair loss. Australas J Dermatol 1997; 38: 101CrossRef
52.
Roberts J., Hordinsky M.K., Olsen E.A., et al. The effects of finasteride on post-menopausal women with androgenetic alopecia [abstract]. Hair Workshop; 1998 May 2–3: Brussels: 16–17
53.
Overstreet J.W., Fuh V.L., Gould J., et al. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J Urol 1999 Oct; 162 (4): 1295–1300PubMedCrossRef
54.
Matzkin H., Barak M., Braf Z. Effect of finasteride on free and total serum prostate specific antigen in men with benign prostatic hypertrophy. Br J Urol 1996; 78: 405–408PubMedCrossRef
55.
Hammerstein J., Meckies J., Leo-Rossberg I., et al. Use of cyproterone acetate in the treatment of acne, hirsutism and virilism. J Steroid Biochem Mol Biol 1975; 6: 827–836
56.
Namer M. Clinical applications of antiandrogens. J Steroid Biochem Mol Biol1988; 31: 719–729
57.
58.
Dawber R.P.R., Sonnex T., Ralfs I. Oral antiandrogen treatment of common baldness in women. Br J Dermatol 1982; 107 Suppl. 22: 20–23
59.
Ekoe J., Burckhardt P., Ruedi B. Treatment of hirsutism, acne and alopecia with cyproterone acetate. Dermatologica 1980; 160: 398–404PubMedCrossRef
60.
Mortimer C., Rushton H., James K. Effective medical treatment for common baldness in women. Clin Exp Dermatol 1984; 9: 342–350PubMedCrossRef
61.
62.
Simpson N. The management of androgenetic alopecia in women. J Dermatol Treatment 1989; 1: 107–113CrossRef
63.
Corbol P., Michard A., Minard J., et al. Antiandrogenic effect of spironolactone: mechanism of action. Endoctinology 1975; 97: 52–58CrossRef
64.
Lobo R.A., Shoupe D., Serafini P., et al. the effects of two doses of spironolactone on serum androgens and anagen hair in hirsute women. Fertil Steril 1985; 43: 200–205PubMed
65.
Loriaux D. Spironolactone and endocrine dysfunction (NIH conference). Ann Intern Med 1976; 85: 630
66.
Burke B., Cunliffe W. Oral spironolactone therapy for female patients with acne, hirsutism or androgenic alopecia. Br J Dermatol 1985; 11 (1): 124–125CrossRef
67.
Rushton D. Quantitative assessment of spironolactone treatment in women with diffuse androgen-dependent alopecia. J Socv Cosmet Chem 1991; 42: 317
68.
Elias P. Epidermal effects of retinoids: supramolecular observations and clinical implications. J Am Acad Dermatol 1986; 15: 797–809PubMedCrossRef
69.
Sporn M., Roberts A., Roche N., et al. Mechanism of action of retinoids. J Am Acad Dermatol 1986; 15: 756–764PubMedCrossRef
70.
Bazzano G., Terezakis N., Galen W. Topical tretinoin for hair growth promotion. J Am Acad Dermatol 1986; 15 (Pt 2): 880–883, 890-3PubMedCrossRef
Metadata
Title
Management of Androgenetic Alopecia
Authors
Chantal Bolduc
Dr Jerry Shapiro
Publication date
01-05-2000
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 3/2000
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.2165/00128071-200001030-00002

Other articles of this Issue 3/2000

American Journal of Clinical Dermatology 3/2000 Go to the issue

Practical Dermatology

Acne Variants

Review Article

Actinic Keratosis

Disease Management

Verrucas

Practical Dermatology

Dermatoses of the Feet

Review Article

Drug-Induced Psoriasis

Adis Drug Evaluation

Topical Metronidazole