Hair Loss

What are the phases of the hair cycle ?

1. anagen, telogen, and catagen phases

Which phase of the hair cycle promotes active growth for 2-6 years?

1. anagen phase

Which phase of the hair cycle does hair stop growing and detaches slowly for 2-4 weeks?

1. catagen phase

Which phase of the hair cycle does hair rest and prepares for the next cycles for 3-4 months?

1. telogen phase

What causes Miniaturization?

1. DHT shortens the anagen phase causing rapid hair loss

What is Androgenetic alopecia (AGA)?

1. Progressive miniaturization of the hair follicle

What are risk factors for Androgenetic alopecia?

1. genetics, age, either gender

What is a sign of alopecia?

1. Thinning of hair or hair loss

What is needed to diagnose AGA?

1. a detailed history & an assessment for underlying causes of hair loss

What are the types of medication-induced hair loss?

1. anagen and telogen hair loss

What is Male Pattern Hair Loss (MPHL)

1. a strong genetic linkage to excess androgen, typically after puberty

Who is most impacted by MPHL? Who is least impacted by MPHL?

1. older white males; older black males

What are patterns of androgenic alopecia in men?

1. Frontal hairline with bi-temporal recession and thinning at the crown of the scalp

What causes MPHL?

1. MPHL is mediated by dihydrotestosterone, the potent form of testosterone, which induces miniaturization of androgen-sensitive hair follicles.

Who is mostly impacted by female pattern hair loss (FPHL)?

1. post-menopausal women

How can FPHL be identified in a woman?

1. Progressive and gradual diffuse thinning of the crown and widening of the midline part with retention of the frontal hairline

What are common risk factors for FPHL?

1. genetic, hormonal, and environmental factors

How is FPHL characterized?

1. by a decrease in duration of anagen phase (of the hair cycle) and by a delay in the initiation of a new anagen phase from the telogen phase

What are Pharmacologic treatment goals for management of androgenetic alopecia?

1. Prevent or slow the process of hair thinning and hair loss and Promote regrowth of hair to improve scalp coverage

What is a realistic expectation to see imporvement in hair growth?

1. a minimum of 4 to 6 months or even up to a year

What are the two FDA approved drugs to treat androgenetic alopecia?

1. topical alopecia and oral finasteride

what kind of drug is Minoxidil?

1. it is an antihypertensive agent

What does minoxidil treat?

1. male and female pattern hair loss

Why is the foam minoxidil formulation preffered?

1. due to the lower incidence of irritation

How is minoxidil solution 2% and 5% applied?

1. apply 1ml BID to a clean, dry scalp. Wash hands after and allow 2-4 hours for the drug to penetrate the scalp so use 2-4 hours before bedtime.

What should you not do when using minoxidil?

1. Do not use hair dryer after applying, may decrease efficacy and Do not use on infected, irritated, or inflamed skin.

How is minoxidil foam 5% applied?

1. Rinse your fingers in COLD water and dry them before applying. Then Use half a capful to the fingertips and message into scalp twice daily and wash hands after application.

What are common adverse effects of minoxidil?

1. contact dermatitis, scalp pruritis/irritation which occurs more with 5% solution

What should patient’s know before using minoxidil?

1. Advise patients to use at least 2 hours before bed – to minimize contamination of pillowcase/bedding.

2. Facial or localized hypertrichosis in women if it gets on the face

What is the brand name for minoxidil

1. rogaine

What is the MOA of minoxidil?

1. it Induces cell proliferation, Reduces follicular microinflammation, and Inducer of wnt/ß-catenin for hair follicle regeneration.

What is the response time for minoxidil?

1. 6-12 months

Why don’t patients stop using minoxidil after successful growth?

1. Hair loss recurs and returns to baseline levels within a few months to a year after discontinuation.’

What are the concentrations and formulations prefered for women?

1. 2% solution or 5% foam

What are the concentrations and formulations prefered for men?

1. 5% solution or 5% foam

A patient with a history of sensitive skin/dermatitis should use ____.

1. the foam

Minoxidil is contraindicated in____

1. patients < 18 years old, > 65 years old, and Women who are pregnant or breastfeeding

if a patient has a history of hyperandrogenism or hirsutism, which minoxidil dose would they start with?

1. 2% minoxidil

What is the MOA for finasteride?

1. a competitive inhibitor of type II 5-alpha reductase, blocks conversion of testosterone into dihydrotestosterone (DHT)

What is the brand name for finasteride?

1. propecia

What is the optimal dosage of finasteride in MPHL?

1. 1mg daily with or without food

Why is 1mg oral finasteride recommended for MPHL?

1. to improve or to prevent the progression of male mild-to-moderate AGA

What happens if a patient stops taking finasteride?

1. hair regrowth can be lost within 1 year after discontinuation of therapy, so it requires continual use

The most common adverse effects while on finasteride adverse effects?

1. Orthostatic hypotension, dizziness, decreased libido, impotence, and ejaculatory disorder

What should be monitored in patients taking finasteride?

1. LFTs baseline every 6 months

Who is finasteride contraindicated in?

1. Pregnant women and premenopausal women

Which medication has off label use for pattern hair loss?

1. dutasteride and spironolactone

what is the brand name for dutasteride?

1. avodart

_____ is approved for AGA in Japan and S. Korea at 0.5mg po QD.

1. dutasteride

Who is spironolactone recommended for?

1. recommend use in FPHL patients with signs of hyperandrogenism or PCOS

What are adverse effects of spironolactone?

1. spotted menstruation, gynecomastia, polyuria, orthostatic hypotension, hyperkalemia.