Docstoc

Clinical trials for hair loss and alopecia A review.doc

Document Sample
Clinical trials for hair loss and alopecia A review.doc Powered By Docstoc
					                         International Biopharmaceutical Association Publication
                Clinical trials for hair loss and alopecia: Management possibilities




Ngozi C. Mbonu, MD, FRIPH
Dept of Laser Therapy, Medical Center Maastricht
Becanusstraat 17, 6216 BX Maastricht, The Netherlands.

C.A Schroeter, MD, PhD
Dept of Laser Therapy, Medical Center Maastricht,
Becanusstraat 17, 6216 BX Maastricht, The Netherlands.
chinwenmbonu@yahoo.com

              Clinical trials for hair loss and alopecia
Abstract
This paper gives an overview of the present scientific knowledge in the clinical trials of hair
loss from excessive hair growth and hair loss in alopecia. Recent advances have been made in
managing this medical problem. Hair loss in terms of removal of excessive hair and hair loss
in alopecia will be addressed. This includes definitions of excessive hair growth, causes of
excessive hair growth, diagnosis, investigations, management and definitions of hair loss,
causes, diagnosis, investigations, types of hair loss, classifications and management. Many of
the clinical trials have reported success but the expectations of the patient remains an
important factor in deciding which treatment option will be applied.



Introduction
Excessive hair growth in hirsutism or hair loss in alopecia continues to be a cosmetic, social
and emotional concern to the people who are affected. A study carried out on psychosocial
impact of hair loss among men in five European countries showed that 43% of them felt that
hair loss was an important part of personal attractiveness, 42% feared becoming bald while
37%, 22%, 21% had concern about getting older, had negative effects on social life and had
feeling of depression respectively (1).

Problems associated with hair growth affects people of all ages and sexes. Statistics show that
approximately 80% of women are affected by the presence of excessive hair growth in a male
like pattern. (2) while almost all Caucasian men by old age and up to half of the male
Caucasian population by middle age are affected by male pattern baldness (3). The hair
follicle undergoes life long cyclic transformation between resting (telogen), active growth
(anagen), and aptoptosis driven regression (catagen) (4). Androgens are the main regulator of
human hair follicles. After puberty, androgen promote transformation of vellus follicles,
producing tiny unpigmented hairs to terminal ones forming larger pigmented hairs in many
areas e.g the axilla in addition to leading to the replacement of terminal hairs by vellus ones
on the scalp causing a gradual onset of alopecia (5). Androgens act within the follicle to alter
the mesenchyme-epithelial cell interactions changing the length of time the hair is growing,
the dermal papilla size, dermal papilla cell, keratinocyte and melanocyte activity (6).
Polycystic ovarian syndrome is the most common endocrine cause of hirsutism and pattern
alopecia in women (7). A study carried out on clinical presentation and etiologic factors of
hirsutism in premenopausal Iranian women shows that majority (62.53%) of the women had
polycystic ovarian syndrome while 35.19% was idiopathic, 0.38% was congenital adrenal


                                                                                              1
                         International Biopharmaceutical Association Publication
                Clinical trials for hair loss and alopecia: Management possibilities


hyperplasia, 0.13% was prolactinoma and 1.77% was undertermined (8). The etiology of hair
loss in alopecia is primarily unknown but linked to medical problems, hormones, drug use
like chemotherapy and genetic factor which plays an important role (9). The later has been
associated with autoimmune disorder (10, 11). A study done by Wengraf et al., 2008 shows
that in addition to a single nucleotide polymorphism in the autoimmune regulator (AIRE) on
chromosome 21q22.3 gene in patients with alopecia, there is an association with haplotype
analysis including six SNPs in the AIRE gene (10). Research also implicates T-lymphocytes
in the pathogenetic mechanism of alopecia areata (12).
Hair loss can be achieved voluntarily or involuntarily. Voluntarily hair loss as in hirsutism
can be achieved when there is excessive hair growth through many means such as shaving,
creams, including recent technologies like lasers (13). Involuntary hair loss as in alopecia
occurs on its own and may occur diffusely or in a circumscribed manner.
Various clinical trials have tried to demonstrate effectiveness of different therapy in managing
voluntary hair loss in excessive hair growth and involuntary hair loss in alopecia. Current
advances in medicine have led to more effective pharmacotherapy such as minoxidil,
finasteride and technologies (14). Use of lasers for removing excessive hair growth in
hirsutism or treating hair loss in alopecia gives patients a more natural appearance of their
skin especially with the constant improvement of the laser technology. Micro and mini
grafting have become increasingly common in hair transplantation resulting in larger numbers
of grafts per session and lengthy technically difficult procedures (15). Lasers have been noted
to be faster, give graft compression, reduce bleeding and operation time in hair transplantation
(16, 17). Considering the improvement in clinical management of excessive hair growth in
hirsutism and hair loss in alopecia, this paper tries to examine the management modalities
used in clinical trials. This paper begins with the definition of excessive hair growth, the
causes, the diagnosis, investigations and management of excessive hair growth in hisutism
followed by definition of hair loss in alopecia, the causes, diagnosis, investigations, new
classification of pattern hair loss and management of hair loss in alopecia.


What is excessive hair growth?
Excessive hair growth sometimes referred to as hirsutism is a disorder of excessive growth of
terminal hairs in androgen-dependent areas in women (18). The disorder is androgen
mediated and come from the adrenal glands or gonads or by conversion in peripheral tissues
of precursor steroids from these organs (19). Although 70-80% of patients with androgen
excess demonstrate hirsutism, some have normal ovulatory function and androgen levels with
no detectable androgen excess (20). Vellus type hairs can be stimulated under the influence of
androgen to begin producing terminal hairs. (21) Increased testosterone induces 5 alpha
reductase activity with the susceptible hair follicle leading in local production of
dihydrotestosterone responsible for the growth and stimulation of the hair follicle that leads to
hirsutism (22)

Causes of Excessive hair
   a. Idiopathic
   b. Androgen dependent women
   c. Polycystic ovarian syndrome
   d. Congenital adrenal hyperplasia
   e. Cushings syndrome
   f. Pituitary, ovarian, adrenal tumors (a-e 23)
   g. Hair-An syndrome



                                                                                               2
                         International Biopharmaceutical Association Publication
                Clinical trials for hair loss and alopecia: Management possibilities


   h. Drug induced (24) and can include testosterone, danazol, anabolic steroid,
      glucocorticoids, minoxidil, phenytoin or cyclosporine A immunosuppressive regimen
      following live donor kidney transplantation


Diagnosis
A careful medical history should consider the site, type and extent or area of hair growth, age
of onset and rate of appearance. Data about the family history, ethnic background, age of
onset and route of appearance will be helpful.

Investigation
Depending on the cause the following can be done:
Physical examination will include pelvic examination to exclude ovarian enlargement and
genitals to exclude hypertrophy, Urinary examination [24 hour 17 ketosteroid excretion and
plasma androgen] (25), Blood examination for plasma testosterone level, free testosterone,
androstanediol glucuronide, pelvic ultrasound, abdominal ultra sound. Other medical
problems has to be excluded such diabetes, thyroid hormone etc.

Management
Treatment of excessive hair can be achieved depending on the cause such as no treatment
(Excessive hair can be self limiting with age), shaving, chemical depilation or creams,
bleaching creams, plucking, waxing, thermolysis, electrolysis, hormonal suppression (oral
contraceptive pill, long acting gonadotropin-releasing hormone analogues and insulin
sensitizers), laser devices. Laser treatment has been currently used in hair removal. There has
been documented success in the treatment of excessive hair growth of different colors with
lasers. Several studies have demonstrated success using laser for hair removal such as a study
which shows that a normal-mode alexandrite laser achieves long term alopecia (26). Blond
hair has also showed some success with a mean hair reduction of 57.4% using ELOS system
which is a combination of optical energy radiofrequency combined (13). A study on evidence
based review of hair removal using lasers and light sources concluded that epilation with
lasers and light sources induces a partial short term hair reduction up to 6 months post
operatively, efficacy of the hair removal improved when repeated treatments are given,
efficacy superior when compared to conventional treatments (shaving, waxing,
electrolysis)(27). Lasers in general offers prolonged mean hair free interval and gives a very
high patient satisfaction. (28)
The next section will be dealing with hair loss in alopecia

What is hair loss?
Hair loss as in alopecia is the excessive shedding of hair in which there is a decrease in the
amount of hair (14). The common form of alopecia is alopecia areata which can affect the
entire scalp (alopecia totalis) or cause loss of all body hair (alopecia universalis)
(11).Alopecia can sometimes result in permanent hair loss known as primary cictricial
alopecias (29). Alopecia areata appears equally in males and females of all age however
children and adolescents are more commonly affected (12)

Causes of hair loss
Primarily idiopathic but the most frequent causes of hair loss in pediatric patients include
tinea capitis, alopecia areata, traction alopecia and trichotillomania (30). Other causes include
1. Genetic such as androgenetic alopecia



                                                                                               3
                          International Biopharmaceutical Association Publication
                 Clinical trials for hair loss and alopecia: Management possibilities


2. Drug induced such as anticoagulants, medicines used for gout, chemotherapy used for
treating cancer, antidepressants etc.
3. Diseases such as addison’s disease, hyperthyroidism (hashimoto’s thyroiditis),
hypothyroidism, iron deficiency, scarring, seborrheic dermatitis, secondary syphilis, systemic
lupus erythromatosis, vitiligo etc
4. Stress induced

Types of hair loss
   1. Alopecia areata: Alopecia areata is a disorder in which there is loss of hair causing
       patches of baldness but with no scarring of the affected area. (11) It is linked to
       autoimmune disorder and is known to occur with the highest observed frequency in
       the rare recessive autoimmune polyendocrinopathy-candiadiasis-ectodermal dystrophy
       (APECED) syndrome caused by mutations of the auto immune regulator (AIRE) gene
       on chromosome 21q22.3 (10). A study carried out on general susceptibility for the
       development of alopecia areata concluded that R620W variant of PTPN22 is a general
       risk factor in alopecia areata with strongest effect observed among patients with severe
       alopecia areata, a positive family history or an early onset of disease (31).
   2. Androgenetic alopecia: This is caused by androgens in genetically susceptible
       women and men. (32). Etiology is not clear but there has been an implication of 5
       alpha reductance activity and increase in dihydrotestosterone (33)
   3. Anagen and Telogen effluvium: This is usually drug induced and can be reversible
       once usage of drugs is stopped. Hair loss occurs through different modalities
   i.      By inducing an abrupt cessation of mitotic activity in rapidly dividing hair matrix
           cells (anagen effluvium)
   ii.     By precipitating the follicles into premature rest (telogen effluvium) (34)

   On the basis of morphologic criteria, hair loss can be further classified as non-scarring and
   scarring types. Non-scarring alopecia include diffuse alopecia, androgenetic alopecia
   which can be in form of male pattern or female pattern and alopecia areata. While scarring
   alopecia result from irreversible destruction of the hair follicle with recognizable loss of
   follicular osita (14)

Diagnosis:
A good medical history is important, as well as a close examination of the lesion.

Investigation:
fungal culture
Skin/scalp biopsy
Serology for lupus erythematosis
Serology for syphilis
Hair follicle specific auto antibodies

Classification of pattern hair loss
Lee et al., 2007 developed a new classification for pattern hair loss. The classification consists
of basic and specific type. The basic type subdivides the anterior hairline into 4 basic types
which are “L”, “M”, “C” and “U”. “M”, “C” and “U” is further subdivided into 3 or 4 grades
based on severity (35).
Type L: No recession is observed along the anterior border in the frontotemporal region. It
resembles a linear line and usually means that no hair loss has occurred.



                                                                                                4
                          International Biopharmaceutical Association Publication
                 Clinical trials for hair loss and alopecia: Management possibilities


Type M: Recession in the frontotemporal hairline is more prominent than the mid-anterior
hairline. This type tends to be symmetrical.
Type M is further subdivided into:
Type MO: The original hair line is preserved and represents type M. No hair loss has
occurred on clinical history. The subject cannot perceive any changes in the anterior hairline.
Type M1: Frontotemporal recession extends further posteriorly but not beyond the anterior
third of a virtual line connecting the original hairline and the top of the vertex
Type M2: Frontotemporal recession extends further posteriorly but not beyond the middle
third of a virtual line connecting the original hairline and the top of the vertex
Type M3: Frontotemporal recession extends beyond the middle third section into the
posterior third of the area of a virtual line connecting the original hairline and the top of the
vertex
Type C: Recession in the mid-anterior hairline is more prominent than the frontotemporal
hairline. The entire anterior hairline regresses posteriorly in the shape of half-circle,
resembling the letter C.
Type C is further divided into 4 subtypes depending on the severity of baldness.
Type CO: The original anterior hairline is preserved and represents type C. No hair loss
occurred in clinical history
Type C1: The mid-anterior hairline receded so that it lies within the anterior third of the
virtual line connecting the original hairline and the top of the vertex
Type C2: The mid-anterior hairline recedes further so that it lies within the middle third of
the virtual line connecting the original hairline and the top of the vertex
Type C3: The mid-anterior hairline recedes further into the posterior third of the virtual line
connecting the original hairline and the top of the vertex.
Type U: The anterior hairline recedes posteriorly beyond the vertex forming a horseshoe
shape resembling the letter U. Type U is the most severe pattern of androgenetic alopecia. It is
further subdivided
Type U1: The entire anterior border of the hairline lies within the superior third of the virtual
line connecting the vertex and the posterior occipital protuberance
Type U2: The entire anterior border of the hair line lies within the middle third of the virtual
line connecting the vertex and the posterior occipital protuberance
Type U3: The entire anterior border of the hair-line lies within the inferior third of the virtual
line connecting the vertex and the posterior occipital protuberance

Specific type
This represents the degree of thinning. There are two specific types which are F and V with
further subdivisions
Type F1: Thinning of the hair on the crown is perceptible
Type F2: Thinning of the hair on the crown is pronounced
Type F3: The hair on the crown is very spare or absent

Type V
The hair around the vertex is notably sparser and further subdivided
Type V1: Thinning of the hair around the vertex area is perceptible
Type V2: Thinning of the hair around the vertex area is pronounced
Type V3: The hair around the vertex area is very spare or absent




                                                                                                5
                         International Biopharmaceutical Association Publication
                Clinical trials for hair loss and alopecia: Management possibilities




(Origin: BASP classification by Lee et al., 2007)




Management of hair loss from alopecia
This depends on the cause, the degree of alopecia as described above in the BASP
classification and patient expectation. Management starts with counseling patients on their
condition. Medical and surgical management has been recognized. Antiandrogens such as
spironolactone, cyproterone acetate, cimetidine, oestrogen and progesterone, finasteride
which is 5 alpha reductase inhibitor. Other possible management includes no treatment, using
limited patchy hair loss-intralesional corticosteroid, extensive hair loss-contact
immunotherapy, dithranol, minoxidil lotion. Other drugs such as diphencyprone,
dinitrochlorobenzene, and camouflage such as Wigs (36) has been used. A pilot study of
randomized controlled trial shows that melatonin increases anagen hair rate in women with
androgenetic alopecia or diffuse alopecia (37) Many of the drugs has been noted to be


                                                                                          6
                          International Biopharmaceutical Association Publication
                 Clinical trials for hair loss and alopecia: Management possibilities


effective in the clinical trial. Photodynamic therapy has been tried in clinical trials with no
response (38, 39) except little success on the bead (38). Hair transplantation can also been
used especially for patients who are unresponsive to treatment or with Ludwig stage 111 if the
occipital donor area is sufficient (40). In particular punch graft hair transplantation as well as
minigraft and micrograft hair transplantation. Lasers have been used for hair loss with
success. A study done with pulsed infrared diode laser (904nm) for the treatment of alopecia
areata showed a 94% regrowth (41). Another study done using 308nm excimer radiation for
alopecia areata showed a regrowth of hair in 41.5% patches while 13 out of 18 lesions in the
scalp showed a complete regrowth of hair(42). Additional the study concluded that 308-nm
excimer laser for the treatment of alopecia areata is an effective therapeutic option for patchy
alopecia areata of the scalp and for some cases with patchy alopecia areata of the beard.
Studies have generally used combination therapy to manage hair loss (43, 44, 45, 46). Some
studies have used other agents for recalcitrant alopecia. A study on sulfasalazine used on
persistent alopecia areata after topical and intralesional corticosteroids, 5% minoxidil or
psoralenplus ultraviolet-A (PUVA) therapy use showed a good response for recalcitrant
alopecia areata (47) Similarly success was shown when essential oils was combined with low
intensity electromagnetic pulses with a decrease in hair loss in 83% of the volunteers and a
more than 20% hair count increase over baseline in 53% of patients (48). The various clinical
trials demonstrate that success has been achieved with respective management possibilities
giving clinicians and patients a wide range of possibilities.

Conclusions
Recent advances of effective pharmacotherapy and technologies for excessive hair growth and
alopecia has provided an innovative method of managing them while offering an effective
results. Clinical trials therefore give patients opportunity to gain access to a new treatment
especially when it is well controlled and done according to good clinical practice and standard
guidelines. In the end there has been a lot of combination and single line therapies applied but
expectations of patients remain an important factor in deciding what treatment modality is
used.



References
1 Alfonso, M., Richter-Appelt, H., Tosti, A., Viera, M.S., Garcia, M. (2005). The
psychosocial impact of hair loss among men: a multinational european study. Curr Med Res.
21 (11): 1829-36
2. Dawber, R.P. (2005).Guidance for the management of hirsuitism. Curr Med Res Opin. 21
(8): 1227-34
3. Ellis, J.A., Sinclair, R.D. (2008). Male pattern baldness : current treatments, future
prospects. Drug discov today. 13 (17-18): 791-7
4. Paus, R. (1998). Principles of hair cycle control. J. Dermatol. 25 (12): 793-802
5. Randall, V.A., Hibberts, N.A., Thornton, M.J., Hamada, K., Merrick, A.E., Kato, S.,
Jenner, T.J., De Oliveira, I., Messenger, A.G. (2000). The hair follicle: a paradoxical
androgen target organ. Horm Res 54 (5-6): 243-50
6. Randall, V.A. 2008. Androgens and hair growth Dermatol Ther 21 (5): 314-28
7. Rosenfield, R.L. (2008). What every physician should know about polycystic ovarian
syndrome. Dermatol Ther. 21 (5): 354-61
8. Ansarin, H., Aziz-Jalali, M.H., Rasi, A., Soltani-Arabshahi, R. (2007). Clinical presentation
and etiologic factors of hirsutism in premenopausal Iranian women. Arch Iran Med. 10(1): 7-
13


                                                                                                7
                         International Biopharmaceutical Association Publication
                Clinical trials for hair loss and alopecia: Management possibilities


9. Whiting, D. A., Olsen, E.A. (2008). Central centrifugal cicatrical alopecia. Dermatol. Ther.
21 (4): 268-78
10. Wengraf, D. A., McDonagh, A.J., Lovewell, T.R., Vasilopoulos, Y., Macdonald-Hull, S.
P., Cork, M.J., Messenger, A.G., Tazi-Ahnini, R. (2008). Genetic analysis of autoimmune
regulator haplotypes in alopecia areata. Tissue antigens. 71 (3): 206-12
11. Delamere, F.M., Sladden, M.M., Dobbins H. M., Leonardi-Bee, J. (2008). Interventions
for alopecia areata. Cochrane database syst. Rev. 16 (2): CD004413
12. Papadopoulos, A.J., Schwartz, R.A., Janniger, C.K. (2000). Alopecia areata, pathogenesis,
diagnosis and therapy. AM J Clin Dermatol. 1 (2): 101-5
13. Schroeter, C.A., Sharma, S., Mbonu, N.C., Reineke, T., Neumann, H.A.M. (2006) Blond
hair removal using ELOS systems. Journal of cosmetic and lasertherapy. 8 (2): 82-6
14. Trueb, R.M. (2003). Hair loss. Praxis 92 (36): 1488-96
15. Fitzpatrick, R.E. (1995). Laser hair transplantation. Tissue effects of laser parameters.
Dermatol. Surg. 21 (12): 1042-6
16. Fitpatrick, R.E., Marchell, N.L. (2000). Laser hair transplantation 11. Dermatol Surg. 26
(5): 419-24
17. Tsai, R.Y., Chen, D.Y, Chan, H.L, Ho, Y.S. (1998). Experience with laser hair
transplantation in Orientals. Dermatol. Surg. 24 (10): 1065-8
18. Somani, N., Harrison, S., Bergfeld, W.F. 2008 The clinical evaluation of hirsutism.
Dermatol Ther. 21 (5): 376-91
19. Rittmaster, R.S., Loriaux, D.L. 1987. Hirsutism. Ann Intern Med. 106 (1): 95-107
20. Azziz, R. (2003). The evaluation and management of hirsutism. Obstet Gynecol. 101(5
part 1): 995-1007
21. Azziz, R., Carmina, E., Sawaya, M.E. (2000). Idiopathic hirsutism. Endocr Rev. 21 (4):
347-62
22. Kirschner, M.A. (1984). Hirsutism and virilism in women. Spec Top endocrinol metab 6:
55-93
23. Somani, N., Harrison, S., Bergfeld, W.F. 2008. The clinical evaluation of hirsuitism.
Dermatol Ther. 21 (5): 376-91
 24. Piraccini, B.M., Lorizzo, M., Rech, G., Tosti, A. 2006. Drug induced hair disorders. Curr.
Saf. 1(3): 301-5
 25. Callan, A. (1982). Management of hirsutism. Australas J Dermatol. 23 (3): 97-104
 26. Laughlin, S.A. and Dudley, O.K. (2000). Long term hair removal using a 3-millisecond
alexandrite laser. J. Cutan Med Surg. 4 (2): 83-8
 27. Haedersdal, M., Wulf, H.C. (2006). Evidence based review of hair removal using lasers
and light sources. J. Eur Acad Dermatol. Venereol. 20 (1): 9-20
28. McGill, D.J., Hutchison, C., Mckenzie, E., McSherry, E, Mackay, I.R. (2007). Laser hair
removal in women with polycystic ovary syndrome. J. Plast Reconstr. Aesthet. Surg. 60 (4):
426-31
29. Harries M.J.,Sinclair, R.D., Macdonald-Hull, S., Whiting, D.A., Griffiths, C.E., Paus,
R.(2008) Management of primary cicatricial alopecias:options for treatment. Br. J. Dermatol.
159 (1): 1-22
30. Phillips, J.H. 3rd, Smith, S.L., Storer, J.S. (1986). Hair loss: Common congenital and
acquired causes. 79(5):207-15
31.Betz, R.C., Konig, K., Flaquer, A., Redler, S., Eigelshoven, S., Kortum, A.K., Hanneken,
S., Hillmer, A., Tuting, T., Lambert, J., De Weert, J., Kruse, R., Lutz, G., Blaumeiser, B.,
Nothen, M.M. (2008). The R620W polymorphism in PTPN22 confers general susceptibility
for the development of alopecia areata. Br J Dermatol. 158 (2): 389-91
32.Price, V.H. (2003). Androgenetic alopecia in women. J. Investig. Dermatol Symp Proc. 8
(1): 24-7


                                                                                             8
                         International Biopharmaceutical Association Publication
                Clinical trials for hair loss and alopecia: Management possibilities


 33. Jamin, C. (2002). Androgenetic alopecia. Ann Dermatol Venereol. 129 (5 pt 2): 801-3.
34. Tosi, A., Misciali, C., Piraccini, B.M., Peluso, A.M., Bardazzi, F. (1994). Drug induced
hair loss and hair growth, incidence, management and avoidance. Drug saf, 10 (4): 310-7.
35. 200 Lee, W.S., Ro, B.I., Hong, S.P., Bak, H., Sim, W.Y., Kim do, W., Park, J.K., Ihm,
C.W., Eun, H.C., Kwon, O.S., Choi, G.S., Kye, Y.C., Yoon, T.Y., Kim, S.J., Kim, H.O.,
Kang, H., Goo, J., Ahn, S.Y., Kim, M., Jeon, S.Y., Oh, T.H. (2007). A new classification of
pattern hair loss that is universal for men and women: basic and specific (BASP)
classification. J.Am Acad Dermatol, 57 (1): 37-46
36. MacDonald Hull, S.P., Wood, M.L., Hutchinson, P.E., Sladden, M. & Messenger, A.G.
(2003). Guidelines for the management of alopecia areata. British journal of dermatology.
149: 692-699
  37. Fischer, T.W., Burmeister, G., Schmidt, H.W., Elsner, P. (2004) Melatonin increases
anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot
randomized controlled trial. Br J Dermatol. 153 (4):859-60.
38. Bissonnettte, R., Shapiro, J., Zeng, H., Mclean, D., Lui, H. (2000). Topical photodynamic
therapy with 5-aminolaevulinic acid does not induce hair growth in patients with extensive
alopecia areata. Br J. Dermatol. 143 (5): 1032-5
 39. Fernandez-Guarino, M., Harto, A., Garcia-Morales, I., Perez-Garcia, B., Arrazola, J.M.,
Jaen, P. (2008). Clin Exp Dermatol, 33 (5):585-7.
40. Bolduc, C., Shapiro, J. (2000). Management of androgenetic alopecia. AM J Clin
Dermatol. 1 (3): 151-8
 41. Waiz M, Saleh, A.Z., Hayani, R., Jubory, S.O. (2006). Use of the pulsed infrared diode
laser (904nm) in the treatment of alopecia areata. J Cosmet Laser Ther. 8 (1): 27-30
 42. Al-Mutairi, N. (2005). 308nm excimer laser for the treatment of alopecia areata.
Dermatol. Surg. 33 (12): 1483-7
 43. Chowdhury, M.M., Rahman, M.H., Wahab, M.A. (2007). Efficacy of combination
therapy for the management regime of alopecia areata. Mymensingh Med J. 16 (2 suppl.):
S19-22
 44. Arca, E., Acikgoz, G., Tastan, H.B., Kose, O., Kurumlu, Z. (2004). An open randomized
comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia.
Dermatology 209 (2): 117-25
 45. Hugo, Perez B.S. (2004). Ketocazole as an adjunct to finasteride in the treatment of
androgenetic alopecia in men. Med hypotheses 62 (1): 112-5
 46. Sotiriadis, D., Patsatsi, A., Lazaridou, E., Kastanis, A., Vakirlis, E., Chrysomallis, F.
(2007). Topical immunotherapy with diphenylcyclopropenone in the treatment of chronic
extensive alopecia areata. Clin Exp Dermatol. 32 (1): 48-51
 47. Rashidi, T., Mahd, A.A. (2008). Treatment of persistent alopecia areata with
sulfadalazine. Treatment of persistent alopecia areata with sulfasalazine. Int J Dermatol 47
(8): 850-2
48. Bureau, J.P., Ginouves, P., Guilbaud, J., Roux, M.E (2003). Essential oils and low-
intensity electromagnetic pulses in the treatment of androgen-dependent alopecia. Adv. Ther.
20 (4): 220-9




                                                                                            9
         International Biopharmaceutical Association Publication
Clinical trials for hair loss and alopecia: Management possibilities




                                                                       10

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:8
posted:6/8/2012
language:English
pages:10
handongqp handongqp
About