F inasteride 3% Minoxidil, 0.025% T retinoin T reatm ent for androgenetic alopecia w ith combin ation ther apy of oral fin asteride, topical 3% minoxidil, and 0.025% tretinoin 2002 7 ( )
F inasteride 3% Minoxidil, 0.025% T retinoin T reatm ent for androgenetic alopecia w ith combin ation ther apy of oral fin asteride, topical 3% minoxidil, and 0.025% tretinoin 2002 7 ( )
2002 7
Fi n a s t e r i de 3% Mi n ox i d i l, 0.025% Tr e t i n o i n ( : ) F in ast eride. Min ox idil. Minoxidil tretinoin m in ox idil. fin ast eride 3% m in ox idil, 0.025% tretinoin. 1999 9 2000 12 12 41. 3,. 12 41 39 (95.1% ), 1(2.4% ). 41 2(4.9% ), 6 (14.9% ),. - i -
fin ast eride 3% minox idil, 0.025% tretinoin,. :,, finasteride, m inoxidil, tretinoin - ii -
=A bs tract = T reatm ent for androgenetic alopecia w ith combin ation ther apy of oral fin asteride, topical 3% minoxidil, and 0.025% tretinoin Seung - Gyu Lee, M.D. (Director : Professor, Gw ang - Seong Choi, M.D.) Departm ent of Derm atology, College of Medicine, Inha Univ er sity, Inchon, Korea F in ast eride is an effectiv e oral m edication in the treatm ent of androg enetic alopecia (A GA ). Min ox idil has a direct effect on h air grow th by stim ulating derm al papillae or follicular h air m atrix cells. Sim ult aneou s adm inistration of t opical minox idil w ith tretinoin m ay enhance th e respon se of A GA t o m inoxidil. T he purpose of this study is t o ev alu at e efficacy of com bin ation therapy of oral fin ast eride, t opical 3% m in ox idil, and 0.025% tretin oin. W e treat ed 41 A GA patient s from 23 to 43 y ear s of age (grade and, accordin g t o the Norw ood - H am ilton classification scale ) w ith com bin ation therapy. T h e result s w ere ev alu at ed by patient self a sses sm ent an d inv estig at or assessm ent by com parision of clinical photography. - iii -
At m onth 12, of the 41 patient enrolled, effectiv e result s w ere ob serv ed in 39 (95.1% ) patient s. P rogres sed hair loss com pared to baselin e w ere 1 (2.4% ) patient s. A dv er se effect s including sex u al dy sfunction s an d skin irrit ation w ere ob serv ed in 2 (4.9% ) an d 6 (14.6% ) patient s, r espectiv ely. But, these adv erse ev ent s resolv ed in a few w eek s. T he com bination th erapy of oral finasteride 1m g/ day, t opical 3% m in ox idil, and 0.025% tretin oin im prov ed A GA m ore efficiently. W e recom m en ded com bination therapy in those patient s w ith A GA w ho desire m edical therapy. K ey w ord s : an drogenetic alopecia, com bin ation therapy, fin ast eride, m inoxidil, tretin oin - iv -
Lis t of T ab le s T able 1. Distribution of patient s an d clinical pattern of androg enetic alopecia by m odified Norw ood- H am ilton classification according to age T able 2. M ale hair grow th questionn aire u sed for patient self assessm ent of chan ges in scalp hair. T able 3. P ercent age of m en w ith improv em ent s in scalp hair by self as sessm ent T able 4. P ercent age of m en w ith improv em ent s in scalp hair by inv estig at or ' s photography - v -
List of Fig ures F igure 1. M odified N orw ood - Ham ilt on cla ssification of an drogenetic alopecia F igure 2. Baseline (A ) and m onth 12(B ) photograph s of patient s treat ed w ith com bin ation therapy rat ed as havin g m oderat ely increased hair grow th from baseline. F igure 3. Baseline (A ) and m onth 12(B ) photograph s of patient s treat ed w ith com bin ation therapy rat ed as havin g greatly in creased hair grow th from baseline. F igure 4. Baseline (A ) and m onth 12(B ) photograph s of patient s treat ed w ith com bin ation therapy rat ed as havin g greatly in creased hair grow th from baseline. - v i -
I. 1 II. 2 III. 4 IV. 13 V. 17 VI. 18 - v ii -
I., 50 60 50%..,, 5 - reduct ase (5RD ) dihy drotestosteron e (DHT ), DHT (Price et al, 1975; It am i et al, 1991). F in ast eride 5RD DHT DHT. F inasteride (Kaufm an et al, 1998; Ley den et al, 1999). Minoxidil 1 40-60% (DeVillez et al, 1987). T retinoin, m in ox idil m in ox idil (Bazzano et al, 1986). fin ast eride minox idil,. fin ast eride m in ox idil, tretinoin,. - 1 -
II. 1. 1999 9 2000 12 12 41. 23 43 28.8, 1. M odified Norw ood- H am ilt on (F ig. 1) (T able 1),. 2. fin ast eride 1 /,, 2 0.025% tretinoin 3% m inoxidil.,. 3.. (T able 2) 6. - 2 -
Grade 0 Grade +3 4 2. Grade +3 : Grade +2 : Grade +1 : Grade 0 : - 3 -
III. 1. 12 41 39 (95.1% ). 12 26 (63.4% ) 31 (75.6% ) (T able 3). 2. 3,. 12 95.1%, 9 (21.9% ), 13 (31.7% ) (F ig. 2), 17 (41.5% ) (F ig. 3, F ig. 4). 1, 1 (T able 4). 3. 41 2(4.9% ), 6 (14.9% ),. - 4 -
4. 41 28 (68.3% ). 27 (65.9% ),,,. - 5 -
T able 1. Distribution of patient s an d clinical pattern of an drogen etic alopecia by m odified Norw ood- H am ilt on clas sification according to age A g e - No. of patient s (% ) 21-25 4 7 2 13 (31.7% ) 26-30 10 4 14 (34.2% ) 31-35 3 3 6 (14.6% ) 36-40 3 3 6 (14.6% ) 41-45 2 2 (4.9% ) T otal 4(9.8% ) 23 (56.1% ) 14 (34.1% ) 41 (100% ) - 6 -
T able 2. M ale hair grow th qu estionn aire u sed for patient self as sessm ent of chan ges in scalp hair. 1.,? 2.,? 3.,? 4.,? 5.,? 6.? T able 3. P ercent ag e of m en w ith im prov em ent s in scalp h air by self a sses sm ent 6 12 No. of patient s w ho an sw ered "y es" (% ) N o. of patient s w ho an sw ered "y es"(% ) 1. 23 (56.1% ) 29 (70.7% ) 2. 25 (61% ) 30 (73.2% ) 3. 26 (63.4% ) 32 (78% ) 4. 24 (58.5% ) 28 (68.3% ) 5. 20 (48.8% ) 25 (61% ) 26 (63.4% ) 26 (63.4% ) 31 (75.6% ) 30 (73.2% ) 6. 30 (73.2% ) 39 (95.1% ) - 7 -
T able 4. P ercent ag e of m en w ith im prov em ent s in scalp hair by inv estigat or ' s photography Grade +3 Grade +2 Grade +1 Grade 0 6 12 8 (19.5% ) 17 (41.5% ) 15 (36.6% ) 13 (31.7% ) 12 (29.3% ) 9 (21.9% ) 6 (14.6% ) 2 (4.9% ) T ot al 41 (100% ) 41 (100% ) (Grade +1) - 8 -
F igure 1. M odified Norw ood- H am ilton classification of androg enetic alopecia - 9 -
(A ) (B ) F igure 2. Baseline (A ) and m onth 12(B ) photograph s of patient s treat ed w ith com bin ation therapy rat ed as havin g m oderat ely increased hair grow th from baseline. - 10 -
(A ) (B ) F igure 3. Baseline (A ) and m onth 12(B ) photograph s of patient s treat ed w ith com bin ation therapy rat ed as havin g greatly in creased hair grow th from baseline. - 11 -
(A ) (B ) F igure 4. Baseline (A ) and m onth 12(B ) photograph s of patient s treat ed w ith com bin ation therapy rat ed as havin g greatly in creased hair grow th from baseline. - 12 -
IV., (Ku ster et al, 1984). (T osti et al, 1999). 5 - reduact ase (5RD ) dihy drotest ost erone (DHT ). DHT (It am i et al, 1991). (Ku st er et al, 1984; W hitin g et al, 1993). F in ast eride 5RD DHT. 5RD 2 1, 2, (H arris et al, 1992; T higpen et al, 1993) F ina st eride 2 5RD (Dallob et al, 1994). Minox idil 1977 Dargie (Dargie et al, 1977) m inoxidil. 1985 De Villez (De Villez, 1985) 56 2% 3% m in ox idil 1 32%, Oslen (Olsen et al, 1985) 126-13 -
12 2% 3% m in ox idil 3. T retinoin m in ox idil. F erry (F erry et al, 1990) 19 2% m inoxidil 0.05% tretinoin m in ox idil 3, tran sepiderm al w at er loss tretin oin,. tretin oin minox idil. Kaufm an (Kaufm an et al, 1998) Ley den (Ley den et al, 1999) 1879 fina st eride, 1 87%, 48% 18%. 1 53%. 3, 1 39 (95.1% ).,. (Kim et al, 2000) 8 fin at eride 68, 57 (83.8% ). fin ast eride - 14 -
. 12 1% 2 (4.9% ) (Kaufm an et al, 1998; Ley den et al, 1999; Kim et al, 2000). Minox idil, Ranchoff (Ran choff et al, 1985) m inoxidil 30 7. T retin oin,,. minox idil tretinoin, 6 (14.6% ). ( et al, 1986; W ilson et al, 1991) m in ox idil tretin oin. finasteride, m in ox idil, tretin oin.,,,. 1. 1 95.1%, fin ast eride, tretin oin, minox idil 1 (Kaufm an et al, 1998; Bazzano et al, 1986; De Villez, 1985) - 15 -
. 3 1.,. - 16 -
V. 1 fin ast eride 3% m inoxidil, 0.025% tretin oin 41. 1. 1 fin ast eride 3% m in ox idil, 0.025% tretinoin 41 39 (95.1% ), 9 (21.9% ), 13 (31.7% ), 17 (41.5% ). 2. F inasteride 2 (4.9% ), 3% m in ox idil 0.025% tretinoin 6 (14.6% ),.. 3. finasteride 3% m inoxidil, 0.025% tretinoin,. - 17 -
VI. P rice VH. T est osterone m et abolism in th e skin. Arch Derm atol 1975;111:1496-1502 It am i S, Kurat a S, S onoda T, T akay asu S. M echanism of action of an drogen in derm al papilla cell. Ann N Y A cad S ci 1991;642:385-395 Kaufm an KD, Olsen EA, W hitin g D, S av in R, DeVillez R, Bergfeld W, et al. F in ast eride in th e treatm ent of m en w ith andr og enetic alopecia. J Am A cad Derm atol, 1998;39:578-589 Ley den J, Dunlap F, Miller B, W inter s P, Lebw ohl M, H ecker D, et al. F in ast eride in the treatm ent of m en w ith frontal m ale patt ern h air loss. J A m A cad Derm atol, 1999;40:930-937 DeVillez RL. T opical minox idil for an drogen etic alopecia. Derm atologica, 1987;175(Suppl 2):50-53 Bazzano GS, T erezakis N, Galen W. T opical tretinoin for hair grow th prom otion. J Am A cad Derm at ol 1986;15:880-883 Ku st er W, H apple R. T he inh erit an ce of com m on b aldness : tw o B or not t w o B?. J Am A cad Derm atol 1984;11:921-926 T osti A, P iraccini BM. An drogen etic alopecia. Int ernation al Journal of Derm atology 1999;38:1-7 - 18 -
W hiting DA. Diagn ostic and predictiv e v alue of horizontal section s of scalp biopsy specim en s in m ale patt ern an dr ogen etic alopecia. J Am A cad Derm at ol 1993;28:755-763 H arris G, A zzolina B, Bagin sky W, Cimis G, Ra sm u s son GH, T olm an RL, et al. Identification and selectiv e inhibition of an isozym e of st eroid 5 alph a - redu ct ase in hum an scalp. P roc Natl A cad S ci U S A 1992;89:10787-10791 T higpen AE, Silv er RI, Guiley ardo JM, Casey ML, M cconn ell JD, Ru ssell DW. T is su e distribution and ont ogeny of steroid 5 alpha - redu cta se isozym e expression. J Clin Inv est 1993;92:903-910 Dallob AL, S adick NS, Ung er W, Lipert S, Geissler LA, Greg oire SL, et al. T he effect of fin ast eride, a 5 alpha - reductase inhibitor, on scalp skin t estost eron e and dihy drotest ost erone con centration s in patient s w ith m ale pattern baldn ess. J Clin En docrinol M et ab 1994;79:703-706 Dargie HJ, Dollery CT, Daniel J. Min ox idil in resistant hypert en sion. Lancet 1977;2:515-518 De Villez RL. T opical m in ox idil therapy in hereditary an drogenetic alopecia. A rch Derm at ol 1985;121:197-202 Olsen EA, W ein er M S, Delong ER, Pinn ell SR. T opical m in ox idil in early m ale patt ern baldnes s. J Am A cad Derm atol 1985;13:185-192 - 19 -
F erry JJ, F orbes KK, VanderLugt JT, S zpun ar GJ. Influen ce of tretinoin on the percut an eou s ab sorption of m inoxidil from an aqueou s t opical solution. Clin Pharm acol T her 1990;47:439-446 S eun g Il Kim, Jae H ak Yoo, Kea Jeun g Kim. A Clinical stu dy of th e effect s of F in ast eride on An drogen etic Alopecia. Ann Derm atol 2000;12:264-270 Ranchoff RE, Bergfeld W F. T opical minox idil reduces blood pressure. J Am A cad Derm atol 1985;2:586-587,,,,,. Minoxidil. 1986;24:181-189 W ilson C, W alk den V, P ow ell S, Shaw S, W ilkin son J, Daw ber R. Cont act derm atitis in r eaction to 2% t opical m inoxidil solution. J Am A cad Derm atol 1991;24:661-662 - 20 -