Alopecia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Pharmacotherapy

Acute Pharmacotherapies

• Androgenetic alopecia

  • For men, oral finasteride or topical minoxidil
  • For women, antiandrogens if adrenal androgens are increased

• Tinea capitus/kerion

  • Oral antifungals

• Alopecia areata

  • Glucocorticoids
  • Psoralen and ultraviolet A (PUVA)
  • Superpotent steriods
  • Cyclosporine
  • Intralesional steriod injections

Chronic Pharmacotherapies

• Topical minoxidil (Rogaine, generic):

• only Rx approved for women as well as men
• Increases duration of anagen and enlarges miniaturized follicles
• Mechanism unclear

• Efficacy:

• Hair counts ~5x higher than placebo with use of 5% solution (men)
• Hair counts 45% higher with use of 5% solution compared with use of 2% solution (men)
• Hair counts returned to those of placebo group within 24 weeks after discontinuation Rx (men)
• Women: increased hair growth in 60% vs. 40% with use of 2% soln vs. placebo
• Advice for patients:

• 1 mL bid applied to dry scalp with spray or dropper; spread lightly w/finger
• Expect decreased loss w/in 2 mos, growth w/in 4-8 mos; stable at 1-1.5 yrs
• Best results if baldness present at vertex x < 5 years and < 10 cm diameter
• cosmetically notable growth occurs in only 30-40%
• Rx must continue indefinitely or regrown hair will be lost
• Side effects = rare contact or irritant dermatitis; no change blood pressure, heart rate or weight