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Androgenic Alopecia Malepattern baldness Common baldness

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... of patients (vertex and frontal hair loss) were enrolled in the study. ... End points included hair counts in the frontal scalp, patient self-assessment, ... – PowerPoint PPT presentation

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Title: Androgenic Alopecia Malepattern baldness Common baldness


1
Androgenic Alopecia (Male-pattern baldness
Common baldness)
  • Commonest type of hair loss. May be a
    physiological process.
  • Prevalence rate is almost 100 in certain races.
  • Mode of inheritance unknown.

2
Pathophysiology
  • Normally
  • On the top Androgen-sensitive follicles
  • On the sides and back of the scalp
    androgen-independent follicles
  • In genetically predisposed individuals(Under
    Influence of Androgens)
  • Terminal hair follicles are transformed into
    vellus.
  • Shortened anagen and an increased telogen.
  • Decreased growth of hair on the scalp as well as
    axilla

3
Role of DHT
  • T converted to DHT with the help of 5
    ?-reductase.
  • Persons with an inherited deficiency of type II5
    ?-reductase castrated prepubertal boys or
    eunuchs do not develop androgenic alopecia
  • Under the influence of DHT, the terminal follicle
    is converted to a vellus follicle
  • High concentrations of DHT seen in the scalp of
    patients with androgenic alopecia.

4
Finasteride - Effects on semen production
  • No effect since
  • Testosterone is responsible for spermatogenesis
  • Men with an inherited deficiency of 5 ?-reductase
    still have normal sperm development.

5
Pharmacokinetic properties of oral finasteride
after repeated administration of 1 mg/day or
after single dose of 5 mg.
  • 1mg/day 5 mg (n12) (n6)

Day 1 Day 17 Cmax (?g/L) 6.5 9.2 38.1 tmax
(h) 1.6 1.3 1.8 t½ (h) 4.5 4.8 4.7 AUC0-24 (?g/L/h
) 38.2 53.2 180.6
6
Finasteride - 1mg
  • Clinical Efficacy
  • Evaluated in three phase III placebo-controlled
    studies, each of 1 years duration
  • Additionally, the two studies in men with mild to
    moderate vertex hair loss continued in a blinded
    manner for a second year.
  • A total of 1879 male patients aged between18 and
    41 years were enrolled in the trials.
  • A wide spectrum of patients (vertex and frontal
    hair loss) were enrolled in the study.

7
Finasteride 1 MgIn Frontal Male Pattern Hair
Loss
  • Double-blind placebo-controlled trial (n 326).
  • End points included hair counts in the frontal
    scalp, patient self-assessment, investigator
    assessment and evaluation of global photographs.
  • Finasteride 1 mg significantly increased scalp
    hair counts in the frontal area (P
  • Cosmetic improvement was noted by patients,
    investigators and global reviewers.
  • Aust J Dermatol 1997 38 (Suppl.2 ) 101-2

8
Finasteride-1 Mg Tolerability
  • Not significantly different from that of placebo
    except for sexual functional disorders
  • Sexual adverse events were reported in (3.8)
    finasteride compared with (2.1) placebo
    recipients and comprised decreased libido(1.8
    vs. 1.3), ejaculation disorders (1.2 vs. 0.7)
    and erectile dysfunction (1.3 vs. 0.7)
  • Resolved in many patients who reported them but
    remained on therapy. It also resolved in those
    who stopped therapy.
  • Small reductions (from 0.7 to 0.5 ng/ml) in serum
    prostate-specific antigen (PSA) may be seen.
    Hence double the reported PSA before interpreting.

9
Finasteride 1mg - Indications
  • Treatment of men with male pattern hair loss and
    to prevent further hair loss in these patients.

10
Finasteride-1mg - Dosage Administration
  • 1mg/day taken with or without food. Continue for
    at least 3 months before assessing. Effects are
    reversed within 12 months of stopping therapy
  • Dosage adjustment unnecessary in elderly or in
    renal insufficiency.
  • Contraindicated in women.

11
Patient 1
Baseline
Month 12
Month 24
J Am Acad Dermatol 1998 39578-89
12
Hair count mean change from baseline ( SE) from
the combined US and international studies for men
who entered the extension studies.
J Am Acad Dermatol 1998 39578-89
13
Investigator assessment mean rating score ( 1
SE) from the combined US and international
studies for men who entered the extension studies.
J Am Acad Dermatol 1998 39578-89
14
Treatment-related sexual adverse events reported
with finasteride. Men with male pattern hair loss
were randomised to receive oral finasteride 1
mg/day (n945) or placebo (n934) for 1 year.
p 0.041 vs. placebo
Drugs 1999 57(1) 111-126
15
Finasteride in frontal hair lossHair count mean
change from baseline ( 1 SE).
All patients 1 mg
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14
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J Am Acad Dermatol 1999 40 930-7.
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