Drugs for Hair Disorders

Question 1

What are the indications for spironolactone?

Answer 1

1. Female pattern hair loss
2. Hirsuitism
3. Acne vulgaris
4. Hidradenitis suppurativa

Question 2

What are the contraindications to spironolactone?

Answer 2

Hyperkalemia
Renal impairment
Personal/family history of breast/ovarian/uterine cancer
Unexplained uterine bleeding

Question 3

What are the adverse effects of spironolactone?

Answer 3

GI effects
Headache, dizziness
Hyperkalemia
Menstrual changes, breast tenderness, gynaecomastia, reduced libido
Agranulocytosis
Feminisation of the male foetus

Question 4

What safety monitoring is required for spironolactone?

Answer 4

UEC
BhCG

Question 5

What is the MOA of minoxidil?

Answer 5

Unknown, not related to vasodilation

Anagen phase is increased
Enlarges miniaturised follicles

Question 6

What are the contraindications to minoxidil?

Answer 6

Hypersensitivity
Pregnancy/lactation
Pheochromocytoma
Pulmonary HTN due to mitral stenosis
Cardiac failure, IHD

Question 7

What are the adverse effects of minoxidil?

Answer 7

Allergic contact dermatitis
Hypertrichosis

Extracutaneous: headache, dizziness , flushing, oedema, palpitations, tachycardia, pericarditis

Question 8

What are the topical formulations and how is minoxidil dosed?

Answer 8

Liquid 2%/5%
Foam 5%

BD application

Question 9

What instructions should patients be given about how to use minoxidil?

Answer 9

Apply to dry/non-inflamed skin
Avoid contact with eyes, mouth
Avoid occlusion
Wash hands after applying
Wait 4 hours before washing hair

Expect shedding during the 1st month
May take 3-4 months for results
Ongoing use is required for benefit

Question 10

What baseline and ongoing monitoring is required for minoxidil?

Answer 10

HR, BP, ECG baseline and during therapy

Question 11

What are the contraindications to tofacitinib?

Answer 11

Hypersensitivity
Pregnancy/lactation
Children<18yrs
Cytopaenias
Active infection or malignancy
Heart block
High risk for CvD or VTE
Severe liver disease
Unreliable patient

Question 12

What drugs interact with tofacitinib?

Answer 12

CYP3A4 drugs
Drugs that prolong PR interval eg CCB
Immunosuppressants
Live vaccines

Question 13

What are the adverse effects of tofacitinib?

Answer 13

Infection (eg VzV, UTI, URTI), NMSC
Headache
Bradycardia
Dyslipidaemia

Cytopaenias, VTE, GI perforation, hepatitis

Question 14

What baseline and ongoing monitoring is required for tofacitinib?

Answer 14

Baseline
Complete hx and exam
FBC, UEC, LFT, BhCG, CPK, lipids
Immunosuppression screen
Age appropriate malignancy screen
Vaccinations catch up
Sun protection advice

Ongoing
FBC, lipids every 4 weeks for 3 months and then every 3 months
Skin exam every 6 months