Q: What is androgenetic baldness? Can women suffer from it?
A.
Androgenetic baldness is a condition characterized by a progressive decrease in hair on the top of the head, previously known as seborrheic baldness and early baldness. Androgenetic baldness usually appears at puberty and gets progressively worse with age. Women also have androgens in their bodies and can also suffer from this disease. The survey found that the prevalence rate in China is 15.73% to 19.75% for men and 2.73% to 4.69% for women. Q: What are the causes of androgenic baldness?
Answer.
(1) Mainly genetic factors, but the causative gene is not yet clear.
(2) Androgens play an important role in the pathogenesis of androgenic baldness: the sensitivity of hair follicles on the top of the head to androgens increases in patients with androgenic baldness, and the 5α-reductase activity in the scalp increases, leading to an increase in the conversion of local testosterone to dihydrotestosterone (DHT) in the area of hair loss, which acts on hair follicles, causing them to atrophy and degenerate, shortening the growth period of hair and increasing the proportion of resting hair, leading to a decrease in hair density and hair diameter. decreases, resulting in baldness.
Q: What are the clinical manifestations of androgenetic alopecia?
Answer.
(1) Males: Often the onset begins at puberty. Most of the hair loss starts from the sideburns on both sides of the forehead and gradually extends in an M-shape toward the top of the head, with the frontotemporal hairline gradually receding backward. There are also forehead sideburns and top of the head hair loss at the same time, the top of the head hair can be completely lost over time, or a small amount of hair remains. Some patients also gradually lose hair in the hairline behind the ear.
(2) Women: the symptoms are milder and manifest as the hair on the top of the head becomes thinning and diffuse hair loss, characterized by a hairline on the forehead that does not move back and little hair loss in the temporal area.
Q: How to determine the severity of the condition?
A.
(1) Males: The Hamilton-Norwood classification is used, which is divided into 7 levels and 12 types, including 8 classical types and 4 variants.
(2) Females: Ludwig classification is used, divided into 3 levels.
See the diagram for a preliminary diagnosis.
Q: How is the diagnosis of this disease determined (confirmed)?
A.
The disease is easy to diagnose, and can be diagnosed by the medical history, typical clinical manifestations, and family history (related relatives with the disease by blood).
The following auxiliary tests can help in the diagnosis.
(1) Hair pulling test: The percentage of hair in the anagen phase in the area of hair loss decreases to <80% and intermediate hair appears. Do not shampoo your hair for at least 24 hours prior to performing this test.
(2) Histopathological examination.
Q: What are the main diseases that distinguish this disease from?
A.
(1) Differentiate from diffuse non-scarring alopecia, such as resting alopecia, anagen alopecia, alopecia areata and plucking fetish.
(2) Female patients with symptoms such as seborrhea, severe acne, hirsutism in women, manifestations of male pattern alopecia, irregular menstruation and obesity need to exclude hyperandrogenemia or diseases related to insulin resistance, and should undergo testing of serum sex hormone levels and blood glucose, and B-mode ultrasound examination of the abdomen and pelvis.
(3) If necessary, tests of thyroid hormones, hemoglobin and anti-nuclear antibodies should be performed to exclude resting hair loss caused by abnormal thyroid function, anemia or autoimmune disease.
Q: How to treat androgenetic alopecia? How effective is the treatment?
Answer.
(1) Since androgenetic alopecia is a process of progressive aggravation, early treatment is emphasized, and the earlier the treatment, the better the results. Treatment methods mainly include internal medication, external medication and hair transplantation, etc. Combination therapy is recommended.
(2) Hair loss symptoms can be significantly relieved within 3 to 6 months by reasonable medication, and new hair can be produced after treatment lasts for 6 to 12 months. However, hair loss treatment is a long-term process and requires continuous medication to achieve a more desirable outcome.
(3) This disease has a great impact on the quality of life of patients, if early diagnosis and appropriate treatment, some patients can get improvement, but also to some patients never get better. It can be said that: if diagnosed and treated early, some patients can improve or be cured; if not diagnosed and treated, if diagnosed but not treated or treated late, it is difficult to get better.
Q: How to treat this disease with finasteride (and similar drugs)?
A.
(1) Finasteride is an oral drug approved by the U.S. Food and Drug Administration and China’s State Food and Drug Administration for the treatment of male androgenetic baldness.
(2) Usage: 1mg/d orally. Hair loss generally starts to decrease after 3 months of taking the drug, and hair growth starts in 6-9 months. The best efficacy can be achieved after 1 to 2 years of continuous administration; if the efficacy is to be maintained, a longer maintenance treatment is required. The effective rate after 1 year of medication is 65% to 90, and the effective rate for hair loss in the forehead is lower than that in the parieto-occipital area.
(3) Recommend at least 1 year of treatment, after 1 year, if there is no significant effect, it is recommended to stop the drug.
(4) Finasteride is generally well tolerated with a low incidence of adverse effects. Individual patients may experience decreased libido, impotence, and decreased ejaculation, most of which gradually disappear during the course of treatment, and these side effects may subside after a few days or weeks if treatment is discontinued.
Q: How is spironolactone used to treat this disease?
A.
(1) Principle: It can reduce the production of testosterone by the adrenal glands, and also has an inhibitory effect on the binding of DHT to androgen receptors.
(2) It is mainly used for female patients. Dosage: 40-200mg/d with a recommended course of treatment for at least 1 year, which may lead to some improvement of symptoms in some patients.
(3) Adverse effects: decreased libido, breast pain, increased urination. The blood potassium concentration needs to be paid attention to during treatment.
(4) Not suitable for treating male patients.
Q: What other drugs can be used to treat this disease?
A.
(1) Ciproterone: It mainly contains ciproterone 100mg and ethinyl estradiol 30μg, which has strong anti-androgenic effect. It is used for female alopecia patients with combined acne and hirsutism, 1 tablet daily, taken on the 5th to 24th day of menstrual cycle. It is contraindicated in patients with hepatic or renal insufficiency and in minors. The main adverse effects are decreased libido and weight gain.
(2) Flutamide: It can inhibit the production of DHT. Dosage: 250mg, 3 times daily, for more than 5 months. The adverse effects of this drug are breast pain, impotence, decreased libido, etc. Therefore, it is not recommended for male patients.
(3) Cimetidine has a weak anti-androgenic effect and can compete with DHT for androgen receptors. Dosage: 300mg, 3 to 5 times daily for more than 5 months. Adverse effects are breast pain, impotence, and decreased libido are not recommended for male patients.
(4) Other supportive drugs are zinc preparations, cysteine, biotin and folic acid, etc.
Q: How to treat this disease with Minoxidil?
A.
(1) There are two clinical doses of 2% and 5% concentration, and the usage is twice a day, the dosage is about 1.0 to 1.5ml each time.
(2) The average onset of action is 12 weeks, the recommended duration of use for more than six months, both men and women can use, the efficiency of up to 50% to 85%, with mild to moderate hair loss is more effective.
(3) If you need to maintain the efficacy, you need to maintain treatment for a long time.
(4) Common adverse events are contact dermatitis and hirsutism.
(5) Combination of oral medications may improve the efficacy.
Q: What is hair transplantation? What are the indications and contraindications? How much does it cost?
A.
(1) Hair follicles from congenitally androgen-insensitive areas (usually occipital) are isolated and transplanted to the balding area. The suppressed hair follicles can be kept alive for a long time. In recent years, with the continuous improvement of hair transplantation technology, the hair transplantation technology of separating hair embryos by follicular units has become more and more mature. Generally the hair starts to grow again after 2 to 3 months after transplantation, and the hair loss after transplantation is only temporary.
(2) Indications are mainly for androgenic baldness below grade 4, hair loss has stabilized after medication, dense occipital hair, and there are enough sources of hairs available for transplantation.
(3) Contraindications include suffering from serious internal diseases, hair in the donor area is too thin and of too poor quality, etc.
(4) Before and after hair transplantation, it is usually necessary to continue oral or topical medication to maintain the growth of non-transplanted hair in the balding area.
(5) Charges are usually calculated by hair follicle unit. If the hair loss area is 10 square centimeters, the number of transplants needed is about 100 units, and each unit is about $8~12.