Management of androgenetic alopecia

Background Androgenetic alopecia (AGA) is the most frequent cause of hair l oss affecting up to 50% of men and 40% of women by the age of 50, Methods This gaper outlines the current status of diagnosis and offers guid elines for optimal management of AGA in both men and women. Results The diagnosis of AGA can usually be confirmed by medical history an d physical examination alone. A trichogram can be useful to assess the prog ression of the hair loss. A scalp biospy is diagnostic but usually not requ ired. In women with signs of hyperandrogenism, investigation for ovarian (p olycystic ovarian disease) or adrenal Gate-onset congenital adrenal hyperpl asia) disorders is required. Mild to moderate AGA in men can be treated wit h oral finasteride or topical minoxidil. Oral finasteride at the dosage of I mg/day produced clinical improvement in up to 66% of patients treated for 2 years. The drug is effective for both frontal and vertex hair thinning, Medical treatment with finasteride or minoxidil should be continued indefin itely since interruption of therapy leads to hair loss with return to pretr eatment status. Mild to moderate AGA in women can be treated with oral anti androgens (cyproterone acetate, spironolactone) and/or topical minoxidil wi th good results in many cases. Hair systems and surgery may be considered f or selected cases of severe AGA both in men and in women. Conclusions Patients with AGA should be informed about the pathogenesis of the condition. If used correctly, available medical treatments arrest progr ession of the disease and reverse miniaturization in most patients with mil d to moderate AGA. (C) 1999 Elsevier Science Ltd. All rights reserved.