Hair Loss

Question 1

Which is the only form of hair loss that can be self-treated?

Answer 1

androgenetic alopecia

Question 2

Which genders are affected by androgenetic alopecia?

Answer 2

Male and female

Question 3

Is androgenetic alopecia scarring or non-scarring?

Answer 3

Non-scarring

Question 4

What stages do hair growth occur?

Answer 4

anagen, catagen, telogen

Question 5

How long do each of the hair growth phases last?

Answer 5

• anagen: 2-6y (determine hair length)
• catagen: 2-3w (no hair growth)
• telogen: 3m (after that, fully matured hair will be shed from hair follicle)

Question 6

Main androgen involved in androgenetic alopecia?

Answer 6

dihydrotestosterone (DHT) (active metabolite of testosterone)

Question 7

How is DHT formed?

Answer 7

Testosterone converted to DHT by enzyme 5-alpha-reductase

Question 8

How does DHT cause hair loss?

Answer 8

DHT binds to androgen receptors on scalp & shortens anagen phase -> hair shafts become shorter & thinner (follicular miniaturisation) -> lower hair coverage over scalp

Question 9

Which regions does hair loss usually occur in men and women?

Answer 9

Men: temporal, mid-frontal, vertex regions
Women: frontal, vertex

Question 10

Treatment options for androgenetic alopecia? (and forensic classification)

Answer 10

• topical minoxidil (GSL)
• PO finasteride 1mg (POM) for men

Question 11

What strength of minoxidil is used in men and women?

Answer 11

Men: usually 5%
Women: 2%, 3%, (5%)

Question 12

Risk factors for hair loss?

Answer 12

• family history
• hormonal changes e.g. PCOS
• stress, childbirth, illness

Question 13

MOA of minoxidil?

Answer 13

• increase cutaneous blood flow to hair follicles
• promote & maintain vascularisation of hair follicles
• transform resting hair follicles (telogen) to active hair follicles (anlagen) & prolong anlagen phase

Question 14

What may happen in the first 2-8w of using TOP minoxidil?

Answer 14

Temporary increase in hair shedding

Question 15

How long until effect is seen from using minoxidil 2% and 5%?

Answer 15

2%: 4m
5%: 2m

Question 16

What happens if minoxidil treatment is stopped?

Answer 16

Hair density will return to pre-treatment levels in 3-4m

Question 17

When to refer to dr if tx is not working?

Answer 17

• for 2%: 8m in women, 12m in men
• for 5%: 4-6m in both men & women

Question 18

Can pregnant & breastfeeding mothers use TOP minoxidil as self-treatment?

Answer 18

No (safety & efficacy not established)

Question 19

Can <18y or >65y, or those without family history of hair loss use TOP minoxidil as self-treatment?

Answer 19

No

Question 20

Counselling points for minoxidil? (7)

Answer 20

• apply when hair & scalp are clean and dry
• can apply regardless if hair is shampooed & washed
• if hair is washed, use hairdryer with cool setting to dry hair after washing before applying
• massage 1mL into affected area BD (morning and night)
• wash & dry hands after application
• do NOT double dose for missed dose
• allow 2-4h for drug to penetrate scalp, avoid activities that may dilute or wash away meds

Question 21

How many hours before sleep do you have to apply minoxidil and why?

Answer 21

2-4h before sleep to avoid staining of clothing & bed linen if not fully dried

Question 22

Can you use a hair dryer after applying minoxidil? Why?

Answer 22

No, will reduce effectiveness of drug and preparations may contain alcohol (flammable)

Question 23

Can you use minoxidil with permanent hair colouring or hair relaxer? How about hair grooming or styling products?

Answer 23

Cannot use minoxidil for 24h before or after application of permanent hair colouring or hair relaxer

Can use hair grooming or styling products after minoxidil has dried (will not affect effectiveness of minoxidil)

Question 24

Minoxidil SE?

Answer 24

• local: redness, itch, dryness, scaling
• excessive hair growth outside application area
• systemic: weight gain, edema, tachycardia, hypotension