Both men and women suffer from hair loss, the hair loss can be temporary (Telogen Affluvium) or permanent as observed in medical condition of Alopecia Aerate resulting in male pattern baldness and female pattern baldness. The different hair restoration treatment options can broadly be categorized as medical hair restoration and surgical hair restoration.
Medical hair restoration includes all drugs or medicines which are available as hair loss restoration treatments for restoring genetically pre-disposed hair loss in men and women as well as for hair loss restoration in non genetic conditions. Though the various medical hair restoration treatments for hair loss restoration have been discussed separately along with each hair loss condition, the medical hair restoration treatments presented here is a round up on different drugs, their mechanism of action, duration of action, side effects and the potential of each drug to be used as combination therapy along with other drugs for enhancing the effect of hair loss restoration treatment.
Medical hair restoration with Minoxidil
Minoxidil has the distinction of the first drug being used for promoting the hair restoration. This medical hair restoration treatment drug was used earlier as an oral antihypertensive drug, but after its hypertrichosis (excessive body hair) effects were noticed, a topical solution of the drug was tested for its hair growing potential. Minoxidil was then approved as medical hair restoration treatment drug for men by the US Food and Drug Administration (FDA) in 1988 as a 2% solution, followed by 5% solution in 1997. For women, the 2% solution was approved in 1991. Though 5% solution is not approved for women, it is used as a medical hair restoration treatment by many dermatologists worldwide. Both solutions are available without a prescription in the US.
Mechanism of action
Minoxidil is thought to have a direct mitogenic effect on epidermal cells, as has been observed both in vitro in vivo. Though the mechanism of its action for causing cell proliferation is not very clear, minoxidil is thought to prevent intracellular calcium entry. Calcium normally enhances epidermal growth factors to inhibit hair growth, and Minoxidil by getting converted to minoxidil sulfate acts as a potassium channel agonist and enhances potassium ion permeability to prevent calcium ions from entering into cells.
Use of Minoxidil has approved by FDA for men (Norwood II-V) and women (Ludwig I-II ) older than 18 years. It is used as a medical hair restoration treatment either for frontal or vertex scalp thinning. It brings about an increase in density which is mostly caused by conversion of miniaturized hairs into terminal hairs rather than a stimulated de novo re-growth. The hair loss becomes stabilized after continued use of drug, which takes about a year’s time for the medical hair restoration treatment to show its complete results.
Hair loss restoration treatment with 0.05% betamethasone dipropionate and 5% topical minoxidil are found to be superior to minoxidil alone.
Pharmacology and Dosage
One milliliter (25 drops) of minoxidil solution must be used twice daily, every day in order to be effective. The drops must be applied directly onto a dry scalp and then slightly spread with the fingers. Whatever is the extent of bald scalp, remember not to apply more than 2ml of the drug every day.
Topical minoxidil is very well tolerated and adverse effects are mainly dermatologic. The most frequent adverse effect is an irritant contact dermatitis.
Occurance of Facial hypertrichosis is seen in 3 to 5% of women cases, it is important to note that such a problem is never seen in men. It affects mostly the forehead and sides of the face. This Hypertrichosis is absolutely reversible; it disappears after the discontinuation of the drug. Thorough hand washing after each application of this drug minimizes irritation and possibly of hypertrichosis to other body areas.
Though minnoxidil does not have any effect on blood pressure, it should be used with caution in patient with cardiovascular diseases. It is also contraindicated in pregnant and nursing mothers.
Medical hair restoration with Finasteride
The drug finasteride was earlier used as treatment for prostate enlargement, under the medical name Proscar. But in 1998, it was approved by FDA for the Medical hair loss restoration in MPHL.
Mechanism of Action
Medical hair restoration treatments with Finasteride depends upon its specific action as an inhibitor of type II 5α-reductase, the intracellular enzyme that converts male hormone androgen into DHT (Dihydro Testosterone). Its action results in significant decrease in serum and tissue DHT levels in even in concentration as low as 0.2mg. Finnasteride is able to stabilize hair loss in 80% of patient with Vertex hair loss and in 70% of patients with frontal hair loss. Most of these patients are able to grow more hair or retain the ones they have. The peculiar thing about Propecia is that its effect is more pronounced in crown area than in the front. The hair that grow after the medical hair restoration treatments are better in texture and are thicker, more like the terminal hair.
The best thing about medical hair restoration treatment with the finnasteride is that it is well tolerated and has minimal side effects. Sexual dysfunction (decreased sex drive, erectile dysfunction, and decreased semen volume) are observed in about 3.8% of cases. But these side-effects subside within few months of Medical hair restoration treatments or disappear within a week’s time as soon as the treatment is stopped.
It generally requires about 6 to 12 months for the m edical hair restoration treatment to be apparent but the side effects appear earlier. So even after the medicine is stopped, there is no possibility of loosing the hair that has been gained, but the side effects are sure to disappear.
The results of a recent study which confirm that finasteride as a 1mg tablet for 48 weeks does not affect spermatogenesis or semen production in men aged 19 to 41 years; have indicated that it is quite safe as a Medical hair restoration treatment.
Pharmacology and Dosage
Finasteride 1mg is to be taken every day, on a regular schedule, with or without food. Because it is metabolized in the liver, caution is advised when treating patients with liver disease. There are no known drug interactions.
As a matter of routine Medical hair restoration treatment, finnasteride is not given to women. Studies have shown that 1 mg of finasteride taken daily for 1 year was shown to have no benefit to postmenopausal women with FPHL However, higher dose finasteride (5 mg/d) was shown to induce significant regrowth in a postmenopausal, nonhyperandrogenic women with FPHL. Finnerstide should never be given to a women in child bearing age.
Medical Hair Restoration Treatment with Combination Therapy
There are reports which say that use of finasteride and topical minoxidil combination therapy as a Medical hair restoration treatment is of more advantage in cases of mild to moderate MPHL. Further studies are in progress.
Many hair transplant surgeons find Propecia (finasteride) to act as an excellent adjunct to the surgical hair restoration. There are several benefits of this kind of combination therapy. As the Medical hair restoration with Propecia brings about a hair re-growth in the crown area, it has a complementary action; it allows the surgeon to have more donor hair to be available for frontal hair transplant and design the hairline at his own will. Since finasteride has no effect in the frontal area of the scalp, it does not have any interference with Surgical Hair Restoration.
Post operative Medical hair restoration
There are many Medical hair restoration products which help the outcome of hair transplant surgery. One such product is copper peptide which helps in wound healing. This micronutrient is available in form of a spray which provides comfort to the patient at the recipient are. Initially, for first three days, instead of the spray the foil wrapped copper peptide gauges are used for hydrating the grafts.
For women with hyperandrogonism, who do not respond well to minoxidil, antiandrogen therapy is another option of Medical hair restoration. In UK the most commonly used anti-androgen for women is CPA (cyproterone acetate), which is used in combination with ethinyl-estradiol. Since the medical hair restoration with CPA causes reduction in serum Vitamin B 12, they are needed to be taken as supplements.
However in United States, where CPA is not available, the aldosterone antagonist spironolactone is given in dosages from 75 to 100 mg per day. However, higher doses (150 to 200 mg per day) appear necessary to produce a significant increase in cosmetically useful hair. The use of spironolactone as a medical hair restoration agent is contraindicated in women with renal insufficiency or hyperkalemia, and in those with a personal or family history of breast cancer.
Medical hair restoration with flutamide has shown improvement as hair loss restoration treatment in women with hirsutism. For hyperandrogenic premenopausal women, flutamide is a better medical hair restoration agent than both the CPA or finestride.
As would be evident to you from the above text, the management of hair loss restoration is different in men and women, and for more details on the subject you can refer to hair loss restoration treatment in men, and hair loss restoration treatment in women.
1. Chantal Bolduc and Jerry Shapiro: ‘Management of Androgenetic Alopecia’, Am J Clin Dermatol 2000 May-Jun; 1 (3)
Elizabeth K. Ross, Shapiro: ‘ Management of Hair Loss’, Dermatol Clin 23 (2005) 227 – 243