Background: Hair loss in women has a various psychosocial impact and effective treatments have been required. Camouflaging products which cover exposed areas on the scalp and hide visible hair loss are common, but medical therapies for female pattern hair loss (FPHL) are not so common. We have treated patients with FPHL using our combination therapy that consists of oral spironolactone, oral and topical minoxidil, and an injectable treatment for six years. Methods: 4568 female patients were treated between the years 2013 and 2018. Our combination therapy consists of 25 mg oral spironolactone once daily, 2.5 mg oral and 5% solution topical minoxidil twice daily, and an injectable treatment once monthly for 6 - 12 months. Digital photographs were taken pre- and post-treatment, and patient assessments were recorded after 6 and 12 months post-treatment. Results: Significant improvement was observed compared to the pre-treatment for all patients in the digital photographs. 95% and 96% of patients reported satisfaction with the results of the treatment after 6 and 12 months post-treatment, respectively. Minor complications were observed in a total of 223 (4.9%) patients, characterized by slight pain and bleeding due to injection, slight palpitation, swelling, hair growth in undesirable areas, headache, dizziness, itching. The seminor complications resolved spontaneously. No treatment-related adverse events were observed. Conclusion: A combination of these therapeutic options offers rapid and highly efficacious treatment for FPHL with minimal complications, and is recommended as an effective treatment for FPHL.
References
[1]
Dinh, Q.Q. and Sinclair, R. (2007) Female Pattern Hair Loss: Current Treatment Concepts. Clinical Interventions in Aging, 2, 189-199. https://www.dovepress.com/articles.php?article_id=162
[2]
Gan, D.C. and Sinclair, R. (2005) Prevalence of Male and Female Pattern Hair Loss in Maryborough. Journal of Investigative Dermatology Symposium Proceedings, 10, 184-189. https://doi.org/10.1111/j.1087-0024.2005.10102.x
[3]
Cash, T.F., Price, V.H. and Savin, R.C. (1993) Psychological Effects of Androgenetic Alopecia on Women: Comparisons with Balding Men and with Female Control Subjects. Journal of the American Academy of Dermatology, 29, 568-575. https://doi.org/10.1016/0190-9622(93)70223-G
[4]
Van Neste, D.J. and Rushton, D.H. (1997) Hair Problems in Women. Clinics in Dermatology, 15, 113-125. https://doi.org/10.1016/S0738-081X(96)00114-9
[5]
Cranwell, W. and Sinclair, R. (2000) Male Androgenetic Alopecia. MDText.com, Inc., South Dartmouth.
[6]
Choe, S.J., Lee, S., Choi, J. and Lee, W.S. (2017) Therapeutic Efficacy of a Combination Therapy of Topical 17α-Estradiol and Topical Minoxidil on Female Pattern Hair Loss: A Noncomparative, Retrospective Evaluation. Annals of Dermatology, 29, 276-282. https://doi.org/10.5021/ad.2017.29.3.276
[7]
Tanaka, Y., Aso, T., Ono, J., Hosoi, R. and Kaneko, T. (2018) Androgenetic Alopecia Treatment in Asians. The Journal of Clinical and Aesthetic Dermatology, 11, 32-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057731
[8]
Shaw, J.C. (1996) Antiandrogen Therapy in Dermatology. International Journal of Dermatology, 35, 770-776. https://doi.org/10.1111/j.1365-4362.1996.tb02970.x
[9]
Sinclair, R., Wewerinke, M. and Jolley, D. (2005) Treatment of Female Pattern Hair Loss with Oral Antiandrogens. British Journal of Dermatology, 152, 466-473. https://doi.org/10.1111/j.1365-2133.2005.06218.x
[10]
Blume-Peytavi, U., Hillmann, K., Dietz, E., Canfield, D. and Garcia Bartels, N. (2011) A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women. Journal of the American Academy of Dermatology, 65, 1126-1134e2. https://doi.org/10.1016/j.jaad.2010.09.724
[11]
van Zuuren, E.J., Fedorowicz, Z. and Carter, B. (2012) Evidence-Based Treatments for Female Pattern Hair Loss: A Summary of a Cochrane Systematic Review. British Journal of Dermatology, 167, 995-1010. https://doi.org/10.1111/j.1365-2133.2012.11166.x
[12]
Gupta, A.K. and Charrette, A. (2015) Topical Minoxidil: Systematic Review and Meta-Analysis of Its Efficacy in Androgenetic Alopecia. SKINmed Journal, 13, 185-189. https://www.ncbi.nlm.nih.gov/pubmed/?term=12.%09Gupta+AK% 2C+Charrette+A.+Topical+minoxidil%3A+systematic+review
[13]
Wester, R.C., Maibach, H.I., Guy, R.H. and Novak, E. (1984) Minoxidil Stimulates Cutaneous Blood Flow in Human Balding Scalps: Pharmacodynamics Measured by Laser Doppler Velocimetry and Photopulse Plethysmography. The Journal of Investigative Dermatology, 82, 515-517. https://doi.org/10.1111/1523-1747.ep12261084
[14]
Lachgar, S., Charveron, M., Gall, Y. and Bonafe, J.L. (1998) Minoxidil Upregulates the Expression of Vascular Endothelial Growth Factor in Human Hair Dermal Papilla Cells. The British Journal of Dermatology, 138, 407-411. https://doi.org/10.1046/j.1365-2133.1998.02115.x
[15]
Buhl, A.E., Conrad, S.J., Waldon, D.J. and Brunden, M.N. (1993) Potassium Channel Conductance as a Control Mechanism in Hair Follicles. The Journal of Investigative Dermatology, 101, 148S-152S. https://doi.org/10.1111/1523-1747.ep12363290
[16]
Colombe, L., Vindrios, A., Michelet, J.F. and Bernard, B.A. (2007) Prostaglandin Metabolism in Human Hair Follicle. Experimental Dermatology, 16, 762-769. https://doi.org/10.1111/j.1600-0625.2007.00586.x
[17]
Katz, H.I., Hien, N.T., Prawer, S.E. and Goldman, S.J. (1987) Long-Term Efficacy of Topical Minoxidil in Male Pattern Baldness. Journal of the American Academy of Dermatology, 16, 711-718. https://doi.org/10.1016/S0190-9622(87)70092-9
[18]
Rietschel, R.L. and Duncan, S.H. (1987) Safety and Efficacy of Topical Minoxidil in the Management of Androgenetic Alopecia. Journal of the American Academy of Dermatology, 16, 677-685. https://doi.org/10.1016/S0190-9622(87)70087-5
[19]
Price, V.H., Menefee, E. and Strauss, P.C. (1999) Changes in Hair Weight and Hair Count in Men with Androgenetic Alopecia, after Application of 5% and 2% Topical Minoxidil, Placebo, or No Treatment. Journal of the American Academy of Dermatology, 41, 717-721. https://doi.org/10.1016/S0190-9622(99)70006-X
[20]
Olsen, E.A., Weiner, M.S., Amara, I.A. and DeLong, E.R. (1990) Five-Year Follow-Up of Men with Androgenetic Alopecia Treated with Topical Minoxidil. Journal of the American Academy of Dermatology, 22, 643-646. https://doi.org/10.1016/0190-9622(90)70089-Z
