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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.
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Pathophysiology
Normally; On the top: Androgen-sensitive follicles
On the sides and back of the scalp: androgen-independent
follicles
In genetically predisposed individuals;(Under Influenceof
Androgens)
Terminal hair follicles are transformed into vellus.
Shortened anagen and an increased telogen.
Decreased growth of hair on the scalp as well asaxilla
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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 eunuchsdo 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 ofpatients with
androgenic alopecia.
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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.
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Pharmacokinetic properties of oral finasteride afterrepeated
administration of 1 mg/day or after singledose of 5 mg.
1mg/day 5 mg(n=12) (n=6)
Day 1 Day 17
Cmax (g/L) 6.5 9.2 38.1
tmax (h) 1.6 1.3 1.8
t (h) 4.5 4.8 4.7
AUC0-24(g/L/h) 38.2 53.2 180.6
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Finasteride - 1mg
Clinical Efficacy
Evaluated in three phase III placebo-controlledstudies, each of
1 years duration
Additionally, the two studies in men with mild to
moderate vertex hair loss continued in a blindedmanner 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 frontalhair loss) were
enrolled in the study.
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Finasteride 1 Mg:In 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 andevaluation of global
photographs.
Finasteride 1 mg significantly increased scalp haircounts in the
frontal area (P
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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
erectiledysfunction (1.3 vs. 0.7%)
Resolved in many patients who reported them but remained
ontherapy. It also resolved in those who stopped therapy.
Small reductions (from 0.7 to 0.5 ng/ml) in serum
prostate-specificantigen (PSA) may be seen. Hence double the
reported PSA beforeinterpreting.
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Finasteride 1mg - Indications
Treatment of men with male
pattern hair loss and to
prevent further hair loss in
these patients.
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Finasteride-1mg - Dosage & Administration
1mg/day taken with or without food. Continue for atleast 3
months before assessing. Effects are reversed
within 12 months of stopping therapy
Dosage adjustment unnecessary in elderly or in
renalinsufficiency.
Contraindicated in women.
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Baseline Month 12 Month 24J Am Acad Dermatol 1998; 39:578-89
Patient 1
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Hair count mean change from baseline ( SE) from thecombined US
and international studies for men who enteredthe extension
studies.
J Am Acad Dermatol 1998; 39:578-89
BaselineMonth
6 12 24
Fin FinPbo Fin
Fin Pbo
Pbo PboMeanHairCountChan
gefrom
Baseline=1SE
-60-40-20
-80
020406080
100120
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FinpeciaJ Am Acad Dermatol 1998; 39:578-89
Investigator assessment mean rating score (+ 1 SE) from
thecombined US and international studies for men who entered
theextension studies.
1.4Fin FinPbo FinFin Pbo
Pbo Pbo
1.2
1.00.80.6
MeanS
core1SE
+
0.40.2
-0.2-0.4-0.6
Baseline 3 6 9 12Month
15 18 21 24
0.0
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FinpeciaDrugs 1999; 57(1): 111-126
Treatment-related sexual adverse events reported with
finasteride.Men with male pattern hair loss were randomised to
receive oralfinasteride 1 mg/day (n=945) or placebo (n=934) for 1
year.
* p = 0.041 vs. placebo
PlaceboFinasteride
0
1
2
3
4
Incidence(%o
fpatients)
Total
Decreased
libido Ejaculationdisorders Erectiledysfunction
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Finasteride in frontal hair lossHair count mean change from
baseline (+ 1 SE).
12Month
141210
All patients 1 mg
Mea
nChangefromBaseline
S.E
(Hairs)
+
Baseline 24
864
20
-2-4-6
J Am Acad Dermatol 1999; 40: 930-7.
