Female pattern or female androgenetic alopecia (FAGA) is still a problem. We reach more precise diagnoses and we prescribe increasingly effective treatments. But, often, the patient demands faster results, better therapeutic responses, fewer risks and side effects. And that, it is still difficult.
One of the main tools in the fight against FAGA is the use of oral antiandrogens. The female hormonal and biological characteristics modulate androgenetic alopecia in such a way that this treatment is often necessary. We have different molecules for this, but perhaps the one with the greatest history and greatest use is cyproterone acetate.
In this regard, a few months ago there was an alarm about Diane, an oral contraceptive of antiandrogenic effect widely used in FAGA, composed of 35 micrograms of ethinyl estradiol and 2 mg of cyproterone acetate (AC). Apparently, there were significant side effects in the users in France, which made their use cautiously suspended.
In Spain, evaluations on this topic have been carried out by experts in Gynecology and Dermatology, which have led to a series of important conclusions, and which we can consider an advance, allowing a rational use of antiandrogens in FAGA. They are the following:
Female Androgenetic Alopecia
- The treatment of FAGA requires oral antiandrogen drugs on many occasions.
- AC is an adequate and effective medication for this purpose .
- Its association with estrogen is essential in women of childbearing age.
- Both, estrogen and antiandrogens, have risks and side effects, more intense in cases of inadequate prescription.
- In healthy women without risk factors, the prescription is considered safe enough.
- In women with relative risk factors, the dose of estrogen should be as small as possible (preferably 20 micrograms of ethinyl estradiol).
- Other oral contraceptives with antiandrogenic action can be used with good results in FAGA, alone or in combination with AC.
- The clinical history and exploration of the woman must be complete (thromboembolic history, history of thrombophilia, smoking habit, obesity, metabolic syndrome, polycystic ovary ...) so that the prescription is reasonably safe.
Frontal Fibrosing Alopecia
Every time we find more women - and some male - diagnosed with this alopecia characterized by an inflammation that produces an irreversible hair fall in the form of band or headband , running along the front edge. Many treatments have been tried without result.
Recently, two novelties have been contributed in this regard, although more scientific evidence is still pending:
- Oral hydroxychloroquine that seems to favorably modify the immunity of patients with this disease. The main requirement is a previous ophthalmological examination and periodically, which proves good condition of the eyes, to prevent them from being damaged by the medication.
- The local injection of peptides , small amino acid sequences, together with vitamins and minerals, repeatedly, seems to improve the basal state of the epidermal and dermal cells in a non-specific manner, which may be a therapeutic support in this disease until two decades ago barely known, and increasingly prevalent. Hair mesotherapy with peptides has no indication in areas where hair has already been lost, but where it is still preserved, in a preventive manner.