Oral Finasteride Research Articles

Expert opinion on current and emerging treatment options in androgenetic alopecia and telogen effluvium: an Indian perspective

<p class="abstract">The diagnosis and management of hair loss needs an organized and systematic approach for recognizing pattern of hair loss and identification of hair loss etiology. Early and specific diagnosis is essential to initiate appropriate treatment in the early phases of hair loss. Topical minoxidil and oral finasteride are the only approved drugs for androgenetic alopecia (AGA). Various other treatment options are widely used but have limited clinical evidence. Similarly, there are no specific treatments recommended for telogen effluvium (TE). However, the treatment may become challenging with increasing availability of new formulations and drugs with no substantial evidence to support them. Multiple focused group discussions were conducted among Indian dermatologists to gain expert opinion on appropriate management of AGA and TE in the current scenario. This article summarizes the consensus clinical viewpoints for topical and oral medications, role of nutritional supplements, and other adjunctive therapies in managing AGA and TE. The panel highlighted that the choice of treatment for AGA and TE depends on the individual hair loss pattern and response to medications. A brief discussion on the use of shampoos and procedures has also been highlighted. </p>

Frontal edema due to mesotherapy for androgenetic alopecia: A case series.

Androgenetic alopecia (AGA) is the most common form of non-cicatricial alopecia in both genders. Currently approved drugs for the treatment of AGA include topical minoxidil in women and topical minoxidil and oral finasteride in men. Other routes of administration of approved drugs have been proposed to enhance therapeutic results for AGA, including intradermal injections, known as mesotherapy. Mesotherapy-or intradermotherapy-is a non-surgical procedure, consisting of multiple intradermal injections of pharmacological substances diluted in small doses. Although minimally invasive, mesotherapy may be related to mild side effects like burning, erythema and headaches, as a few reports indicate. Among the most serious adverse events, subcutaneous necrosis, scalp abscesses, and angioedema have been described. This multicenter retrospective, descriptive study aims to report 14 cases of frontal edema resulting from mesotherapy for AGA treatment. In our patients, the edema mostly arose in the first two sessions and lasted between 1 and 4 days, with a favorable outcome after a local cold compress. In all our cases of edema, lidocaine was the anesthetic used. Minoxidil and dutasteride might also play a role as causative agents. To the best of our knowledge, this is the largest case series focused on frontal edema after mesotherapy for AGA and gives clinicians helpful information for when performing this technique. Dermatologists should already consider and be conscious of this possible mesotherapy side effect, as it can be remarkably disruptive to affected patients.

Photosensitivity reaction induced by finasteride

The patient visited our office complaining of a desquamating eruption on his face since two months. On extensive history-taking, he had received oral finasteride for four months to prevent alopecia androgenetica, indicating drug-induced photosensitivity. Withdrawal of finasteride for two weeks resulted in an improvement in the facial rash.

Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial.

BackgroundOral finasteride is a well‐established treatment for men with androgenetic alopecia (AGA), but long‐term therapy is not always acceptable to patients. A topical finasteride formulation has been developed to minimize systemic exposure by acting specifically on hair follicles.ObjectivesTo evaluate the efficacy and safety of topical finasteride compared with placebo, and to analyse systemic exposure and overall benefit compared with oral finasteride.MethodsThis randomized, double‐blind, double dummy, parallel‐group, 24‐week study was conducted in adult male outpatients with AGA at 45 sites in Europe. Efficacy and safety were evaluated. Finasteride, testosterone and dihydrotestosterone (DHT) concentrations were measured.ResultsOf 458 randomized patients, 323 completed the study and 446 were evaluated for safety. Change from baseline in target area hair count (TAHC) at week 24 (primary efficacy endpoint) was significantly greater with topical finasteride than placebo (adjusted mean change 20.2 vs. 6.7 hairs; P < 0.001), and numerically similar between topical and oral finasteride. Statistically significant differences favouring topical finasteride over placebo were observed for change from baseline in TAHC at week 12 and investigator‐assessed change from baseline in patient hair growth/loss at week 24. Incidence and type of adverse events, and cause of discontinuation, did not differ meaningfully between topical finasteride and placebo. No serious adverse events were treatment related. As maximum plasma finasteride concentrations were >100 times lower, and reduction from baseline in mean serum DHT concentration was lower (34.5 vs. 55.6%), with topical vs. oral finasteride, there is less likelihood of systemic adverse reactions of a sexual nature related to a decrease in DHT with topical finasteride.ConclusionTopical finasteride significantly improves hair count compared to placebo and is well tolerated. Its effect is similar to that of oral finasteride, but with markedly lower systemic exposure and less impact on serum DHT concentrations.

Efficacy, tolerability, and safety of montelukast versus finasteride for the treatment of moderate acne in women: A prospective, randomized, single-blinded, active-controlled trial.

Acne is a chronic inflammatory skin disease which involves the pilosebaceous unit. Tissue inflammation isone of the crucial mechanisms, amongst others. Of the various cytokines, leukotriene B4 (LT-B4) is the most potentleucocyte chemotactic mediator. Montelukast is an antagonist of the LT-B4 receptor. Finasteride is an antiandrogen whichspecifically inhibits the 5α-reductase enzyme. This study aimed at comparing the efficacy, tolerability and safety of montelukast versus finasteride in the treatmentof moderate acne in women. This randomized, single-blinded, prospective trial over 12weeks recruited 65 female subjects with moderate acne vulgaris (Global Acne Grading System Scale) for evaluation. One group (n=30) received oral montelukast (10mg PO daily), while the second group (n=25) received oral finasteride (2.5mg PO daily) in combination with topical clindamycin 2% solution. Lesion count and acne severity were evaluated at time intervals of 0 (baseline), 4, 8, and 12weeks. Adverse effects of the drugs were noted. Both lesion count and severity of acne decreased significantly after treatment in both the groups as compared to the baseline. The acne severity score reached from 33.93 in time zero to 20.6 in the 12th week and 35.71 at baseline to 16.43 at the end of treatment in the Montelukast and Finasteride groups, respectively. Side effects were noted in 3 patients and 2 patients in the monteleukast and finasteride group, respectively, which were transient and non-serious in nature proving the satisfactory tolerability and safety of these two drugs. The results of this study show that both montelukast and finasteride have good efficacy in the treatment of acne. Finasteride has more efficacy than montelukast for treating moderate acne in normo-androgenic women.

Managing patterned hair loss – a hair raising task!

Diffuse alopecia wields a significant psychosocial burden by virtue of its clinical presentation and visibility. Patterned alopecia is an umbrella term with the focus point being androgen-mediated alopecias - androgenetic alopecia/male pattern baldness/male androgenetic alopecia and female pattern hair loss/female androgenetic alopecia, both of which have a genetic susceptibility that alters the follicular sensitivity to circulating androgens. Diffuse alopecia affects nearly half the population based on weighted averages. It may present with hair shedding and hair thinning (miniaturization) or a combination. With the female variant, the role of androgens is not fully delineated; hence, the term female pattern hair loss which has replaced prior nomenclature. Managing patterned hair loss has seen a sea change in the last decade, moving well beyond the FDA-approved modalities - topical minoxidil and oral finasteride. Through this short review, the authors have attempted to condense existing information into a ready reference.

Understanding Pattern Hair Loss-Hair Biology Impacted by Genes, Androgens, Prostaglandins and Epigenetic Factors.

Pattern hair loss (PHL) is the most frequent cause of hair loss in men and women, accounting for 65% of consultations in a hair referral center. PHL is understood to represent a hereditary, age-dependent progressive thinning of the scalp hair, which follows distinct clinical patterns with notable differences depending on sex and age of onset. Clinical and investigative advances have helped us to understand some of the pathogenic steps, leading to PHL. Besides genetic factors and peculiarities of androgen metabolism, additional pathogenic factors that are suspected include microbiomata, oxidative stress, and microinflammation. While further suspects are likely to be exposed, individual diversity of causal agents, as well as of the sequence of events, or combined factors, must be kept in mind. A large number of therapeutic molecules claimed to be active and patented in this field, and their limited efficacy in offering a definitive cure of PHL confirm the complexity of PHL. The aim of therapy is to retard progression of hair thinning and increase hair coverage of the scalp. As yet, two FDA-approved drugs are available for this purpose, oral finasteride, and topical solution of minoxidil. Variations in posology and formulation allow for an enhancement of patient comfort and treatment efficacy. Antiandrogen treatments in women with normal androgen levels have questionable efficacy while having health risks.

Efficacy and safety profile of oral spironolactone use for androgenic alopecia: A systematic review

To the Editor: Androgenic alopecia (AGA) is a psychologically taxing dermatologic condition estimated to affect nearly 50% of women by the age of 50.1 Currently, the only medications approved by the United States Food and Drug Administration in the treatment of hair loss are topical minoxidil and oral finasteride. Considering the limited treatment options available for women, it is important to consider additional therapeutic agents. Although not currently approved by the Food and Drug Administration for dermatologic conditions, spironolactone has been proposed as a potential treatment agent for AGA due to its ability to decrease circulating androgens and counteract androgen effects on hair follicles.

Is there a rationale for the use of botulinum toxin in the treatment of Androgenetic Alopecia?

Androgenetic alopecia (AGA) is the most common form of alopecia in men and women. It is a chronic and progressive condition, characterized by a decline in the metabolic activities, with progressive miniaturization of the hair follicle. It may compromise self-esteem and quality of life in several affected individuals.1 Currently, the FDA approved drugs for the treatment of AGA are only topical minoxidil in women and topical minoxidil and oral finasteride in men.1 Recently, studies have pointed out injectable Botulinum toxin (BT) as an emergent possible adjuvant treatment for AGA.

Use of Topical Finasteride Vs Systemic Finasteride in Male Pattern Baldness

In this study we have analyzed the use of finasteride which is a type P-selective 5a-reductase inhibitor. By decreasing dihydroxytestestrone (DHT) level, it is found to be effective in the treatment of male androgenic alopecia. In this study, we compared the effect of topical vs. systemic finasteride in the treatment of androgenic alopecia. Our study is a randomized clinical trial study having 30 male patients. They have come for alopecia treatment at Nesam hospital, Coimbatore, India. We have selected male patients with androgenic alopecia and divided them into two groups (A, B), randomly having 15 patients in each group. For group A, Topical finasteride (0.1%) with minoxidil (5%) solution was given. Group B patients received topical minoxidil with oral finasteride (1mg) tablets. All patients were regularly followed up till the end of 6 months. A Patient had a first review in the first week followed by monthly follow up. Following parameters were taken into account: size of bald area, total hair count, and terminal hair. Data was analyzed by Chi-square statistical test. Each month the terminal hair, size of bald area and hair count between the two groups were compared. In the initial few months group, A showed good improvement. But Serial measurements indicated that a significant increase in hair counts and terminal hair counts is seen in both groups. This study showed that on long term follow-up of more than 3 months, both topical and systemic finasteride groups had similar results.

“Comparison of QR 678® &amp; QR678® Neo as monotherapy and as combination therapy with 5% Minoxidil solution and oral Finasteride in the treatment of male androgenetic alopecia—Which is better?”

Hair is an essential aspect of image and is correlated with youth, elegance, fitness and achievement. Hair loss leads to lowered self-esteem, lack of confidence and depression amongst affected individuals. The US Food and Drug Administration (FDA) permitted management options for male Androgenetic Alopecia (AGA) are topical Minoxidil and oral Finasteride. These agents are beneficial in controlling hair loss, but can only induce minimal new hair growth.

Update Treatment of Male Androgenetic Alopecia

Background: Male androgenetic alopecia (MAGA), also known as androgenetic alopecia, is the most common hair loss in males who have a genetic predisposition. The pattern of baldness in MAGA starts from the frontal area in a triangular pattern, followed by progressive thinning of the vertex until baldness occurs. Generally, the diagnosis of MAGA is established by clinical examination. FDA has approved a combination of topical minoxidil and oral finasteride for MAGA treatment. Currently, there is another treatment option like dutasteride, a prostaglandin analog, ketoconazole, and co-adjuvant therapy like laser therapy, hair transplantation, and so on. Purpose: To provide an updated treatment for MAGA. Review: Etiopathogenesis of MAGA is influenced by genetic susceptibility and hormonal factors. The European Consensus Group set the evaluation diagnosis of MAGA to include a historyof hair fall, physical examination, hair examination, supporting examination, and clinical documentation. There are therapeutic options for MAGA, including antiandrogen therapies, androgen-independent therapies, and co-adjuvant therapies. The FDA has approved a combination of topical minoxidil and oral finasteride for MAGA treatment. MAGA may affect patients’ quality of life and self-esteem. In general, patients expect higher. Conclusion: MAGA is the most common progressive hair loss in males. The MAGA therapy is expected to achieve cosmetically significant regrowth and to slow additional hair loss.

A Scoping Review of Pharmacotherapy, Complementary, and Alternative Medicine (CAM), and Surgical Therapies for Androgenic Alopecia

Androgenic alopecia (AGA) is the most common form of non-scarring alopecia, affecting millions of men and women in the United States (U.S.). This review highlights alternative and complementary treatment options for AGA. The treatment regimens for AGA have increased in pharmacotherapeutics, surgical, and complementary (CAM) categories. Each of the different treatment approaches can now be utilized by dermatologists to combat patient hair loss. The U.S. Food and Drug Administration (FDA) has approved only two agents to treat AGA: prescription-only, oral finasteride and over-the-counter (OTC), topical minoxidil. Increased availability of therapies claiming hair regrowth properties, coupled with limited pharmacotherapeutic options for AGA, lead patients to seek alternative treatments. Increased awareness of the current evidence supporting complementary and alternative therapies among dermatologists will facilitate appropriate and timely education of AGA patients.

A Multimodal Hair-Loss Treatment Strategy Using a New Topical Phytoactive Formulation: A Report of Five Cases

Introduction. Current approved medications for hair loss, such as topical minoxidil and oral finasteride, may have suboptimal efficacy or side effects precluding continued use in some patients. Thus, we report an evaluation of the efficacy, safety, and tolerability of a new topical botanical formulation -GASHEE containing over 12 phytoactive ingredients that affect multiple targets in the cascade of pathophysiologic events that cause hair loss. Five patients with various hair-loss conditions, including cases of previous treatment failures, are presented. Case Presentation. This is a case series of four women and one man with hair loss due to various causes, four of whom had failed minoxidil treatment for over a year. All patients used the topical treatment as a sole therapy for at least 3 months before the documentation of outcomes, which involved interval changes noted through each patient's account, direct observation, and photography. Discussion. In all patients, we observed significant improvements in hair regrowth in the nape, crown, vertex, and temple areas after 3–15 months of treatment. All patients were highly satisfied with their results and reported no adverse events. Although the use of botanicals in the treatment of hair loss is in an infant stage, the new formulation used in this study demonstrated a good efficacy related to hair growth, warranting further evaluation.

Review of selected endpoints in studies evaluating the effectiveness and efficacy of topical finasteride use for androgenetic alopecia

Androgenetic alopecia (AGA) is a disorder that worsens over the time. A metabolite of testosterone called dihydrotestosterone is implicated in the pathogenesis of AGA by exerting its effect on genetically predisposed hair follicles. Oral finasteride (FNS) targets this enzymatic step and is one of the two approved medications for the condition, the other one being topical minoxidil. This paper aimed to dissect the current literature on the endpoints chosen to measure the efficacy and effectiveness of using topical FNS for managing AGA. PubMed database was searched from October to November 2021 with the following terms including (\&amp;quot;Finasteride\&amp;quot;[Title] OR \&amp;quot;Finasteride\&amp;quot;[MeSH Terms]) AND (\&amp;quot;Local\&amp;quot;[Title] OR \&amp;quot;Topical\&amp;quot;[Title]). All human studies that investigated the use of topical FNS for AGA were included. Following the initial abstract scanning, studies that only investigated animal objects were excluded. Additionally, studies that did not have at least one clinical endpoint were overlooked. This review highlighted the available tools of hair evaluation in the reviewed literature. Objective tools represent the majority. These assessment methods were inconsistently applied across the reviewed studies, which as discussed earlier led to results that are hard to combine statistically. Considering these observations, future investigators are encouraged to make use of validated and standardized methods. Despite their growing significant subjective measures of hair growth on the other hand were not included in all the investigations.

Role of Low-Level Light Therapy (LLLT) in Androgenetic Alopecia.

Androgenetic alopecia (AGA) is the commonest type of alopecia affecting over half of men and women. Only two drugs have been approved so far (minoxidil and finasteride), and hair transplant is the other treatment alternative. Low-level laser therapy (LLLT) has been claimed to be a new safe devise-based modality for stimulating hair growth in men and women in AGA. Searches of PubMed and Google Scholar were carried out using keywords alopecia, hair loss, and LLLT. Fifteen studies were found to be strongly relevant and were analyzed. Studies have shown that LLLT stimulated hair growth in both men and women. Studies with largest randomized controlled trials demonstrated statistically significant hair regrowth by terminal hair count in both males and females. One study also showed that LLLT and minoxidil had similar efficacy in hair growth and that combination therapy was even more effective. LLLT represents a non-invasive, safe, and potentially effective treatment option for patients with AGA who do not respond or are not tolerant to standard treatment of AGA. Moreover, combining LLLT with topical minoxidil solution and oral finasteride may act synergistic to enhance hair regrowth. However, the level of evidence of the studies is still low and hence more controlled large studies are needed.

A Mixture of Tocopherol Acetate and L-Menthol Synergistically Promotes Hair Growth in C57BL/6 Mice.

Oral finasteride and topical minoxidil are single components approved by the US FDA for treating hair loss. Some other compounds originating from natural products are also traditionally used for promoting hair growth. In this study, observations of treated keratinocyte cells were used to demonstrate that tocopherol acetate, L-menthol, and stevioside exert an effect on cell regeneration. Furthermore, these were topically applied to the shaved skin of C57BL/6 mice to observe their effects on hair growth. A mixture of tocopherol acetate, L-menthol, and stevioside showed the highest potential for promoting hair growth in vivo. In in vivo experiments, the mixture of tocopherol acetate, L-menthol, and stevioside was more effective than tocopherol acetate or L-menthol alone in promoting hair growth. The transcriptome analysis of skin from the dorsal side of a mouse treated with tocopherol acetate or L-menthol versus vehicle revealed key changes in keratin, keratin-associated protein, forkhead box, sonic hedgehog, fibroblast growth factor 10, desmoglein 4, deoxyribonuclease 1-like 2, and cadherin 3, known to play roles in promoting hair growth.

Platelet-rich plasma has a place in the treatment of androgenetic alopecia

Androgenetic alopecia (AGA) is one of the most common problems seen in dermatologic settings. Topical minoxidil and oral finasteride are the only treatments approved by the US Food and Drug Administration. While both treatments are effective, they are not without complications and require long-term daily use. Many studies have found platelet-rich plasma (PRP) to be beneficial1; however, the criticism is that most studies are small, uncontrolled, reliant on the subjective analysis of results, and have a wide variation in methodologies.

Prescribing Habits for Androgenic Alopecia among Dermatologists in Spain in 2019–2020: A Cross-Sectional Study

Background: In 2017, we carried out a cross-sectional study with the aim of describing androgenic alopecia (AGA) prescription habits among dermatologists who practice in Spain. Three years later, we repeated this study with the aim of describing the current situation and comparing it with previous data. Material and Methods: Descriptive cross-sectional study using online questionnaires autocompleted by dermatologists working in Spain. Results: The responses of 243 dermatologists were analyzed. The most common treatments prescribed for MAGA were topical minoxidil (100%), oral finasteride (92.6%), oral dutasteride (75.7%), and oral minoxidil (50.6%). For premenopausal female AGA (FAGA), the most common treatments were topical minoxidil (99%), oral contraceptives (75%), nutricosmetics (71%), and oral minoxidil (67.9%). Lastly, the most common treatments prescribed in patients with postmenopausal FAGA were topical minoxidil (99.2%), oral finasteride (79%), oral durasteride (71.6%), and oral minoxidil (63%). Conclusions: In conclusion, AGA is the most frequent alopecia in the trichology clinic. The most common treatments prescribed in male AGA (MAGA) and postmenopausal FAGA were topical minoxidil and oral finasteride, while in premenopausal FAGA, topical minoxidil, oral contraceptives, and nutricosmetics were most commonly prescribed. In the past three years, oral dutasteride and oral minoxidil have increased drastically among the most prescribed therapies for MAGA, premenopausal FAGA, and postmenopausal FAGA.

Topical Finasteride versus Topical Spironolactone in the Treatment of Androgenetic Alopecia

Abstract Background: Androgenetic Alopecia (AGA) is a non-scarring alopecia that affects both males and females. It is characterized by a progressive miniaturization of hair follicles with a characteristic pattern distribution in genetically predis-posed men and women. Topical finasteride is being investigated as a new treatment for AGA with fewer side effects than oral finasteride. Topical Spironolactone is the most commonly used off-label anti-androgen for the treatment of AGA. In the treatment of AGA, it acts by decreasing the production and competitively blocking the androgen receptor in the target tissue. Aim of Study: The aim of this study was to evaluate the role and compare the effect of topical finasteride and topical spironolactone in the treatment of (AGA). Patients and Methods: After meeting inclusion and ex-clusion criteria and diagnosis of AGA was clinically established by the characteristic distribution of frontal and vertex hair in males and the Christmas tree pattern of diffuse hair loss at middle hairline in females. It was dermosopically established by the characteristic hair shaft thickness heterogeneity, peripilar brown depressions (peripilar signs) and focal atrichia and also folliscope established for hair density. Cases included in this study had Norwad-Hamilton Scale types I to VII for men and Ebling Scale types I to IV for women. Result: Our study shows that a topical spironolactone is better than topical finasteride in male and female group. Conclusion: In this study, topical finasteride and topical spironolactone are good options for management of androgenic alopecia but topical spironolactone is better than topical finasteride with few side effects when compared to oral administration.