Hair and nail disorders
Rashmi Sarkar, Anupam Das, Sumit Sethi in Concise Dermatology, 2021
The drug finasteride has been used to treat androgenetic alopecia in men with good results. Its effect is limited to the specific testosterone receptor, which is found only in the hair follicle and prostate gland (the drug was originally developed to treat prostatic hypertrophy). It is well tolerated and its side effects are just higher than placebo; however, a statistically non-significant increase in the incidence of male breast cancer has been reported in men taking the drug. The progress of pattern alopecia in men is halted by castration, but there are few patients who would undergo the operation for this purpose. In women, the use of an anti-androgen–prostagen combination (cyproterone acetate and ethinylestradiol – DianetteR) has been tried and some reduction in the rate of hair loss has been claimed. The antihypertensive vasodilator minoxidil has also been used topically, as increased hair growth was noted as a side effect from its oral use. Although the drug may increase hair growth in 20–30% of patients, hair is lost again when treatment stops, and the extent to which hair regrowth occurs is modest. Finasteride is contraindicated in women at risk of pregnancy – because it would cause feminization of a male fetus and variable results have been reported from studies in which it has been given to women with female pattern hair loss alopecia.
Disorders of hair and nails
Ronald Marks, Richard Motley in Common Skin Diseases, 2019
In women, the use of an anti-androgen–prostagen combination (cyproterone acetate and ethinylestradiol – Dianette®) has been tried and some reduction in the rate of hair loss claimed. The antihypertensive vasodilator minoxidil has also been used topically, as increased hair growth was noted as a side effect from its oral use. Although the drug may increase hair growth in 20–30 per cent of patients, the hair is lost again when treatment stops, and the extent to which hair regrowth occurs is modest. Finasteride is contraindicated in women at risk of pregnancy – because it would cause feminization of a male fetus and variable results have been reported from studies in which it has been given to women with androgenetic alopecia. Hair transplantation utilizes hairs from the occipital scalp which are harvested and reimplanted in other areas. The best results are achieved with transplantation of single or small numbers of follicular units but typically 2000–3000 units have to be transplanted to achieve a reasonable outcome.
Polycystic ovary syndrome and hyperandrogenism in adolescents
Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo in Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Antiandrogens can be used in combination with CHC or metformin to achieve further improvement in cutaneous symptoms. Spironolactone is most commonly used. It functions as an aldosterone antagonist in addition to directly inhibiting 5α-reductase activity, decreasing active androgen concentrations at hair follicles.113 Spironolactone doses are started at 25 mg and adjusted over time while monitoring for hyperkalemia. The highest recommended dose is 200 mg daily. Combination metformin and spironolactone has been found to be superior to either drug alone in improving menstrual irregularity, hirsutism, serum androgen levels, and insulin resistance.116 Finasteride is an antiandrogen that blocks hepatic 5α-reductase, reducing conversion of testosterone to dihydrotestosterone.117 Intermittent low-dose oral finasteride was found to be effective for treatment of hirsutism in adolescent girls with PCOS or idiopathic hirsutism.118 Importantly, both spironolactone and finasteride must be used in combination with effective contraception in sexually active adolescents due to teratogenic potential.
Enhanced skin penetration of Finasteride loaded DMSO-liposomes for the treatment of androgenic alopecia: comparison with conventional liposomes
Published in Drug Development and Industrial Pharmacy, 2023
Shweta Ramkar, Monika Kaurav, M. S. Sudheesh, Ravi Shankar Pandey
Androgenic alopecia (AGA) is caused due to the action of high dihydrotestosterone on androgen receptors present in hair follicles, and treatment during the early stages of alopecia can increase the chances of recovery or at least slow the progression [5]. Finasteride (FIN is used in the treatment of male pattern baldness (i.e. androgenetic alopecia) by inhibiting 5-α reductase in scalp follicles. However, long-term use of FIN via the oral route is restricted because of side effects, such as sexual disabilities and reduced libido, that occur due to systemic exposure to the drug [6]. It is not approved by FDA for use in women due to severe side effects like genetic abnormalities and teratogenicity [5]. It is previously reported that vesicular systems had the potential to deliver the bioactive into the skin layer when applied topically for the treatment of AGA. Recently, different types of vesicular systems viz. liposomes, transfersomes, ethosomes, cerosomes, and transethosomes were studied for the delivery of Coenzyme Q10 a strong antioxidant for the treatment of AGA [7]. Post-clinical observations by authors claimed that transethosomes were superior in delivering the Coenzyme Q10 deeper in the skin. In another study, FIN and baicalin were co-loaded into phospholipid vesicles. Vesicles delivered the FIN deeper into the skin layer and improvement in hair growth was observed in C57BL/6 mice after 21 d [7].
Topical finasteride for the treatment of male androgenetic alopecia and female pattern hair loss: a review of the current literature
Published in Journal of Dermatological Treatment, 2022
Poonkiat Suchonwanit, Wimolsiri Iamsumang, Kanchana Leerunyakul
The use of topical finasteride in the treatment of AGA was first introduced by Mazzarella et al. who conducted a preliminary placebo-controlled trial of topical finasteride. Twenty-eight males and 24 females with AGA were randomly allocated to receive 0.005% finasteride solution or vehicles (50% ethyl alcohol, 25% propylene glycol, and 25% distilled water) twice daily for 16 months. Hair regrowth was observed among patients treated with topical finasteride in the fourth month and sustained throughout the study. Increased hair density at the periphery of balding patches and progressive thickening of hair texture were reported as the responses to the treatment. By 6 months, the rate of hair loss which was evaluated by hair counts from the wash tests showed a significant decrease compared to those applying vehicles. Finasteride-treated patients continued to show a significant reduction in hair loss until the end of the study. The investigators also noted a large number of dropouts from the placebo group due to a lack of improvement (15).
A review of the treatment of male pattern hair loss
Published in Expert Opinion on Pharmacotherapy, 2020
Katherine York, Nekma Meah, Bevin Bhoyrul, Rodney Sinclair
Side effects of finasteride include lowered libido, erectile dysfunction, reduced ejaculatory volume, temporary reduction in sperm count, testicular pain, depression and gynecomastia.[16] A 10-year follow- up study reported reduced libido as the most frequent side effect, whilst gynecomastia and depression were not reported at all[17]. A systematic review of nine trials, including 3570 patients, identified sexual dysfunction in 1.5% of men taking finasteride[12]. A more recent network meta-analysis demonstrated no significant difference between active treatment with dutasteride 0.5mg or finasteride 1mg and placebo, for the outcome global sexual disturbance[13]. The lay press has highly publicized persistent sexual side effects associated with finasteride [18–20] but controlled clinical trial data have found a low incidence of sexual side effects that abate on stopping treatment.[21]
Related Knowledge Centers
- Antiandrogen
- Benign Prostatic Hyperplasia
- Biosynthesis
- Dihydrotestosterone
- Enzyme Inhibitor
- Hirsutism
- Pattern Hair Loss
- Oral Administration
- Topical Medication
- 5Α-Reductase Inhibitor