Hair Loss - Finasteride Treatment May Not Prevent TE After Minoxidil Withdrawl

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Finasteride Treatment May Not Prevent TE After Minoxidil Withdrawl (All Topicals & Shampoos)

posted by minoxidil, 26.12.2008, 21:04

ť Finasteride Treatment May Not Prevent Telogen Effluvium After Minoxidil
ť Withdrawal
ť
ť Archives of Dermatology
ť
ť Oral 1-mg finasteride and 5% topical minoxidil are currently widely used
ť to treat androgenetic alopecia (AGA) in men.1-2 Although the
ť finasteride-minoxidil association has not been widely tested in humans,3
ť results in animal models suggest that the combination of the 2 treatments
ť may be more effective in inducing hair regrowth than either treatment
ť alone.4
ť
ť Topical vs Oral Regimens
ť
ť Until a few years ago topical minoxidil was the only effective treatment
ť available for AGA. Since the introduction of finasteride, increasing
ť numbers of patients have switched from minoxidil to finasteride because the
ť oral treatment is easier to manage than topical application.
ť
ť Interruption of minoxidil treatment is well known to induce telogen
ť effluvium because the follicles phase simultaneously to telogen, having
ť prolonged their anagen growth under the effect of minoxidil. This often
ť produces severe hair loss with obvious thinning.
ť
ť There are no data about the capacity of finasteride treatment to prevent
ť aggravation of AGA after minoxidil treatment interruption. Our observations
ť indicate that such benefits may not exist.
ť
ť
ť Report of Cases
ť
ť In 1997, a 24-year-old man consulted us because of AGA . He started
ť applying topical 5% minoxidil, 1 mL, twice daily. In October 1999, the
ť patient was given 1 mg of finasteride in addition to topical minoxidil
ť because the latter had produced only moderate regrowth. In May 2001, the
ť patient was satisfied with his hair growth, which had considerably
ť improved, with elongation and thickening of the hair in the temporal and
ť vertex regions, but decided to interrupt minoxidil application for personal
ť reasons. However, in November 2001, he returned to our offices because of a
ť noticeable worsening of his AGA, complaining of severe hair loss for 2
ť months. Clinical examination revealed evident hair thinning.
ť
ť Follow-up in February 2002 confirmed the worsening of his AGA compared
ť with the pictures obtained before minoxidil treatment interruption. At
ť follow-up in February 2003, the condition had remained stable.
ť
ť We have recently observed 2 other patients who developed severe hair loss
ť with evident worsening of AGA after interruption of 5% minoxidil treatment,
ť despite continued finasteride treatment. Acute telogen effluvium started
ť approximately 3 months after minoxidil withdrawal.
ť
ť
ť Comment
ť
ť It is important to stress that all of these patients had been treated with
ť a minoxidil-finasteride combination for 2 years with good improvement of
ť their clinical presentation. The reason finasteride does not prevent
ť telogen effluvium after minoxidil withdrawal may reside in the different
ť mechanisms by which these drugs act on the follicle. Finasteride is a
ť 5-reductase type II inhibitor that decreases dihydrotestosterone
ť production. It is effective in the frontotemporal region and in the vertex
ť area. Minoxidil is a potassium channel opener and exerts its action through
ť the activity of its metabolite, minoxidil sulfate. The exact mechanism of
ť its action on the hair follicle is still debated, but it probably acts by
ť stimulating the growth of the hair matrix and/or dermal papilla cells.
ť
ť Our observations indicate that minoxidil and finasteride may have a
ť synergistic effect on the hair follicles. This is promising with regard to
ť using the 2 drugs in combination, but we also believe that physicians
ť should be alerted to the risk of aggravation of AGA when the use of 1 of
ť the 2 drugs (minoxidil) is interrupted.
ť
ť So far, all of our patients who interrupted their minoxidil treatment and
ť continued using finasteride have experienced worsening of AGA. However, we
ť have no long-term findings for patients who discontinued finasteride use
ť while continuing minoxidil therapy. Data from the literature indicate that
ť finasteride withdrawal leads to slow and progressive hair loss, with return
ť to pretreatment state within 1 year. Thus we can speculate that withdrawal
ť of finasteride treatment in patients using the combination
ť finasteride-minoxidil might be followed by a slow and not severe hair loss,
ť but further observation is needed to confirm this hypothesis.

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Finasteride Treatment May Not Prevent TE After Minoxidil Withdrawl - HairSite Admin, 29.06.2008, 01:34 (All Topicals & Shampoos)
- Finasteride Treatment May Not Prevent TE After Minoxidil Withdrawl - minoxidil, 26.12.2008, 21:04