Androgenetic alopecia (also known as male pattern baldness). Also known as androgenetic alopecia (AGA), is a prevalent ailment that prompts many individuals to seek medical assistance. It is distinguished by follicles that gradually shrink in size, which ultimately results in baldness.
About eighty percent of males of the Caucasian race are affected by AGA. Although it is prevalent in men of all different racial origins. Caucasian males are plagued by it more commonly than men of other ethnicities.
Traditional pharmacologic treatment for androgenetic alopecia (AGA) focuses on lowering levels of dihydrotestosterone (DHT). In addition to stimulating boosting hair follicles via the use of minoxidil or 5-alpha reductase (5AR) inhibitors. However, new and innovative therapies are investigating the inhibition of Janus kinase and the application of platelet-rich plasma (PRP). Other treatments include hair transplant, scalp micro-needling, laser therapy, and hair mesotherapy.
Pathophysiology to treat androgenetic alopecia
A genetic predisposition causes AGA; however, the data suggest that androgens are related to the condition’s origin. DHT is the main androgen implicated in AGA, and men with AGA have higher quantities of DHT in their bodies. 5AR is responsible for the conversion of circulating testosterone into DHT.
There are three different forms of alpha-reductase receptor isoenzymes. Nonetheless, the importance of types I and II in the therapy of AGA cannot be overstated. The hair follicles and sebaceous glands that makeup type I are found in the skin. But type II is found in the inner sheath of follicles in the chest, scalp, face, genitals, and prostate gland.
AGA also affects the normal cycle of hair growth. It is more common to find hair in the resting stage than it is it in the growing stage.
Because of this, the amount of hair that grows in particular parts of the head thins out. Furthermore, some of the follicles are on the smaller side, making them more sensitive to the effects of androgen. The concentration of these tiny hair follicles is what genetically determines the pattern of hair loss that a person experiences.
The FDA has approved the treatment of androgenetic alopecia with the 5AR inhibitor finasteride. The medicine achieves its effect by suppressing type II 5AR, inhibiting the testosterone’s conversion to DHT.
The research carried out by experts on finasteride 0.25% and 0.5% solution to oral finasteride 1 mg was due to the undesirable side effects of oral finasteride. Even though the studies were on a smaller scale, they showed a comparable increase in hair regrowth with fewer adverse effects compared to the individuals who received topical medication.
The Food and Medication Administration (FDA) approved medication for the management of AGA to topical minoxidil. Both a 2% solution, a 5% solution, and a 5% foam are available for purchase. Research has shown that the 5% solution is more helpful than the 2% solution.
Minoxidil may stimulate hair growth in several ways; however, the precise mechanism(s) by which it does so is not entirely understood. It has been demonstrated in vitro and Vivo that it has a direct mitogenic impact on epidermal cells. Additionally, it has been shown to extend the time that keratinocytes may survive in vitro.
Additionally, topical minoxidil may prevent calcium from entering cells, boosting epidermal growth factors and making it possible for hair to grow in previously bald areas. There is a tiny proportion of men who see some hair regeneration, but the majority of men continue to experience hair loss. It occurs in around half of all males. If one wishes to maintain their current level of hair growth, the medication must be taken indefinitely.
Spironolactone, Ketaconazole, and Prostaglandin F2 Analogues
Combination treatment with oral finasteride and ketaconazole shampoo has been investigated as a potential method for the treatment of androgenetic alopecia (AGA). Ketoconazole has been shown to inhibit the DHT pathway, which contributes to the drug’s antiandrogenic activities, although the underlying mechanism remains unknown. In addition to this, it has the potential to calm skin inflammation.
Spironolactone is a diuretic that also possesses antiandrogenic effects. It inhibits androgen receptors, which causes a reduction in testosterone levels. Most of the clinical research on spironolactone ranging from 50 to 200 mg per day, has been conducted on women who have AGA, and the outcomes have been inconsistent.
Low-level Laser Therapy
Experts can also treat AGA using low-level laser treatment. At specific wavelengths, it would appear that lasers can stimulate hair regrowth. Several different laser therapy equipment is available, such as a comb, hood, and helmet designed to be worn on the head. The HairMax LaserComb is the only one of these products that have received clearance from the FDA.
Hair Transplantation and Micro-needling excellent solution for androgenetic alopecia
Micro-needling is gaining popularity due to the discovery that it can help encourage hair regeneration in patients who suffer from alopecia. Its most recent application is to enhance the delivery of topical medications, while it has a history of use in the cosmetics industry. Micro-needling is a technique that uses several excellent needles. Surgeons use these needles to create tiny punctures in the skin, stimulating the growth of new blood vessels, releasing growth elements, and encouraging the formation of Wnt proteins.
Experts have identified Wnt proteins to trigger dermal papillae stem cells, leading to hair development. Hair growth is caused by the production of specific growth factors and the stimulation of the hair bulge. In most cases, experts perform micro-needling with a topical medication like minoxidil.
The studies conducted to assess the effectiveness of micro-needling with topical minoxidil have been relatively minor; nonetheless, some have revealed statistically significant results.
Emerging Treatment Options
Several novel therapeutics, including JAKs and PRP injections, are either in development or research subjects as potential treatments for AGA. JAKs are now being researched as potential novel medications to treat alopecia; nevertheless, there is a lack of information regarding their application in AGA.
Conclusion about androgenetic alopecia
The healthcare professional should have a conversation with the patient about the available options and then prescribe treatment based on the actual findings and the patient’s choice, all the while considering the dosing plan and cost.