植髮-台灣毛髮移植醫學會TMAHT

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2015年台灣毛髮移植醫學會韓式美型植髮讀書會研究報告
发佈時間:2015-05-07   点击率:1338

主講者 鍾文桂醫師   共同參與: 鄒積鎮醫師 林宜蓉醫師 黃挺達醫師


The androgen most closely implicated in the expression of male pattern hair loss in dihydrotestosterone(DHT).

 

Two isoenzymes of 5AR

Type I: pilosebaceous unit and sebaceousgland

Type II: outer root sheath of scalp hairfollicle, prostate, and dermal papilla

 

Key steps in androgen pathway:

1. Testosterone bound to circulatingbinding globulins

2. Testosterone enters target cell

3. Conversion of testosterone to DHT by5-alpha-reductase

4. DHT binds to cytosol androgenreceptor(AR)

5. DHT-AR complex enters cell nucleus

6. DHT-AR complex binds to DNA, producingcell-specific mRNA

7. Protein synthesis produces physiologic effect

Alternative pathway:

1. Direct binding of testosterone to alternate cytosol AR

2. T-AR complex enters cell nucleus

 

 

Therapeutic approach to female pattern hairloss

1. careful physical examination, including hair pull and trichogram.

2. Laboratory evaluation to rule out endocrine disorders, iron deficiency, lupus, other systemic disorders.

3. Consider scalp biopsy to rule out alopecia areata, telogen effuvium, inflammatory or scarring hair loss processes.

4. Being topical minoxidil 2%solution

5. Consider hair transplantation, if appropriate.

6. Consider antiandrogen therapy.

 

Hair growth medication and mechanism of action

1. Minoxidil: topical hypertrichotic agent. calcium channel opener, vasodilator.

2. Finasteride: type II 5AR blockade.

3. Fluridil: topical anti-androgen

4. Dutasteride: type I and type II 5AR blockade.

5. Flutamide: systemic nonsteroidal antiandrogen

6. Spironolactone: systemic weak antiandrogen

7. Cyproterone acetate: systemic potent antiandrogen

8. Inocoterone acetate: topical antiandrogen

 

Tips on using minoxidil

1. men should use 5% solution

2. women should use 2% solution

3. use twice daily to maximize efficacy

4. apply to scalp, not hair

5. apply to all thinning areas, not just to the crown

6. use dropper, not spray attachment

7. if scalp irritation develops, consult dermatologist

8. transient hair loss can occur 4-8 weeks after initiation. reassure patient about this and continue medication

 

Tips on using finasteride

1. begin use at earliest signs of hair loss

2. Take baseline photos for future comparison

3. no change in hair density over time is success, not failure

4. discuss sexual concerns at each visit

5. if needed(rarely), prescribe sildenafil,tadalafil, or vardenafil to enhance sexual performance

6. women should not handle crushed or broken tablets

7. women should not use finasteride

8. no risk of developing fetus exposed to semen of men on finasteride

上一篇:2014年08月17日台灣毛髮移植醫學會頒發授證
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