Androgenetic alopecia (AGA), or male pattern baldness, is the most common cause of male pattern baldness.
There are several therapies used to treat this condition, with 5-alpha reductase inhibitors and minoxidil being the most commonly used.
Other current treatment options include laser therapy, scalp micro-needling, hair mesotherapy, and hair transplantation.
The development of new drug therapies has been slow; however, there are currently investigations against JanusKinase inhibitors and autologous platelet-rich plasma injections in men with AGA. Androgenetic alopecia (AGA), or male pattern baldness, is a common condition that causes many men to seek medical attention.
It is characterized by the gradual reduction of hair follicles. in size and lead to balding over time. AGA affects approximately 80% of Caucasian men.
Although it is common in males of various ethnic origins, Caucasian males are more commonly affected. Traditionally, drug treatment with AGA aims to lower dihydrotestosterone (DHT) and stimulate hair follicles through the use of 5-alpha-reductase (5AR) inhibitors or minoxidil; however, new and experimental therapies are exploring inhibition of Janus kinase (JAK) and the use of platelet-rich plasma (PRP). Other therapies include laser therapy, scalp micro-needling, hair mesotherapy, and hair transplantation.
Pathophysiology
androgenetic alopecia is the result of a genetic predisposition; However, the evidence shows that the cause is androgen-related. DHT is the primary androgen involved in androgenetic alopecia, and DHT levels are higher in men with AGA.2 Circulating testosterone is converted to DHT via the 5AR. and Type I and Type II are important in the treatment of AGA.
Type I is found in the skin, including sebaceous glands and hair follicles, and Type II is found in the inner root sheath of hair follicles on the scalp, face, chest, genitals, and prostate.
Hair: The growth cycle is also affected in androgenetic alopecia. Hairs in the telogen or resting phase are more prevalent than hairs in the anagen or growth phase. This leads to a decrease in hair in certain areas of the head.
In addition, some of the hair follicles are smaller and more sensitive to androgens.
The pattern in which hair loss occurs is genetically determined by the distribution of these tiny hair follicles.
5-alpha reductase inhibitors
Finasteride is an FDA-approved 5AR inhibitor for androgenetic alopecia. The drug works by inhibiting the conversion of testosterone to DHT by blocking Type II 5AR.
For dosage, side effects, and advice, see TABLE 1.4 Due to unsatisfactory side effects of oral finasteride, studies were conducted comparing finasteride 0.25% and 0.25% topical solution 5% with oral finasteride 1 mg.
The studies were small but showed a similar improvement in hair growth with fewer side effects compared to topical therapy groups.5 (Currently, the topical formulation is not available in the United States.
Dutasteride is also used off-label to treat AGA and is an inhibitor of both Type I and Type II).
5-alpha reductase inhibitors, In addition, dutasteride is a more potent inhibitor of these two isoenzymes compared to finasteride.
A 29-week, multicenter, randomized, double-blind, double-dummy, parallel-group study was conducted in 917 men aged 20 to 50 years. Years with AGA.
Men were randomized to receive dutasteride 0.02, 0.1, or 0.5 mg/day, finasteride 1 mg/day, or matched placebo.
The primary endpoint was a change in hair count from baseline within a 2.54 cm diameter area at the tip of the scalp.
Dutasteride 0.5 mg was found to be superior to finasteride 1 mg at weeks 12 and 24 in increasing hair count (both, P=0.003).
Secondary endpoints included hair growth and hair restoration.
Dutasteride 0.5 mg significantly improved hair count and hair width when compared with finasteride at Week 24 (P = .016 and P = .004, respectively).
The tolerability of these active ingredients was similar. This study suggests that dutasteride is an alternative to finasteride in the treatment of AGA as it appears to provide better short-term outcomes compared to finasteride.6 Long-term studies are needed. to confirm these results.
TABLE 1 lists the side effects, dosage, and advice for dutasteride.
Dutasteride has additionally been employed in hair mesotherapy, the method of injecting tiny amounts of compounds into the mesoblast of the scalp just under the skin’s surface.
Hair mesotherapy exploitation of dutasteride together with some vitamins has been studied on a restricted basis.
Mesotherapy is employed to stop general facet effects and to extend the native circulation of pharmaceutical agents or vitamins.
The studies are limited and therefore the outcomes are variable.
Minoxidil:
Rogaine Topical minoxidil was the primary drug approved by the government agency for the treatment of AGA. it’s out there in 2% and 5% answers and 5% foam, and therefore the 5% answer has been shown to be resultive|simpler|more practical} than the 2% solution.5,8 There are many mechanisms by that Rogaine may promote hair growth; however, the precise mechanism of action is unclear. it’s been shown each in vivo and in vitro to own an instantaneous mitogenic effect on cuticular cells, and in vitro, it prolongs the survival time of keratinocytes. In addition, topical minoxidil may oppose Ca entry into the cells, which can increase epidermal growth factors to permit hair growth.
In more or less 50% of men, hair loss is stopped, and a little proportion of men experience some hair regrowth.5 The drug should be continued indefinitely or hair growth can subside.
Dosing, facet effects, and associated degreed subject matter points are enclosed in TABLE 1.4
Ketoconazole, corticosteroid, and autacoid F2 Analogues
Ketoconazole shampoo has been thought about as an agent to help with the treatment of Agha as a combination medical aid with oral finasteride.
The mechanism is unclear; however, ketoconazole inhibits the DHT pathway, conferring antiandrogenic properties.
In addition, it’s going to scale back inflammation in the skin. Clinical trials ought to be conducted so as to validate its effectiveness.1,5 Spironolactone could be a potassium-sparing diuretic that has antiandrogenic properties; it blocks steroid hormone receptors and reduces androgen levels.
Most of the clinical knowledge exploitation fifty to two hundred mg/day of corticosteroid are in girls with AGA, and therefore the results have been variable.
Patients using the autacoid F2 analog latanoprost to treat eye disease practiced the facet impact of elongation of eyelashes and eyebrows; as a result, a randomized, double-blind, placebo-controlled trial was conducted in sixteen men using latanoprost 0.1ily versus placebo to judge scalp hair growth.
The 24-week study resulted in a vital increase in hair density from baseline compared with the placebo. completely different concentrations of bimatoprost, another autacoid F2 analog, are presently being studied in men with AGA.1 though these results seem positive, the study populations are too tiny to extrapolate results. extra studies ought to be conducted with a larger patient population for an extended amount of your time to see the effectiveness of the therapy.
Low-Level Laser Therapy
Low-level laser therapy has also been used to treat AGA. It appears that lasers can stimulate hair growth at certain wavelengths; However, the mechanism of this action has not been determined.
Various laser therapy devices are available, including a comb, hood, and headgear. Among these, the HairMax LaserComb is the only FDA-approved device.
A meta-analysis was performed to evaluate the effectiveness of non-surgical treatments for AGA. Low-level laser light therapy demonstrated a mean difference in hair count of 17.66 hairs/cm2 compared to placebo (P<0.00001).
This therapy can be used in conjunction with drug therapy to improve outcomes. More information is needed to determine efficacy and the best place in therapy.
Microneedling and Hair Transplantation
Microneedling has gained popularity and has been shown to be beneficial in stimulating hair growth. in alopecia.
Previously used for cosmetic purposes, it is now used to enhance topical drug delivery.
Microneedling uses multiple fine needles, usually attached to a roller, to create tiny punctures in the skin that stimulate neovascularization, release growth factors, and promote Wnt protein expression.
Hair growth is the result of the release of certain growth factors. and hair growth activation and Wnt proteins have been found to stimulate stem cells in dermal papillae, resulting in hair growth.
Microneedling is typically used in conjunction with topical therapies such as Minoxidil and PRP.
Studies evaluating the effectiveness of micro-needling in conjunction with topical minoxidil are small, but some have reported statistically significant results.
A 12-week study was conducted to compare weekly micro-needling plus minoxidil 5% solution to minoxidil 5% solution alone.
Minoxidil was applied twice daily in both cohorts of 50 men.
In the microneedling group, minoxidil was applied 24 hours after the micro-needling session as the session caused slight erythema in the area where it was performed.
One of the endpoints of the study was hair count in a predefined 1 cm diameter area at the end of 12 weeks.>
The treatment group showed a hair count of 91.4 hairs per cm2 compared to 22.2 hairs per cm2 in the control group (p=0.039).
Patients reported no side effects and results were maintained 8 months after treatment.
Conclusion:
Over the past 30 years, there have been very few advances in the treatment of AGA; However, with research into JAK inhibitors, this could change in the future.
As clinicians consider options to treat this condition, drugs such as finasteride, minoxidil, and dutasteride, which have been extensively studied and shown positive results, are becoming available and should be considered first-line therapies.
Additionally, PRP and microneedling are less common options that show promising results.
Healthcare providers should discuss options with patients and prescribe therapy based on actual results along with patient preferences, taking into account dosing schedules and costs.
Read also: Androgenetic Alopecia
