Hair Loss Flashcards
How many hair follicles are on our heads?
Approximately 125, 000 hair follicles
40-100 hairs on non-shampoo
200-300 on a shampoo day
What are some conditions involving hair loss?
Tinea capitis (fungal infection): diagnosed by a MD
Anorexia
Severe acute illnesses (car accidents and pregnancy)
Alopecia areata (body attacks hair follicles): autoimmune
Cancer chemo/radiation therapy
Why is hair loss in females more complex?
It is caused by more reasons than men, but a lot of the same drugs can be used.
Female-pattern baldness
Menopause
Stress
Pregnancy (1-3 months after delivery)
Contraceptive use (starting or stopping)
etc.
Describe female-pattern baldness
Most common form of hair loss in women
It affects 1/6 women
Thinning is more diffuse, compared to men (hair all around thins vs. the receding hairline in men)
Describe male-pattern baldness?
Most common form in men
It affects 1/3 men
By age 30, 30% of Caucasian males experience male-pattern baldness
What is the etiology of balding?
Testosterone in men and women is converted into DHT by a-reductase.
DHT has a negative impact on hair
DHT is converted into estrogenic compounds by aromatase into estrogenic compounds.
a-reductase inhibitors (in men and women) and aromatase activators in women can reduce the amount of DHT
What are some treatment options for hair loss?
Men:
Minoxidil (2% solution or 5% foam)
Choosing strength depends on man’s age + size of spot is a factor
Finasteride (1mg capsule): an a-reductase inhibitor (reduces amount of DHT produced)
Women:
Minoxidil (5% foam or 1/2 capsule OD)
Women cannot use finasteride at all without contraception. There are serious concerns for fetal health of male offspring
What is the efficacy of minoxidil in men?
This drug has the ability to promote hair growth, but the exact mechanism is unknown.
New growth is also fine “baby” hair
It also has the best effects if hair growth is needed on the crown vs. receding forehead
Best if the patient uses minoxidil before the age of 40
Stop trying this agent, if no results in 8-12 months
Once discontinued, new hair is lost within 3 months
Does the scalp need to be healthy to use minoxidil?
Yes, conditions like psoriasis on the scalp can increase absorption of minoxidil
What are the instructions for minoxidil use?
1ml BID to dry scalp (regardless of affected area)
Requires 4 hours of contact (apply before going to bed)
Can minoxidil cause hair loss?
Yes, minoxidil might cause accelerated hair loss initially before they see benefits
Does body heat make minoxidil less efficacious?
Yes, it can have an effect. That is why it should be mixed on a non-porous surface
Describe the efficacy of finasteride?
Growth is mainly seen on crown
Growth occurs within 3 months
Requires continous use
Can slow hair loss
Side effects:
Decreased libido in 2-3% of men (this is something we must mention to every patient that gets on finasteride)
Are minoxidil and finasteride the best options as hair loss drugs?
No, the agents available for this indication are not the strongest. Minoxidil and finasteride came lower on the list of potential agents
What is the relationship between polycystic ovary syndrome and hair growth?
Polycystic ovary syndrome is a complex situation that has a lot of symptoms. Hirsutism is one of the symptoms associated with this condition. Hair growth in women can be indicative of this condition.
