Hair Loss

[Michael Scally MD]

Manabe M, Tsuboi R, Itami S, et al. Guidelines for the diagnosis and treatment of male-pattern and female-pattern hair loss, 2017 version. The Journal of dermatology 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/1346-8138.14470

Male-pattern hair loss (MPHL, androgenetic alopecia) is a slowly progressive form of alopecia which begins after puberty. In 2010, we published the first Japanese edition of guidelines for the diagnosis and treatment of MPHL. It achieved the original goal of providing physicians and patients in Japan with evidence-based information for choosing efficacious and safe therapy for MPHL.

Subsequently, new therapeutic drugs and treatment methods have been developed, and women's perception of MPHL has undergone change and the term "female-pattern hair loss (FPHL)" is becoming more common internationally. Thus, here we report a revised version of the 2010 guidelines aimed at both MPHL and FPHL.

In these guidelines, finasteride 1 mg daily, dutasteride 0.5 mg daily and topical 5% minoxidil twice daily for MPHL, and topical 1% minoxidil twice daily for FPHL, are recommended as the first-line treatments. Self-hair transplantation, irradiation by light-emitting diodes and low-level lasers, and topical application of adenosine for MPHL are recommended, whereas prosthetic hair transplantation and oral administration of minoxidil should not be performed. Oral administration of finasteride or dutasteride are contraindicated for FPHL.

In addition, we have evaluated the effectiveness of topical application of carpronium chloride, t-flavanone, cytopurine, pentadecane and ketoconazole, and wearing a wig. Unapproved topical application of bimatoprost and latanoprost, and emerging hair regeneration treatments have also been addressed.

We believe that the revised guidelines will improve further the diagnostic and treatment standards for MPHL add FPHL in Japan.

 

[Dr JIM]

Manabe M, Tsuboi R, Itami S, et al. Guidelines for the diagnosis and treatment of male-pattern and female-pattern hair loss, 2017 version. The Journal of dermatology 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/1346-8138.14470

Male-pattern hair loss (MPHL, androgenetic alopecia) is a slowly progressive form of alopecia which begins after puberty. In 2010, we published the first Japanese edition of guidelines for the diagnosis and treatment of MPHL. It achieved the original goal of providing physicians and patients in Japan with evidence-based information for choosing efficacious and safe therapy for MPHL.

Subsequently, new therapeutic drugs and treatment methods have been developed, and women's perception of MPHL has undergone change and the term "female-pattern hair loss (FPHL)" is becoming more common internationally. Thus, here we report a revised version of the 2010 guidelines aimed at both MPHL and FPHL.

In these guidelines, finasteride 1 mg daily, dutasteride 0.5 mg daily and topical 5% minoxidil twice daily for MPHL, and topical 1% minoxidil twice daily for FPHL, are recommended as the first-line treatments. Self-hair transplantation, irradiation by light-emitting diodes and low-level lasers, and topical application of adenosine for MPHL are recommended, whereas prosthetic hair transplantation and oral administration of minoxidil should not be performed. Oral administration of finasteride or dutasteride are contraindicated for FPHL.

In addition, we have evaluated the effectiveness of topical application of carpronium chloride, t-flavanone, cytopurine, pentadecane and ketoconazole, and wearing a wig. Unapproved topical application of bimatoprost and latanoprost, and emerging hair regeneration treatments have also been addressed.

We believe that the revised guidelines will improve further the diagnostic and treatment standards for MPHL add FPHL in Japan.

Nice synopsis @Michael Scally MD worthy of a download.

 

[Froz3nnn]

I took Finasteride and the lack of dht just ruined my life.. SICK

 

[Michael Scally MD]

Suchonwanit P, Srisuwanwattana P, Chalermroj N, Khunkhet S. A randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil versus 3% minoxidil solution in the treatment of male androgenetic alopecia. Journal of the European Academy of Dermatology and Venereology : JEADV 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.15171

BACKGROUND: The synergism of combined use between oral finasteride and topical minoxidil has been established in treating androgenetic alopecia among men. However, the concern regarding adverse effects of finasteride use has been rising.

OBJECTIVE: To compare the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil versus 3% minoxidil solution in men with androgenetic alopecia.

METHODS: Forty men aged 18 to 60 years with androgenetic alopecia were randomized to 24 weeks of treatment with a finasteride/minoxidil or minoxidil solution twice daily. Primary efficacy endpoint was the change from baseline in hair density and hair diameter at week 24. Secondary endpoints included global photographic assessment by treatment-blinded investigators and subjects. Changes in plasma dihydrotestosterone levels and adverse events were recorded.

RESULTS: At week 24, the combined solution of finasteride and minoxidil was significantly superior to minoxidil alone in improvements of hair density, hair diameter and global photographic assessment (all P < 0.05). About 90% of patients treated with the combined solution experienced moderate to marked improvement. The combined solution also had minimal effect on plasma dihydrotestosterone levels, approximately 5% reduction. There were also no systemic adverse events reported by patients in both groups.

CONCLUSION: Treatment with topical solution of 0.25% finasteride admixed with 3% minoxidil was significantly superior to 3% minoxidil solution for promoting hair growth in male androgenetic alopecia, and well tolerated. This article is protected by copyright. All rights reserved.

 

[Big Timi]

Fuck it, shaved my head, looks great.

 

[ThE SiCkNeSs]

Suchonwanit P, Srisuwanwattana P, Chalermroj N, Khunkhet S. A randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil versus 3% minoxidil solution in the treatment of male androgenetic alopecia. Journal of the European Academy of Dermatology and Venereology : JEADV 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.15171

BACKGROUND: The synergism of combined use between oral finasteride and topical minoxidil has been established in treating androgenetic alopecia among men. However, the concern regarding adverse effects of finasteride use has been rising.

OBJECTIVE: To compare the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil versus 3% minoxidil solution in men with androgenetic alopecia.

METHODS: Forty men aged 18 to 60 years with androgenetic alopecia were randomized to 24 weeks of treatment with a finasteride/minoxidil or minoxidil solution twice daily. Primary efficacy endpoint was the change from baseline in hair density and hair diameter at week 24. Secondary endpoints included global photographic assessment by treatment-blinded investigators and subjects. Changes in plasma dihydrotestosterone levels and adverse events were recorded.

RESULTS: At week 24, the combined solution of finasteride and minoxidil was significantly superior to minoxidil alone in improvements of hair density, hair diameter and global photographic assessment (all P < 0.05). About 90% of patients treated with the combined solution experienced moderate to marked improvement. The combined solution also had minimal effect on plasma dihydrotestosterone levels, approximately 5% reduction. There were also no systemic adverse events reported by patients in both groups.

CONCLUSION: Treatment with topical solution of 0.25% finasteride admixed with 3% minoxidil was significantly superior to 3% minoxidil solution for promoting hair growth in male androgenetic alopecia, and well tolerated. This article is protected by copyright. All rights reserved.

I read that study before and I’m really interested in the results. Does the finasteride work systematically or locally I wonder. I’m contemplating buying this on eBay since it’s from India and doesn’t seem to violate any of the prescription rules since it’s a topical solution.

 

[ohio79]

Has anyone ever looked into Scalp micro pigmatation? If so how was your experience. Thanks

 

[bob hughes]

I took Finasteride and the lack of dht just ruined my life.. SICK

Did you recover from this afterwards? Apparently that class of drugs can cause a permanent syndrome, impotence, depression, muscles wasting, many other symptoms. Reportedly even one dose can cause this permanent syndrome. And there’s absolutely no cure or even treatment. I’ve read absolute horror stories, nightmares about this. Essentially you’re fucked for life if you’re one of the very small percentage of people this happens to. Accutane, finasteride, dutasteride, I think there’s a couple others. Anyway, scared the shit out of me, so much that I would never consider touching one of these drugs.

 

[Michael Scally MD]

Peeva E, et al "A phase IIa randomized, placebo-controlled study to evaluate efficacy and safety of Janus kinase inhibitors PF-06651600 and PF-06700841 in alopecia areata: 24-week results" EADV 2018; Abstract D3T01.1A. https://press.pfizer.com/press-release/pfizer-presents-positive-phase-2-data-alopecia-areata-during-late-breaker-session-27th (Pfizer Presents Positive Phase 2 Data in Alopecia Areata During Late-Breaker Session at the 27th European Academy of Dermatology and Venereology (EADV) Congress | Pfizer Pharmaceutical News and Media | Pfizer: the world&#039;s largest research-based pharmaceutical company)

Pfizer Inc. (NYSEFE) today announced results from its Phase 2a study of PF-06651600, an oral Janus kinase (JAK) 3 inhibitor, and PF-06700841, a tyrosine kinase (TYK) 2/JAK1 inhibitor, compared to placebo, in patients with moderate to severe alopecia areata (AA), an autoimmune disease characterized by hair loss and often associated with profound psychological consequences.

Both JAK inhibitors met the primary efficacy endpoint in improving hair regrowth on the scalp relative to baseline at week 24 (33.6 points and 49.5 points for JAK3 and TYK2/JAK1, respectively) as measured by the Severity of Alopecia Tool (SALT) score (100 point scale). The findings were presented during a Late-Breaking News session at the 27th European Academy of Dermatology and Venereology (EADV) Congress in Paris, France.

 

[Michael Scally MD]

Andy G, John M, Mirna S, et al. Controversies in the treatment of androgenetic alopecia: The history of finasteride. Dermatologic Therapy 2018;0:e12647. https://doi.org/10.1111/dth.12647

Male androgenetic alopecia (AGA) affects up to 60% of men by the age of 50. Currently, there are only two approved drugs for the treatment of male AGA: topical minoxidil and oral finasteride

Topical minoxidil is readily available over the counter and has a well‐established safety record. However, following 24 weeks of treatment, less than 40% of men respond to the drug. Additionally, due to the topical route of administration, compliance with minoxidil remains low.

In contrast, oral finasteride, a 5‐alpha reductase inhibitor, demonstrated efficacy in arresting hair loss in more than 80% of patients following 12 months of treatment.

However, controversy surrounding potential adverse sexual side effects has negatively affected public perception of the drug and may significantly reduce the number of patients that can benefit from the drug.

 

[Michael Scally MD]

The Medical and Psychosocial Associations of Alopecia: Recognizing Hair Loss as More Than a Cosmetic Concern

Alopecia encompasses a broad range of hair loss disorders, generally categorized into scarring and non-scarring forms. Depending on the specific pathogenesis of hair loss and geographic location, a number of psychiatric and medical comorbidities, including but not limited to thyroid disease, lupus erythematosus, diabetes mellitus, atopic dermatitis, sinusitis, coronary artery disease, anxiety, depression, and suicidality, have been identified in association with alopecia. In addition to the numerous associated comorbid conditions, patients with alopecia report decreased quality-of-life measures across symptomatic, functional, and global domains.

While alopecia can affect patients of all ages, genders, and ethnicities, hair loss may more significantly impact women as hair represents an essential element of femininity, fertility, and female attractiveness in society.

Individuals of lower socioeconomic status may also face health disparities in the context of alopecia as a majority of hair loss treatments are considered cosmetic in nature and accordingly are not covered by third-party insurance providers.

Although traditionally thought of as a merely aesthetic concern, alopecia encompasses a significant burden of disease with well-defined comorbid associations and genuine psychosocial implications, and thus should be assessed and managed within a proper medical paradigm.

Marks DH, Penzi LR, Ibler E, et al. The Medical and Psychosocial Associations of Alopecia: Recognizing Hair Loss as More Than a Cosmetic Concern. American journal of clinical dermatology 2018. The Medical and Psychosocial Associations of Alopecia: Recognizing Hair Loss as More Than a Cosmetic Concern

 

[Michael Scally MD]

Butt G, Hussain I, Ahmed FJ, Choudhery MS. Efficacy of platelet-rich plasma in androgenetic alopecia patients. J Cosmet Dermatol 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocd.12810

BACKGROUND: Androgenetic alopecia (AGA), a patterned hair loss in both males and females, is a commonly occurring disease worldwide. Conventionally, no curative or satisfactory treatment is available for this condition. Therefore, in the current study, we aim to use platelet-rich plasma (PRP) as an alternative treatment option for the AGA patients.

MATERIALS AND METHODS: A total of 30 patients (20 men and 10 women) with AGA were included in the study between February 2017 and November 2017. Blood (9 cc) from each AGA patient was collected in 10 cc syringe, and PRP was isolated using commercially available kit under sterilized conditions. Isolated PRP was injected in the bald areas of scalp of AGA patients. The whole procedure was repeated after one month (two treatment sessions), and patients were followed for six months.

The efficacy of PRP for restoration of hair was assessed using parameters such as hair density, terminal to vellus hair ratio, photographs, pull test, physician global assessment score, and patient global assessment score.

RESULTS: Mean hair density on first visit (before treatment) was 34.18 +/- 14.36/cm(2) which was increased to 50.20 +/- 15.91/cm(2) after 6 months of first treatment (P value <0.05). On a scale of three, mean scores of physician and patient global assessments were 1.45 +/- 0.57 and 1.60 +/- 0.62, respectively. Mean percentage reduction of hair pulled was 29.2% (P value <0.05) after PRP treatment. Terminal to vellus hair ratio was increased in 60% of patients after PRP therapy. No remarkable adverse effects were noted in patients.

CONCLUSION: Results showed that PRP is an effective treatment option in androgenetic alopecia as indicated by higher hair density, satisfactory physician and patient global assessment scores, and increase in terminal to vellus hair ratio.

 

[Bundy55]

I’m going to switch from finasteride to dutasteride. I’ve heard dutasteride takes about 6 months to build up in your system. Should I stay on the finasteride the first 6 months of dutasteride use then drop the fin?

 

[Dr JIM]

Since both of these drugs are FDA approved for male pattern baldness I’d suggest you do some research on them rather than deciding what to do based upon the opinion of others.

For instance did you know both of theses medications are associated
with ED is some patients?

Jim

 

[Bundy55]

Since both of these drugs are FDA approved for male pattern baldness I’d suggest you do some research on them rather than deciding what to do based upon the opinion of others.

For instance did you know both of theses medications are associated
with ED is some patients?

Jim

Yes Doc. I research anything I put into my body. I’m aware of the finasteride horror stories but decided it was worth the risk for me. I’ve been on finasteride for over a year with no issues. I figure since I seem to tolerate these drugs well switching to Dut wouldn’t be a big deal

From my understanding Dutasteride seems to be more selective and better at blocking DHT than Finasteride. That’s my reasoning for wanting to make the switch. I’ve also heard it’s better for your prostate than finasteride

 

[Michael Scally MD]

HairClone: A Unique Start-up Developing Personalised Cell Replacement Therapies to Reverse Hair Loss
HairClone: A Unique Start-up Developing Personalised Cell Replacement Therapies to Reverse Hair Loss

MANCHESTER, England--(BUSINESS WIRE)--HairClone (https://cts.businesswire.com/ct/CT?id=smartlink&url=http%3A%2F%2Fwww.hairclone.me&esheet=51908496&newsitemid=20181204005166&lan=en-US&anchor=www.hairclone.me&index=1&md5=ca88b85d63a9c17308ab4105a2a2b8e2) has a growing clinical partner and banking associate network of leading hair transplant surgeons across the globe who are so convinced of the promise of this approach they are helping to fund scientists in the UK and US. Already over 100 million people are within 50 miles of a network clinic.

The most common type of hair loss in men and women (androgenetic alopecia) is caused by the affected hair follicles losing their natural regenerative abilities, causing them to miniaturise, producing the appearance of thinning hair.

HairClone is developing a treatment to replace these lost cells. A few of a patient’s non-affected follicles will be harvested in a simple out-patient procedure. Potent cells will be isolated from these follicles, multiplied in the laboratory, and micro-injected into the affected part of the scalp with the intention of rejuvenating the hair shafts, making them thicker and longer.

A later treatment, currently in the research phase, will involve the creation of brand new hairs for individuals who have clear baldness and already lost large amounts of hair.

Hairclone is expected to start the world’s first hair follicle bio-bank in early 2019. Bio-banking will allow patients to store a small number of their hair follicles at the earliest age. These will then be used as the patient needs treatment.

 

[Dr JIM]

Very interesting BUT for the majority, the cost would be prohibitive and certainly not covered by insurance.

 

[Michael Scally MD]

International Society of Hair Restoration Surgery: 2017 Practice Census Results
https://ishrs.org/wp-content/uploads/2017/12/report_2017_ishrs_practice_census-08-21-17.pdf

 

[Munky]

I'm using rogain it actually is working, got lucky

 

[maxmuscle01]

Check out quiff and Co. videos on youtube. Super cool option