HAIR LOSS MEDICINAL TREATMENT (MINOXIDIL – FINASTERIDE)
Medicinal treatment is a first-line therapy both for male-pattern hair loss and for female-pattern hair loss.
The purpose of the treatment is to slow down hair loss rate and/or to invert the progress of hair follicles’ miniaturisation.
Until today there are two medicinal products approved by the FDA (American Food and Drug Administration) for the above mentioned purposes: finasteride (orally administered hormonal modulator) and minoxidil (topical biological modulator).
Minoxidil, which is a vasodilator medication and is commercially available in concentration of 2% and 5%, increases the length of anagen phase (a hair growth cycle during which hair grow and they are full of melanin) while it strengthens and enlarges the tiny hair follicles, thus stopping the progress of hair loss. To have the best outcome in a period of 26 – 52 weeks, with the greatest improvement on the top of the head and the least on the frontal hairline, it needs an application of 1ml minoxidil on the scalp just twice a day. Apart from its topical application, if it is necessary it is possible to use infusions of minoxidil at the areas of the scalp showing hair thinning.
Dermatological side effects occur rarely with minoxidil and these may include swelling of the face and unwanted hair growing in adjacent areas of the forehead or face. It is also worth noting that treatment discontinuation leads gradually (in a period of 4 – 6 months) to the previous state of hair thinning. This is why regular monitoring of the scalp using trichoscopy is necessary, to maintain the effect based on objective measures and to increase, decrease or continue with the same dosing regimen to maintain the result.
The action of finasteride is similar. Finasteride is the first per os treatment that was approved and it is available as a pill. It is actually a 5α-reductase inhibitor (mainly type II), an enzyme, responsible for hair loss, that converts testosterone into dihydrotestosterone (DHT). The best response to treatment is occured at the crown of the head while the hairline at the front appears the least degree of improvement.
However, it should be mentioned that finasteride is a teratogen to women willing to become pregnant, while it does not effect post-menopausal women. In cases of male patients, there are side effects (reduced sexual functioning and libido) rarely observed in less than 2% of them and reversible after treatment discontinuation. In many cases, side effects can be resolved during continuous treatment.
The last active substance that is being used in more recent years for the treatment of hair loss is dutasteride, a drug that was used for the treatment of benign prostatic hyperplasia. Its mode of action is similar to finasteride’s but it has not been approved by FDA yet. Nevertheless it can be administered both to men and to women showing intense hair loss, which may lead to significant hair shedding. It can be administered as a pill or as an infusion at the areas of hair thinning and hair loss.
Another point that is worth mentioning is that medicinal treatment methods are only effective during the time they are administered. Moreover, they are effective only in the first stages of hair loss, during which hair become thinner and hair miniaturization is evident. In those areas of the scalp where no hair growing occurs, drugs cannot reactivate the inactive hair follicles.
The results of treatment using drugs can be objectively assessed through the advanced method of trichoscopy. Trichoscopy is actually hair and scalp dermoscopy using a hand-held device for trichoscopy or videotrichoscopy with polarised light and it actually is the most reliable method for recording and monitoring the effects of treatment for hair loss. Through this examination, it is possible to record the number of hair follicles per square centimetre of the scalp, as well as to assess the quality, density and thickness of hair with maximum precision thanks to the electronic processing of the findings. These data are objective and they can be used to assess and evaluate treatment effectiveness, since the examination should preferably be repeated every 3 months or 6 months.