Androgenetic Alopecia: An Evidence-Based Treatment Update
- 2.8k Downloads
Androgenetic alopecia (AGA) is one of the most common chronic problems seen by dermatologists worldwide. It is characterized by progressive hair loss, especially of scalp hair, and has distinctive patterns of loss in women versus men, but in both genders the central scalp is most severely affected. It often begins around puberty and is known to effect self-esteem and the individual’s quality of life. In contrast to the high prevalence of AGA, approved therapeutic options are limited. In addition to the scarce pharmacologic treatments, there are numerous nonprescription products claimed to be effective in restoring hair in androgenetic alopecia.
The purpose of this paper is to review published medical and non-medical treatments for male and female AGA using the American College of Physicians evidence assessment methods. MEDLINE, EMBASE and Cochrane Library were searched for systematic reviews, randomized controlled trials, open studies, case reports and relevant studies of the treatment of male and female AGA. The relevant articles were classified according to grade and level of evidence.
The medical treatments with the best level of evidence classification for efficacy and safety for male AGA are oral finasteride and topical minoxidil solution. For female AGA, topical minoxidil solution appears to be the most effective and safe treatment. The medical treatments corresponding to the next level of evidence quality are some commonly used therapeutic non-FDA-approved options including oral and topical anti-hormonal treatments. Surgical treatment of follicular unit hair transplantation is an option in cases that have failed medical treatment although there is high variation in outcomes.
Some articles, especially those concerning traditional herbs claimed to promote hair regrowth, were published in non-English, local journals.
An assessment of the evidence quality of current publications indicates that oral finasteride (for men only) and topical minoxidil (for men and women) are the best treatments of AGA.
KeywordsFinasteride Fulvestrant Minoxidil Dutasteride Male Breast Cancer
No sources of funding were used to prepare this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
- 19.Whiting DA, Waldstreicher J, Sanchez M, Kaufman KD. Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts in horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men and postmenopausal women. J Investig Dermatol Symp Proc. 1999;4:282–4.PubMedCrossRefGoogle Scholar
- 25.Gupta AK, Charrette A. The efficacy and safety of 5alpha-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatol Treat. 2014;25(2):156–61.Google Scholar
- 40.Kucerova R, Bienova M, Novotny R. Current therapies of female androgenetic alopecia and use of fluridil, a novel topical antiandrogen. Scr Med (Brno). 2006;79:35–48.Google Scholar
- 50.Bazzano GS, Terezakis N, Galen W. Topical tretinoin for hair growth promotion. J Am Acad Dermatol. 1986;15:880–3, 90–3.Google Scholar
- 55.Blume-Peytavi U, Hillmann K, Dietz E, Canfield D, Garcia Bartels N. A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. J Am Acad Dermat. 2011;65:1126–34 e2.Google Scholar
- 57.American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 1994;93:137–50.Google Scholar
- 59.Blume-Peytavi U, Lonnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2012;66:794–800.PubMedCrossRefGoogle Scholar
- 70.Uebel CO, da Silva JB, Cantarelli D, Martins P. The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg. 2006;118(6):1458–66.Google Scholar
- 71.Perez-Meza D, Leavitt M, Mayer M. The growth factor. Part 1: clinical and histological evaluation of the wound healing and revascularization of the hair graft after the hair transplant surgery. Hair Transpl Forum Int. 2007;17:173–5.Google Scholar
- 74.Watanabe Y, Nagashima S, Hanzawa N. Efficacy of adenosine on male androgenetic alopecia. Jpn J Dermatol. 2005;115:57.Google Scholar
- 77.Morganti P, Fabrizi G, James B, Bruno C. Effect of gelatin-cystine and serenoa repens extract on free radicals level and hair growth. J Appl Cosmetol. 1998;16:57–64.Google Scholar
- 78.Gehring W, Gloor M. Use of the phototrichogram to assess the stimulation of hair growth—an in vivo study of women with androgenetic alopecia. Z Hautkr. 2000;75:419–23.Google Scholar
- 79.Shao LX. Effects of the extract from bergamot and boxthorn on the delay of skin aging and hair growth in mice. Zhogguo Zhong Yao Za Zhi. 2003;28:766–9.Google Scholar
- 80.Bussoletti C, Mastropietro F, Tolaini MV, Celleno L. Use of a cosmetic caffeine lotion in the treatment of male androgenetic alopecia. J Appl Cosmetol. 2011;29:167–80.Google Scholar
- 85.Kim SH, Jeong KS, Ryu SY, Kim TH. Panax ginseng prevents apoptosis in hair follicles and accelerates recovery of hair medullary cells in irradiated mice. In vivo (Athens, Greece). 1998;12:219–22.Google Scholar
- 86.Thorat RM, Jadhav VM, Kadam VJ. Development and evaluation of polyherbal formulation for hair growth-promoting activity. Int J Pharm Tech Res. 2009;1:1251–4.Google Scholar
- 90.Camacho FM, Camacho-Serrano F, Moreno Gimenez JC, et al. Treatment of alopecias of male and female patterns. Clinical efficacy of aminexil and SP94 in two surveys of 180 patients, men and women. Medicina Cutanea Ivero-Latino-Americana. 2013;41:18–33.Google Scholar
- 92.Siedel U. Cimicifuga for the prevention of hair loss. Phamazeutische Zeitung. 2003;148:44.Google Scholar
- 101.Floersheim GL. An examination of effect of biotin on alopecia and hair quality. Zeitschrift fur Hautkrankheiten. 1992;67:246–52.Google Scholar
- 108.Gupta AD, Daigle D. The use of low level light therapy in the treatment of androgenetic alopecia and female pattern hair loss. J Dermatol Treat. 2014;25(2):162–3.Google Scholar
- 110.Jimenez JJ, Wikramanayake TC, Bergfeld W, et al. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind Study. Am J Clin Dermatol. 2014;15(2):115–27.Google Scholar