July 7, 2002

Hormones Influence Efficacy Of Treatment For Women's Alopecia

The effectiveness of minoxidil compared to cyproterone in treating female alopecia depends on whether or not body mass index is high or if biochemical hyperandrogenism is present, suggests a study from France.

Minoxidil was more effective in the absence of other signs of hyperandrogenism, hyperseborrhoea and menstrual cycle modifications when the body mass index was low and nothing argued in favour of biochemical hyperandrogenism.

But, when other signs were present and when the body mass index was high - factors which pointed to a diagnosis of biochemical hyperandrogenism - cyproterone acetate treatment was more effective, report specialists in Paris.

They noted that although hormone studies had shown the androgen-dependent character of female androgenetic alopecia, there had been few controlled studies of therapies for alopecia in women.

To compare topical minoxidil and cyproterone acetate in the treatment of this condition, the specialists randomised 66 women with female-pattern alopecia into two equal groups for 12 menstrual cycles.

One group received two local applications of topical minoxidil 2.0 percent 2.0 mL/day ^-1 plus combined oral contraceptive. The other group received cyproterone acetate 52 mg/day ^-1 plus ethinyl oestradiol 35 µg for 20 of every 28 days.

There was a mean reduction of 2.4 ± 6.2 per 0.36 cm² in hairs of diameter >40 µm in the cyproterone acetate group and a mean increase of 6.5 ± 9.0 per 0.36 cm² in the minoxidil group.

Comparison of the total number of hairs at 12 months and the body mass index showed a borderline positive correlation in the cyproterone acetate group and a negative correlation in those who received minoxidil.

There was no significant difference in the total number of hairs among cyproterone acetate patients according to the presence or absence of other symptoms of hyperandrogenism. With minoxidil, on the other hand, the total number of new hairs was higher in patients with isolated alopecia.

Variations in scalp seborrhoea were significant in both groups. The result was better - for acne and hirsutism as well - with cyproterone acetate than minoxidil.

British Journal of Dermatology 2002; 146 (6), 992-999

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