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.
"Typically, in my practice the patients who come to visit range in
age from very young (with early onset at age 14 or 15) to those in
their 30s and 40s. They are just starting to bald and hair loss
might be something very prominent in their family, or they are
coming in early and they just want to make sure that the thinning
they are experiencing is male androgenetic alopecia and not
something else," says Maria Hordinsky, M.D., professor and
chairwoman, department of dermatology, University of Minnesota,
Minneapolis.
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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