Androgenetic alopecia treatment options are plentiful
May 2011
Androgenetic alopecia is the most common type of hair loss in men,
but there are numerous options for treating the condition, and more
are being developed.
Androgenetic alopecia affects about 50 million American men. It is
estimated that a man has a 50 percent chance of experiencing hair
loss by age 50. This hereditary androgen dependent condition is
characterized by a receding hairline as well as a loss of hair on
top of the scalp, according to the American Academy of Dermatology.
Dr. Hordinsky says patients with very extensive hair loss are not a large part of the population at her practice.
"Most people who come in for an evaluation are coming in fairly early on," she says.
Available therapies
Treatment approaches vary depending on the patient, and range from pills and topical medications to devices and hair transplant procedures. Clinicians must conduct an evaluation before prescribing treatment, particularly for patients in their early teens.
"If a 15-year-old comes in with his mom and dad and he is experiencing hair thinning and hair loss, then the dermatologist has to evaluate if there is anything else going on that could explain the change in hair density," Dr. Hordinsky says.
For patients in the 18- to 35-year-old range, discussions should include topical treatments, such as minoxidil (Rogaine, McNeil-PPC), the prescription medication finasteride (Propecia, Merck) and the laser comb, such as the HairMax LaserComb (Lexington International), she says. Combination treatments are also commonly discussed.
Dr. Hordinsky says that for people in the 18- to 35-year-old group, there probably would not be a discussion about hair transplantation because the patient's hair loss is still evolving and the goal is to be able to treat and stop the process as best possible.
"At this point it starts to get individualized and dependent on what the patient wants," she says. "Do they want to take a pill, put something on their scalp either in the form of a liquid or foam twice a day, or do they want to try using the laser comb three times a week?"
Dermatologists can start working through what fits the person's lifestyle when determining the best treatment options, Dr. Hordinsky says.
Other approaches
When new drugs were being developed and being studied in clinical trials — such as when minoxidil or finasteride were being introduced — there were many more patients visiting dermatology offices for male androgenetic alopecia, she says.
"Overall there are fewer people being seen now for male androgenetic alopecia," Dr. Hordinsky says. "Rogaine and the laser comb are over-the-counter, so people can just go buy them and they do not have to see the dermatologist."
After patients try these options, their perception that the over-the-counter therapies don't work could bring them into the clinic, or they may feel they are missing something that needs to be investigated.
Patients with more extensive hair loss may benefit from hair transplantation.
"The medical dermatologist with an interest in hair diseases can partner with a hair transplant specialist, who does hair transplantation on a regular basis. For this group of patients, I partner with Ron Shapiro, M.D., an excellent hair transplant surgeon in our area and someone who is also on our adjunct faculty," she says.
A medical dermatologist should refer the patient, and the hair transplant surgeon can then conduct an assessment and discuss the procedure, cost and other details. The most popular type of hair transplant surgery today is follicular transplantation or transplantation of follicular units.
"This technique that has been around for quite some time and it is a very good technique with outstanding cosmetic results. Patients are very satisfied," Dr. Hordinsky says.
On the horizon
New devices, such as the HairMax LaserComb, are continuing to come onto the market, and others are in development and will be available in the future, Dr. Hordinsky says.
As Dermatology Times reported in January, an upcoming U.S. clinical research study on the use of latanoprost (Allergan) is getting off the ground. Allergan is recruiting volunteers for clinical trials of a hair-growth treatment based on the active ingredient in Latisse (bimatoprost ophthalmic solution, 0.03 percent), the company's eyelash-growth treatment.
According to information from Allergan on the National Institutes of Health's ClinicalTrials.gov website, the trial's initial phase will observe a group of 28 patients, comprising men with moderate male pattern baldness and women with moderate female pattern hair loss. The Food and Drug Administration approved Latisse in 2008. Some physicians prescribe Latisse off-label to treat hair loss.
Scalp health
Overall, it is important for dermatologists to not only complete a medical evaluation and make treatment recommendations, but also to focus on good scalp health.
"Inflammation of the scalp, seborrheic dermatitis, or any type of dermatitis can be associated with hair loss, so it is important for patients to maintain a clean, healthy scalp," Dr. Hordinsky says. "That can be done by teaching patients about seborrheic dermatitis, and instructing them on different shampoos that can be used."
As patients use these different products, such as minoxidil topically when it is in the liquid formulation, a residue of the drug might remain on the scalp surface, she says. It is important, therefore, to keep the scalp clean, so as patients reapply the medicine it is being applied to a clean healthy scalp for optimal drug absorption.
The same can be recommended to those men who apply camouflage products to the scalp and who may or may not also be using a topical medication.
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