Patrícia Guedes Rittes, MD
Androgenic alopecia is a common disorder affecting both men and women. Both androgenic alopecia and telogen effluvium can be treated with mesotherapy, with results ranging from good to excellent. During the Fourth International Mesotherapy Congress in 1985, the first paper outlining a protocol on this topic was presented by Dr. Philippe Petit.
Androgenic alopecia is defined by a chronic, diffuse, progressive hair loss. Patients have hair loss in a ratio of 2 to 1, that is, for every 2 new hair threads, one is lost.
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HAIR LOSS & HAIR REGROWTH
Phillipa McCaffery, MD
Androgenetic alopecia ( AGA ) is the commonest form of hair loss affecting both men and women. It affects around 50% of men and between 20% - 50 % of women by the age of 50.
AGA is caused by progressive, gradual shrinking of normal hair follicles that produce normal (terminal) hairs into miniturised hair follicles that produce fine (vellus) hairs. The terminal-to-vellus hair ratio, normally 2:1 gradually reduces until it is reversed.
Although AGA is considered by most doctors to be a cosmetic condition, it can have significant psychological and physical effects on those affected by it. Loss of hair allows increased ultraviolet light to reach the scalp and, in Australia, the highest incidence of malignant melanoma is on the scalps of balding men. AGA has also been linked to prostrate and cardiac conditions in older men. Women are particularly prone to suffering the adverse psychological effects of hairloss, as a thick head of hair is a highly valued aspect of feminine beauty in almost every culture.
AGA occurs most commonly in Caucasian men, followed by Asian and African American men. AGA has it’s lowest incidence in Native American and Eskimo men.
Almost all men and women with AGA begin to loose their hair prior to the age of 40 and many will commence loosing their hair by the age of 30.
AGA is distinguished from all other types of Alopecia by it’s gradual onset.
Men present with gradual thinning in the temporal areas, producing a V shaped frontal hairline. As baldness progresses, a bald patch appears on the crown of the head, which increases in size as the frontal hairline recedes. Eventually the receeding frontal hairline and the bald patch meet up, leading to loss of hair on most of the top of the head, whilst the hair around the base of the head remains intact. This pattern of hair loss is classified as Norwood/Hamilton stages 1-7.
Women usually present with diffuse thinning of hair on the crown of the head. This pattern of hair loss is classified as Ludwig stages
1-3. V shaped temporal recession does occur in women but usually to a lesser degree than in men. In general, women maintain their frontal hairline.
AGA is inherited however, the exact mechanism of inheritance has not been determined. It is also likely that systemic or external factors also play a role.
There are currently only 2 clinically proven, TGA/FDA–approved medications available for treatment of AGA - Minoxidil and Finasteride.
Although the exact mechanism of action is unknown, Minoxidil appears to lengthen the duration of the anagen ( growth ) phase of hair, and it may increase the blood supply to the follicle. Used alone, regrowth is more pronounced on the crown than in the frontal scalp and is not noted for at least 4 months. Consequently, many people grow discouraged and give up using Minoxidil before it has had a chance to work.
Patients are advised to use Minoxidil in combination with a scalp roller to maximise the beneficial results of Minoxidil. New hair growth can be seen within 4-6 weeks with daily scalp rolling and a single application of Minoxidil per week, greatly improving patient compliance.
Treatment with Minoxidil and the Scalp Roller is necessary indefinitely as stopping treatment can lead to reversion to the pre-treatment balding pattern.
Finasteride is taken orally and is a 5 alpha-reductase type 2 inhibitor. It is not an antiandrogen. The drug can be used only in men. Finasteride has been shown to diminish the progression of ALA in males who are treated, and to stimulate hair regrowth.
Finasteride must be continued indefinitely because discontinuation results in gradual progression of the disorder.
In women with ALA, especially those with a component of hyperandrogenism, drugs that act as androgen suppressants (eg, spironolactone and oestradiol/ anti- androgen combination oral contraceptives) may be beneficial.
Surgical treatment of ALA has been performed for the past 4 decades via Hair Transplantation. The main problem is covering the bald area with sufficient donor plugs to produce a normal hair pattern. Micrografting produces a more natural appearance than the old technique of transplanting plugs. Scalp reduction has been attempted to decrease the size of the scalp to be covered by transplanted hair. However, the scars produced by the reduction technique often spread and become more noticeable with time.
Ideally, if treatment with Minoxidil and the Scalp Roller is commenced as soon as hair loss becomes apparent, the need for Surgical treatment can be prevented.
Non Surgical Hair Regrowth with the Scalp Roller - Combined with Minoxidil:
How does it work?
A Scalp Roller is an instrument consisting of a heavy duty plastic roller head covered in tiny stainless steel needles.(0.5mm to 1mm is ideal)