TRICHOGENIC & ANTITRICHOGENIC AGENTS
Topical minoxidil
(Rogaine) is effective in reversing the progres-sive miniaturization of
terminal scalp hairs associated with andro-genic alopecia. Vertex balding is
more responsive to therapy than frontal balding. The mechanism of action of
minoxidil on hair follicles is unknown. Chronic dosing studies have
demonstrated that the effect of minoxidil is not permanent, and cessation of
treatment will lead to hair loss in 4–6 months. Percutaneous absorption of
minoxidil in normal scalp is minimal, but possible systemic effects on blood
pressure should be monitored in patients
with cardiac disease.
Finasteride (Propecia)
is a 5α-reductase
inhibitor that blocks the conversion of testosterone to dihydrotestosterone ,
the androgen responsible for androgenic alopecia in genetically predisposed
men. Oral finasteride, 1 mg/d, promotes hair growth and prevents further hair loss
in a significant proportion of men with androgenic alopecia. Treatment for at
least 3–6 months is necessary to see increased hair growth or prevent further
hair loss. Continued treatment with finasteride is necessary to sustain
bene-fit. Reported adverse effects include decreased libido, ejaculation
disorders, and erectile dysfunction, which resolve in most men who remain on
therapy and in all men who discontinue finasteride.
There are no data to
support the use of finasteride in women with androgenic alopecia. Pregnant
women should not be exposed to finasteride either by use or by handling crushed
tablets because of the risk of hypospadias developing in a male fetus.
Bimatoprost (Latisse)
is a prostaglandin analog that is available as a 0.03% ophthalmic solution to
treat hypotrichosis of the eye-lashes. The mechanism of action is unknown.
Treatment consists of nightly application to the skin of the upper eyelid
margins at the base of the eyelashes using a separate disposable applicator foreach
eyelid. Contact lenses should be removed prior to bimato-prost application.
Side effects include pruritus, conjunctival hype-remia, skin pigmentation, and
erythema of the eyelids. Although iris darkening has not been reported with
applications confined to the upper eyelid skin, increased brown iris
pigmentation, which is likely to be permanent, has occurred when bimatoprost
ophthal-mic solution was instilled onto the eye.
Eflornithine
(Vaniqa) is an irreversible inhibitor of ornithine decarboxylase, which
catalyzes the rate-limiting step in the biosyn-thesis of polyamines. Polyamines
are required for cell division and differentiation, and inhibition of ornithine
decarboxylase affects the rate of hair growth. Topical eflornithine has been shown
to be effective in reducing facial hair growth in approximately 30% of women
when applied twice daily for 6 months of therapy. Hair growth was observed to
return to pretreatment levels 8 weeks after discontinuation. Local adverse
effects include stinging, burning, and folliculitis.
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