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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.