What are the guideline sources, guidelines and references for Androgenetic alopecia ?
Guideline sources The following summarized guidelines for the evaluation and management of androgenetic alopecia are prepared by our editorial team based on guidelines from the Japanese Dermatological Association (JDA 2018), the European Dermatology Forum (EDF 2018), and the American Association of Family Physicians (AAFP 2009). 1 2 3 Pathway Androgenetic alopecia Management Guidelines 1. Diagnostic investigations Laboratory evaluation: obtain targeted endocrine evaluation (testosterone, DHEA sulfate, and prolactin levels) in female patients presenting with hair loss associated with abnormal menses, history of infertility, hirsutism, unresponsive cystic acne, virilization, or galactorrhea. B https://web.pathway.md/diseases/recTxvwyqLJm31lBs 1/5 6/23/23, 2:35 AM Androgenetic alopecia Pathway 2. Medical management Topical minoxidil, male-pattern hair loss: As per EDF 2018 guidelines, offer topical minoxidil 2-5% solution 1 mL or half a cap of 5% foam BID to improve or to prevent the progression of androgenetic alopecia in > 18 years old male patients with mild-to-moderate disease, Hamilton-Norwood IIv-V. A Consider offering topical minoxidil 5% solution or half a cap of 5% foam for greater efficacy. B Show 4 more As per JDA 2018 guidelines, offer topical minoxidil 5% for initial treatment of male-pattern hair loss. A As per AAFP 2009 guidelines: Offer topical minoxidil 2% for hair regrowth in patients with male-pattern hair loss. A Recognize that discontinuation of minoxidil results in loss of any positive effects of treatment (hair growth) in 6 months. A Topical minoxidil, female-pattern hair loss: As per EDF 2018 guidelines, offer topical minoxidil 2% solution 1 mL BID or half a cap of 5% minoxidil topical foam once daily to improve or to prevent the progression of androgenetic alopecia in > 18 years old female patients. A Show 3 more As per JDA 2018 guidelines, offer topical minoxidil 1% for initial treatment of female-pattern hair loss. A As per AAFP 2009 guidelines: Offer topical minoxidil 2% for hair regrowth in patients with female-pattern hair loss. B Recognize that discontinuation of minoxidil results in loss of any positive effects of treatment (hair growth) in 12 months. A Other topical therapies: offer topical adenosine in patients with male-pattern hair loss. B Show 2 more Oral minoxidil: do not use oral minoxidil for the treatment of androgenetic alopecia. D 5-alpha-reductase inhibitors, male-pattern hair loss: As per EDF 2018 guidelines, offer oral finasteride 1 mg/day to improve or to prevent the progression of androgenetic alopecia in > 18 years old male patients with mild-to-moderate disease, Hamilton-Norwood IIv-V. A Show 3 more As per JDA 2018 guidelines, offer oral finasteride or dutasteride in patients with male-pattern hair loss. A As per AAFP 2009 guidelines: Offer oral finasteride to promote hair regrowth in patients with male-pattern hair loss. A Recognize that discontinuation of finasteride results in loss of any positive effects of treatment (hair growth) in 12 months. A https://web.pathway.md/diseases/recTxvwyqLJm31lBs 2/5 6/23/23, 2:35 AM Androgenetic alopecia Pathway 5-alpha-reductase inhibitors, female-pattern hair loss: As per EDF 2018 guidelines: Avoid using oral finasteride in postmenopausal patients with female-pattern hair loss. D Insufficient evidence to recommend for or against the use of oral finasteride in patients with female-pattern hair loss. I As per JDA 2018 guidelines, do not use oral finasteride or dutasteride in patients with female- pattern hair loss. D Hormonal therapy (male-pattern hair loss): do not use oral estrogens or androgen receptor antagonists to improve or to prevent the progression of androgenetic alopecia in male patients. D Show 2 more Hormonal therapy (female-pattern hair loss): insufficient evidence to support the use of oral anti-androgens (chlormadinone acetate, cyproterone acetate, drospirenone, spironolactone, flutamide) to improve or to prevent the progression of androgenetic alopecia in normoandrogenic female patients. Show 3 more Therapies with no evidence for benefit: As per EDF 2018 guidelines, insufficient evidence to recommend for or against the use of the following topical therapies in the treatment of patients with androgenetic alopecia: biochanin A I polysorbate 60 I curcuma aeruginosa I ketoconazole I roxithromycin I zinc pyrithione I glyceroloxyesters and silicium I niacin derivates I viprostol or latanoprost I cysteine or histidine I adenosine I hibiscus I melatonin I proanthocyanidins I red ginseng I tretinoin I valproic acid. I Show 3 more As per JDA 2018 guidelines, do not offer the following therapies in patients with pattern hair loss: https://web.pathway.md/diseases/recTxvwyqLJm31lBs 3/5 6/23/23, 2:35 AM Androgenetic alopecia Pathway bimatoprost latanoprost growth factors cell transplantation therapy. D 3. Nonpharmacologic interventions Use of wigs: consider advising the use of wigs as an option for hair loss. C 4. Therapeutic procedures Laser therapy: As per EDF 2018 guidelines: Consider offering low-level laser therapy (with devices using energy levels shown to be effective in randomized-controlled clinical trials) as an ancillary therapy in patients with androgenetic alopecia. C Insufficient evidence to recommend for or against treatment for > 6 months with low-level laser therapy. I As per JDA 2018 guidelines, offer irradiation with LED and low-level lasers in patients with pattern hair loss. B 5. Surgical interventions Self-hair transplantation, male-pattern hair loss: As per EDF 2018 guidelines: Consider offering follicular unit transplantation in male patients with androgenetic alopecia with sufficient donor hair. C Consider combining follicular unit transplantation with finasteride 1 mg/day to achieve a better clinical outcome. C As per JDA 2018 guidelines, offer self-hair transplantation in patients with male-pattern hair loss. B Self-hair transplantation, female-pattern hair loss: As per EDF 2018 guidelines, consider offering follicular unit transplantation in female patients with sufficient donor hair. C As per JDA 2018 guidelines, consider offering self-hair transplantation in patients with female- pattern hair loss. C Prosthetic hair transplantation: do not offer prosthetic hair transplantation in patients with pattern hair loss. D https://web.pathway.md/diseases/recTxvwyqLJm31lBs 4/5 6/23/23, 2:35 AM Androgenetic alopecia Pathway References 1. Manabe M, Tsuboi R, Itami S et al. Guidelines for the diagnosis and treatment of male-pattern and female-pattern hair loss, 2017 version. J Dermatol. 2018 Sep;45 9 1031 1043. Open 2. Anne L Mounsey, Sean W Reed. Diagnosing and treating hair loss. Am Fam Physician. 2009 Aug 15;80 4 356 62. Open 3. V Kanti, A Messenger, G Dobos et al. Evidence-based S3 guideline for the treatment of androgenetic alopecia in women and in men - short version. J Eur Acad Dermatol Venereol. 2018 Jan;32 1 11 22. Open https://web.pathway.md/diseases/recTxvwyqLJm31lBs 5/5