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Desai D, Nohria A, Sikora M, Buontempo M, Shapiro J, Caplan AS, Garshick M, Lo Sicco KI. Assessing the influence of medications with antagonistic effects on low-dose oral minoxidil in patients with alopecia: A retrospective study. JAAD Int 2024; 17:1-3. [PMID: 39268196 PMCID: PMC11387517 DOI: 10.1016/j.jdin.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Affiliation(s)
- Deesha Desai
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Ambika Nohria
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Michelle Sikora
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
- New York Medical College, Valhalla, New York
| | - Michael Buontempo
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Avrom S Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Michael Garshick
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York
| | - Kristen I Lo Sicco
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
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Luo X, Ni X, Zhi J, Jiang X, Bai R. Small molecule agents against alopecia: Potential targets and related pathways. Eur J Med Chem 2024; 276:116666. [PMID: 39002436 DOI: 10.1016/j.ejmech.2024.116666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
Alopecia has emerged as a global concern, extending beyond the middle-aged and elderly population and increasingly affecting younger individuals. Despite its growing prevalence, the treatment options and effective drugs for alopecia remain limited due to the incomplete understanding of its underlying mechanisms. Therefore, it is urgent to explore the pathogenesis of alopecia and discover novel and safer therapeutic agents. This review provided an overview of the prevailing clinical disorders of alopecia, and the key pathways and targets involved in hair growth process. Additionally, it discusses FDA-approved drugs and clinical candidates for the treatment of alopecia, and explores small molecule compounds with anti-alopecia potential in the drug discovery phase. These endeavors are expected to provide researchers with valuable scientific insights and practical information for anti-alopecia drug discovery.
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Affiliation(s)
- Xinyu Luo
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Xinhua Ni
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Jia Zhi
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Xiaoying Jiang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Renren Bai
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China.
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Li T, Zhang G, Zhou X, Guan J, Zhao W, Zheng Y, Lee J, Wang P, Zhao Y. Cedrol in ginger (Zingiber officinale) as a promising hair growth drug: The effects of oral and external administration on hair regeneration and its mechanism. Bioorg Chem 2024; 151:107709. [PMID: 39137599 DOI: 10.1016/j.bioorg.2024.107709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024]
Abstract
Ginger is an important cooking spice and herb worldwide, and scientific research has gradually confirmed the effect of ginger on preventing hair loss. Cedrol (CE) is a small sesquiterpene molecule in ginger and its external administration (EA) has shown hope in promoting hair growth, and alternative administration mode has become a potential treatment scheme to improve the efficacy of CE. The purpose of this study is to evaluate the effects of oral administration (OA) and EA of CE on hair regeneration of C57BL/6 alopecia areata (AA) mice induced by cyclophosphamide (CP) and to clarify the potential hair growth mechanism of CE in AA model in vitro and in vivo. The results showed that CE-OA has a shorter hair-turning black time and faster hair growth rate, and can lessen hair follicle damage induced by CP and promote hair follicle cell proliferation. Its effect is superior to CE-EA. At the same time, CE can increase the cytokines IFN-γ, IL-2, and IL-7 in the serum of mice, and decrease the expression of adhesion factors ICAM-1 and ELAM-1, thus alleviating the immunosuppression induced by CP. Mechanism research shows that CE regulates the JAK3/STAT3 signaling pathway, activates the Wnt3α/β-catenin germinal center, and ameliorates oxidative stress induced by CP, thus promoting the proliferation of hair follicle cells and reversing AA. These results provide a theoretical basis for understanding the anti-AA mechanism of CE-OA, indicating that CE can be used as raw material for developing oral hair growth drugs.
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Affiliation(s)
- Tao Li
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Guiming Zhang
- Liaoning Xinzhong Modern Medicine Co., Ltd., Benxi 117002, China
| | - Xinyang Zhou
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Jian Guan
- Liaoning Xinzhong Modern Medicine Co., Ltd., Benxi 117002, China
| | - Wenjie Zhao
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Yifei Zheng
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Jungjoon Lee
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Peng Wang
- ORxes Therapeutics (Shanghai) Co., Ltd., Shanghai, 200120, China.
| | - Yuqing Zhao
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji 133002, China.
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4
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Gupta AK, Taylor D, Ravi SP, Wang T, Talukder M. A bibliometric analysis of alternative drug therapy options in the treatment of androgenetic alopecia. J Cosmet Dermatol 2024; 23:3287-3294. [PMID: 38873787 DOI: 10.1111/jocd.16427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/19/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Oral finasteride and topical minoxidil formulations are the only FDA-approved drug therapies for androgenetic alopecia (AGA). Research into dutasteride, topical finasteride, and nontopical minoxidil (low-dose oral and sublingual) formulations in the treatment of AGA has spiked within recent years. Early findings show that these alternative drug therapies may have similar to improved efficacy and safety profiles relative to the conventional treatment options. AIMS Conducting a bibliometric analysis, compare trends in publications on these alternative drug therapies, identify key contributors, evaluate major findings from top-cited articles, and elucidate gaps in evidence. METHODS A search was conducted on the Web of Science database for publications on the use of alternative drug therapies in the treatment of AGA. A total of 95 publications, published between January 2003-March 2024, and their citation metadata were included in the analysis. RESULTS Dutasteride showed the greatest (n = 37) and longest (20+ years) history of publications, as well as the highest cumulative citations (n = 914); however, nontopical minoxidil showed a burst in research activity within the last 5 years (n = 33 publications since 2019). A relatively low number of randomized control trials (n = 3) for nontopical minoxidil suggests a need for higher-quality evidence. CONCLUSIONS Our analysis reveals major trends, contributors, and gaps in evidence for alternative drug therapies for AGA, which can help inform researchers on their future projects in this growing field of study. There is enthusiasm for exploring off-label formulations: nontopical forms of minoxidil (oral and sublingual), topical finasteride, and mesotherapy.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Tong Wang
- Mediprobe Research Inc., London, Ontario, Canada
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5
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Pozo-Pérez L, Tornero-Esteban P, López-Bran E. Clinical and preclinical approach in AGA treatment: a review of current and new therapies in the regenerative field. Stem Cell Res Ther 2024; 15:260. [PMID: 39148125 PMCID: PMC11328498 DOI: 10.1186/s13287-024-03801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/11/2024] [Indexed: 08/17/2024] Open
Abstract
Androgenetic alopecia (AGA) is the most prevalent type of hair loss. Its morbility is mainly psychological although an increased incidence in melanoma has also been observed in affected subjects. Current drug based therapies and physical treatments are either unsuccessful in the long term or have relevant side effects that limit their application. Therefore, a new therapeutic approach is needed to promote regenerative enhancement alternatives. These treatment options, focused on the cellular niche restoration, could be the solution to the impact of dihydrotestosterone in the hair follicle microenvironment. In this context emerging regenerative therapies such as Platelet-rich plasma or Platelet-rich fibrine as well as hair follicle stem cells and mesenchymal stem cell based therapies and their derivatives (conditioned medium CM or exoxomes) are highlighting in the evolving landscape of hair restoration. Nanotechnology is also leading the way in AGA treatment through the design of bioinks and nanobiomaterials whose structures are being configuring in a huge range of cases by means of 3D bioprinting. Due to the increasing number and the rapid creation of new advanced therapies alternatives in the AGA field, an extended review of the current state of art is needed. In addition this review provides a general insight in current and emerging AGA therapies which is intented to be a guidance for researchers highlighting the cutting edge treatments which are recently gaining ground.
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Affiliation(s)
- Lorena Pozo-Pérez
- Dermatology Department, Clínico San Carlos Hospital, Madrid, Spain.
- Institute for Health Research of Clinico San Carlos Hospital (IdISSC), Madrid, Spain.
| | - Pilar Tornero-Esteban
- Cellular GMP Manufacturing Facility, Institute for Health Research of Clinico San Carlos Hospital (IdISSC), Madrid, Spain
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Nohria A, Desai D, Sikora M, Mandal S, Caplan A, Shapiro J, Sicco KIL. To evaluate hypertrichosis with low dose oral minoxidil and spironolactone combination therapy for alopecia. Arch Dermatol Res 2024; 316:510. [PMID: 39133327 DOI: 10.1007/s00403-024-03261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/19/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024]
Abstract
Low dose oral minoxidil (LDOM) is an efficacious and safe treatment for alopecia, however, a notable side effect is hypertrichosis. Spironolactone, known for treating hirsutism, is also used off-label for the treatment of certain forms of alopecia and may reduce LDOM-induced hypertrichosis. We performed a retrospective review of 54 patients seen at NYU Langone Health and compared hypertrichosis rates in female alopecia patients on LDOM monotherapy versus those on combination therapy with spironolactone. Among 54 patients, 37 received LDOM alone and 17 received the combination. Hypertrichosis developed in 33.3% of patients, with lower rates in the combination group (17.6% vs. 40.5% for monotherapy). Although not statistically significant, the trend suggests spironolactone may mitigate hypertrichosis. The study highlights the potential of combination therapy to address hypertrichosis and calls for larger studies to confirm these findings.
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Affiliation(s)
- Ambika Nohria
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA.
| | - Deesha Desai
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michelle Sikora
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
- New York Medical College, Valhalla, NY, USA
| | - Soutrik Mandal
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Avrom Caplan
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
| | - Kristen I Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
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7
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Desai DD, Nohria A, Sikora M, Anyanwu N, Shapiro J, Lo Sicco KI. Assessing low-dose oral minoxidil efficacy in androgenetic alopecia: a comparative study of AGA and AGA unmasked by telogen effluvium. Arch Dermatol Res 2024; 316:514. [PMID: 39133308 DOI: 10.1007/s00403-024-03257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 07/09/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024]
Abstract
Androgenetic alopecia (AGA) significantly impacts patients' psychological well-being, and treatment options have historically been limited. However, the advent of low-dose oral minoxidil (LDOM) has revolutionized AGA management. This study compares the treatment response and safety of LDOM in patients with AGA alone versus those with AGA unmasked by telogen effluvium. Our findings indicate that LDOM is effective and safe for both groups, showing comparable efficacy and safety profiles. These results support the use of LDOM as a reliable treatment option for AGA, potentially improving patient outcomes and quality of life.
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Affiliation(s)
- Deesha D Desai
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA.
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Ambika Nohria
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
| | - Michelle Sikora
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
- New York Medical College, Valhalla, NY, USA
| | - Nnaemeka Anyanwu
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
| | - Kristen I Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, USA
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8
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Hill RC, Wang Y, Shaikh B, Ong M, Christos PJ, Lipner SR. Spironolactone treatment for dermatologic indications is not associated with hypotension in a single-center retrospective study. J Am Acad Dermatol 2024; 90:1245-1247. [PMID: 38483433 PMCID: PMC11096061 DOI: 10.1016/j.jaad.2024.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 05/18/2024]
Affiliation(s)
| | - Yu Wang
- Department of Dermatology, Wake Forest School of Medicine, Wake Forest, North Carolina
| | - Bilal Shaikh
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Michael Ong
- Weill Cornell Medical College, New York, New York
| | - Paul J Christos
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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9
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Jha AK, Zeeshan MD, Singh A, Singh AK. Efficacy and safety of spironolactone versus bicalutamide in female pattern hair loss: A retrospective comparative study. Australas J Dermatol 2024. [PMID: 38762801 DOI: 10.1111/ajd.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/20/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Female-pattern hair loss (FPHL) is characterized by decreased scalp hair density, thinning of hair shafts, and progressive miniaturization of hair follicles. OBJECTIVE To compare the safety and efficacy of spironolactone versus bicalutamide in female pattern hair loss [FPHL]. METHODS The study design was retrospective, and all eligible females aged between 18 years and 50 years with FPHL were included. We identified 120 patients from our database who fulfilled the inclusion and exclusion criteria, and patients were then categorized into two groups, Group A comprising patients who were taking 100 mg of spironolactone once daily and Group B comprising patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2% in both groups. Patient were analysed at approximately at 24 weeks from the commencement of the treatment. RESULTS Mean reduction in hair loss severity score on Sinclair scale was 19.51% in spironolactone group compared to 28.20% in bicalutamide group at 24 weeks, which was statistically significant. On global photographic assessment, marked improvement was seen in bicalutamide group compared to spironolactone group (p = 0.139). CONCLUSIONS Our study, though limited by its retrospective design and small sample size, showed that bicalutamide has greater efficacy and better safety profile in comparison to spironolactone in the treatment of FPHL.
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Affiliation(s)
- Abhijeet Kumar Jha
- Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India
| | - M D Zeeshan
- Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India
| | - Anupama Singh
- Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India
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10
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Vandishi AK, Esmaeili A, Taghipour N. The promising prospect of human hair follicle regeneration in the shadow of new tissue engineering strategies. Tissue Cell 2024; 87:102338. [PMID: 38428370 DOI: 10.1016/j.tice.2024.102338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/11/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
Hair loss disorder (alopecia) affects numerous people around the world. The low effectiveness and numerous side effects of common treatments have prompted researchers to investigate alternative and effective solutions. Hair follicle (HF) bioengineering is the knowledge of using hair-inductive (trichogenic) cells. Most bioengineering-based approaches focus on regenerating folliculogenesis through manipulation of regulators of physical/molecular properties in the HF niche. Despite the high potential of cell therapy, no cell product has been produced for effective treatment in the field of hair regeneration. This problem shows the challenges in the functionality of cultured human hair cells. To achieve this goal, research and development of new and practical approaches, technologies and biomaterials are needed. Based on recent advances in the field, this review evaluates emerging HF bioengineering strategies and the future prospects for the field of tissue engineering and successful HF regeneration.
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Affiliation(s)
- Arezoo Karami Vandishi
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Esmaeili
- Student Research Committee, Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Taghipour
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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11
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Panchaprateep R. Medical Treatment for Androgenetic Alopecia. Facial Plast Surg 2024; 40:252-266. [PMID: 37871637 DOI: 10.1055/a-2196-4713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
Androgenetic alopecia is a common type of hair loss, which is generally influenced by genetic factors and systemic androgens resulting in follicular miniaturization.1 It can cause cosmetic problems leading to psychological distress among affected men and women. Effective standard medical treatments available are topical minoxidil 2 to 5%, oral finasteride, oral dutasteride, and hair transplantation.1 However, some patients do not achieve favorable results with standard treatments. For these reasons, other novel treatments have been developed, including new medications, regenerative medicines (autologous platelet-rich plasma, adipose-derived stem cells, micrograft generation, and exosome), and low-level laser therapy.
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Affiliation(s)
- Ratchathorn Panchaprateep
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Absolute Hair Clinic, Bangkok Thailand
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Vañó-Galván S, Fernandez-Crehuet P, Garnacho G, Gómez-Zubiaur A, Hermosa-Gelbard A, Moreno-Arrones OM, Saceda-Corralo D, Serrano-Falcón C. [Translated article] Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Hair Disorders Group of the Spanish Academy of Dermatology and Venererology (AEDV). ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T347-T355. [PMID: 38336246 DOI: 10.1016/j.ad.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 02/12/2024] Open
Abstract
Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Hair Disorders Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.
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Affiliation(s)
- S Vañó-Galván
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Madrid, Spain; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, Spain.
| | - P Fernandez-Crehuet
- Servicio de Dermatología, Hospital Universitario Reina Sofia, Córdoba, Spain; Clinica Fernández-Crehuet, Córdoba, Spain
| | - G Garnacho
- Servicio de Dermatología, Hospital Universitario Reina Sofia, Córdoba, Spain; Clinica Garnacho, Córdoba, Spain
| | - A Gómez-Zubiaur
- Unidad Capilar, Instituto Médico Ricart, Madrid, Spain; Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Príncipe Asturias, Madrid, Spain
| | - A Hermosa-Gelbard
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, Spain
| | - O M Moreno-Arrones
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, Spain
| | - D Saceda-Corralo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, Spain; Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, Madrid, Spain
| | - C Serrano-Falcón
- Unidad de Dermatología Medico Quirúrgica, Hospital Inmaculada, Granada, Spain; Clínica Dermatológica Serrano, Granada, Spain
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Vañó-Galván S, Fernandez-Crehuet P, Garnacho G, Gómez-Zubiaur A, Hermosa-Gelbard A, Moreno-Arrones OM, Saceda-Corralo D, Serrano-Falcón C. Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Trichology Group of the Spanish Academy of Dermatology and Venererology (AEDV). ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:347-355. [PMID: 37890616 DOI: 10.1016/j.ad.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Trichology Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.
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Affiliation(s)
- S Vañó-Galván
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Madrid, España; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, España.
| | - P Fernandez-Crehuet
- Servicio de Dermatología, Hospital Universitario Reina Sofia, Córdoba, España; Clinica Fernández-Crehuet, Córdoba, España
| | - G Garnacho
- Servicio de Dermatología, Hospital Universitario Reina Sofia, Córdoba, España; Clinica Garnacho, Córdoba, España
| | - A Gómez-Zubiaur
- Unidad Capilar, Instituto Médico Ricart, Madrid, España; Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Príncipe Asturias, Madrid, España
| | - A Hermosa-Gelbard
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, España
| | - O M Moreno-Arrones
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, España
| | - D Saceda-Corralo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, España; Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, Madrid, España
| | - C Serrano-Falcón
- Unidad de Dermatología Medico Quirúrgica, Hospital Inmaculada, Granada, España; Clínica Dermatológica Serrano, Granada, España
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14
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Rosenthal A, Conde G, Greco JF, Gharavi NM. Management of androgenic alopecia: a systematic review of the literature. J COSMET LASER THER 2024; 26:1-16. [PMID: 38852607 DOI: 10.1080/14764172.2024.2362126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 06/01/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
We aimed to determine the efficacy of the various available oral, topical, and procedural treatment options for hair loss in individuals with androgenic alopecia. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the National Library of Medicine was performed. Overall, 141 unique studies met our inclusion criteria. We demonstrate that many over the counter (e.g. topical minoxidil, supplements, low-level light treatment), prescription (e.g. oral minoxidil, finasteride, dutasteride), and procedural (e.g. platelet-rich plasma, fractionated lasers, hair transplantation) treatments successfully promote hair growth, highlighting the superiority of a multifaceted and individualized approach to management.
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Affiliation(s)
- Amanda Rosenthal
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Geena Conde
- Department of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph F Greco
- Department of Research, Greco Hair Restoration, Sarasota, FL, USA
| | - Nima M Gharavi
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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15
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Gupta AK, Talukder M, Shemer A, Piraccini BM, Tosti A. Low-Dose Oral Minoxidil for Alopecia: A Comprehensive Review. Skin Appendage Disord 2023; 9:423-437. [PMID: 38376087 PMCID: PMC10806356 DOI: 10.1159/000531890] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 02/21/2024] Open
Abstract
Low-dose oral minoxidil (LDOM) has demonstrated a promising safety and efficacy profile in the treatment of various hair disorders, including male androgenetic alopecia (AGA) and female-pattern hair loss (FPHL); however, it lacks FDA approval. The usual LDOM starting dose for male AGA is 1-5 mg/day, depending on physician preference and the patient's condition. For FPHL, it is 0.5-1 mg/day. The maximum dose is generally 5 mg/day. If patients respond well without major side effects, the dose may be gradually increased since the LDOM's efficacy appears to be dose-dependent. Patients may use LDOM long term if the treatment outcome is satisfactory. The common side effects of LDOM are hypertrichosis and cardiovascular symptoms. Females are more prone to hypertrichosis than males. The side effects of LDOM can be categorized as (a) dose-dependent type A side effects (hypertrichosis and cardiovascular symptoms) and (b) idiosyncratic type B side effects (pericardial effusion). Minoxidil acts via multiple pathways. Although minoxidil has a relatively short half-life of around 4 h, its hypotensive effect may last approximately 72 h. Effective treatments for alopecia are limited. Therefore, LDOM could be an important addition to the available therapies for managing some hair disorders, including AGA.
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Affiliation(s)
- Aditya K. Gupta
- Mediprobe Research Inc., London, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mesbah Talukder
- Mediprobe Research Inc., London, ON, Canada
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
| | - Avner Shemer
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Antonella Tosti
- Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Wu X, Du YZ. Nanodrug Delivery Strategies to Signaling Pathways in Alopecia. Mol Pharm 2023; 20:5396-5415. [PMID: 37817669 DOI: 10.1021/acs.molpharmaceut.3c00620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Over 50% of the global population suffers from hair loss. The mixed results in the treatment of hair loss reveal the limitations of conventional commercial topical drugs. One the one hand, the definite pathogenesis of hair loss is still an enigma. On the other hand, targeted drug carriers ensure the drug therapeutic effect and low side effects. This review highlights the organization and overview of nine crucial signaling pathways associated with hair loss, as well as the development of nanobased topical delivery systems loading the clinical drugs, which will fuel emerging hair loss treatment strategies.
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Affiliation(s)
- Xiaochuan Wu
- Jinhua Institute of Zhejiang University, Jinhua, Zhejiang 321299, China
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - Yong-Zhong Du
- Jinhua Institute of Zhejiang University, Jinhua, Zhejiang 321299, China
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China
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17
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Santana FDFV, Lozi AA, Gonçalves RV, Da Silva J, Da Matta SLP. Comparative effects of finasteride and minoxidil on the male reproductive organs: A systematic review of in vitro and in vivo evidence. Toxicol Appl Pharmacol 2023; 478:116710. [PMID: 37805090 DOI: 10.1016/j.taap.2023.116710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023]
Abstract
Finasteride and minoxidil are medicaments commonly prescribed for treating benign prostatic hyperplasia (BPA), hypertension, and/or androgenetic alopecia (AGA). The mechanism of action of finasteride is based on the interference in androgenic pathways, which may lead to fertility-related disorders in men. Minoxidil, however, can act in multiple ways, and there is no consensus that its use can adversely affect male fertility. Since finasteride and minoxidil could be risk factors for male fertility, we aimed to compare their impact on the two reproductive organs testis and epididymis of adult murine models, besides testis/epididymis-related cells, and describe the mechanism of action involved. For such, we used the PRISMA guideline. We included 31 original studies from a structured search on PubMed/MEDLINE, Scopus, and Web of Science databases. For in vivo studies, the bias analysis and the quality of the studies were assessed as described by SYRCLE (Systematic Review Centre for Laboratory Animal Experimentation). We concluded that finasteride and minoxidil act as hormone disruptors, causing oxidative stress and morphological changes mainly in the testis. Our results also revealed that finasteride treatment could be more harmful to male reproductive health because it was more associated with reproductive injuries, including damage to the epididymis, erectile dysfunction, decreased libido, and reduced semen volume. Thus, this study contributes to the global understanding of the mechanisms by which medicaments used for alopecia might lead to male reproductive disorders. We hope that our critical analysis expedites clinical research and reduces methodological bias. The registration number on the Prospero platform is CRD42022313347.
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Affiliation(s)
| | - Amanda Alves Lozi
- Department of General Biology, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Reggiani Vilela Gonçalves
- Department of Animal Biology, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil; Department of General Biology, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Janaina Da Silva
- Institut de recherche en santé, environnement et travail (Irset) - UMR 1085, Institut national de la santé et de la recherche médicale (Inserm), Université de Rennes, Rennes, France
| | - Sérgio Luis Pinto Da Matta
- Department of Animal Biology, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil; Department of General Biology, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
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18
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Kang MS, Park TE, Jo HJ, Kang MS, Lee SB, Hong SW, Kim KS, Han DW. Recent Trends in Macromolecule-Based Approaches for Hair Loss Treatment. Macromol Biosci 2023; 23:e2300148. [PMID: 37245081 DOI: 10.1002/mabi.202300148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/21/2023] [Indexed: 05/29/2023]
Abstract
Macromolecules are large, complex molecules composed of smaller subunits known as monomers. The four primary categories of macromolecules found in living organisms are carbohydrates, lipids, proteins, and nucleic acids; they also encompass a broad range of natural and synthetic polymers. Recent studies have shown that biologically active macromolecules can help regenerate hair, providing a potential solution for current hair regeneration therapies. This review examines the latest developments in the use of macromolecules for the treatment of hair loss. The fundamental principles of hair follicle (HF) morphogenesis, hair shaft (HS) development, hair cycle regulation, and alopecia have been introduced. Microneedle (MN) and nanoparticle (NP) delivery systems are innovative treatments for hair loss. Additionally, the application of macromolecule-based tissue-engineered scaffolds for the in vitro and in vivo neogenesis of HFs is discussed. Furthermore, a new research direction is explored wherein artificial skin platforms are adopted as a promising screening method for hair loss treatment drugs. Through these multifaceted approaches, promising aspects of macromolecules for future hair loss treatments are identified.
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Affiliation(s)
- Moon Sung Kang
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, 46241, Republic of Korea
| | - Tae Eon Park
- School of Chemical Engineering, Pusan National University, Busan, 46241, Republic of Korea
| | - Hyo Jung Jo
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, 46241, Republic of Korea
| | - Min Seok Kang
- School of Chemical Engineering, Pusan National University, Busan, 46241, Republic of Korea
| | - Su Bin Lee
- School of Chemical Engineering, Pusan National University, Busan, 46241, Republic of Korea
| | - Suck Won Hong
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, 46241, Republic of Korea
- Engineering Research Center for Color-Modulated Extra-Sensory Perception Technology, Pusan National University, Busan, 46241, Republic of Korea
| | - Ki Su Kim
- School of Chemical Engineering, Pusan National University, Busan, 46241, Republic of Korea
- Institute of Advanced Organic Materials, Pusan National University, Busan, 46241, Republic of Korea
| | - Dong-Wook Han
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, 46241, Republic of Korea
- BIO-IT Fusion Technology Research Institute, Pusan National University, Busan, 46241, Republic of Korea
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19
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Gao JL, Streed CG, Thompson J, Dommasch ED, Peebles JK. Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics. J Am Acad Dermatol 2023; 89:774-783. [PMID: 34756934 DOI: 10.1016/j.jaad.2021.08.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.
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Affiliation(s)
- Julia L Gao
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.
| | - Carl G Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts; Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts
| | | | - Erica D Dommasch
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jon Klinton Peebles
- Department of Dermatology, Kaiser-Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
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20
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Gao JL, Sanz J, Tan N, King DS, Modest AM, Dommasch ED. Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study. J Am Acad Dermatol 2023; 89:504-510. [PMID: 36780950 DOI: 10.1016/j.jaad.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. OBJECTIVE We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. METHODS Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. RESULTS TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). LIMITATIONS Inability to determine causation and limited generalizability. CONCLUSION TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.
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Affiliation(s)
- Julia L Gao
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Dartmouth Health, Lebanon, New Hampshire; George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Jessika Sanz
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; New York Institute College of Osteopathic Medicine, Jonesboro, Arkansas
| | - Nicholas Tan
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Case Western University School of Medicine, Cleveland, Ohio
| | - Dana S King
- Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Erica D Dommasch
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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21
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Goldberg LJ. Alopecia - New building blocks. J Am Acad Dermatol 2023; 89:S1-S2. [PMID: 37591559 DOI: 10.1016/j.jaad.2023.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 08/19/2023]
Abstract
Hair loss is devastating to the patient, but the diagnosis and treatment of alopecia are also difficult for primary care providers and even dermatologists. Given recent advances in the field, there has never been a more pressing time to reevaluate and improve upon the significant clinical skills needed to accurately diagnose and treat our patients with hair loss. This CME activity on alopecia is designed to (1) educate dermatologists in a simple, succinct fashion on the identification of, and the distinction between, the diverse types of hair loss and (2) discuss how to manage them.
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Affiliation(s)
- Lynne J Goldberg
- Department of Dermatology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Boston Medical Center, Boston, Massachusetts.
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22
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Aleissa M. The Efficacy and Safety of Oral Spironolactone in the Treatment of Female Pattern Hair Loss: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e43559. [PMID: 37719557 PMCID: PMC10502763 DOI: 10.7759/cureus.43559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Oral spironolactone has been proposed as a potential treatment for hair loss due to its antiandrogenic properties. However, the efficacy and safety of spironolactone for treating hair loss are not well-established. The objective of this study was to conduct a systematic review of the current literature on the use of oral spironolactone in female pattern hair loss. We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies that assessed the efficacy and safety of oral spironolactone for treating hair loss. We searched for eligible papers in PubMed, Web of Science (ISI), Embase, and Scopus. All analyses were done using R software version 4.2.3 (R Foundation for Statistical Computing, Vienna, Austria). The overall rate of improved hair loss was 56.60%, with a higher rate of improvement (65.80%) observed in the combined therapy group compared to the monotherapy group (43.21%). However, there was significant heterogeneity in the efficacy outcomes, and hair loss did not improve or showed a modest improvement in 37.80% of all patients. The rates of adverse events reported in at least two studies were scalp pruritus or increased scurf (18.92%), menstrual disorders (11.85%), facial hypertrichosis (6.93%), and drug discontinuation (2.79%). The overall adverse events rate was 3.69%, but there was significant heterogeneity in the rates of different adverse events. In conclusion, the present study suggests that spironolactone is an effective and safe treatment option for hair loss. However, further research is needed to fully understand the heterogeneity of treatment response and adverse events and identify factors that may predict treatment response.
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Affiliation(s)
- Majed Aleissa
- Department of Dermatology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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23
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Sand J, Walen S. Noninvasive Hair Rejuvenation. Clin Plast Surg 2023; 50:509-520. [PMID: 37169416 DOI: 10.1016/j.cps.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Both nonsurgical and surgical modalities for the treatment of hair loss are being used by providers at an increasing rate worldwide. Men and woman are affected by hair loss, but the pathophysiology of the hair loss is thought to be different between sexes; therefore, gender must play a role in treatment decisions. Currently, there are 3 Food and Drug Administration-approved nonsurgical androgenetic alopecia treatments: minoxidil, finasteride, and low-light laser therapy. Platelet-rich plasma injections are showing promise as a single modality and as an adjunct to other nonsurgical and surgical treatments of androgenetic alopecia.
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Affiliation(s)
- Jordan Sand
- Spokane Center for Facial Plastic Surgery, 217 W. Cataldo Avenue, Spokane, WA 99201, USA
| | - Scott Walen
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive H-091, Hershey, PA 17033, USA.
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24
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Desir N, Desai AD, Jafari A, Lipner SR. Insights Into Perceptions and Gender Differences About Androgenetic Alopecia in an Observational Study of Commenters on the New York Times Oral Minoxidil Article. J Cutan Med Surg 2023; 27:399-400. [PMID: 37083142 DOI: 10.1177/12034754231170215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Noelle Desir
- Weill Cornell Medical College, New York, NY, USA
| | - Amar D Desai
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Alexander Jafari
- Department of Dermatology, Tulane University, New Orleans, LA, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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25
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Kaiser M, Abdin R, Gaumond SI, Issa NT, Jimenez JJ. Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs. Clin Cosmet Investig Dermatol 2023; 16:1387-1406. [PMID: 37284568 PMCID: PMC10239632 DOI: 10.2147/ccid.s385861] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.
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Affiliation(s)
- Michael Kaiser
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rama Abdin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Simonetta I Gaumond
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Naiem T Issa
- Forefront Dermatology, Vienna, VA, USA
- Issa Research and Consulting, LLC, Springfield, VA, USA
| | - Joaquin J Jimenez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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26
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Deoghare S, Sadick NS. Combination therapy in female pattern hair loss. J COSMET LASER THER 2023; 25:1-6. [PMID: 37289953 DOI: 10.1080/14764172.2023.2222942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/04/2023] [Indexed: 06/10/2023]
Abstract
Patterned hair loss is a common type of non-scarring alopecia, characterized by miniaturization of hair follicles. The etiology of female pattern hair loss (FPHL) is not clearly linked to androgens or other hormones thereby making it a challenging condition to treat. Various treatment modalities, like minoxidil (topical or oral), spironolactone, finasteride, have been tried alone or in combination with variable results. Combination therapy is superior to the monotherapy, since these multiple treatment modalities act by targeting different pathogenetic pathways, making the treatment aggressive and more effective.
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Affiliation(s)
- Shreya Deoghare
- AHRS Fellow, Sadick Dermatology, New York, USA and Senior Resident, Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pune, India
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Devjani S, Ezemma O, Kelley KJ, Stratton E, Senna M. Androgenetic Alopecia: Therapy Update. Drugs 2023; 83:701-715. [PMID: 37166619 PMCID: PMC10173235 DOI: 10.1007/s40265-023-01880-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
Androgenetic alopecia (AGA), also known as male pattern hair loss (MPHL) or female pattern hair loss (FPHL), is the most common form of alopecia worldwide, and arises from an excessive response to androgens. AGA presents itself in a characteristic distribution unique to both sexes. Despite its prevalence, AGA can be quite challenging to treat. The condition is chronic in nature and stems from an interplay of genetic and environmental factors. There are only two US Food and Drug Administration (FDA)-approved drugs for the condition: topical minoxidil and oral finasteride. However, numerous non-FDA-approved treatments have been shown to be effective in treating AGA in various studies. Some of these treatments are relatively new and still to be explored, thus emphasizing the need for an updated review of the literature. In this comprehensive review, we discuss the evaluation of AGA and the mechanisms of action, costs, efficacies, and safety profiles of existing, alternative, and upcoming therapeutics for this widespread condition.
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Affiliation(s)
- Shivali Devjani
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Ogechi Ezemma
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Kristen J Kelley
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Emma Stratton
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA
| | - Maryanne Senna
- Department of Dermatology, Lahey Hospital and Medical Center, 67 South Bedford St, #100, Burlington, MA, 01803, USA.
- Harvard Medical School, Boston, MA, USA.
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Kinoshita-Ise M, Fukuyama M, Ohyama M. Recent Advances in Understanding of the Etiopathogenesis, Diagnosis, and Management of Hair Loss Diseases. J Clin Med 2023; 12:jcm12093259. [PMID: 37176700 PMCID: PMC10179687 DOI: 10.3390/jcm12093259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Hair-loss diseases comprise heterogenous conditions with respective pathophysiology and clinicopathological characteristics. Major breakthroughs in hair follicle biology and immunology have led to the elucidation of etiopathogenesis of non-scarring alopecia (e.g., alopecia areata, AA) and cicatricial alopecia (e.g., lichen planopilaris, LPP). High-throughput genetic analyses revealed molecular mechanism underlying the disease susceptibility of hair loss conditions, such as androgenetic alopecia (AGA) and female pattern hair loss (FPHL). Hair loss attracted public interest during the COVID-19 pandemic. The knowledge of hair loss diseases is robustly expanding and thus requires timely updates. In this review, the diagnostic and measurement methodologies applied to hair loss diseases are updated. Of note, novel criteria and classification/scoring systems published in the last decade are reviewed, highlighting their advantages over conventional ones. Emerging diagnostic techniques are itemized with clinical pearls enabling efficient utilization. Recent advances in understanding the etiopathogenesis and management for representative hair diseases, namely AGA, FPHL, AA, and major primary cicatricial alopecia, including LPP, are comprehensively summarized, focusing on causative factors, genetic predisposition, new disease entity, and novel therapeutic options. Lastly, the association between COVID-19 and hair loss is discussed to delineate telogen effluvium as the predominating pathomechanism accounting for this sequela.
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Affiliation(s)
- Misaki Kinoshita-Ise
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
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Godse K, De A, Vedamurthy M, Shankar DSK, Shah B, Girdhar M, Bhat R, Ganjoo A, Tahiliani S, Patil A. Low-dose Oral Minoxidil in the Treatment of Alopecia: Evidence and Experience-based Consensus Statement of Indian Experts. Int J Trichology 2023; 15:91-97. [PMID: 38179013 PMCID: PMC10763725 DOI: 10.4103/ijt.ijt_70_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/09/2023] [Indexed: 01/06/2024] Open
Abstract
Alopecia is a highly prevalent condition worldwide including in India. There are different types of alopecia with differing etiology, presentation, and hence treatment. Androgenetic alopecia represents the most common form of hair loss affecting male as well as female population termed as male and female pattern hair loss, respectively. Several treatment options are available for the treatment of alopecia with often unsatisfactory results resulting in psychological distress among such patients. Topical minoxidil is known to be effective in the treatment of alopecia. However, oral minoxidil is not currently approved for the treatment of alopecia. This expert consensus is prepared to provide guidance to the clinicians regarding the use of oral minoxidil in the treatment of alopecia. Extensive literature review was performed to prepare the draft consensus which was then revised based on the suggestions and comments from the experts. The final draft was circulated to the experts for review and approval. This consensus document provides overview of evidence related to oral minoxidil and consensus from the experts for its use in the treatment of minoxidil.
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Affiliation(s)
- Kiran Godse
- Department of Dermatology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Maya Vedamurthy
- RSV Skin and Research Centre, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - D. S. Krupa Shankar
- Department of Dermatology, Krupa Shankar Skin Care Center, Mallige Hospital, Bengaluru, India
| | - Bela Shah
- Department of Dermatology, BJ Medical College, Ahmedabad, Gujarat, India
| | - Mukesh Girdhar
- Department of Dermatology, Max Super Speciality Hospital, New Delhi, Delhi, India
| | - Ramesh Bhat
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Anil Ganjoo
- Department of Dermatology and Venereology, Saroj Hospital and Heart Institute, New Delhi, Delhi, India
| | - Sushil Tahiliani
- Department of Dermatology, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
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Müller Ramos P, Melo DF, Radwanski H, de Almeida RFC, Miot HA. Female pattern hair loss: therapeutic update. An Bras Dermatol 2023:S0365-0596(23)00053-3. [PMID: 37003900 DOI: 10.1016/j.abd.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 04/03/2023] Open
Abstract
Female androgenetic alopecia or female-pattern hair loss (FPHL) is highly prevalent and has a great impact on the quality of life. The treatment is a routine challenge in dermatological practice, as many therapeutic options have a limited level of evidence and often do not meet patients expectations. Lack of knowledge of the pathogenesis of the hair miniaturization process and the factors that regulate follicular morphogenesis restricts the prospect of innovative therapies. There is also a lack of randomized, controlled studies with longitudinal follow-up, using objective outcomes and exploring the performance of the available treatments and their combinations. Topical minoxidil, which has been used to treat female pattern hair loss since the 1990s, is the only medication that has a high level of evidence and remains the first choice. However, about 40% of patients do not show improvement with this treatment. In this article, the authors critically discuss the main clinical and surgical therapeutic alternatives for FPHL, as well as present camouflage methods that can be used in more extensive or unresponsive cases.
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Affiliation(s)
- Paulo Müller Ramos
- Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Daniel Fernandes Melo
- Department of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Hélio Amante Miot
- Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Wikramanayake TC, Haberland NI, Akhundlu A, Laboy Nieves A, Miteva M. Prevention and Treatment of Chemotherapy-Induced Alopecia: What Is Available and What Is Coming? Curr Oncol 2023; 30:3609-3626. [PMID: 37185388 PMCID: PMC10137043 DOI: 10.3390/curroncol30040275] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Millions of new cancer patients receive chemotherapy each year. In addition to killing cancer cells, chemotherapy is likely to damage rapidly proliferating healthy cells, including the hair follicle keratinocytes. Chemotherapy causes substantial thinning or loss of hair, termed chemotherapy-induced alopecia (CIA), in approximately 65% of patients. CIA is often ranked as one of the most distressing adverse effects of chemotherapy, but interventional options have been limited. To date, only scalp cooling has been cleared by the US Food and Drug Administration (FDA) to prevent CIA. However, several factors, including the high costs not always covered by insurance, preclude its broader use. Here we review the current options for CIA prevention and treatment and discuss new approaches being tested. CIA interventions include scalp cooling systems (both non-portable and portable) and topical agents to prevent hair loss, versus topical and oral minoxidil, photobiomodulation therapy (PBMT), and platelet-rich plasma (PRP) injections, among others, to stimulate hair regrowth after hair loss. Evidence-based studies are needed to develop and validate methods to prevent hair loss and/or accelerate hair regrowth in cancer patients receiving chemotherapy, which could significantly improve cancer patients’ quality of life and may help improve compliance and consequently the outcome of cancer treatment.
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32
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Feaster B, Onamusi T, Cooley JE, McMichael AJ. Oral minoxidil use in androgenetic alopecia and telogen effluvium. Arch Dermatol Res 2023; 315:201-205. [PMID: 35244759 DOI: 10.1007/s00403-022-02331-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 11/27/2022]
Abstract
While current studies have supported oral minoxidil as a novel, adjunctive therapy in non-scarring forms of alopecia, there continues to be limited data on oral minoxidil for these conditions. To assess oral minoxidil use in the treatment of androgenetic alopecia and telogen effluvium, a multi-center, retrospective analysis was conducted in 105 adult patients treated for androgenetic alopecia and/or telogen effluvium with oral minoxidil (dose range 0.625-2.5 mg) once daily for ≥ 52 weeks, case matched by age (± 5 years) and gender with 105 controls with androgenetic alopecia and/or telogen effluvium who were not treated with oral minoxidil. 80 women (76.2%) with a mean age of 57.5 ± 13.56 (range 24-80) and 25 men (23.8%) with a mean age of 40.4 ± 13.79 (range 19-63) were included. Efficacy was evaluated based on provider assessment of clinical response and clinical photographic evaluation using a 3-point scale (worsening, stabilization, and improvement). 52.4% of patients demonstrated clinical improvement and 42.9% demonstrated stabilization. There was a significant difference in clinical response between the patient and control group, p < 0.001. Retrospective study design. These results suggest that oral minoxidil can be an effective treatment in androgenetic alopecia and telogen effluvium.
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Affiliation(s)
- Brittany Feaster
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
| | - Toluwalashe Onamusi
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
| | | | - Amy J McMichael
- Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA.
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33
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John JM, Sinclair RD. Systemic minoxidil for hair disorders in pediatric patients: a safety and tolerability review. Int J Dermatol 2023; 62:257-259. [PMID: 35965281 DOI: 10.1111/ijd.16373] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/23/2022] [Accepted: 07/26/2022] [Indexed: 01/20/2023]
Abstract
Topical minoxidil has been used for many years to treat adult alopecia, and there is growing evidence supporting the off-label use of low-dose oral minoxidil (LDOM). However, there is little data on its use in pediatrics, and there are no recommended treatment guidelines. Adverse events are of particular concern in this population. We retrospectively reviewed the medical records of 63 patients aged between 0 and 12 years from a specialist hair clinic who were treated with LDOM or sublingual minoxidil (SM) to evaluate its safety and tolerability. LDOM and SM were generally well-tolerated, with mild hypertrichosis being the most commonly reported adverse event. Further large-scale studies are warranted to determine the efficacy and optimum dosage of systemic minoxidil for alopecia in the pediatric population.
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Affiliation(s)
- Jared M John
- Sinclair Dermatology, East Melbourne, Victoria, Australia
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34
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Gomes TF, Soares RO. Pediatric androgenetic alopecia: an updated review. J Dtsch Dermatol Ges 2023; 21:19-25. [PMID: 36688435 DOI: 10.1111/ddg.14940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023]
Abstract
Pediatric androgenetic alopecia is an underrecognized disorder. A clinical evaluation with trichoscopy should be made in children and adolescents with hair loss and/or reduced hair density. Diagnosis is usually clinical, by observation of the hair loss pattern and performance of trichoscopy. In some cases, hyperandrogenism should be excluded. Although there is no approved therapy for androgenetic alopecia in pediatric age, topical minoxidil, oral minoxidil and topical finasteride may be very useful. Hair transplant may be an option for girls in selected cases. This article is a review of the current state of evidence concerning pediatric androgenetic alopecia.
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35
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Wang C, Du Y, Bi L, Lin X, Zhao M, Fan W. The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review. Clin Cosmet Investig Dermatol 2023; 16:603-612. [PMID: 36923692 PMCID: PMC10010138 DOI: 10.2147/ccid.s398950] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Introduction Androgenetic alopecia (AGA) has negative impacts on both men and women in terms of appearance and mental stress. Spironolactone is a synthetic aldosterone receptor antagonist known to stimulate hair growth and has been widely used by dermatologists to treat AGA. Objective To conduct a systematic review evaluating the efficacy and safety of topical and oral spironolactone in AGA treatment. Methods We searched PubMed, Embase, the Cochrane Library, and the Web of Science until October 23rd, 2022, for human studies evaluating the efficacy of spironolactone for the treatment of AGA, regardless of doses and routes. Results We retrieved 784 papers and ultimately 7 articles matched our inclusion criteria and comprised 618 AGA patients (65 men, 553 women), 414 of them received spironolactone treatment. Oral spironolactone doses ranged from 25mg to 200mg daily, with the vast majority between 80mg and 110 mg. Dosage forms for topical spironolactone use include gels of 1% and solutions of 5% twice daily. Both oral and topical spironolactone have been shown efficacy for alopecia recovery, but topical use has significantly fewer side effects and is suitable for any gender. It showed better efficacy in combination with other therapies such as oral or topical minoxidil compared with monotherapy. Conclusion Spironolactone is an effective and safe treatment of androgenic alopecia which can enhance the efficacy when combined with other conventional treatments such as minoxidil. Topical spironolactone is safer than oral administration and is suitable for both male and female patients, and is expected to become a common drug for those who do not have a good response to minoxidil. Furthermore, more high-quality clinical randomized controlled studies should be performed.
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Affiliation(s)
- Chaofan Wang
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yimei Du
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Lingbo Bi
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xuewen Lin
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Min Zhao
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Weixin Fan
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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36
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Gomes TF, Soares RO. Aktuelle Übersicht zur androgenetischen Alopezie bei Kindern und Jugendlichen. J Dtsch Dermatol Ges 2023; 21:19-26. [PMID: 36721944 DOI: 10.1111/ddg.14940_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023]
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Anti-Alopecia Activity of Alkaloids Group from Noni Fruit against Dihydrotestosterone-Induced Male Rabbits and Its Molecular Mechanism: In Vivo and In Silico Studies. Pharmaceuticals (Basel) 2022; 15:ph15121557. [PMID: 36559008 PMCID: PMC9784383 DOI: 10.3390/ph15121557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
Androgenic alopecia (AA) is a condition that most commonly affects adult men and is caused by an increase in the hormone dihydrotestosterone (DHT) in the hair follicles. Anti-alopecia drugs should be discovered for hair follicles to enter the anagen growth phase. Therefore, this study evaluated the hair growth-promoting activity of Noni fruit’s water, ethyl acetate, n-hexane fractions, and sub-fractions from the active fraction in the alopecia male white rabbit model. The Matias method was modified by inducing rabbits using DHT for 17 days, followed by topical application of Noni fruit solution for 21 days. Meanwhile, hair growth was evaluated by histological observation of the follicular density and the anagen/telogen (A/T) ratio in skin tissue. In the first stage, five groups of male white rabbits were studied to obtain the active fraction; DHT+Minoxidil as standard, DHT+vehicle (NaCMC 1%), DHT+FW, DHT+FEA, and DHT+FH. The FEA as the active fraction was followed by open-column chromatography separation (DCM:Methanol) with a gradient of 10% to produce sub-fractions. In the second stage, the six main sub-fraction groups of male rabbits studied were DHT+FEA-1 to DHT+FEA-6. The follicular density of groups FEA-3 was 78.00 ± 1.52 compared with 31.55 ± 1.64 and 80.12 ± 1.02 in the Vehicle and Minoxidil groups. Additionally, group FEA-3 showed large numbers of anagen follicles with an A/T ratio of 1.64/1 compared to the vehicle group of 1/1.50 and 1.39/1 for Minoxidil control. Group FEA-3 was identified by LC-MS/MS-QTOF, followed by molecular docking to the androgen receptor (PDB: 4K7A), causing alopecia. The results showed that three alkaloid compounds with skeleton piperazine and piperidine, namely (compounds 2 (−4.99 Kcal/mol), 3 (−4.60 Kcal/mol), and 4 (−4.57 Kcal/mol)) had a binding affinity similar to Minoxidil, with also has alkaloid skeleton piperidine−pyrimidine (−4.83 Kcal/mol). The dynamic behavior showed the stability of all androgen receptor compounds with good RMSD, SMSF, and SASA values after being studied with 100 ns molecular dynamics (MD) simulations. This study produced a common thread in discovering a class of alkaloid compounds as inhibitors of androgen receptors that cause alopecia.
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Xu K, Yu E, Wu M, Wei P, Yin J. Cells, growth factors and biomaterials used in tissue engineering for hair follicles regeneration. Regen Ther 2022; 21:596-610. [DOI: 10.1016/j.reth.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
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Affiliation(s)
- Ronan Talty
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Brett King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
- Correspondence to: Brett King, MD, PhD, Department of Dermatology, Yale School of Medicine, 333 Cedar St, LCI 501, PO Box 208059, New Haven, CT 06510.
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40
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Modha JD, Pathania YS. Comprehensive review of oral minoxidil in alopecia. J Cosmet Dermatol 2022; 21:5527-5531. [PMID: 36065675 DOI: 10.1111/jocd.15324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/08/2022] [Accepted: 08/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND There have been various treatment modalities available for alopecia in the form of topical and systemic with a variable response. The compliance of the patients is important in reaping results in alopecia. Minoxidil has come a long-way finding its use from topical formulations to systemic at lower dose in different alopecia. OBJECTIVE The objective of this article is to discuss various conditions in alopecia where oral minoxidil has found its role. METHODS A comprehensive literature search was performed relating to oral minoxidil role in various alopecia. Various clinical trials, case series, and case reports were searched on PubMed and Google Scholar. The references of available studies were also reviewed to collect the additional resources. Available data from various studies and case reports were collected and consolidated to provide a concise overview of oral minoxidil indications in various alopecia. RESULTS Oral minoxidil has been used in various non-scarring and scarring alopecia at a lower dosage with less side effects and with promising results. Androgenetic alopecia and female pattern hair loss were the two conditions where it has been used more commonly than other alopecia, providing a ray of hope along with overcoming the issues related to topical formulations and compliance.
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Affiliation(s)
- Jay D Modha
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Rajkot, India
| | - Yashdeep Singh Pathania
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Rajkot, India
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41
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Noninvasive Hair Rejuvenation. Facial Plast Surg Clin North Am 2022; 30:419-431. [DOI: 10.1016/j.fsc.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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42
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Medina DAA, Cazarín J, Magaña M. Spironolactone in Dermatology. Dermatol Ther 2022; 35:e15321. [DOI: 10.1111/dth.15321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jorge Cazarín
- Service of Dermatoloy Hospital General de México “Dr. Eduardo Liceada”, S.S. Ministry of Health
| | - Mario Magaña
- Service of Dermatoloy Hospital General de México “Dr. Eduardo Liceada”, S.S. Ministry of Health
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Trüeb RM. Understanding Pattern Hair Loss-Hair Biology Impacted by Genes, Androgens, Prostaglandins and Epigenetic Factors. Indian J Plast Surg 2022; 54:385-392. [PMID: 34984074 PMCID: PMC8719969 DOI: 10.1055/s-0041-1739252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pattern hair loss (PHL) is the most frequent cause of hair loss in men and women, accounting for 65% of consultations in a hair referral center. PHL is understood to represent a hereditary, age-dependent progressive thinning of the scalp hair, which follows distinct clinical patterns with notable differences depending on sex and age of onset. Clinical and investigative advances have helped us to understand some of the pathogenic steps, leading to PHL. Besides genetic factors and peculiarities of androgen metabolism, additional pathogenic factors that are suspected include microbiomata, oxidative stress, and microinflammation. While further suspects are likely to be exposed, individual diversity of causal agents, as well as of the sequence of events, or combined factors, must be kept in mind. A large number of therapeutic molecules claimed to be active and patented in this field, and their limited efficacy in offering a definitive cure of PHL confirm the complexity of PHL. The aim of therapy is to retard progression of hair thinning and increase hair coverage of the scalp. As yet, two FDA-approved drugs are available for this purpose, oral finasteride, and topical solution of minoxidil. Variations in posology and formulation allow for an enhancement of patient comfort and treatment efficacy. Antiandrogen treatments in women with normal androgen levels have questionable efficacy while having health risks.
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Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Switzerland
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44
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Randomized clinical trial of low-dose oral minoxidil for the treatment of female pattern hair Loss: 0.25 mg versus 1 mg. J Am Acad Dermatol 2022; 87:396-399. [DOI: 10.1016/j.jaad.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
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45
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Kowe P, Madke B, Bansod S. Oral minoxidil in trichology: A review. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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46
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Nestor MS, Ablon G, Gade A, Han H, Fischer DL. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. J Cosmet Dermatol 2021; 20:3759-3781. [PMID: 34741573 PMCID: PMC9298335 DOI: 10.1111/jocd.14537] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 01/05/2023]
Abstract
Background Androgenetic alopecia (AGA) is the most common form of hair loss consisting of a characteristic receding frontal hairline in men and diffuse hair thinning in women, with frontal hairline retention, and can impact an individual's quality of life. The condition is primarily mediated by 5‐alpha‐reductase and dihydrotestosterone (DHT) which causes hair follicles to undergo miniaturization and shortening of successive anagen cycles. Although a variety of medical, surgical, light‐based and nutraceutical treatment options are available to slow or reverse the progression of AGA, it can be challenging to select appropriate therapies for this chronic condition. Aims To highlight treatment options for androgenetic alopecia taking into consideration the efficacy, side effect profiles, practicality of treatment (compliance), and costs to help clinicians offer ethically appropriate treatment regimens to their patients. Materials and Methods A literature search was conducted using electronic databases (Medline, PubMed, Embase, CINAHL, EBSCO) and textbooks, in addition to the authors' and other practitioners' clinical experiences in treating androgenetic alopecia, and the findings are presented here. Results Although topical minoxidil, oral finasteride, and low‐level light therapy are the only FDA‐approved therapies to treat AGA, they are just a fraction of the treatment options available, including other oral and topical modalities, hormonal therapies, nutraceuticals, PRP and exosome treatments, and hair transplantation. Discussion Androgenetic alopecia therapy remains challenging as treatment selection involves ethical, evidence‐based decision‐making and consideration of each individual patient's needs, compliance, budget, extent of hair loss, and aesthetic goals, independent of potential financial benefits to the practitioners.
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Affiliation(s)
- Mark S Nestor
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, Florida, USA.,Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Glynis Ablon
- Ablon Skin Institute & Research Center, Manhattan Beach, California, USA.,Department of Dermatology, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Anita Gade
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
| | - Haowei Han
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
| | - Daniel L Fischer
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
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Moussa A, Kazmi A, Bokhari L, Sinclair RD. Bicalutamide improves minoxidil-induced hypertrichosis in female pattern hair loss: A retrospective review of 35 patients. J Am Acad Dermatol 2021; 87:488-490. [PMID: 34740752 DOI: 10.1016/j.jaad.2021.10.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/12/2021] [Accepted: 10/25/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | - Ahmed Kazmi
- Sinclair Dermatology, Melbourne, Victoria, Australia
| | - Laita Bokhari
- Sinclair Dermatology, Melbourne, Victoria, Australia
| | - Rodney D Sinclair
- Sinclair Dermatology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
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48
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Rudnicka L. The changing landscape of managing hair loss: a 30-year perspective. J Eur Acad Dermatol Venereol 2021; 35:2123-2124. [PMID: 34647660 DOI: 10.1111/jdv.17651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Yin L, Svigos K, Gutierrez D, Peterson E, Lo Sicco K, Shapiro J. Low-dose oral minoxidil increases hair density and thickness in androgenetic alopecia: a retrospective analysis of 60 patients. J Eur Acad Dermatol Venereol 2021; 36:e200-e202. [PMID: 34637178 DOI: 10.1111/jdv.17731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/18/2021] [Accepted: 09/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- L Yin
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - K Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - D Gutierrez
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - E Peterson
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - K Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - J Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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Vahabi-Amlashi S, Layegh P, Kiafar B, Hoseininezhad M, Abbaspour M, Khaniki SH, Forouzanfar M, Sabeti V. A randomized clinical trial on therapeutic effects of 0.25 mg oral minoxidil tablets on treatment of female pattern hair loss. Dermatol Ther 2021; 34:e15131. [PMID: 34529341 DOI: 10.1111/dth.15131] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
Topical minoxidil solution is recommended treatment for female pattern hair loss. However, some complications, such as skin allergies, have prevented some patients from completely receiving this treatment. This study intends to evaluate the therapeutic and side effects of oral minoxidil 0.25 mg tablets treatment on FPHL and compare it with conventional treatment of 2% topical minoxidil. This study is a triple-blind randomized clinical trial in which 72 women with FPHL were treated as two separate groups. Group 1 was treated with oral minoxidil 0.25 mg tablets and topical placebo solution, while topical minoxidil solutions and oral placebo tablets were used to treat group 2 patients. In the oral minoxidil group, the average hair diameter and hair density after the 9-month treatment reached from 0.044 mm and 102 per cm2 to 0.048 mm and 115 per cm2 , respectively. In the topical minoxidil group, the average hair diameter and hair density from initial values of 0.044 mm and 107 per cm2 increased to 0.047 mm and 113 per cm2 . In both groups, the changes of hair diameter and hair density were significant compared to initial values (p < 0.001), while the trend of changes was not statically different between the two groups (p = 0.077, p = 0.674 for hair diameter and hair density, respectively) and side effects were trivial. In conclusion, oral minoxidil is an effective and new treatment for FPHL, even with a minimal dose, which can be used as an alternative treatment, especially for patients with poor compliance against topical minoxidil.
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Affiliation(s)
- Sadegh Vahabi-Amlashi
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouran Layegh
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Kiafar
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mohammadreza Abbaspour
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Hajebi Khaniki
- Student Research Committee, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Forouzanfar
- Electronics Group, Engineering Faculty, Birjand University, Birjand, Iran
| | - Vahideh Sabeti
- Resident of Dermatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Dermatology, Imam Reza Hospital, Mashhad, Iran
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