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1 J Korean Med Ophthalmol Otolaryngol Dermatol 2015;28(4):12-28 pissn eissn Original Article / 원저탈모치료에관한최신동향 장인욱 고우신 윤화정동의대학교한의과대학안이비인후피부과학교실 The Latest Trends of Treatment for Alopecia In-Wook Jang Woo-Shin Ko Hwa-Jung Yoon Dept. of Korean Medical Opthalmology & Otolaryngology & Dermatology, Dong-eui University Abstract Objective : The purpose of this study is to analyse research trend on alopecia including androgenetic alopecia, alopecia areata, etc. Methods : We searched Pubmed, CNKI and OASIS on the title "alopecia" in recent 5 years. Results : We found 23 studies on Pubmed, 20 on CNKI, and 3 on OASIS about treatments of alopecia. The subjects of them were about 5α-reductase inhibitor, Minoxidil, steroids, immunosuppression, laser therapy, PRP, microneedling, stem cell, herbal medicine, integrative medicine, external treatments and syndrome differentiation. Conclusions : In recent studies in western medicine were about combination therapy or safety and presented validities and superiorities about new treatments. Integrative medicine, external treatment and researches about patients' characteristics were reported in TCM. Korean medicine has advantages of considering whole body and phychological problems. Key words : Alopecia; Treatment; Integrative medicine c 2015 the Society of Korean Medicine Ophthalmology & Otolaryngology & Dermatology This is an Open Access journal distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 12

2 장인욱외 2 인 : 탈모치료에관한최신동향 Ⅰ. 서론 탈모증은모발이존재해야할부위에서모발이없는상태를의미하며 1) 반흔성, 비반흔성탈모증으로구분하며, 반흔성탈모증은모낭이파괴되고섬유조직으로회복되어영구적인탈모상태가되는것으로외상, 홍반성루푸스, 경피증, 편평태선, 종양, 감염등이원인이된다. 반면비반흔성탈모증은조직이섬유화되지않고모낭도그대로보존되어있는데, 휴지기탈모증, 유전성안드로겐탈모증, 원형탈모증, 생장기탈모증등이있다 2). 한의학적관점에서는탈모는髮墮, 髮去, 髮落, 毛拔, 油風, 禿瘡, 鬼舐頭라불리며, 그원인은內因과外因으로나누어內因으로는腎虛, 肺氣虛, 血熱, 氣血虛, 血虛, 瘀血, 七情등을, 外因으로는風邪, 風熱, 濕熱, 五味傷, 風, 火등을원인으로보고있으며 3), 치료는辨證施治를통한한약치료와體鍼療法, 藥鍼療法, 光學療法등外治法을다양하게적용하고있다 4). 최근미용에대한관심이높아지면서탈모치료에대한요구가증대됨에따라서양의학및한의학적으로다양한치료방법이시도되고있으나탈모에관하여종합적으로분석한국내연구로는이등 5), 이 6), 김등 7), 임등 4), 장등 8) 의탈모에관한문헌적고찰이있었으며김등 9) 의탈모에관한임상적고찰이있을뿐탈모치료의최신경향에대하여체계적으로분석한논문은없었다. 이에저자는탈모치료와관련된최근의연구동향을살펴보고이를토대로한의학적탈모치료의발전방향을모색하고자하였다. Ⅱ. 연구방법 탈모에관한최신연구동향을파악하기위해최근 Corresponding author : Hwa-Jung Yoon, Dept. of Korean Medicine Opthalmology & Otolaryngology & Dermatology, Dong eui University, 62, Yangjeong-ro, Busanjin-gu, Busan, Korea (Tel : , yhj1226@deu.ac.kr) Recieved 2015/10/14 Revised 2015/11/8 Accepted 2015/11/15 5년간해외의학관련잡지및국내한의학관련잡지에수록된탈모에대한논문을검색하여 in vivo 연구와임상증례보고를제외한탈모단독치료논문을대상으로조사, 연구하였다. 1. Pubmed 검색어는 alopecia로 23편의논문을선별하였다 (Table 1). 2. 중국학술정보원 (CNKI, China National Knowledge Infrastructure) 검색어는 alopecia로 20편의논문을선별하였다 (Table 2). 3. 전통의학정보포털 (OASIS, Oreintal Medicine Advanced Searching Integrated System) 검색검색어는탈모로 3편의논문을선별하였다 (Table 3). Ⅲ. 결과 1. 5α-전환효소억제와관련된연구안드로겐성탈모에서실질적인탈모를일으키는물질은 Dihydrotestosterone(DHT) 으로안드로겐이 5 α-전환효소의작용으로전환된물질이다. 이를억제하기위해서사용되는약물은 Finasteride와 Dutasteride 가있다. Finasteride의경우 Type 2 5α- 환원효소에만작용하는반면 Dutasteride 는 Type 1,2 5α- 환원효소에모두작용하여전립선관련질환에비교적적은양으로도효과가크다 10). Finasteride와 Dutasteride 의남성에대한적용및효과에대해서는이미많은보고가있어왔다. 최근 3년간에서보고된연구는여성형탈모에서의 Finasteride와 Dutasteride 13

3 Table 1. Research Papers on Alopecia Searched in Pubmed Treatment Year First Author Title Publication Journal 5α-reductase inhibitor 2013 Oliveira-Soares R 2014 Boersma IH 2015 Chandrashekar BS Minoxidil 2013 Sakr FM 2013 Uprit S Finasteride 5 mg/day Treatment of Patterned Hair Loss in Normo-androgenetic Postmenopausal Women The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride Preparation and evaluation of a multimodal minoxidil microemulsion versus minoxidil alone in the treatment of androgenic alopecia of mixed etiology: a pilot study Preparation and characterization of minoxidil loaded nanostructured lipid carrier gel for effective treatment of alopecia Int J Trichology Indian J Dermatol Venereol Leprol Indian Dermatol Online J Drug Des Devel Ther Saudi Pharm J 2014 Hsu CL Minoxidil may suppress androgen receptor-related functions Oncotarget Steroids 2012 Sardesai VR A study to evaluate the efficacy of various topical treatment modalities for alopecia areata 2015 Senila SC Intravenous methylprednisolone pulse therapy in severe alopecia areata Immunosuppresion 2013 Park KY 2015 Jabbari A Combination therapy with cyclosporine and psoralen plus ultraviolet a in the patients with severe alopecia areata: a retrospective study with a self-controlled design Reversal of Alopecia Areata Following Treatment With the JAK1/2 Inhibitor Baricitinib Int J Trichology Indian J Dermatol Venereol Leprol Ann Dermatol EBioMedicine 2014 Hammerschmidt M Efficacy and safety of methotrexate in alopecia areata An Bras Dermatol Laser 2013 Ohtsuki A 308-nm Excimer Lamp for the Treatment of Alopecia Areata: Clinical Trial on 16 Cases Indian J Dermatol 2013 McMichael AJ Excimer laser: a module of the alopecia areata common protocol. J Investig Dermatol Symp Proc 2013 Munck A Use of low-level laser therapy as monotherapy or concomitant therapy CMAJ 14

4 장인욱외 2 인 : 탈모치료에관한최신동향 2014 Jimenez JJ for male and female androgenetic alopecia Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study Am J Clin Dermatol 2014 Avci P Low-level laser (light) therapy (LLLT) for treatment of hair loss Lasers Surg Med PRP 2014 Khatu SS Platelet-rich plasma in androgenic alopecia: myth or an effective tool J Cutan Aesthet Surg 2014 Gkini MA 2014 Cervelli V 2015 Singh S Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation Role of platelet-rich plasma in chronic alopecia areata: Our centre experience J Cutan Aesthet Surg Biomed Res Int Indian J Plast Surg 2015 Singhal P Efficacy of platelet-rich plasma in treatment of androgenic alopecia Asian J Transfus Sci Microneedling 2013 Dhurat R Stem Cell 2015 Fukuoka H 2015 Li Y A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study Hair Regeneration Treatment Using Adipose-Derived Stem Cell Conditioned Medium: Follow-up With Trichograms Hair regrowth in alopecia areata patients following Stem Cell Educator therapy Int J Trichology Eplasty BMC Med Table 2. Traditional Chinese Medicine Research Papers on Alopecia Searched in CNKI Treatment Year First Author Title Publication Herbal Medicine 2012 Ren F The Clinical Observation of Yi Ling Qu Shi Sheng Fa Decoction on Treating Androgenic Alopecia and Analysis of Content of Elements in Hair Nanjing University of Chinese Medicine 2012 Han M The Clinical Observation of Treating and Androgenetic Alopecia by Using the Huazhi Shengfa Decoction Chengdu University of Traditional Chinese Medicine 2013 Wen Q Clinical Observation of Qushi Jianfa Decoction on Treating Alopecia Heilungjiang University of 15 15

5 Seborrheica(Damp-Heat Fumigating Upward Type) Chinese Medicine 2014 Zhou JJ The Observation of Clinical Efficacy on the Androgenic Alopecia Liver and Kidney Insufficiency Which Treatded by Bu Fa Yin Combined with Ce Bai Tincture Shandong University of Traditional Chinese Medicine Integrative medicine 2009 Wei XS The Clinical Research on Treating Androgenic Alopecia with Traditional Chinese Medicine and Western Medicine Guangzhou University of Chinese Medicine 2010 Zou DM The Clinical Observation of Integrative Medicine on Alopecia Areata Contemporary Medicine 2011 Cheng ZQ The Clinical Observation of integrative medicine on 58 cases of alopecia areata China Journal of Modern Medicine 2012 Liu M Effect of Glycyrrhizin capsule and Yangxueshengfa on alopecia areata Med J West China 2013 Liu JW Effect of Ear Acupuncture and Glycyrrhizin capsule on Androgenetic Alopecia Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine 2014 Sun YC Traditional Chinese Medicine (TCM) Syndrome Differentiation with Finasteride Piece of Clinical Research for the Treatment of Seborrheic Alopecia HeNan University of Traditional Chinese Medicine External 2013 Xiao Q Clinical Observation on Dermal Needle and Self-made ShengFa Tincture for Alopecia Areata West J of Traditional Chinese Medicine 2014 Lin KR Clinical observation of Chinese comprehensive therapy on androgenetic alopecia of damp and heat in the spleen and the stomach pattern SH. J. TCM 2014 Shi ZH Clinical Observation of Treatment with Shen Ying Yang Zhen Dan Compound 640-nm Red Light for the Blood Deficiency and Wind Dryness Type of Alopecia Areata Nanjing University of Chinese Medicine 2014 Wang ZJ Clinical observation on treating 108 cases of alopecia in TCM Clinical Journal of Chinese Medicine 2014 Zuo YQ Clinical Observation of TCM Five Elements Music Therapy on Alopecia Areata Patients Depression Emotion Hubei Journal of Traditional Chinese Medicine 16

6 장인욱외 2 인 : 탈모치료에관한최신동향 Syndrome Differentiation 2009 Jiang Y The Electron Telescope Study on Traditional Chinese Medicine and Western Medicine Syndrome Differentiation and Typing in Androgenetic Alopecia Nanjing University of Chinese Medicine 2012 Huang J Investigation and Analysis on Syndrome Differentiation-type and Constitution of TCM of Androgenetic Alopecia Guangzhou University of Chinese Medicine 2014 Qin Z Correlation Research of Clinical Investigation of Androgenic Alopecia and Syndrome Differentiation Based on Chinese Medicine Nanjing University of Chinese Medicine 2014 Park MJ Research on Constitution Types of Chinese Medicine and Psychological Assessment in Patients with Alopecia Areata and Relation Analysis Chin J Dermato Venerol Integ Trad W Med 2015 Qiu J The Clinical Observation of Chinese Medicine Syndrome Differentiation on 124 cases of Androgenic Alopecia Nei Mongol Journal of Traditional Chinese Medicine Table 3. Korean Medicine Research Papers on Alopecia Searched in OASIS Year First Author Title Publication Journal A Study of Clinical features and classification of Alopecia patients in 2009 Lee TH Korean medical clinic Korean Med Opthalmol Otolaryngol Dermatol A Clinical Trial on Efficacy of 2013 Hong JA Gagamchengyoung-tang(Jiājiǎnqīngyíng-tāng) in the Alopecia Patients with Febrile Tendency Korean Med Opthalmol Otolaryngol Dermatol Retrospective Study about the Causes and the Effects of Korean 2013 Lee JH Medicine Treatment on Alopecia. Focused on Acquired Febrile Alopecia Korean Med Opthalmol Otolaryngol Dermatol 17

7 의적용에관한보고가 2편, Finasteride의외용제로서의가능성에대한보고가 1편있었다. Oliveira-Soares 11) 등은폐경기의정상안드로겐수치의탈모환자들에게서 Finasteride 5mg을경구투여하였을때 40명중 32명에게서유의한효과가나타났으며그중 16명은외관상으로두드러지는변화가나타났음을보고하였다. Boersma 12) 등은안드로겐성탈모가나타나는여성환자에게 Finasteride 1.25mg과 Dutasteride 0.15 mg을 3년간투여한경과를관찰하였으며그결과약물복용후모발의밀도가유의미하게증가하는것을확인하였음을보고하였다. Chandrashekar 13) 등은 2년간 Finasteride 를경구복용하고 5% Minoxidil을도포해온환자들에게상기치료를 5% Minoxidil과 0.1% Finasteride 혼합연고도포로변경하였을때 84.4% 가현상태를유지하였으며 Finasteride의대표적부작용인성욕감퇴도줄었다고보고하였다. 2. Minoxidil 관련연구 Minoxidil과관련하여기존에보고된내용은 Minoxidil 의정확한발모기전은밝혀지지않았으나모발의성장기를연장시키고모낭을확장시키는것으로추측된다는것이다. 혈관근육을이완시켜혈압을낮추는역할을하여칼륨채널과연관성이있는것으로보이나명확히밝혀진것은없으며두피의혈류순환을개선시켜이로인해모발의성장을촉진시킨다는가설이가장유력하다고사료된다 14). Minoxidil 의발모효과를뒷받침할만한많은연구가이루어졌으므로단독요법의효과보다는다른요법과의병행이나그기전에관한연구가진행되고있다. Sakr 15) 등은비스테로이드성소염진통제 (NSAIDs) 인 Diclofenac과 Minoxidil 을혼합하여도포하였을때 Minoxidil 단일도포군에비해유의미한효과의차이가나타났다고보고하였다. Uprit 16) 등은지질나노구조체를이용한혼합에멀전 을사용하는방법이 Minoxidil의효과를증대시킬수있다고보고하였다. Hsu 17) 등은 Minoxidil의도포부위에서안드로겐수용체 (AR) 과관련된단백질및효소전반의기능의저하가관찰되었으며이를토대로관련물질들의기능저하가안드로겐수용체의활성을저하시키는것으로생각된다고보고하였다. 3. 스테로이드관련연구탈모분야에서스테로이드는일반적으로원형탈모증에다용된다. 최근 5년간의보고에서도원형탈모증에스테로이드를사용한논문이 2편검색되었다. Sardesai 18) 등은원형탈모증환부에 Triamcinolone 을주입하는방법과환부에 Betamethasone 을도포하는방법이 Minoxidil을도포하는방법에비해효과적이라고보고하였으며, Senila 19) 등은다발성원형탈모증, 전두탈모증, 전신탈모증환자에게 500mg의 methylprednisolone을 3일간주사하는것을 1달간격으로 3회시행하였을때 81% 에서개선효과를보였다고보고하였다. 4. 자가면역억제와관련한연구원형탈모증의뚜렷한원인은밝혀지지않았으나 T 세포와관련된자가면역질환으로간주하고있다. 이와관련하여다른자가면역질환치료제로알려진물질을원형탈모증치료에응용한보고와 Methotrexate 의원형탈모환자에투여에대한안전성과관련된보고가있었다. Park 20) 등은 Cyclosporine의경구투여와 psoralen 처리한피부에자외선을조사하는두가지치료를병행한결과 32명중 18명에서유의한효과가나타나새로운치료방법으로서의가능성에대해보고하였다. Jabbari 21) 등은 JAK에대한작용을하는류마티스치료제인 Baricitinib 이원형탈모증에효과가있을것으로추정되며이와관련해서추가적인연구가필요 18

8 장인욱외 2 인 : 탈모치료에관한최신동향 할것이라보고하였다. Hammerschmidt 22) 등은 Methotrexate 단독투여시원형탈모환자의 67.7% 에서 50% 이상의모발재생이나타났고스테로이드와동시투여시에도 77.3% 에서 50% 이상의모발재생을보였으며부작용이나타나지않았다고보고하였다. 5. 레이저요법에관한연구저강도의레이저나광원을두피에조사하는경우모발의유지에도움이될뿐만아니라새로운모발의발생을촉진하는것으로알려져있다. Ohtsuki 23) 등은 308nm Excimer Lamp 를탈모환자의환부에조사한결과 16명중 14명에서유의미한효과가있었으며, 10명에서는 50% 이상의모발이재생되었다고보고하였다. Munck 24) 등은저강도광선요법 (LLLT) 를사용하여 32명중 8명에서는양호한효과를, 20명에게서는보통의효과가나타났다고보고하였다. Jimenez 25) Avci 26) 등은저강도광선요법 (LLLT) 가모발의탈락을예방하고생장을촉진시켜모발의유지에도움을준다고보고하였으며, 효과는높으나부작용은거의없어탈모에대한안전한치료방법이라고주장하였다. 6. 자가혈소판농축혈장치료술 (PRP, Platelet-rich plasma) 에관한연구자가혈소판농축혈장치료술은현재그효과나안전성에관한논란이많은편이나안드로겐성탈모증이나원형탈모증을가리지않고전반적인탈모에대한새로운치료방법으로서제시되고있다. Khatu 27) 등은환부에 PRP를주입하는처치를받은 11명의안드로겐성탈모환자모두치료후당김테스트를통과하였으며모공의숫자도cm2당평균 22.09에서 93.09으로증가하였다고보고하였다. Gkini 28) 등은안드로겐성탈모환자를대상으로 PRP요법을시행한후 1년간경과관찰을한결과 3 개월이후에머리빠짐이가장줄고밀도가가장높아지는것을확인하였고, 이후에도뚜렷한모발의탈락증상없이잘유지되는것을확인하였다고보고하였다. Cervelli 29) 등은 10명의남성형탈모환자에게 PRP 요법을환부에시술한결과 3번의시술후에환부및기저선상에서모발의현저한증가가나타났다고보고하였다. Singh 30) 등은원형탈모환자 20명에게환부에 4주간격으로 6회 PRP요법을시행하고 1년뒤의경과를관찰한결과 19명에게서증상의개선을확인하였으며, 1명이재발하였으나부작용이나타나지않았다고보고하였다. Singhal 31) 등은 10명의안드로겐성탈모환자에게서 2~3주간격으로 3개월간 PRP요법을시행한결과, 모발수, 모발두께, 모낭의힘등에서뚜렷한호전을가져왔으며, 부작용은없었다고보고하였다. 7. 롤러침 (Microneedling) 과관련한연구롤러침과관련해서는논문은 1건만이검색되었으나독자편지의형태로롤러침의효과가높다는것을알리는내용이 2편있었다. Dhurat 32) 등은안드로겐성탈모환자에게 microneedling 과함께 Minoxidil 을도포하는경우와 Minoxidil만을도포하는경우로나누어처치한결과모발수, 전문가평가, 환자평가모두에서 microneedling 군이현저한차이로높은효과가있었음을보고하였다. 8. 줄기세포와관련한연구줄기세포를활용하여탈모증상에대하여모발의재생을촉진시키거나모발의탈락을방지하는방법에대한연구가보고되었다. Fukuoka 33) 등은남녀각각 11명의탈모환자에게 19

9 지방유래줄기세포를추출하여피하에주입하여경과를관찰한결과 Placebo에비해뚜렷한모발생장효과가나타났으며, 남녀구분없이모두모발수가증가했다고보고하였다. Li 34) 등은체내의단핵세포들이처리된제대혈세포에노출되어조정된이후에다시체내로주입되는 Stem Cell Educator therapy를다발성원형탈모증, 전두탈모증, 전신탈모증환자총 9명에게시행한결과 4주이후에원형탈모증과전신탈모증은모발의재성장이나타났으며, 원형탈모증환자중 1명과전신탈모증환자 1명은완전한모발의재성장이일어났다고보고하였다. 9. 한약단독투여의효과에관한연구任 35) 은薏苓祛濕生髮湯을투여한경우 85.93% 가호전을보였으며, Finasteride 투여군은 67.39% 가호전을보여한약투여군이 Finasteride군대비높은치료율을보였다고보고하였다. 또한정상인과탈모환자의모발구성성분이다르며, 호전을보이는경우모발조성이정상화됨을관찰하였다. 韓 36) 은濕熱熏蒸형으로변증된안드로겐성탈모환자에게化脂生髮湯과祛濕健髮湯을투여한결과化脂生髮湯은 86.1%, 祛濕健髮湯은 70.5% 의환자에게서호전을나타냈다고보고하였다. 文 37) 은濕熱上烝으로진단된지루성탈모환자에게祛濕健髮湯을투여한결과 83.4% 에서호전을보였고 Finasteride와 Minoxidil 을병용한경우의 53.1% 보다높은효과를보였으며피지분비를줄여주는효과가있어탈모에효과적인것으로생각된다고보고하였다. 周 38) 는肝腎不足으로진단된안드로겐성탈모환자에게補髮飮과측백팅크를병용한군에서는 82.14% 가, 七寶美髯丹과측백팅크를병용한군에서는 66.66% 가유효한효과를보였고특히補髮飮 측백팅크병용군이모발수의증가, 두피소양감등에서확연한효과가나타났으며환자의제반호소사항을줄여주는효과가더컸다고보고하였다. 홍 39) 등은寒熱辨證으로열성탈모로진단된탈모환자 30명에게침구치료와加減淸營湯복용을병행한결과모발의열감및두피증상은감소하였으며모발의밀도는 12% 가량증가하였다고보고하였다. 10. 한 양약병용투여의효과에관한연구 韋 40) 는生髮湯과 Finasteride 투여군, 生髮湯단독투여군, Finasteride 단독투여군순으로두피소양감과모발수등에서개선이나타났다고보고하였다. 鄒 41) 는甘草酸캡슐과養血生髮캡슐, Minoxidil을모두사용한군에서養血生髮캡슐과 Minoxidil을사용한군보다더나은효과를보였다고보고하였다. 成 42) 은甘草酸과 Minoxidil 치료에한약치료를병용하는것이甘草酸과 Minoxidil만병용하여치료한것에비해 10% 정도치료율이높게나타났다고보고하였다. 43) 柳등은甘草酸캡슐과養血生髮캡슐병용군이 98.3%, 養血生髮캡슐단독투여군 80% 의치료율을보였다고보고하였다. 劉 44) 는耳針과甘草酸을병용한경우 95% 의환자에서호전을보였으며, 耳針치료만시행한경우 75% 에서호전을나타내耳針단독치료군에비해더나은효과를보였다고보고하였다. 孫 45) 은 Finasteride 1mg단독투여군은 47.36%, 한약병용치료군은 77.79% 로더높은치료율을보였으며한약병용치료군은탈모외제반증상도호전시켰다고보고하였다. 11. 外治法의효과에관한연구 46) 肖등은원형탈모환자에게피부침과生髮팅크를함께사용한결과 98.33% 에서증상의호전을보였다고보고하였다. 林 47) 등은脾胃濕熱형으로진단된안드로겐성탈모환자에게七星針을사용한결과, 90.91% 의호전을보였으며, 한약복용군의 84.38% 의호전율대비높은 20

10 장인욱외 2 인 : 탈모치료에관한최신동향 효과를나타내었다고보고하였다. 史 48) 는血虛風燥형으로진단된원형탈모환자에게神應養眞丹과 640nm적외선조사요법을병행한결과 85% 에서호전반응을보여神應養眞丹단독투여군의 55% 에서호전반응을보인데비해높은효과를나타내었으며, 탈모범위에서도병행치료군에서더높은효과가나타났다고보고하였다. 49) 王 등은首烏生髮飮加減을복용하고速效生髮精을도포한결과환자의 98.15% 에서유효한효과가나타났다고보고하였다. 50) 左 등은원형탈모증환자에게養血生髮캡슐과五行음악치료를병행한결과음악치료병행군에서 95%, 養血生髮캡슐치료군에서 76.3% 의호전효과를보였다고하며음악치료가주는정서적안정효과로인해치료효과가있는것으로보인다고보고하였다. 12. 탈모환자의특징에관한연구 蔣 51) 은안드로겐성탈모환자의모근을전자현미경으로관찰하여분석한결과전두부, 두정부, 후두부, 측두부의각각의모근에서 O, Na, Mg, K, Ca, S, Cl, Zn, P의구성이다르게나타났으며, 濕熱內蘊, 血虛風燥, 肝腎不足으로각각진단된환자의모발에서는 K의구성만이다르게나타났다고보고하였다. 黄 52) 은안드로겐성탈모환자 62명을변증한결과脾胃濕熱형이 46명으로 74.2%, 肝腎不足형이 16명으로 25.8% 로나타났으며, 탈모환자중에서脾胃濕熱형이濕熱체질의대부분을차지한다고보고하였다. 秦 53) 는안드로겐성탈모환자 120명을변증한결과濕熱蘊結 74명, 血虛風燥 25명, 肝腎不足 21명의분포로나타났으며, 비교적낮은연령에서는濕熱蘊結과血虛風燥가많이나타나나고령의경우肝腎不足이많이나타났다고보고하였다. 54) 朴 등은원형탈모환자 113명에게심리평가를시행한결과정상인대비내외향성, 신경증, 정신병항목점수가높게측정되어불안과우울경향을보였 으며, 중의학적체질을조사하였더니대부분偏頗형으로나타났으며, 陰虛형, 瘀血형, 氣虛형, 氣滯형등의순으로겸하는것으로나타났다고보고하였다. 邱 55) 등은안드로겐성탈모환자 124명의증상을변증한결과, 濕熱蘊脾, 肝腎陰虛, 血熱風燥, 血虛風燥, 肝膽濕熱, 胃熱熾盛, 肝鬱脾虛, 腎氣不固순으로나타났으며, 두가지의변증을겸한것으로보이는경우에도濕熱蘊脾와肝腎陰虛, 濕熱蘊脾와胃熱熾盛의순으로나타나는등전반적으로濕熱蘊脾로변증이되는경우가많이나타났다고보고하였다. 이 56) 등은탈모증환자의동반증상으로두부의열감, 지루성두피등의피부염, 경항부통증, 소화기기능저하및만성허약의 4가지로분류하였는데, 소화기기능저하및만성허약을동반한경우가가장많았으며남성의경우두피의열감또는통증을, 여성의경우소화기기능저하및만성허약증을동반한경우가많이나타났다고보고하였다. 이 57) 등은탈모를주소로내원한환자 1050명과그중치료를받은환자 153명을대상으로후향적조사를실시한결과, 남성과여성의비는 2:1, 20~30 대가대부분을차지하였고, 가족력의경우부계가족력이 44% 로높고, 정수리탈모와복합형탈모가가장많이나타났으며, 치료환자의 56% 가호전을보였다고보고하였다. Ⅳ. 고찰탈모증은모발이존재해야할부위에서탈락되는상태를의미하며휴지기탈모증, 안드로겐탈모증, 원형탈모증, 생장기탈모증등이있다 2). 한의학에서는髮墮, 髮去, 髮落, 油風, 禿瘡등으로불리고內 外因으로구분하여辨證施治를통한내과적인한약치료와體鍼療法, 藥鍼療法, 光學療法등의外治法을병행하고있다 3,4). 최근미용에대한관심이증가하는추세로탈모에 21

11 대하여다양한치료법이시도되고있다. 탈모에대하여종합적으로분석한연구는이등 5), 이 6), 김등 7), 장등 8) 의탈모에관한문헌적고찰과김등 9) 의탈모에관한임상적고찰이있으며, 임등 4) 의탈모의동서의학적고찰에관한연구가있었으나최신의탈모치료경향에대하여체계적으로분석한논문은없었다. 이에저자는탈모치료와관련된최근의연구동향을살펴보고이를토대로한의학적탈모치료의발전방향을모색하고자연구를진행하였다. Pubmed에서 alopecia로최근 5년간의논문을검색하여치료에관한임상논문을선별하였더니 23건이조건에부합하였다. 기존치료방법에대한연구의연장선상에있는논문이 10건이었으며, 새로운치료방법의적용에대한논문이 13건이었다. 경구투여약물의효과에대한연구는 5α- 환원효소억제제인 Finasteride, Dutasteride 11-13) 와자가면역억제제인 Baricitinib 21) 과 Methotrexate 22) 에관련한연구가있었다. 외치법으로는외용제로서 Minoxidil의효과증대를위한연구 15-17), 스테로이드의국소부위도포나주사의효과 18,19) 에대한연구가이루어졌고, 외부자극을통한방법으로는건선의치료를응용한 puva 요법 20), 308nm Excimer Laser 23) 나저강도광선요법 24-26), 롤러침 32) 에대한연구가있었다. 기타요법으로자가혈소판농축혈장치료술 27-31) 과줄기세포치료효과 33,34) 에관한보고가있었다. 23편의논문중기존의치료방법으로알려진 5α- 환원효소억제제 (Finasteride, Dutasteride) 나 Minoxidil, 스테로이드, 자가면역질환치료제에관한연구는안전성과다른요법과의병행가능성에관한것이었으며, Diclofenac 병행요법, cyclosporine과 psoralen 처리피부의자외선조사, Baricitinib, 레이저요법, 자가혈소판농축혈장치료술과같은새로운치료법의경우부작용이거의나타나지않았기때문에기존치료법대비안전하다고주장하고있으나광범위한연구가행해지지않아안정성에대해서는추가 적이며광범위한연구가행해져야할것으로보인다. CNKI와 OASIS에서각각 alopecia와탈모로최근 5년간의논문을검색하여치료에관한임상논문을선별한결과총 23건이조건에부합하였다. 한약단독치료에관한논문이 5편, 한 양약병용투여에관한논문이 6편, 外治法에관한논문이 5편, 탈모환자의특징에관한논문이 7편이었다. 한약단독투여의효과에관한연구에서薏苓祛濕生髮湯 35) 과祛濕健髮湯 37) 은 Finasteride에비해높은효과를보였고안드로겐성탈모환자에서濕熱熏蒸형은化脂生髮湯 36) 이, 肝腎不足형은補髮飮 38) 이더높은효과를나타냈으며加減淸營湯은열성탈모환자에서증상개선효과 39) 가있었다. 한 양약병용투여의효과에관한연구에서는병용투여군이양약단독투여군에비해높은효과 40-45) 를보였으며탈모와관련된두피소양감이나두피지루등과같은동반증상의개선 40,42,45) 을보였다고보고하였다. 外治法으로는자극을통한방법으로피부침 46), 七星針 47), 광선요법으로적외선조사요법 48), 외용제로서生髮팅크 46) 와速效生髮精 49), 그리고五行음악치료 50) 에대한연구가있었다. 탈모환자는전자현미경을통한모근성분분석결과정상군과조성에차이 51) 가있었으며안드로겐성탈모환자의경우脾胃濕熱형이나濕熱蘊結형의변증유형의빈도가높게나타났다는보고 52,53,55) 가있었다. 심리평가에서는대부분의원형탈모환자가불안과우울경향을보이며중의학적으로偏頗체질을나타낸다 54) 고보고되었다. 국내에서는탈모환자를역학적으로조사한보고 57) 와탈모에동반된증상을기반으로환자의유형을분석한연구 56) 가있었다. 23편의논문중甘草酸의효능과관련된논문이 3 편있었으며타약물의효능을검증하기위한병용요법으로서甘草酸이사용된논문이 1편, 養血生髮캡슐이사용된논문이 3편이있었다. 중의학에서甘草酸과養血生髮캡슐은 Finasteride 나 Minoxidil 과같이 22

12 장인욱외 2 인 : 탈모치료에관한최신동향 탈모환자에게흔히쓰이는처방으로, 관련된연구가활발히진행되고있다. 탈모치료효과를보인薏苓祛濕生髮湯, 祛濕健髮湯, 化脂生髮湯, 補髮飮등의한약처방이나外治法에대해서도최대효과를낼수있는용량및빈도와안정성에대한연구가추가적으로필요할것으로생각된다. 탈모환자에대한중의학논문에서가장흔하게나타나는변증은濕熱의범주에속하는脾胃濕熱형이나濕熱蘊結형으로국내연구에서두피열로인한열성탈모의빈도가높다는것과유사한측면이있다. 이를통해탈모치료시熱치료를가장먼저고려해야할것으로보인다. 서양의학적치료에비해한의학적치료가가진장점은탈모증상뿐아니라동반증상을함께개선시키는점으로韋 40), 成 42), 孫 45) 등의논문에서언급되고있다. 한의학적치료에서는全一觀에입각하여비록국소부위에한정되어나타나는현상일지라도전체의상황을반영하고있는것으로간주하여진단과치료를시행 58) 하므로환자의주된호소증상및동반증상이함께개선된다. 원형탈모증을정신적인측면에서분석 54) 하거나치료에응용하려는시도 50) 는形神一體論의관점에근거를둔것으로생각된다. 서양의학에서도신체화장애와같이정신증상이신체증상을유발하는범주를다루고있으나일부에불과한반면정신의식의사유활동과인체생명활동의동일시는한의학적생명인식의특징으로七情을병을일으키는內因으로간주하여치료대상으로삼고있다 58). 서양의학과한의학에서공통적으로연구되고있는분야는 Excimer Laser, 저강도광선요법, 적외선조사요법과같은광선요법과롤러침, 칠성침과같은피부손상을통한재생유도에관한것이다. 이와같이외치법에대한연구가활발히이루어지고있으며국내에서는새로운치료법으로봉독 59), 자하거 60), 홍화 60,61), 호도 61) 등의약침시술과매선치료 62) 가제시되고있으나증례보고에그쳐지속적인연구가필요할 것으로생각된다. 이와같이탈모치료에대한새로운방법이다양하게제시되고있으며, 이에대한한의학적인관점에서의접근이필요하다. 상기제시된치료법들은기존한의학적치료방법에대한보완및실질적인근거마련에도움이될것이다. Minoxidil 과 PRP의경우환부의혈류개선을통한발모촉진효과가있는데이러한작용은活血祛瘀와유사하다고볼수있으므로기존치료법외活血祛瘀를새로운치료법으로고려해볼수있다. 甘草酸, 養血生髮캡슐과같이중의학에서다용되는처방을응용하거나피부침, 음악치료, 적외선조사요법과같은외치법을병용하여치료율을높일수있을것이다. 최근질병의원인에대해정신과적으로접근하려는시도가계속되고있다. 정신적인영역을치료의범주에포함시키는한의학의특성을적극적으로활용한다면탈모치료에보다나은결과를가져올수있을것이라생각된다. 또한탈모에대한사상의학적접근은새로운관점의진단과치료방법을제시할수있을것으로사료된다. 본연구에서언급된서양의학과중의학의유용한치료법들은기존탈모치료에응용될수있을것이며, 이와관련하여추가적인연구가필요할것으로사료된다. Ⅴ. 결론국내외학술지에게재된탈모치료와관련된논문 46편을수집하고분석하여다음과같은결론을얻었다. 1. 서양의학적치료에관한최신연구는기존의치료방법으로알려진 5α- 환원효소억제제 (Finasteride, Dutasteride) 나 Minoxidil, 스테로이드, 자가면역질환치료제에관한연구는안전성및다른요법과 23

13 의병행가능성에대하여이루어지고있고저강도광원요법 (LLLT), 자가혈소판농축혈장치료술 (PRP), 롤러침, 줄기세포치료등과같은새로운치료방법들이제시되고있으며그적용범위및기존치료법대비효과에대하여다양한연구가진행되고있다. 2. 중국에서는甘草酸과養血生髮캡슐의효능에관한연구가활발히행해지는것으로보이며한약과양약의병용투여및外治法과같이한약치료와병행하여치료할수있는방법에대한연구도많이이루어지고있다. 모근의구성성분과변증별분석을통하여탈모환자의특징에대한연구가진행되고있다. 3. 한의학적치료는서양의학적치료에비해탈모증상뿐아니라신체전반의증상을개선시킨다는점에서강점이있으며, 정신적인영역을치료의범주에포함시키는점에서차별점이있다. References 1. Min BG. Diagnosis and treatment of hair & scalp disorders. Seoul:Hanmi Book. 2005: 21-3, Jung JY, Han KH. Common Skin Disease in Korea. Seoul:MDWorld. 2009: Jang HY, Choi KH, Kim SH, Kwon KR, Kim BW. Bibliographic Studies of Depilation. 2002;5(2): Yim SBN, Choi GD, Kim SK. A literature study about the comparison of Oriental-Occidental medicine on the alopecia. The J of Jehan oriental medical academy. 1999;4(1): Lee PR, Ahn KS. A Literatural Investigation into Pathology of Alopecia Areata. J. of Orient Med Pathol. 1991;7: Lee YJ. A Bibliographical Study of Oriental Medical Records on Alopecia. J. of Kor Orient Med Society. 1995;16(1): Kim NW, Noh SS. A literatual studies on the yupung. J Orient Med Surg Opthalmol Otolaryngol. 1998;11(1): Jang HY, Choi KH, Kim SH, Kwon KR, Kim BW. Bibliographic Studies of Depilation. J Pharmacopuncture. 2002;5(2): Kim HJ, Chae BY. A Clinical Study of Alopecia. J Orient Med Surg Opthalmol Otolaryngol. 1996;9(1): Levy LL, Emer JJ. Female pattern alopecia: current perspectives. Int J Womens Health. 2013;5: Oliveira-Soares R, E Silva JM, Correia MP, André MC. Finasteride 5 mg /day Treatment of Patterned Hair Loss in Normo-androgenetic Postmenopausal Women. Int J Trichology Jan;5(1): Boersma IH, Oranje AP, Grimalt R, Iorizzo M, Piraccini BM, Verdonschot EH. The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia. Indian J Dermatol Venereol Leprol Nov-Dec;80(6): Chandrashekar BS, Nandhini T, Vasanth V, Sriram R, Navale S. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. Indian Dermatol Online J Jan-Feb;6(1): Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol Feb;150(2): Sakr FM, Gado AM, Mohammed HR, Adam 24

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