85: Androgenetic Alopecia Flashcards
What is Androgenetic Alopecia (AGA)?
Androgenetic Alopecia (AGA) is the most common type of hair loss characterized by nonscarring progressive miniaturization of the hair follicle with shortening of the anagen phase in genetically predisposed men and women, typically following a specific pattern distribution.
What are the epidemiological factors associated with AGA?
The epidemiological factors associated with AGA include:
1. Onset at any age following puberty.
2. Increasing frequency with age:
- 50 y/o men: 50% to 60% affected.
- 70 y/o men: 80% affected.
3. Prevalence and severity are lower among Asians, Native Americans, and African Americans.
4. In Chinese men:
- 10% to 20% affected at ages 40-49.
- 40% to 60% affected by age 70 and beyond.
5. The frequency and severity is lower in women, appearing later in life, with 25% in Korean women and 12% to 15% in Chinese women over 70 y/o.
What are the clinical features of Male Pattern Hair Loss?
The clinical features of Male Pattern Hair Loss, specifically the Hamilton-Norwood type, include:
- Most frequent clinical pattern in men (occasionally in women).
- Characteristic finding: recession of the frontal hairline in a triangular pattern, followed by vertex thinning until the top of the scalp is completely bald.
- The occipital area and sides of the scalp are spared.
What are the characteristics of Female Pattern Hair Loss?
Female Pattern Hair Loss, specifically the Ludwig type, is characterized by:
- Diffuse thinning of the centroparetal region while maintaining the frontal hairline.
- It is the most common type of AGA in women (occasionally in men).
- There are two scales describing this pattern:
- 3-point Ludwig scale
- 5-point Sinclair scale.
What are the risk factors associated with Male AGA?
The risk factors associated with Male AGA include:
- Determined by genetic factors.
- Strong paternal influence on the risk of balding.
- Has a complex polygenic basis with 12 genetic regions associated with AGA as of the current writing.
What is the primary androgen responsible for follicular pathology in AGA?
Dihydrotestosterone is the androgen chiefly responsible for the follicular pathology in AGA, acting primarily on the dermal papilla.
What are some signaling molecules implicated in the inhibition of hair growth?
Signaling molecules include:
1. Transforming growth factor (TGF)-β1
2. Transforming growth factor (TGF)-β2
3. Dickkopf 1 (member of the WNT signaling family)
4. Interleukin-6
5. Prostaglandin D2 synthase and its product, prostaglandin D.
What should be documented in the patient history for diagnosing AGA?
The patient history should document:
- The first manifestation of hair loss and the course (chronic or intermittent)
- Family history of AGA
- Symptoms such as pruritus and trichodynia
- Any systemic diseases or nutritional behaviors prior to hair loss.
What are the key components of the clinical examination for AGA?
The clinical examination involves:
- Assessment of the scalp skin, hair, facial and body hair, and nails.
- Scalp examination to check for associated findings like seborrhea or seborrheic dermatitis.
What is the purpose of the hair pull test in diagnosing AGA?
The hair pull test (Sabouraud maneuver) is used to assess hair density and identify short and fine miniaturized hairs, helping to exclude scarring alopecia.
What are the key genetic factors associated with androgenetic alopecia (AGA) in men?
Key genetic factors include:
- Androgen receptor (AR)
- Histone deacetylases (HDAC) 4 and 9
- WNT molecule WNT10A
AGA is recognized as an androgen-dependent trait in men.
How does the clinical presentation of androgenetic alopecia differ between men and women?
In men, AGA typically presents as a longstanding, slowly progressing reduction of hair density, often with thinning at the frontal, parietal, or vertex regions. In women, the etiology is less understood, but there is an increased frequency of balding in first-degree male relatives, and hormonal dysregulation may play a role.
What are the important aspects to document in a patient’s history when diagnosing androgenetic alopecia?
Important aspects to document include:
1. Family history of hair loss
2. First manifestation of hair loss and its course (chronic or intermittent)
3. Duration and pattern of hair loss (e.g., frontal, parietal)
4. Symptoms such as pruritus and trichodynia
5. Gynecologic history in women, including menstrual cycle disturbances
6. Recent systemic diseases or significant weight loss
7. Environmental factors and hairstyles that may contribute to hair loss.
What clinical examination techniques are used to assess androgenetic alopecia?
Clinical examination techniques include:
- Scalp examination: Assessing the scalp skin, hair, and associated findings like seborrhea or dermatitis.
- Hair examination:
1. Parting hair to assess density
2. Comparing part width across different regions (frontal, occipital, temporal)
3. Dermoscopy/trichoscopy to evaluate hair follicle openings and identify miniaturized hairs
4. Hair pull test (Sabouraud maneuver) to assess hair loss.
What is the significance of a positive pull test in diagnosing hair shedding?
A positive pull test indicates that more than 10% of the grasped hairs are pulled away, confirming active hair shedding. It may be positive in the frontal region but typically negative in the occipital region.
What are the peripheral signs of hyperandrogenism that may be observed in patients?
Peripheral signs of hyperandrogenism include:
- Acne
- Seborrhea
- Oily skin
- Obesity.
What role does dermoscopy play in the examination of AGA?
Dermoscopy is a noninvasive tool that improves the examination of scalp skin and hair shafts by magnification. In AGA, it helps assess hair follicle openings, hair shaft caliber variations, and can reveal hair diameter variations and an increased number of vellus hairs.
What findings in AGA can be observed through a phototrichogram?
Findings in AGA observed through a phototrichogram include:
- Reduced hair density in a pattern distribution compared to the occipital area.
- Anagen-to-Telogen ratio is normal or decreased when comparing frontal or vertex to the occiput.
When is a biopsy indicated in the diagnosis of AGA?
A biopsy is indicated when the diagnosis is uncertain. It is performed as a deep, 4-mm cylindrical punch and evaluated by dermatopathologists using both vertical and horizontal sectioning.
What laboratory tests are associated with AGA in men?
Laboratory testing for AGA in men is generally not necessary unless there is an underlying disorder or associated disease. However, there are possible positive associations with:
- Insulin resistance
- Metabolic syndrome
- Hypertension
- Benign prostate hyperplasia
Additionally, measurement of the prostate-specific antigen value is recommended before introducing finasteride therapy.
What diagnostic tools can confirm androgenetic alopecia (AGA) and differentiate it from other conditions?
Diagnostic tools include dermoscopy to assess hair follicle openings and hair shaft caliber variations, global photography for long-term follow-up, and phototrichogram to measure hair density and anagen-to-telogen ratio. A biopsy may be performed if the diagnosis is uncertain.
What histological findings are characteristic of AGA?
Findings include increased miniaturized (vellus-like) hair follicles, a terminal-to-vellus hair ratio of <3:1, increased telogen-to-anagen ratio, and mild perifollicular lymphohistiocytic infiltration.
What precaution should be taken before starting finasteride in a male patient with AGA and a family history of prostate cancer?
The prostate-specific antigen value should be measured before introducing finasteride therapy.
What is the preferred biopsy site for AGA, and why?
The central scalp is preferred as it is representative of the hair loss process. The bitemporal area should be avoided due to the presence of miniaturized hairs independent of AGA.
What is the purpose of a trichogram in diagnosing AGA?
A trichogram is used to rule out other differential diagnoses or comorbidities, but it is not a routine diagnostic tool for AGA.
What conditions are associated with AGA in men?
Conditions include insulin resistance, metabolic syndrome, hypertension, and benign prostate hyperplasia.
What is the significance of perifollicular fibrosis in AGA?
Perifollicular fibrosis is a histological feature of longstanding AGA.
What is the normal terminal-to-vellus hair ratio in a healthy scalp?
The normal terminal-to-vellus hair ratio in a healthy scalp is greater than 7:1.
What is the significance of an increased telogen-to-anagen ratio?
An increased telogen-to-anagen ratio is a histological feature of AGA.
What is the significance of follicular stelae in AGA?
Follicular stelae are tracts beneath miniaturized follicles and are a histological feature of AGA.
What is the significance of lymphohistiocytic infiltration in AGA?
Mild perifollicular lymphohistiocytic infiltration around the upper hair follicle is a histological feature of AGA.
What is the significance of seborrhea in AGA?
Seborrhea is an associated finding in AGA and may indicate seborrheic dermatitis.
What is the significance of hair caliber variations in AGA?
Hair caliber variations are a characteristic finding in AGA and can be assessed using dermoscopy.
What is the significance of a positive hair pull test in AGA?
A positive hair pull test indicates active hair shedding and may be positive in the frontal region in AGA.
What is the significance of miniaturized hair follicles in AGA?
Miniaturized hair follicles are a characteristic histological feature of AGA.
What clinical signs may indicate a diagnosis other than Androgenetic Alopecia (AGA) in women?
Clinical signs may include reduction of eyebrows or eyelashes and peripheral signs of hyperandrogenism such as acne, seborrhea, oily skin, and obesity.
What findings in a biopsy can indicate Androgenetic Alopecia (AGA)?
Findings include:
- Increased number and proportion of miniaturized (vellus-like) hair follicles
- <3:1 ratio of terminal to vellus-like hair follicles
- Increased telogen-to-anagen ratio
- Increased follicular stelae beneath miniaturized follicles
- Mild perifollicular lymphohistiocytic infiltration around the upper hair follicle.
How does dermoscopy aid in the diagnosis of AGA?
Dermoscopy is a noninvasive tool that improves examination of scalp skin and hair shafts by magnification.
What can biopsy indicate in Androgenetic Alopecia (AGA)?
- Increased number and proportion of miniaturized (vellus-like) hair follicles
- <3:1 ratio of terminal to vellus-like hair follicles
- Increased telogen-to-anagen ratio
- Increased follicular stelae beneath miniaturized follicles
- Mild perifollicular lymphohistiocytic infiltration around the upper hair follicle
How does dermoscopy aid in the diagnosis of AGA?
Dermoscopy is a noninvasive tool that improves examination of scalp skin and hair shafts by magnification, allowing assessment of hair follicle openings, hair shaft caliber variations, and identifying changes such as hair diameter variations and increased vellus hairs in AGA.
What is the role of laboratory testing in diagnosing AGA in men?
Laboratory testing for AGA in men is generally not necessary unless there is an underlying disorder or associated disease. However, conditions like insulin resistance, metabolic syndrome, hypertension, and benign prostate hyperplasia may have a positive association with AGA.
What is the recommended approach for ruling out causes of hyperandrogenism in women with androgen excess?
An interdisciplinary approach involving gynecologists, endocrinologists, and dermatologists is recommended to rule out causes such as:
- Polycystic ovary syndrome
- Congenital adrenal hyperplasia
- Androgen-secreting tumors
- Cushing syndrome
What laboratory tests should be performed to assess hyperandrogenism in women?
The following tests should be determined:
- Free androgen index
- Sex hormone-binding globulin
- Prolactin
Further testing may include:
- 17-OH-progesterone
- Follicle-stimulating hormone
- Estradiol
- Cortisol
When should measurements for hormonal testing be taken in women?
Measurements should be taken:
- Between 8:00 and 9:00 am
- Between the 2nd and 5th day of the menstrual cycle
What is the significance of stopping hormonal intake before blood hormone testing?
Blood hormone testing should be done at least 2 months after stopping any hormonal intake to ensure accurate results, as hormonal contraceptives or estrogens can lead to elevated sex hormone-binding globulin levels, which may falsify the outcome of the free androgen index.
What supportive role does serum ferritin level play in the treatment of diffuse androgen-dependent alopecia in women?
Adequate serum ferritin levels may have a supportive role during the treatment of diffuse androgen-dependent alopecia in women, particularly if diffuse effluvium is suspected.
A female patient complains of diffuse hair thinning and a positive pull test in the frontal region. What additional tests should be conducted to rule out other causes of hair loss?
Tests include measuring free androgen index, sex hormone-binding globulin, prolactin, and possibly ferritin levels or thyroid-stimulating hormone. Blood hormone testing should be done between the 2nd and 5th day of the menstrual cycle.
A woman with AGA is found to have elevated sex hormone-binding globulin levels. What could be the cause, and how should testing be adjusted?
Elevated levels may result from oral contraceptive use. Blood hormone testing should be done at least 2 months after stopping hormonal intake.
A 40-year-old woman with AGA is diagnosed with polycystic ovary syndrome. What interdisciplinary approach is recommended?
Collaboration with gynecologists, endocrinologists, and dermatologists is recommended to manage hyperandrogenism and associated conditions.
A woman with AGA is found to have diffuse effluvium. What additional tests should be conducted?
Tests include measuring ferritin levels or thyroid-stimulating hormone.
What is the recommended approach for ruling out causes of hyperandrogenism in women with suspected androgenetic alopecia?
An interdisciplinary approach involving gynecologists, endocrinologists, and dermatologists is recommended to rule out causes such as:
- Polycystic ovary syndrome
- Congenital adrenal hyperplasia
- Androgen-secreting tumors
- Cushing syndrome
What laboratory tests should be performed to assess hyperandrogenism in women suspected of having androgenetic alopecia?
The following laboratory tests should be performed:
- Free androgen index
- Sex hormone-binding globulin
- Prolactin
Further testing may include:
- 17-OH-progesterone
- Follicle-stimulating hormone
- Estradiol
- Cortisol
What are the timing and conditions for blood hormone testing in women suspected of hyperandrogenism?
Blood hormone testing should be conducted under the following conditions:
1. Timing: Between 8:00 and 9:00 am
2. Cycle Phase: Between the 2nd and 5th day of the menstrual cycle
3. Post-Hormonal Intake: At least 2 months after stopping any hormonal intake
What factors can affect the outcome of the free androgen index in women undergoing testing for hyperandrogenism?
Factors that can affect the outcome include:
- Use of oral contraceptives/estrogens, which can lead to elevated sex hormone-binding globulin levels, thus falsifying the free androgen index results.
- Measurement of ferritin levels or thyroid-stimulating hormone if diffuse effluvium is suspected.
What is the significance of adequate serum ferritin levels during the treatment of diffuse androgen-dependent alopecia in women?
Adequate serum ferritin levels may play a supportive role during the treatment of diffuse androgen-dependent alopecia in women, indicating the importance of monitoring nutritional status in conjunction with hormonal evaluations.
What is the Hamilton-Norwood classification used for?
The Hamilton-Norwood classification is used to categorize the stages of male pattern hair loss. It provides a standardized way to assess the severity and progression of hair loss in men.
What are the stages of the Ludwig classification for female pattern hair loss?
The Ludwig classification for female pattern hair loss consists of three stages:
- Stage I: Mild thinning, primarily at the crown.
- Stage II: Moderate thinning, with more noticeable hair loss.
- Stage III: Severe thinning, with significant hair loss across the scalp.
How does the Olsen scale differ from the Hamilton and Ludwig classifications?
The Olsen scale is specifically designed for assessing female pattern hair loss and includes:
- Male pattern (Hamilton): Similar to Hamilton classification but for females.
- Diffuse (Ludwig): Represents a more generalized thinning across the scalp.
- Frontal accentuation: Characterized by hair loss primarily at the front of the scalp, resembling a Christmas tree pattern.
How does the Hamilton-Norwood classification assist in the management of male pattern hair loss?
The Hamilton-Norwood classification provides a standardized system to categorize the stages of male pattern hair loss, which aids in:
1. Assessment: Helps clinicians evaluate the severity of hair loss.
2. Treatment Planning: Guides the selection of appropriate treatment options based on the stage of hair loss.
3. Monitoring Progress: Allows for tracking changes in hair loss over time, facilitating adjustments in treatment as necessary.
4. Patient Communication: Enhances understanding between the clinician and patient regarding the condition and expected outcomes.
What are the implications of the Ludwig classification for female pattern hair loss in treatment decisions?
The Ludwig classification categorizes female pattern hair loss into three stages, which has several implications for treatment decisions:
1. Stage Identification: Helps in identifying the severity of hair loss, which is crucial for treatment selection.
2. Tailored Treatments: Different stages may respond better to specific treatments, such as topical minoxidil or anti-androgens.
3. Prognosis: Understanding the stage can provide insights into the likely progression of hair loss and inform patients about expected outcomes.
4. Psychosocial Support: Recognizing the stage can help in addressing the emotional and psychological impact of hair loss on patients.
What is Telogen Effluvium and what are its associated characteristics?
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Telogen Effluvium is characterized by:
- Acute or chronic diffuse hair loss
- Caused by an increased number of hair follicles in the telogen phase
- Reduced hair density over the entire scalp
- Associated with severe illness, psychological trauma, crash diets, or certain medications
- Hair Pull Test results are diffusely positive
What are the key features of Diffuse Alopecia Areata?
-
Diffuse Alopecia Areata is characterized by:
- No patterned distribution of hair loss
- Possible personal or family history of alopecia areata
- Patchy or total hair loss, hair loss in other body sites, and nail abnormalities
- A biopsy can confirm the diagnosis
What is Central Centrifugal Cicatricial Alopecia and its demographic significance?
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Central Centrifugal Cicatricial Alopecia is:
- A scarring alopecia of the vertex region
- Most common in women of African descent
- Dermoscopy shows loss of follicular ostia confirming the scarring type
- Biopsies are useful to confirm the diagnosis
What are the characteristics of Frontal Fibrosing Alopecia?
-
Frontal Fibrosing Alopecia is characterized by:
- Frontotemporal band-like scarring alopecia
- Frontotemporal band-like recession, loss of eyebrows, perifollicular erythema, and hyperkeratosis
- Histology shows lymphocytic scarring alopecia
What causes Traction Alopecia and what are its implications?
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Traction Alopecia is caused by:
- Chronic tension on the hair shaft
- Hair loss is initially reversible but may become permanent if tension continues
- Often associated with a history of tight braiding
A patient reports hair loss after a crash diet and psychological trauma. What condition might this indicate, and how can it be confirmed?
This may indicate telogen effluvium, characterized by diffuse hair loss and a positive hair pull test.
What are the key characteristics of Telogen Effluvium and how can it be diagnosed?
-
Telogen Effluvium is characterized by:
- Acute or chronic diffuse hair loss
- Increased number of hair follicles in the telogen phase
- Reduced hair density over the entire scalp
- Associated with severe illness, psychological trauma, crash diets, or certain medications
- Diagnosis: The Hair Pull Test is diffusely positive, indicating the condition.
How does Central Centrifugal Cicatricial Alopecia differ from Frontal Fibrosing Alopecia in terms of presentation and demographics?
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Central Centrifugal Cicatricial Alopecia:
- Scarring alopecia of the vertex region
- Most common in women of African descent
- Dermoscopy shows loss of follicular ostia
-
Frontal Fibrosing Alopecia:
- Characterized by frontotemporal band-like scarring alopecia
- Associated with loss of eyebrows, perifollicular erythema, and hyperkeratosis
- Histology shows lymphocytic scarring alopecia
- Key Difference: The demographic and specific presentation of scarring patterns.
What are the clinical implications of Diffuse Alopecia Areata and how can it be confirmed?
-
Diffuse Alopecia Areata is characterized by:
- No patterned distribution of hair loss
- Possible personal or family history of alopecia areata
- Patchy or total hair loss, hair loss in other body sites, and nail abnormalities
-
Clinical Implications:
- It may indicate an underlying autoimmune condition.
- Confirmation: A biopsy can confirm the diagnosis of Diffuse Alopecia Areata.
What is Traction Alopecia and what factors contribute to its development?
-
Traction Alopecia is caused by:
- Chronic tension on the hair shaft due to hairstyles such as tight braiding.
- Initially, hair loss is reversible, but it may become permanent if the tension continues.
-
Key Factors:
- History of tight hairstyles
- Awareness of hair care practices is essential to prevent this condition.
What is the main therapeutic aim in the clinical course and prognosis of Androgenetic Alopecia (AGA)?
The main therapeutic aim is the improvement or prevention of disease progression, particularly during early, mild to moderate stages.
What are the side effects associated with Finasteride treatment for AGA?
Side effects of Finasteride include:
- Impaired sexual function
- Erectile dysfunction
- Ejaculation dysfunction
- Reduced ejaculate volume
- Loss of libido
- Gynecomastia
- Testicular pain
- Hypersensitivity reactions
- Possible negative impact on spermatogenesis.
What is the recommended application method for Minoxidil to avoid contamination?
Minoxidil should be applied at least 2 hours before bed time to avoid contamination of the pillow with subsequent facial contact.
What is the significance of assessing response to treatment with Finasteride?
Response to treatment with Finasteride is assessed at 6 months, and it may take up to 12 months for some patients to show a response. Continuous treatment is necessary to maintain efficacy.
What are the contraindications for using Finasteride in women?
Finasteride is contraindicated in women who are:
- Pregnant or of child-bearing potential (due to risk of feminization of a male fetus)
- Experiencing active depression or current sexual dysfunction.
A 50-year-old male with AGA is considering finasteride treatment. What are the potential side effects and contraindications of this medication?
Side effects include impaired sexual function, gynecomastia, and mood alterations. Contraindications include active depression, current sexual dysfunction, and use by pregnant women or women of childbearing potential.
A 60-year-old male with AGA is considering minoxidil. What are the application guidelines and potential side effects?
Minoxidil should be applied twice daily (1 mL or half a cap of 5% foam). Side effects include hypertrichosis and irritant dermatitis.
A 25-year-old male with AGA is considering finasteride. How long does it take to assess the treatment’s efficacy?
Efficacy is assessed at 6 months, but it may take up to 12 months for a response in some patients.
A male patient with AGA is concerned about post-finasteride syndrome. What symptoms might he experience?
Symptoms include sexual dysfunction, loss of libido, depression, suicidal ideation, impaired cognition, and fatigue.
A patient with AGA is considering minoxidil. What precautions should be taken during application?
Minoxidil should be applied at least 2 hours before bedtime to avoid contamination of the pillow and subsequent facial contact.
A 30-year-old male with AGA is considering finasteride. What is the mechanism of action of this medication?
Finasteride is a 5α-reductase type 2 inhibitor that prevents the conversion of testosterone to dihydrotestosterone, the androgen responsible for follicular pathology.
What are the main therapeutic aims in the management of Androgenetic Alopecia (AGA)?
The main therapeutic aims in the management of AGA are:
- Improvement of the condition.
- Prevention of disease progression, particularly during early, mild to moderate stages.
What is the improvement associated with AGA treatment?
Improvement of the condition.
What is the prevention associated with AGA treatment?
Prevention of disease progression, particularly during early, mild to moderate stages.
What are the side effects associated with Finasteride treatment for AGA?
The side effects associated with Finasteride treatment for AGA include:
- Impaired sexual function
- Erectile dysfunction
- Ejaculation dysfunction
- Reduced ejaculate volume
- Loss of libido
- Gynecomastia
- Testicular pain
- Hypersensitivity reactions
- Possible negative impact on spermatogenesis.
What is the recommended application method for Minoxidil to avoid contamination?
Minoxidil should be applied at least 2 hours before bedtime to avoid contamination of the pillow with subsequent facial contact.
What is the significance of assessing response to Finasteride treatment at 6 months?
Assessing response to Finasteride treatment at 6 months is significant because it helps determine the effectiveness of the treatment. Some patients may take up to 12 months to show a response, so early assessment is crucial for ongoing management decisions.
What precautions should be taken regarding the use of Minoxidil during pregnancy?
Minoxidil use should be discontinued during pregnancy and lactation to avoid potential risks to the fetus or nursing infant.
What is the role of Dutasteride in the treatment of AGA?
Dutasteride is a 5α-reductase inhibitor that can be considered at a dose of 0.5 mg a day if treatment with 1 mg finasteride is ineffective over 12 months. It inhibits isoenzymes type 1 and type 2.
What are the potential side effects of cyproterone acetate when used as an antiandrogen?
The side effects of cyproterone acetate include depressive mood changes and liver toxicity.
What surgical options are available for treating AGA?
Surgical options for treating AGA include hair transplantation, scalp reduction surgery, or a combination of both. Hair transplantation is less invasive than scalp reduction and involves transplanting follicular units of 1 to 4 hairs in large numbers and high densities.
What is the significance of Follicular Unit Transplantation in AGA treatment?
Follicular Unit Transplantation can improve AGA in patients with sufficient donor hair supply and medically controlled or spontaneously stabilized AGA, especially in the frontoparietal area. The success of the procedure depends on the surgical team’s skills.
What are some non-permanent hair replacement measures for AGA?
Non-permanent hair replacement measures include nonsurgical hair replacement methods, full and partial hair replacement measures (such as wigs), and various hair-binding techniques and hair extension and supplementation techniques.
What is the purpose of Low-Level Laser Therapy in AGA treatment?
Low-Level Laser Therapy is used as an ancillary treatment for AGA, exposing tissues to low levels of visible or near-infrared light. It can be performed at home using devices like a LaserComb or a helmet, although results are inconsistent and provide low-quality evidence.
What counseling should be provided to patients with AGA?
Counseling for patients with AGA should address the high prevalence and psychosocial burden of the condition, offering practical tips on handling the disease in daily life and suggesting professional psychological help if needed.
Why is early diagnosis and screening important in AGA?
Early diagnosis and treatment are important to prevent progression of AGA. For patients with longstanding advanced AGA, especially in male pattern baldness, scalp examination should include screening for benign and malignant skin lesions due to increased UV exposure of the balding scalp and lack of protective full hair.
What factors influence the success of hair transplantation in a patient with longstanding AGA?
Success depends on the surgical team’s skills, the patient’s donor hair supply, and whether AGA is medically controlled or stabilized. Combining finasteride and/or topical minoxidil with transplantation may reduce postoperative progression.
What medications are recommended for a 30-year-old woman with AGA and signs of hyperandrogenism?
Oral antiandrogens like spironolactone (100-200 mg/day) combined with a safe contraceptive are recommended. Side effects include menstrual disturbances and hyperkalemia.
What should a 45-year-old male with AGA know about low-level laser therapy?
Low-level laser therapy can be an ancillary treatment for AGA, but results are inconsistent, and evidence quality is low.
What counseling options are available for a male patient with AGA concerned about the psychosocial impact?
Counseling should include practical tips for managing the condition and, if needed, professional psychological help.
What is the evidence for platelet-rich plasma therapy in AGA?
There is no evidence-based recommendation for platelet-rich plasma therapy in AGA.
What is the recommended dosage of dutasteride for a 50-year-old male with AGA after finasteride failure?
The recommended dosage of dutasteride is 0.5 mg per day.
What non-surgical hair replacement options are available for a patient with AGA?
Options include full and partial wigs, hair-binding techniques, and hair extensions or supplementation techniques.
What medication might be causing menstrual disturbances in a 35-year-old woman with AGA?
Spironolactone may cause menstrual disturbances. It should be combined with a safe contraceptive in women of childbearing age.
How is low-level laser therapy administered for AGA?
It can be performed at home using a LaserComb or wearing a helmet for a certain amount of time.
What is the role of finasteride in hair transplantation for a 45-year-old male with AGA?
Finasteride may reduce postoperative progression of AGA when combined with follicular unit transplantation.
What are the potential side effects of cyproterone acetate when used as an antiandrogen in female patients with hyperandrogenism?
- Depressive mood changes
- Liver toxicity
How does Follicular Unit Transplantation (FUT) improve Androgenetic Alopecia (AGA) in patients?
FUT can improve AGA in patients with sufficient donor hair supply and medically controlled or spontaneously stabilized AGA, especially in the frontoparietal area. The success of the procedure depends on the surgical team’s skills.
What are the considerations for using Low-Level Laser Therapy as an ancillary treatment for AGA?
- Exposure of tissues to low levels of visible or near infrared light.
- Can be performed at home using a LaserComb or a helmet.
- Inconsistent results provide low-quality evidence.
- Improvement in total hair count has been partly reported.
What counseling strategies should be offered to patients with AGA to address the psychosocial burden of the condition?
- Practical counseling with tips on handling the disease in daily life.
- Professional psychological help might be needed due to the high prevalence and significant impairment of life caused by AGA.
What is the role of early diagnosis and treatment in the management of AGA, particularly in patients with longstanding advanced cases?
Early diagnosis and treatment are crucial to prevent progression of AGA. In patients with longstanding advanced AGA, especially in male pattern baldness, scalp examination should include screening for benign and malignant skin lesions due to increased UV exposure of the balding scalp and lack of protective full hair.
