Conventional Treatments

These treatments have been around for many years and should only be prescribed, in our opinion, after genome analysis.

This is what we do at our centre.

On the other hand, finasteride is now available as a topical solution.

ROGAINE (MINOXIDIL®)

This product increases the duration of the anagen phase and can even trigger a new cycle by accelerating hair loss in the telogen phase: this is the "shedding effect" sometimes observed. Basically, the hair thickens and grows. It works by stimulating the growth of hair follicles by activating the papillary dermis germinal cells.

The lotion should be applied once or twice a day; the 5% lotion is more effective in men.

For women the 2% lotion is recommended; the risks of irritation or skin allergy are greater than in men.

The results can only be noticeable after 6 months of application. This compound, in order to be active, must be transformed into minoxidil sulphate, which requires the enzyme action of sulphotransferase; if the activity of this enzyme is insufficient, minoxidil will not be effective; hence the interest of genome analysis, which informs us of these elements before applying the treatment, thus avoiding treating a patient for a long period of time with a product that is not suitable.

FINASTERIDE (PROPECIA®)

To date 2 substances can slow down the formation of DHT, finasteride (trade name Propecia) which blocks type 2 of 5-alpha reductase and dutasteride (Avodart) with much longer elimination (half-life of 5 weeks instead of 8 hours for finasteride) which blocks 2 types 1 and 2 of 5-alpha reductase; the latter does not have FDA approval for hair loss but only for benign prostatic hyperplasia (BPH).

Studies have shown after 5 years of treatment with finasteride:

• New hair growth in 48% of patients, (6% when placebo used)
• Stabilization of baldness in 42% of patients, (19% when placebo used)
• No effect/ constant hair loss in 10% of patients, (75% when placebo used)

But this effectiveness on hair loss can be accompanied by harmful effects on male sexual function in a certain percentage of cases (4.5%), the frequency of occurrence is in fact difficult to assess, because patients often do not dare talk about it. Side effects include decreased libido, erectile dysfunction, testicular pain, breast congestion or even gynecomastia, and depression.

Side effects have disappeared in patients who have stopped treatment, and in 58% of the patients who continued this treatment. For some subjects, these effects may persist after stopping treatment: "Post-Finasteride Syndrome" (PFS).

In some countries and now in France, this substance is available as a lotion, with a lower systemic passage than with tablets in order to reduce side effects.

Other effects:

• Finasteride lowers the level of PSA (Prostate Specific Antigen) in the blood
• Finasteride may decrease the rate of low-grade prostate cancer, but may increase the risk of high-grade tumour (risk in younger people aged 40-50 years old)
• Effect on fertility: In men, finasteride may decrease the number of sperm in semen. It is formally contraindicated for pregnant women and those wishing to become pregnant, due to the risk of malformation of the male embryo (hypospadias)

This treatment has been used on postmenopausal women (varying results depending on different studies).

Biotin

Biotin, vitamin H or B7 participates in many metabolic processes: development of blood cells, the nervous system and skin cells and also keratin which is present in nails and hair.

Not much is synthesized by the human body (intestinal bacteria), so it must be provided by food; it is a vitamin that disappears when cooked but is present in many foods.

The recommended doses are around 50 micrograms per day.

Many laboratories market it.

Other treatments

Many other treatments are sometimes indicated as the origins of alopecia are sometimes multiple.

Certain treatments or antidepressants can cause hair loss, as well as iron deficiency, a period of stress, a slimming diet, thyroid disorders with specific treatment for each situation. The most common causes, especially in women, are iron deficiency. An insufficient level of iron should be systematically looked for before any hair loss.

Inflammatory skin conditions (Frontal fibrosis alopecia, lichen planopilaris, Pseudopelade of Brocq) can also be responsible for hair loss.