Treatment Options for Hair Loss Due to Androgenetic Alopecia in Women (Part III)
Other Treatment Options
Cimetidine: A histamine blocker once found on pharmacy shelves under the brand name Tagamet, primarily used in the treatment of gastrointestinal ulcers. Cimetidine also has a fairly potent anti-androgenic effect and has been shown to block the dihydrotestosterone hormone in the scalp. Cimetidine is used for the treatment of (hirsutism) in women. Studies in women have shown promising results in the treatment of Androgenic Alopecia. Because high doses are required in treatment, cimetidine should not be used in the treatment of Androgenic Alopecia in male patients due to the likelihood of adverse sexual side effects.
Ketoconazole: Prescribed to treat fungal infections, ketoconazole reduces the production of testosterone and other androgens. Due to its anti-androgenic effect, it can be used as an adjunct in the treatment of hair loss. The 1% version is now available over-the-counter in shampoos. However, it is more effective at 2% concentrations. It has significant side effects. Additionally, hair lotions containing 2% ketoconazole along with Saw Palmetto extract, Vitamin B6, and Zinc Oxide are used. Formulations enriched with Niacin, Caffeine, Linolenic acid, and Jojoba oil are also preferred in Europe.
Azelaic Acid: Approved by the FDA for the treatment of acne (comedonal acne and inflammatory acne). Azelaic acid is widely used in the treatment of acne and rosacea. It is also included in dermocosmetic products to eliminate skin blemishes through its chemical peeling effect.
It is used in the treatment of androgenetic alopecia (baldness). Azelaic acid is included in shampoos and hair tonics to promote hair growth and help hair strands appear thicker, fuller, and shinier.
Commercial products containing azelaic acid:
Xandrox: Topical 5% Minoxidil solution with azelaic acid,
Lipogaine: Topical 5% Minoxidil solution with azelaic acid (retinol, saw palmetto extract, and B vitamins)
ReMox III and IV: Topical 15% Minoxidil solution with azelaic acid
Crinagen: Topical 5% Azelaic acid solution. Distilled water, polysorbate 20, gamma linolenic acid, zinc acetate, niacin, vitamin B6, saw palmetto extract, ginkgo biloba, oleic acid, tea tree oil, riboflavin, grape seed extract, Vitamin (such as d-alpha tocopherol), Vit E, and Proanthocyanidins.
It has been shown that the Azelaic acid and Proanthocyanidins in the formula block 5-alpha-reductase activity, thereby blocking dihydrotestosterone (DHT), which is the primary cause of male and female pattern hair loss.
There are studies indicating that it stimulates hair regrowth by preventing hair loss within 4 to 6 months. Its use is safe for both men and women.
Azelaic acid, along with its antimicrobial effect in humans, eliminates fungal infections that cause hair loss. It is known to be used for maintaining healthy hair follicles on the scalp and for its inflammatory effects. Azelaic acid induces histamine release, which is an important factor in preventing the cascade of reactions leading to inflammation. Furthermore, it has been shown to be effective in types of alopecia associated with hair follicle inflammation.
Azelaic acid is also known to be an effective 5-alpha-reductase inhibitor in reducing scalp DHT (dihydrotestosterone) levels.
Is Azelaic Acid Effective in the Treatment of Hair Loss?
A research finding (1988 British Journal of Dermatology, Stamatiadis) demonstrates that Azelaic acid is a 5-alpha-reductase inhibitor. The study showed that when combined with zinc sulfate and vitamin B6, 5-alpha-reductase inhibition reached up to 90%.
In general, Azelaic acid is inexpensive and widely used. Pure Azelaic acid creams are available as prescription medications for acne and rosacea.
Overall, azelaic acid is well tolerated. Topically applied azelaic acid does not readily enter the bloodstream. Azelaic acid is applied topically to the skin. When applied once to human skin in vitro, approximately 3-5% penetrates through the stratum corneum layer. About 4% of the topically applied dose undergoes systemic absorption. When applied topically, it is metabolized in the skin to a negligible extent. The most common adverse effect, seen in 1-5% of patients, is mild skin irritation.
Azelaic acid is a dicarboxylic acid naturally found in whole grains, rye, barley, and animal products. The FDA has approved it as a topical preparation for acne treatment. When azelaic acid, vitamin B6, and zinc sulfate are combined in small amounts, the 5-alpha-reductase enzyme can be inhibited by up to 90%.
Due to the synergistic activity of these compounds in 5-alpha-reductase inhibition, this combination has become highly effective in the treatment of male pattern baldness.
Rp.
Azelaic acid 5%
Vit B6 620 mg
Zinc sulfate 1220 mg
Distilled water ad 100 g
Prostaglandin analogues: Prostaglandin analogues such as latanoprost, travoprost, and bimatoprost are used topically in the treatment of glaucoma and ocular hypertension. During these treatments, they have been observed to accelerate eyelash growth. Bimatoprost is the only FDA-approved medication for eyelash hypotrichosis. There are studies in male pattern androgenetic alopecia only with a limited number of patients. In a case study involving the injection of 0.03% bimatoprost solution into areas of female pattern hair loss, no success was achieved. Studies suggesting that shampoos containing ketoconazole increase hair density as well as the size and proportion of anagen follicles in male pattern hair loss, together with ketoconazole’s systemic antiandrogenic effect, raised the consideration that it could be effective in FPHL; however, there are no comprehensive studies conducted in this regard.
Low-Level Light Therapy: Administered using systems containing diodes emitting light at a wavelength of 650-900 nm. There are views suggesting that light activates hair follicles, increases blood flow in hair follicles, regulates adenosine triphosphate production in mitochondria, and stimulates the transition of hair into the anagen phase. The paradoxical increase in hair growth observed during diode laser application and the benefit of alopecia areata from ultraviolet therapy can be regarded as clinical evidence for the treatment of alopecia with diode laser. In 2007, the HairMax laser comb received FDA clearance for the treatment of male pattern hair loss, and in 2011 for female pattern hair loss. The device is applied via a hair comb aligned with the laser beam. Although studies in FPHL are limited, an increased hair count and enhanced hair tensile strength have been detected in both temporal and vertex regions. Reported side effects include scalp irritation or erythema. It can serve as an ideal alternative as an adjunct to medical or surgical treatment, or for patients resistant to therapy.
Hair Transplantation Surgery: An option for patients whose condition is resistant to therapies and who desire a permanent solution. However, unlike men, the donor area is more limited in female pattern alopecia due to the diffuse thinning pattern. Hair transplantation procedures are generally expensive and uncomfortable treatments. Even if the outcomes obtained are not remarkably aesthetic, the realistic objective should be a moderate improvement in hair density. Complications may include temporary hair loss in areas adjacent to donor and recipient sites due to decreased blood flow at incision sites, infection, and pain.
Future Treatments
Various research groups have focused on the development of cell-mediated therapies for androgenetic alopecia observed in both men and women. Two main approaches are under investigation: direct injection of cultured cells or the use of cell-secreted factors that increase hair growth rate. It has been demonstrated that cells obtained from the mesenchymal tissue of hair follicles can be cultured and utilized to stimulate new hair formation in epithelial tissue. Phase 1 and Phase 2 studies on these approaches are ongoing. Another treatment modality gaining growing popularity today is platelet-rich plasma therapy, known as PRP. Platelets contain numerous growth factors, and their additive effect is also utilized in hair transplantation. There is a need for larger-scale, controlled studies on this subject.
Conclusion
Female pattern hair loss is a condition that negatively impacts patients both aesthetically and psychologically. Many patients also experience the anxiety of becoming completely bald. Individuals should first be reassured regarding this issue, and subsequently, effective treatment should be initiated without delay. The only FDA-approved treatment is 2% minoxidil solution. Nevertheless, considering the patient’s other clinical findings, response to treatment, and treatment side effects, it is essential to plan various treatment options tailored to the individual in a timely manner. Prior to treatment, expected outcomes should be discussed realistically with the patient. It should be clarified that the realistic goal is to halt hair loss and achieve a modest increase in hair density.
Wishing you a pleasant week…
References:
1- Türkderm 2014; 48: Special Issue 1: 31-5 İdil Ünal Androgenetic alopecia in women.
2- Standardisierte Rezepturen (NRF/SR)
Exp. Pharm. Ahmet Nezihi Pekcan
Pekcan Pharmacy – Konya
[email protected]
Tel: (332) 3520657
http://www.majistralformul.com/
