This time, I'd like to introduce you to the guidelines for alopecia areata.
In Japan, the guidelines were published in 2017. I'm a man myself, so I'm not sure what the term "hair loss" means.
Epidemiology
What is male pattern baldness?
Androgenetic alopecia is a phenomenon in which the hair on the frontal and parietal areas of the head becomes softer, thinner and shorter, and eventually the hair no longer appears on the skin surface.
In the case of Japanese men, it is said to be more pronounced between the ages of 25 and 30, gradually progressing to completion after the age of 40.Statistics show that the incidence of male pattern baldness in Japanese males averages about 30% for all ages, and that heredity and male hormones are involved in the development of male pattern baldness. In women, unlike men, it has been observed as a pattern of thinning over a relatively large area at the top of the head, and the onset time is also different from men, being more common during menopause.
Nowadays, the term "female pattern hair loss" is used more often than "male pattern alopecia" internationally.
We will not go into the diagnosis and pathology here.
The following is a list of highly recommended treatment methods.
Fenasteride (male form only)
Using 12 randomized controlled trials, 3,927 male subjects were included.
In a systematic review over an observation period of 12 to 24 months, the number of hard hairs per cm2 of hair loss was significantly higher than in the placebo group at both 6 months (p < 0.001) and 24 months (p < 0.001) after treatment. There was a tendency for sexual dysfunction to be higher in the placebo group.
In a randomized controlled trial of finasteride (1 mg/day, 0.2 mg/day) in 414 "Japanese" male subjects with an observation period of 48 weeks, 58% of the subjects showed at least a mild improvement at 1 mg/day, and 54% at 0.2 mg/day. At 0.2 mg/day, 54% of the patients showed more than mild improvement.
And in a non-randomized controlled trial of continued 1 mg/day dosing, 78% of patients each achieved at least mild improvement after 2 to 3 years of continued dosing, and the rate showed an increasing trend.
Although the side effects are a concern, the results seem to indicate that the effects will gradually appear.
About Dutasteride
Sixteen randomized controlled trials were used, involving 4,950 male subjects. In a systematic review with observation periods of 6 to 60 months, a comparison of the proportion of subjects who showed an increase in hair volume by photographic evaluation of the head showed that the 0.5 mg/day Clozapine group was superior to the placebo group.
In a 6-month randomized controlled trial of 917 male subjects treated with 0.5 mg/day of Clozapine and 1 mg/day of finasteride, dutasteride was more effective in increasing the number of total hairs and the diameter of hairs, but there was no significant difference in the number of hard hairs with a diameter of 60 μm or greater between the two. However, there was no significant difference in the number of hairs with a diameter of 60 μm or greater.
In addition, photographic evaluation of the parietal and frontal regions revealed a 7-point scoring scale ranging from markedly worsened (-3) to markedly improved (+3), and the investigator's scoring showed no significant difference between the two groups. In the evaluation by the three-member expert panel, dutasteride showed a better effect.However, the results showed that the difference in scores was slight, 0.14 for the top of the head and 0.24 for the frontal region. From these results, it is necessary to further study the difference in efficacy between the two.
In terms of side effects, sexual dysfunction has been reported in 3.3% to 5.4% of patients.
About Minoxidil
Fourteen randomized controlled trials and one systematic review have been conducted on male pattern baldness, and ten randomized controlled trials and one systematic review have been conducted on female pattern baldness. For male pattern baldness, the results of a systematic review of 924 male subjects over a 24-week observation period showed a significant increase in the total number of hairs in the hair loss area in the 2% minoxidil group compared to the placebo group, averaging 20.90 hairs (95% CI 9.07-32.74) from baseline.
With regard to female pattern baldness, a systematic review of 1,242 female subjects using eight randomized controlled trials of 1%, 2%, and 5% minoxidil, with observation periods of 24 to 32 weeks, found that minoxidil was effective.
The number of hairs within 1 cm2 of the hair loss area in the minoxidil group increased on average by 13.18 hairs (95% confidence interval 10.92 to 15.44) compared to the placebo group.
Conclusion
We do not know how the treatments recommended in the Japanese guidelines are treated in other countries, but we have learned that it is advisable to consult a medical professional for treatment. Since there have been reports of side effects in these treatments, consultation is necessary for a safe and secure treatment.
It may be difficult to consult with them, but there are some things that you cannot solve by yourself, so you should be brave enough to consult with them.
