2,4 diamino – 6 – piperi – dinopyrimidine – 3 – oxide
Exact mechanism of hair growth stimulation remains unknown. The Vasodilating action of Minoxidil in increasing local blood supply does not pay a role. Recent studies suggest that Minoxidil may have 2 actions:
Finasteride 1mg slows the progress of hair loss and increased hair growth in Androgenetic Alopecia ( AGA ).
1mg and 5mg showed similar result, so the recommended dosage is 1mg daily.
9 pairs of identical twin males with AGA were recruited. Finasteride was given to one of each paired twins. At 1 year, 100% of the finasteride group had retained hair compared to 56% of the placebo group.
In 1997 the FDA approved a 1mg dose of finasteride for the treatment of AGA. It is important to counsel patients about appropriate expectations and the need for continued therapy. Reversing miniaturization is a slow process. Should take continuously for at least a year before evaluating efficacy.
The American Hair Loss Association recommends finasteride as the first line for all men with AGA.
Finasteride fails to prevent progress of hair loss in female pattern hair loss when the blood level of androgen is normal.
A very safe drug. The most atlk about adverse effects were decreased sex drive and erectile dysfunction. Incidence however was about 0.5% or 1 in every 200 treated cases. Symptoms usually occur during the first one to three months on start, and severity diminishes or disappear with continue use.
The amount of the active drug in semen is negligible. No evidence that exposure to pregnant women through semen is a risk to human fetus.
There are tons of shampoo on the market claiming to restore hair, there is only one that was reported to work according to several research studies.
It acts in both androgen-dependent and androgen-independent manners.
A study in mice indicated that ketoconazole may have a direct stimulatory effect on hair growth.
Androgen is a hormone which, when bound to receptors in the hair follicles, lead to the shrinking of these follicles. When the follicles shrink the life cycle of the hair becomes shorter with every cycle, this leads to hair miniaturization.
Ketoconazole acts as a relatively mild anti-androgen by:
Bald scalp in AGA was found to have a varying degrees of inflammation around the hair follicles. This inflammation when induced by a yeast called Malassezia may be partly responsible for hair loss. The anti-inflammatory and anti-fungal properties of Ketoconazole account for its beneficial effect in AGA.
It is usually used off-labelled in 2 ways:
It is beneficial for AGA patients who cannot tolerate minoxidil because of scalp irritation or contact dermatitis.
Used together, Ketoconazole may enhance the effectiveness of other hair loss treatments such as minoxidil and propecia.
In another study (Pierard-Franchimont 1998) Ketoconazole 2% shampoo was reported to be almost as effective as Minoxidil 2% topical solution in improving hair density. More confirmatory studies are required.
Oral Ketoconazole is not advised as the high concentrations required to affect androgen production exceeds the safety limit. In AGA the only tissue that requires a high concentration of Ketoconazole is the hair follicles. A local application in the form of a shampoo is the best way to delivered Ketoconazole to the affected area. Please note that this shampoo is not used as an cleansing agent, but as a scalp treatment.
Optimal usage is every third day (2 to 3 times a week), leaving the shampoo on the scalp for 3–5 minutes before rinsing. More frequent use is unnecessary but continuous use is required to maintain the benefit. Other shampoo can be used on the other days of the week.
3 times a week for 4 weeks. Repeated only as required.
When first begin treatment with Ketoconazole, it is possible to have more shedding of hair. Don’t worry as shedding often indicates better response to treatment and better result.