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 II 5 ?-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 (n=12) (n=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 between 18 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 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 and evaluation of global photographs.
Finasteride 1 mg significantly increased scalp hair counts in the frontal area (P<0.001).
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
12. Hair count mean change from baseline ( SE) from the combined US and international studies for men who entered the extension studies.
13. Investigator assessment mean rating score (+ 1 SE) from the combined US and international studies for men who entered the extension studies.
14. Treatment-related sexual adverse events reported with finasteride. Men with male pattern hair loss were randomised to receive oral finasteride 1 mg/day (n=945) or placebo (n=934) for 1 year.
15. Finasteride in frontal hair loss Hair count mean change from baseline (+ 1 SE).
