Management tactics for patients with common alopecia areata

Before starting treatment of a patient with common baldness, it is necessary to conduct a thorough examination to identify and correct possible causes of symptomatic, or telogen, hair loss (severe stress; general diseases accompanied by hypoproteinemia, anemia; thyroid dysfunction; childbirth; taking a number of medications and, conversely, stopping oral contraceptives, etc.).

In the treatment of early and moderate manifestations of common male pattern baldness, the methods of choice are topical minoxidil (2% or 5%) or systemic finasteride (1 mg daily; Propecia). In cases of predominantly frontal hair thinning, finasteride is preferred. In cases of parietal baldness, either of the two therapies can be recommended due to their equal effectiveness; the choice of method is left to the patient. The doctor's task is to clearly explain the mechanism of action of the drugs and possible complications. It should be noted that the simultaneous administration of both medications is unacceptable, since combination therapy is currently only at the experimental stage.

The effectiveness of the treatment should be assessed once every 6 months. If the results are unsatisfactory after a year, an alternative method is used. Treatment with minoxidil or finasteride is prescribed for an indefinite period. It is known that stopping the therapy leads to hair loss and restoration of the degree of baldness that was present at the beginning of the treatment.

In cases of severe baldness (IV-VIII types according to the classification of J. Hamilton), monotherapy with minoxidil or finasteride does not give satisfactory results. The method of choice is surgical correction of alopecia, which in some cases should be combined with therapeutic methods to prevent loss of hair remaining in the androgen-sensitive zone. In some cases, it is necessary to recommend the patient to use a hairpiece or wig.

In the treatment of early/moderate hair loss in women, the best results are achieved with a combination of minoxidil and antiandrogens. Because of the risk of feminization of the male fetus, antiandrogens should only be used in women of childbearing age with adequate contraception. For this reason, finasteride has never been tested in premenopausal women; it has not been shown to be effective in older women.

Topical minoxidil (2%) therapy in women gives better results than in men. The use of 5% minoxidil solution in women is not recommended due to the risk of localized and generalized hypertrichosis, although rarely observed.

Unlike men, in women with pronounced manifestations of common baldness, combined therapy with minoxidil and antiandrogens is effective. It should be remembered that the assessment of the examination results of each patient, the prescription of antiandrogens and the choice of a specific drug should be agreed with a gynecologist-endocrinologist. As with men, in some cases it is necessary to resort to hair transplantation or wearing a hairpiece/wig.

Patients of both sexes suffering from gastric ulcer and duodenal ulcer may be recommended to take cimetidine, which is a DTS inhibitor and a histamine H2 receptor blocker.

A necessary part of the treatment of patients with common baldness is the fight against depression, which develops both as a result of hair loss and as an undesirable side effect when taking antiandrogens.

When choosing a method of treating a patient, the doctor must carefully weigh the real benefits and possible harm of the therapy.