Female pattern alopecia or female androgenetic alopecia (FAGA) continues to be a problem. We are more easily reaching accurate diagnoses and prescribing increasingly effective treatments. But patients often demand faster results, better therapeutic responses, fewer risks and fewer side effects. And that is still difficult.
One of the main tools in the fight against FAGA is the use of oral anti-androgens. Female hormonal and biological characteristics modulate androgenetic alopecia in such a way that this treatment is often necessary. We have different molecules for this purpose, but perhaps the one with the longest history and greatest use is cyproterone acetate.
In this regard, a few months ago, alarm was raised about Diane, an oral contraceptive with an anti-androgenic effect widely used in AGF, composed of 35 micrograms of ethinyl estradiol and 2 mg of cyproterone acetate (CA). Apparently, significant side effects were produced in France in female users, which led to the precautionary suspension of its use.
In Spain, evaluations have been carried out on this subject by experts in Gynecology and Dermatology, which have allowed us to reach a series of important conclusions, and which we can consider an advance, by allowing a rational use of antiandrogens in FAGA. They are the following:
Female Androgenetic Alopecia
- The treatment of FAGA requires oral antiandrogen drugs on many occasions.
- AC is a suitable and effective drug for this purpose.
- Its association with estrogens is essential in women of childbearing age.
- Both estrogens and anti-androgens have risks and side effects, more intense in cases of inappropriate prescription.
- In healthy women without risk factors, the prescription is considered sufficiently safe.
- In women with relative risk factors, the estrogen dose should be as small as possible (preferably 20 micrograms of ethinyl estradiol).
- Other oral contraceptives with anti-androgen action can be used with good results in FAGA, alone or in combination with AC.
- The clinical history and examination of the woman should be complete (thromboembolic history, history of thrombophilia, smoking, obesity, metabolic syndrome, polycystic ovary…) for the prescription to be reasonably safe.
Frontal Fibrosing Alopecia
More and more women -and some men- are diagnosed with this alopecia characterized by an inflammation that produces an irreversible hair loss in the form of a band or diadem, running along the front edge. Many treatments have been tried without result.
Recently, two novelties have been contributed in this regard, although they are still awaiting further scientific evidence:
- Hydroxychloroquine orally which appears to favorably modify immunity in patients with this disease. The main requirement is a previous and periodic ophthalmologic examination, which proves the good condition of the eyes, to prevent them from being damaged by the drug.
- The local injection of peptides, small sequences of amino acids, together with vitamins and minerals, repeatedly, seems to improve the basal state of the epidermal and dermal cells in a non-specific way, which can be a therapeutic support in this disease, which until two decades ago was hardly known, and which is becoming more and more prevalent. Hair mesotherapy with peptides is not indicated in areas where hair has already been lost, but in areas where it is still preserved, as a preventive measure.