Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short version

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Abstract

Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian men and 42% of women. Patients afflicted with androgenetic alopecia may undergo significant impairment of quality of life. The European Dermatology Forum (EDF) initiated a project to develop evidence-based guidelines for the treatment of androgenetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.

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Most cited references 95

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Finasteride in the treatment of men with androgenetic alopecia

Keith D Kaufman, Elise A Olsen, David Whiting … (1998)

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The role of platelet plasma growth factors in male pattern baldness surgery.

Carlos Oscar Uebel, Denise Cantarelli, Pedro Martins … (2006)

Follicular units are commonly used in baldness surgery, and they have become a global procedure for both male and female patients. The yield from micrografts varies between 70 and 85 percent. Yield is determined by factors such as quality of the harvested donor area, preparation of the units, care taken during the implantation procedure, and follicular apoptosis. To improve hair density and stimulate follicular unit growth, an experimental study was designed using platelet plasma growth factors obtained from the patient's autologous plasma. The author established a protocol within a group of 20 patients with male pattern baldness. The data showed a gaussian distribution; to compare the two procedures involved in this clinical trial, the paired t test was used. The author observed a significant difference in the yield of follicular units when comparing the experimental with the control areas of the scalp (p < 0.001). The areas treated with platelet plasma growth factors demonstrated a yield of 18.7 follicular units per cm2, whereas the control areas yielded 16.4 follicular units per cm2, an increase in follicular density of 15.1 percent. Among patients who used the experimental protocol, some experienced only 3 percent and others experienced a 52 percent increase in density. This study provides a new perspective and contribution to baldness surgery with follicular unit megasessions, and demonstrates an improvement that can be introduced into baldness surgery clinics with less morbidity and a low cost-to-benefit ratio. Further studies may improve the efficiency of the technique and allow digital programs to better evaluate the increase in hair density.

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A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men.

Elise A Olsen, Frank Dunlap, Toni Funicella … (2002)

Topical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in individuals with androgenetic alopecia (AGA). Results can be variable, and historical experience suggests that higher concentrations of topical minoxidil may enhance efficacy. The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of men with AGA. A total of 393 men (18-49 years old) with AGA applied 5% topical minoxidil solution (n = 157), 2% topical minoxidil solution (n = 158), or placebo (vehicle for 5% solution; n = 78) twice daily. Efficacy was evaluated by scalp target area hair counts and patient and investigator assessments of change in scalp coverage and benefit of treatment. After 48 weeks of therapy, 5% topical minoxidil was significantly superior to 2% topical minoxidil and placebo in terms of change from baseline in nonvellus hair count, patient rating of scalp coverage and treatment benefit, and investigator rating of scalp coverage. Hair count data indicate that response to treatment occurred earlier with 5% compared with 2% topical minoxidil. Additionally, data from a patient questionnaire on quality of life, global benefit, hair growth, and hair styling demonstrated that 5% topical minoxidil helped improve patients' psychosocial perceptions of hair loss. An increased occurrence of pruritus and local irritation was observed with 5% topical minoxidil compared with 2% topical minoxidil. In men with AGA, 5% topical minoxidil was clearly superior to 2% topical minoxidil and placebo in increasing hair regrowth, and the magnitude of its effect was marked (45% more hair regrowth than 2% topical minoxidil at week 48). Men who used 5% topical minoxidil also had an earlier response to treatment than those who used 2% topical minoxidil. Psychosocial perceptions of hair loss in men with AGA were also improved. Topical minoxidil (5% and 2%) was well tolerated by the men in this trial without evidence of systemic effects.

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Author and article information

Journal

Title: Journal of the European Academy of Dermatology and Venereology

Abbreviated Title: J Eur Acad Dermatol Venereol

Publisher: Wiley

ISSN: 09269959

Publication date Created: January 2018

Publication date (Print): January 2018

Publication date (Electronic): November 27 2017

Volume: 32

Issue: 1

Pages: 11-22

Affiliations

[1 ]Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Berlin Germany

[2 ]Department of Dermatology; University of Sheffield; Sheffield UK

[3 ]Centre Sabouraud; Hôpital St. Louis; Paris France

[4 ]Private Practices; Berlin, Leipzig Germany

[5 ]Private Practice; Neuenhagen Germany

[6 ]Department of Dermatology and Venerology; Papageorgiou Hospital; Aristotle University; Thessaloniki Greece

[7 ]Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA

[8 ]Private Practice; Bologna Italy

[9 ]Department of Dermatology; Hopital Erasme; Université Libre de Bruxelles; Brussels Belgium

[10 ]Department of Dermatology; University of Bologna; Bologna Italy

[11 ]Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy, Division of Evidence Based Medicine; Berlin Germany