2015年台灣毛髮移植醫學會韓式美型植髮讀書會研究報告

2017.4.262017.4.26 診所資訊診所資訊

 
 
 
The androgen most closely implicated in the expression of male pattern hair loss in dihydrotestosterone(DHT).

Two isoenzymes of 5AR
Type I: pilosebaceous unit and sebaceousgland
Type II: outer root sheath of scalp hairfollicle, prostate, and dermal papilla

Key steps in androgen pathway:
1. Testosterone bound to circulatingbinding globulins
2. Testosterone enters target cell
3. Conversion of testosterone to DHT by5-alpha-reductase
4. DHT binds to cytosol androgenreceptor(AR)
5. DHT-AR complex enters cell nucleus
6. DHT-AR complex binds to DNA, producingcell-specific mRNA
7. Protein synthesis produces physiologic effect
Alternative pathway:
1. Direct binding of testosterone toalternate cytosol AR
2. T-AR complex enters cell nucleus


Therapeutic approach to female pattern hairloss
1. careful physical examination, includinghair pull and trichogram.
2. Laboratory evaluation to rule outendocrine disorders, iron deficiency, lupus, other systemic disorders.
3. Consider scalp biopsy to rule outalopecia areata, telogen effuvium, inflammatory or scarring hair lossprocesses.
4. Being topical minoxidil 2%solution
5. Consider hair transplantation, ifappropriate.
6. Consider antiandrogen therapy.

Hair growth medication and mechanism ofaction
1. Minoxidil: topical hypertrichotic agent.calcium channel opener, vasodilator.
2. Finasteride: type II 5AR blockade.
3. Fluridil: topical anti-androgen
4. Dutasteride: type I and type II 5ARblockade.
5. Flutamide: systemic nonsteroidal antiandrogen
6. Spironolactone: systemic weakantiandrogen
7. Cyproterone acetate: systemic potentantiandrogen
8. Inocoterone acetate: topicalantiandrogen

Tips on using minoxidil
1. men should use 5% solution
2. women should use 2% solution
3. use twice daily to maximize efficacy
4. apply to scalp, not hair
5. apply to all thinning areas, not just tothe crown
6. use dropper, not spray attachment
7. if scalp irritation develops, consultdermatologist
8. transient hair loss can occur 4-8 weeksafter initiation. reassure patient about this and continue medication

Tips on using finasteride
1. begin use at earliest signs of hair loss
2. Take baseline photos for futurecomparison
3. no change in hair density over time issuccess, not failure
4. discuss sexual concerns at each visit
5. if needed(rarely), prescribe sildenafil,tadalafil, or vardenafil to enhance sexual performance
6. women should not handle crushed orbroken tablets
7. women should not use finasteride
8. no risk of developing fetus exposed tosemen of men on finasteride


來源:台灣毛髮移植醫學會
主講者 鍾文桂醫師 共同參與: 鄒積鎮醫師 林宜蓉醫師 黃挺達醫師

服務項目 / Service items