The main manifestations of female baldness are hair loss and thinning in the head and the anterior area, and the prevalence increases with age. In addition to genetic factors, abnormal androgen metabolism and iron deficiency are also possible pathogenic factors. There are currently three commonly used drugs for the treatment of female alopecia: minoxidil, spironolactone, and cyproterone acetate.
Iron-deficiency alopecia: Alopecia is generally seen on the top of the head or around the forehead and diffuse alopecia appears progressively. Mostly caused by iron deficiency, once the timely supplement of iron and iron-rich foods, hair loss will be reversed.
Balding after delivery: A sudden drop in estrogen levels after delivery causes hair loss. Acute diffuse hair loss. As long as postpartum nutrition is properly increased, attention is paid to rest and symptomatic treatment, new hair can often grow again.
I. Minoxidil: Non Androgen Dependent Drugs
Minoxidil is a K+ channel opener that can directly dilate blood vessels, mainly for severe refractory hypertension. About 80% of patients experience hirsutism after taking minoxidil. To take advantage of this side effect, minoxidil was developed as a topical topical preparation for the treatment of alopecia.
Minoxidil is an FDA-approved first-line treatment for baldness in women. The main mechanism is: to dilate blood vessels, improve microcirculation; increase the volume of hair follicles, make hair thicker; stimulate and prolong hair growth cycle, make hair longer and more. A 5-year follow-up confirmed that topical minoxidil has long-term sustained effects.
Minoxidil solutions (tannins, tinctures) are available in 2% and 5% sizes. Men can use 2% and 5% sizes. Women only recommend 2%. This is because about 10% of women suffer from hirsutism (face, arms, and legs hirsutism) after 2-3 months of treatment with 5% minoxidil.
Usage and dosage: Apply 1ml each time, 2 times a day, apply on the affected part of the head, and massage 3~5 minutes by hand. This dose is used regardless of the size of the affected area. Minoxidil can be transdermally absorbed (0.3 to 4.5%) and its daily dose should not exceed 2 ml, otherwise it can cause systemic adverse reactions.
The average onset time is 12 weeks. In the first 2 to 8 weeks of treatment, there may be a brief period of restless hair loss, and the disappearance of symptoms of hair loss will continue; continuous use must be adhered to, otherwise new hair can completely resolve by 1 to 6 months after drug withdrawal.
Minoxidil solution contains propylene glycol, which can cause pruritus, dandruff, and scalp erythema. Hair growth may occur in unwanted areas. Wash hands after use! !
II. Spironolactone: Oral Anti-androgen Drugs
Female androgens (androstenedione) are mainly synthesized by the adrenal cortex and secreted by the ovaries. The conversion of androstenedione to dihydrotestosterone acts on the hair follicle androgen receptors to shrink the hair follicles, causing the hair to taper during the growth phase, shortening the hair growth cycle, and leading to progressive hair loss. Premature or severe female patients can be accompanied by hyperandrogenism.
Spironolactone is an aldosterone inhibitor and is also a weaker testosterone synthesis inhibitor and a weaker androgen receptor inhibitor. Spironolactone is the most commonly used oral anti-androgen drug in the treatment of female pattern baldness. Studies have shown that 44% of female bald patients may have hair regeneration after taking it.
For patients with early mild female pattern baldness, the purpose of treatment is to reduce hair loss and treat with spironolactone alone; for moderate to severe female pattern baldness patients, spironolactone should be combined with minoxidil solution to promote hair regeneration. treatment.
Long-term oral spironolactone should pay attention to monitor blood potassium and blood pressure.
The efficacy and adverse reactions of spironolactone are positively related to the dose. Spironolactone can cause orthostatic hypotension, electrolyte imbalance, menstrual cycle disorders, breast tenderness, and abnormal liver function.
III. Cyproterone: Oral progestogen drugs
Cyproterone acetate is a progesterone that lowers androgen levels and can directly block androgen receptors. For women with alopecia and normal hormone levels, there is a curative effect. When cyproterone acetate was used for 12 months, about 88% of female patients had hair loss and stopped developing, but the promotion of hair regeneration was poor.
The use of cyproterone acetate alone or in combination with ethinyl estradiol or spironolactone can improve hair growth in women with alopecia. Studies have shown that the combination of cyproterone acetate and ethinyl estradiol is more effective in patients with hyperandrogenism.
Female baldness, especially in patients with acne and hirsutism, can be taken orally with Diane-35 (containing cyproterone acetate 2mg, ethinylestradiol 35μg), menstrual cramps on the first 1-5 days, one tablet daily, continuous Take 21 days, stop medication for 7 days, and start the next course of treatment.
Cyproterone acetate can cause female fetal feminization and is strictly prohibited for women during pregnancy; it can be excreted with milk and is strictly prohibited for lactating women.
The side effects of Diane-35 include thromboembolism, cerebrovascular accidents, hypertension, and liver damage.