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Tactics of management of patients with usual alopecia

 
, medical expert
Last reviewed: 15.05.2018
 
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Before starting treatment of a patient with normal alopecia, a thorough examination should be carried out 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, on the contrary, stopping oral contraceptives, etc.).

In the treatment of initial and moderately expressed manifestations of normal baldness in men, the methods of choice are local use of minoxidil (2% or 5%) or general treatment with finasteride (1 mg per day, Propecia). With the predominant hair thinning in the frontal region, the treatment with finasteride is more preferable. With alopecia in the parietal region, you can recommend any of the two indicated methods of therapy in connection with their equal effectiveness; The choice of method remains with the patient. The doctor's task is to explain the mechanism of action of the drugs and possible complications. It should be noted that the simultaneous administration of both medicines is unacceptable, since the combination therapy is currently only at the experimental stage.

The effectiveness of treatment is sufficient to assess once every 6 months. If the results are unsatisfactory in a year, an alternative method is used. Treatment with minoxidic or finasteride is prescribed for an indefinitely long time. It is known that the cessation of therapy leads to hair loss and restoration of the degree of baldness that took place at the time of treatment.

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

In the treatment of initial / moderate manifestations of normal baldness in women, the best results are obtained by the combination of minoxidil and antiandrogens. Because of the risk of feminization of the male fetus, the appointment of antiandrogen to women of childbearing age is permissible only under condition of adequate contraception. It is for this reason that finasteride has never been tested in women before the onset of menopause; in older women the drug was ineffective.

Local therapy with minoxidil (2%) in women gives better results than for men. The use of a 5% solution of minoxidil in women is not recommended because of the risk of localized and common hypertrichosis, although rarely observed.

Unlike men, in women with severe manifestations of normal baldness, combined therapy with minoxidil and antiandrogens is effective. It should be remembered that the evaluation of the results of the examination of each patient, the appointment of antiandrogens and the choice of a particular drug should be coordinated with the gynecologist-endocrinologist. As in 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 can be recommended taking cimetidine, which is an inhibitor of DTS and a blocker of H2 histamine receptors.

A necessary link in the treatment of patients with normal hair loss is the fight against depression, which develops as a result of hair loss, and as an undesirable side effect when taking antiandrogen.

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

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