Patient 35 years old, suffering from androgenic alopecia, response to treatment after 5 months.
Androgenic alopecia is the most common form of alopecia in men, affecting more than 60% of men throughout their lives.
CAUSES
The cause of androgenic alopecia is genetic and hormonal. In men who start with androgenic alopecia there is usually a direct family history, although its absence does not exclude that this type of alopecia can appear. In male androgenic alopecia, the hair follicles of the frontal, upper and crown area are more sensitive to the action of androgens (male hormones). Androgens induce a miniaturization of the follicles (i.e. they become thinner) and without treatment they will disappear. This type of alopecia usually begins around the age of 20-25 years or earlier.
The characteristic clinical feature of men with androgenic alopecia is the loss of hair density (i.e. “thinning” of the scalp). The most frequently affected areas are the frontal region (receding hairline) and the crown of the head. Not all patients with androgenic alopecia will reach the most advanced degree of baldness, although if treatment is not instituted, the course of androgenic alopecia is usually slowly progressive, especially during youth.
The diagnosis of male androgenic alopecia is made clinically and by analysis with the trichoscope (used in the office). Thanks to this non-invasive diagnostic technique, an early diagnosis of early forms of androgenic alopecia can be made, allowing the patient to benefit from early treatment to stop his alopecia. For the follow-up of androgenic alopecia it is essential to have a correct digital monitoring with standardized photographs, in order to be able to assess the evolution and therapeutic response to treatments in the medium to long term.
Regarding complementary tests, since male androgenic alopecia is not usually associated with other concomitant diseases, in the case of males it is not usually necessary to request periodic analytical studies.
TREATMENT
At present there is no curative treatment for male androgenic alopecia, i.e. the available therapies must be maintained in the long term in order to maintain the results. It is not necessary to maintain these treatments “for life”, but the longer they are used, the better the results will be. If they are used for a period of time (e.g. 3 years) and then discontinued, the patient will have improved over that period and will then retain some of the improvement over a prolonged period of time. However, he will not maintain full improvement if he completely abandons any treatment option.
The goal of treatment for androgenic alopecia is primarily to slow the progression of alopecia. However, most patients also achieve an improvement in hair density, in some cases very significant. The effect of medical therapies is the thickening of existing fine hair.
The strategy usually used is to perform a more intensive treatment at the beginning of the treatment (first 2 years), since the effect of the therapies does not begin to be appreciated until 6 months, being maximum at 12-18 months. Thereafter, the frequency and intensity of treatments can be decreased to make them more comfortable and sustainable in the long term. The multitude of treatment options available today allows us to make changes to suit the needs of the patient and their alopecia at any given time.
Bibliographic reference:
-New Treatments for Hair Loss. Vañó-Galván S, Camacho F. Actas Dermosifiliogr. 2017 Apr;108(3):221-228. doi: 10.1016/j.ad.2016.11.010.
-Vañó-Galván S, Saceda-Corralo D, Moreno-Arrones OM, Rodrigues-Barata R, Morales C, Gil-Redondo R, Bernárdez-Guerra C, Hermosa-Gelbard Á, Jaén-Olasolo P. Effectiveness and safety of oral dutasteride for male androgenetic alopecia in real clinical practice: A descriptive monocentric study. Dermatol Ther. 2020 Jan;33(1):e13182. doi: 10.1111/dth.13182.