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Baldness Treatments
 Minoxidil for pattern baldness
 Minoxidil for female baldness
 Minoxidil for male baldness
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 Finasteride for female baldness
 Tretinoin for pattern baldness
 Diazoxide for pattern baldness
 Ketoconazole for pattern baldness
 Antiandrogens for pattern baldness
 Contraceptives for female baldness
 Spironolactone for female baldness
 Flutamide for female baldness
 Cyproterone acetate for baldness

The desire to treat hair loss disorders leads to the understanding of the mechanisms involved in the Minoxidil’s crucial involvement in the stimulation of hair re-growth. Consequently, this line of research also leads to the understanding of the biology of hair growth. Histological inspection on primates showed that Minoxidil treatment causes proportional increase in anagen follicles, a decrease in the telogen follicles, and an increase in the size of the hair follicle. However, the only noted effect of Minoxidil treatment in humans is its role in the human hair cycle, although the possibility of Minoxidil increasing the hair diameter is currently being studied.

Minoxidil does not display hormonal or immunosuppressant effects when used as a treatment drug in male pattern baldness. Application of Minoxidil in plucked anagen hair bulbs showed a significant increase in the proliferation index when cells were counted and measured by a flow cytometer. This result is noted in both in vitro and in vivo studies where Minoxidil exhibits a direct mitogenic effect on epidermal cells.

FDA approved 2% topical Minoxidil (Rogain) in 1988 where over-the-counter products became available in the market eight years later. 5% topical Minoxidil (Rogain Extra Strength) was approved and went into the market as over-the-counter drug in 1998. An astounding increase in hair growth was observed in clinical experiments after 6-8 weeks of Minoxidil treatment, peaking in the hair count and hair weight at 12-16 weeks. This was not caused by the reversal of the follicular miniaturization process which led scientists to believe that Minoxidil triggered follicles in the latent part of telogen into anagen.

Clinical trials of the efficacy of topical Minoxidil in men

There is no question about the effectiveness of using Minoxidil in treating androgenic alopecia in both men and women. However the histological studies’ results suggest that Minoxidil treatment is less conclusive on humans than on animals.

  • Olsen and colleagues studied 2294 men with Hamilton III to VI patterns of male baldness characterized by significant frontal and vertex hair loss. Patients between ages 18 and 50 were randomly subjected to 1ml of 2% or 3% topical Minoxidil versus placebo twice a day for 4months and then the placebo group was changed to active drug. The terminal and vellus hair were counted directly from the target areas located in the mid-vertex region, the area where greatest hair loss were noted in previous researches. Olsen and colleagues were able to highlight the significance of treatment of 2% Minoxidil in increasing the terminal hair counts at the mean target area although the development was noted in 4-6 months.
  • Studies on two randomized double-blind placebo controlled set-up evaluating 5% Minoxidil topical solution versus 2% Minoxidil solution were done. It was found that the 5% concentration was effective in men under the age group 18-49 with mild to moderate vertex hair loss. After 48 weeks of twice-a-day application of 5% Minoxidil, the following results was taken: 57% of 139 patients had re-growth when 5% Minoxidil was applied; 41% of 142 persons had hair re-growth with 2% Minoxidil topical solution; and 23% of 71 patients exhibited the same results on the placebo-treated group. The quality of re-growth was mild to moderate in most individuals, while those using the 5% formulation showed greater improvement. Peak hair counts were already noted at 6 weeks on both concentrations, although hair counts and the patients’ rating of scalp coverage were higher with 5% Minoxidil.
  • Greater improvements were seen for the 5% Minoxidil topical solution on a study of 36 men ages 18 to 40 years old based on the hair weight. Although, the study was conducted on smaller sample sizes, it has been treated as statistically significant because it the study found that target area hair-weights increased by 35% for 5% Minoxidil compared to the increase of 25% in 2% Minoxidil. Untreated and placebo-controlled groups lost 6% in hair weight per year.
  • The evaluations of Price and colleagues on four groups of nine men with pattern baldness, three of which apply either 2% Minoxidil or 5% Minoxidil while the fourth group received no treatment, showed that subjects receiving 5% Minoxidil had faster response in terms of increased hair weight and number as opposed to those patients receiving 2% topical Minoxidil. The study documented a similar percentage increase in growth at the 96th week. Also, it was duly noted that whatever hair was regained in the period of 3-4 months were lost when the treatment of 2% Minoxidil was discontinued, indicating that Minoxidil treatment must be continuous to ensure effectivity.
  • There are no notable changes on the cardiovascular activities of the patients using 2% and 5% Minoxidil compared with the control group in a period of one year.

Clinical Use in male pattern hair loss

Apart from Minoxidil, there is no drug that is seen to prevent further hair loss in male pattern baldness. 5-year term usage of Rogaine for twice a day has shown positive results despite continuous shedding over the first several month of the treatment as anagen is induced and telogen hairs are shed. The hair counts remained above baseline. Lesser response on hair re-growth was noted on 2% Minoxidil if it is used less than twice a day.

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