Many drugs of systemic action, prescribed for various reasons, can cause common hypertrichosis as a side effect, and also positively affect the hair condition on the scalp (benoxaprofen, cyclosporin A, PUVA), but their targeted systemic use in conventional baldness is unreasonable, for undesirable complications.
Of the trichogenes of general action, only minoxidil causes significant clinical improvement with topical application. Minoxidil (Loniten), a derivative of piperidinopyridamine, is a potent vasodilator for systemic use and is prescribed for severe hypertension. With topical application in the form of a 2% solution, minoxidil (Rogaine, Regaine, Alopecia, etc.) converts pushrod hair to terminal hair in 30% of patients. The drug restores the growth of terminal hair along the edges of the bald patch and sometimes (<10% of patients) over its entire surface.
In men, minoxidil is more effective in the early stages of baldness (<10 years) with a diameter of a bald head not exceeding 10 cm, and a hair density of at least 20 / cm 2. The solution is applied to the carefully dried skin of the scalp twice a day, in the morning and in the evening, 1 ml each. It is colorless, odorless, quickly absorbed. After applying the drug, you can use any means for styling hair.
Local treatment with minoxidil is appropriate to compare with the treatment of diabetes mellitus with insulin: continuous use of the drug is necessary. Because 3 months after the cessation of treatment, baldness resumes.
In young, beginnings of balding, subjects cosmetic effect is better and is achieved faster than in elderly people with large bald spots.
The effectiveness of treatment in women is slightly higher than that of men. The peak of efficacy is observed one year from the start of therapy, then the rate of conversion of hair to terminal hair decreases. The question of the necessary type of topical application of minoxidil in hair transplantation has not been resolved. The drug is not effective in alopecia caused by chemotherapy.
Side effects. Allergic dermatitis is rare (<19 patients). 3-5% of patients may have folliculitis. Ssch radically appeared reports of cases of increased hair growth outside the zone of application of the drug (eyebrows, beards, on the hands, auricles). Influence on hemodynamics in hypertensive patients and people with normal arterial pressure is absent.
In isolated cases, it is possible to change the blood pressure of the heartbeat, chest pain, shortness of breath, arrhythmia, headache, dizziness.
Contraindication is hypersensitivity to minoxidil.
The mechanism of hair stimulation with minoxidil or its metabolite, minoxidil sulfate, remains unclear. Perhaps, the drug acts at the level of the hair follicles, regulating potassium channels. Perhaps, there is a direct stimulation of the epithelium of the follicle. In an experiment with cultures of hair follicles in animals, minoxidil increased cysteine consumption, proliferation of matrix cells and the outer root vagina, and helped normalize the morphological characteristics of the follicle. Recent studies have shown that minoxidil contributes to the vascularization of the dermal papilla, inducing angiogenesis. The role of increased blood flow in the skin of the scalp has yet to be clarified. It can be argued that the action of minoxidil is not anti-androgenic, as the patients did not show a change in serum and urine concentrations of androgens.
Thus, when the drug is used, the miniaturization of the hair follicle stops, its cycle is normalized; which leads to an increase in the diameter of the produced hair and an increase in the length of the follicle. As the results of the histological examination showed, these changes in patients become clearly pronounced after 5 weeks of therapy.
A new, more concentrated solution of minoxidil (5%) has recently been developed, which makes it possible to create a greater concentration of the drug at the level of the hair follicle. The mode of application of the solution is usual twice a day; The desired result is achieved in a shorter period of time.
Analogues of minoxidil
Aminexil (Aminexil, Dercap) is a structural analog of minoxidil. According to the clinical study, amineksil reduces hair loss in 8% of men and 66% of women. In 80% of women, the diameter of the hair has increased. The drug is part of the shampoo for washing the head (company L'Oreal).
Cromakalim (BRL 34915), like minoxidil, acts on the potassium channels and stimulates the synthesis of DNA in keratinocytes and hair follicles. The drug was also initially used to treat hypertension. Using cromakalima to restore hair growth is patented by Upjohn Company.
Diazoxide (Diazoxide, Hyperstat IV, Proglycem) is an antihypertensive agent acting through potassium channels; like minoxidil causes hair growth. Since diazoxide exists only as a pressure-lowering agent, it is recommended to prepare the preparation for local treatment of alopecia on its own.
Pinacidil (Pinacidil) is an antihypertensive agent that causes hair growth like minoxidil. Passes clinical approbation as an anti-alopecia remedy.
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