Medical Management

There are approximately 3 lakh products marketed across the world for treating hairloss. But, only 2 products are approved by the USFDA. They are…
1. Minoxidil Lotion
2. Finasteride Tablets
3. Laser Therapy
The Minoxidil is first introduced in the United States in 1988 and available in 2%, 5% and 10% concentrations all over the world. It should be administered as a topical agent and should not be taken orally. Initially this drug was used to control hypertension as it is a vasodilator.

MOA: The Minoxidil is a non specific biologic response modifier with an unknown mechanism of action in hair growth. The Minoxidil enlarges and revitalizes the shrunken intermediate hair follicles and thereby stimulating them to grow into terminal hairs. It also stimulates the dormant hair roots to grow into new hair.

Mode of Application: The solution must be applied directly on the scalp twice a day by using filler (provided in the pack). NOT TO BE APPLIED ON HAIR.
The 2% preparation can be used safely by women; for men 5% is preferable. There are several new formulations available in the form of gel and foam. The foam preparation is a long acting formulation and can be applied ONCE A DAY only. The Minoxidil is also mixed with other ingredients like Retin A and Azelic Acid to increase the efficacy of the drug. But the tolerance is subjective and such preparations should be taken by the advice of physician only.

Special Precautions:     
         Sometimes scalp irritation develops due to the drug then takes the advice of the doctor.
        Transient hair loss can occur 4 – 8 wks after initiation of drug usage. Nothing is there to worry just continue the medication for a optimum period of 6 – 9 months to see the efficacy of the drug.

Finasteride:
This medication was indicated for treating hair loss since 1998.

MOA: It inhibits the enzyme 5-alpha reductase type II that helps in the conversion of testosterone to DHT (dihydro testosterone). This DHT is the main culprit for hair loss in men. The finasteride is available in tablet form (1 mg) and should be taken orally. It’s more efficacious in the anterior mid-scalp and crown (vertex) area. It mainly acts by increasing the hair shaft diameter thereby augmenting the hair volume.
(i.e.; if the diameter is doubled, the volume is quadrupled without any change in the existing no. of follicles)
It primarily halts or slows down the hair loss progression and increases hair growth.
It can be synergistically combined with Minoxidil to achieve maximum benefit. It will also reduce the blood level of PSA (Prostate Specific Antigen). PSA is the serum marker and it may be elevated in other prostrate problems usually observed in men aged above 50 yrs.

Safety: Long term safety profile was excellent. 0.3% of patients reporting loss of libido or erectile disfunction after 5 yrs of usage in the age group of men greater than 40 yrs.
Mean semen levels are very low that won’t produce any risk to developing fetus.
No other side effects and drug interactions have been reported so far.
The half life of the drug is 4 – 6 hrs it gets excreated through urine.

How to use: It is approved for men aged 18 – 41 yrs.
It is crucial to stress the patients that no change in hair density over a time is not a treatment failure but it is a success as it is maintaining the existing roots safely. Maximum efficacy of the drug is noticed by 2 yrs.

Risks for Women: Contra indicated in women who are (or) might potentially become pregnant because it may cause abnormalities in male fetus. They should not handle even a broken or crushed tablet.
Other drugs under clinical trails still not approved by USFDA.
Dutasteride – potent inhibitor of type I and type II 5 AR, it is still not approved for hair loss treatment. Half life is 240 hrs. 

Anti-androgens:
These medications block the function of the male hormones. Ex: Spironolactone, Flutamide, Cyproterine acetate and GNRH analogues. Men should never use these drugs. The androgenetic alopecia in men is not due to an excess of male hormones but due to genetic predisposition.

Cyproterine acetate: It is potent anti androgen it exerts its effect by competing with DHT by androgen receptor blocking. It is effective in women who have evidence of higher androgen levels acne, hirsuitism and men. irregularities with obesity. 

Flutamide: Pure non steroidal anti androgen. Dosage 250 mg/day.
Spiranolactane: It is a potassium sparing diuretic with weak anti androgen properties. Dosage 100 – 200 mg/day. It causes irregular periods, feminization of male fetus and hyper kalemia.

Topical androgen receptor blockers: Fluridil – it is under study.
Ketoconazole is an anti-androgen and anti-fungal that can be used by both men and women as a topical agent (shampoo). It increases the percentage of hairs in the Anagen (growth) phase of the hair cycle.

These medications should be used only under the supervision of a physician and after complete evaluation of hormones.
Candidates for Medical Management:
Those in the early stages of hair loss are usually the BEST candidates for medical management. One should remember that no pharmaceutical hair loss product can deliver instant results. You must be both persistent and patient enough willing to use products for at least 6 months to 1 yr. The disappointment that some people experience during these treatments is often due to their unrealistic expectations.
Minoxidil and Finasteride can stop the hair loss in a significant no. of men for a significant length of time. In some cases, they may even result in a dense hair growth but CANNOT CURE baldness permanently.
LASER THERAPY—In this LASERbeam is used to stimulate scalp and miniaturising hair for promoting the existing hair growth.It is used as caps,combs etc.. Recently one model is approved by USFDA.
But this treatment also gives the temporary results only.

 
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