| BackgroundAndrogenetic alopecia (AGA),characterized by progressive miniaturization of hair follicle with a characteristic pattern distribution, is the most common hair loss disorder in men, which typically presents as a diffuse reduction in hair density over the frontal and central areas. The current studies support the thesis that AGA is a kind of polygenetic disease with androgen-dependent trait. Dihydrotestosterone (DHT), converted from testosterone, is the more potent androgen. DHT is known to be closely related to the pathogenesis and development of male AGA (MAGA).The conventional management of AGA includes oral finasteride and topical minoxidil lotion.The previous studies have suggested that oral finasteride is more effective than topical minoxidil. However, few researches have compared the efficacy of single and combined use of1mg oral finasterid and5%topical minoxidil solution, and the correlation between serum androgen levels and MAGA severity, treatment efficacy as well as prognosis has not been well clarified.ObjectiveWe aimed to evaluate the efficacy of oral finasteride,5%topical minoxidil and combined treatment for12months, to find out the efficacy-influenced factors, and to analyze the correlation of the efficacy of finasteride and serum androgen levels including dihydrotestosterone(DHT)、testosterone (T) and sex hormone binding globulin(SHBG).MethodsAccording to the inclusion and exclusion criteria, We selected400cases and90controls with matched ages, courses, types and severity of AGA.140patients were assigned to took lmg/day oral finasteride for12months,110patients applied topical5%minoxidil solution twice daily for12months, and150patients received both treatments. After the baseline visit, the patients returned to our clinic for efficacy and safety evaluations every3months till the end of the trial. The patients and controls took the blood examination of serum androgens including T, DHT and SHBG at the baseline visit, while patients of finasteride group reexamined the items every3months. The statistical analysis were carried out with SPSS16.0programmer.ResultsThe onset age of AGA patients with positive family history was significantly lower than that of those without family history (27.12±7.75vs.29.67±6.78years,p<0.05). The clinical cure rate of lmg/d finasteride for12months was72.95%, that of5%minoxidil was59.14%, and that of combined treatment was89.23%. No significant differences of efficacy were found between lmg oral finasteride and5%topical minoxidil treatment within the first3months, and then the patients in the finasteride group showed greater improvement than those in the minoxidil group. However, the mean cure rate of those in the combined group remained highest. Significant differences were noticed in the efficacy of different scalp regions during the treatment of oral finasteride, that was, vertex region improved most, next came anterior/mid region, and frontal/temporal region showed least improvement (p<0.05).The period of treatment was positively correlated with the efficacy of patients in the finasterid and combined groups, and the severity of AGA was also concerned with the cure rates in all the patients. However, no relation could be seen between the treatment efficacy and family history (p>0.05). Besides, age was negatively correlated with finsteride efficacy (p<0.05), but age had no concern with the efficacy of5%minoxidil and combined treatment.Adverse events were rare (finasteride2.41%&minoxidil6.15%), and mild in most cases, and the majority of side effects disappeared soon after the drug withdrawal. The mean serum DHT level of AGA patients was higher than that of controls (132.22±54.09vs.72.02±21.61nmol/L, p<0.001).Serum DHT level and DHT/T level could decrease steadily during the treatment of finasteride (p<0.05). Moreover, the decrease rates were positively correlated with the finasterid efficacy (p<0.001).Nevertheless, Serum T, SHBG and free T index didn’t changed significantly from baseline (p>0.05).In addition, the severity of AGA were independent of the baseline values of serum T, DHT and SHBG (p>0.05), and the prognosis of AGA also had no concern with the baseline values of serum T and SHBG (p>0.05), but in our study, patients with pre-treatment DHT value≥120nmol/L turned out to present better finasteride efficacy than those with DHT value<120nmol/L.ConclusionBoth finasteride and5%topical minoxidil were effective and safe during the treatment, although oral finasteride was more effective and combined treatment showed the greatest improvement.The vertex and anterior/mid region responded better to finasteride treatment than frontal/temporal region. The period of treatment and severity of AGA were significantly correlated to the treatment efficacy. Serum DHT levels of patients were significantly higher than controls, and could decrease during the finasteride treatment. In addition, the more serum DHT and DHT/T level decreased, the better efficacy the patient would present. Thus, we can conclude DHT do play an important role in the pathogenesis of AGA, and serum DHT level can work as a monitoring and predictive indicator of finasteride efficacy and also help to decide the proper period of treatment. |
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