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Topical Finasteride Versus Topical Spironolactone in the Treatment of Androgenetic Alopecia

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Topical Finasteride Versus Topical Spironolactone in the Treatment of Androgenetic Alopecia Med. J. Cairo Univ., Vol. 88, No. 3, June: 1017-1022, 2020 www.medicaljournalofcairouniversity.net Topical Finasteride versus Topical Spironolactone in the Treatment of Androgenetic Alopecia AYMAN E. YOUSEF, M.D.*; AHMED S. ABDELSHAFY, M.D.* and MOUSA A.S. ALMABROUK, M.Sc.** The Department of Dermatology and Venereology, Faculty of Medicine, Zagazig University, Egypt* and Tripoli University, Libya** Abstract susceptibility of hair follicles to androgenic mini- aturization. It is the most common cause of hair Background: Androgenetic Alopecia (AGA) is a non- loss that affects up to 70% of men and 40% of scarring alopecia that affects both males and females. It is characterized by a progressive miniaturization of hair follicles women at some point in their lifetime. Men typi- with a characteristic pattern distribution in genetically predis- cally present with hairline recession at the temples posed men and women. Topical finasteride is being investigated and vertex balding while women present with as a new treatment for AGA with fewer side effects than oral normally diffusely thin hair over the top of their finasteride. Topical Spironolactone is the most commonly scalps [1] . used off-label anti-androgen for the treatment of AGA. In the treatment of AGA, it acts by decreasing the production and competitively blocking the androgen receptor in the target Topical Finasteride has been specifically for- tissue. mulated to function by means of local application to the scalp. It has been designed to significantly Aim of Study: The aim of this study was to evaluate the role and compare the effect of topical finasteride and topical reduce the body's direct exposure to the drug and spironolactone in the treatment of (AGA). thus minimize any potentially adverse effects that Patients and Methods: After meeting inclusion and ex- may arise from such exposure [2] . clusion criteria and diagnosis of AGA was clinically established by the characteristic distribution of frontal and vertex hair in Topically applied Spironolactone does not have males and the Christmas tree pattern of diffuse hair loss at the same side effects as the orally ingested Aldac- middle hairline in females. It was dermosopically established tone. In fact, the topically applied Spironolactone by the characteristic hair shaft thickness heterogeneity, peripilar works so well that it is often used as a one-two brown depressions (peripilar signs) and focal atrichia and also folliscope established for hair density. Cases included in this punch combination with Propecia, it also decreases study had Norwad-Hamilton Scale types I to VII for men and testosterone production in the adrenal gland by Ebling Scale types I to IV for women. depleting microsomal cytochrome p450 and by Result: Our study shows that a topical spironolactone is affecting the cytochrome p450-dependent enzyme better than topical finasteride in male and female group. 17a-hydroxylase and desmolase, as well as com- Conclusion: In this study, topical finasteride and topical petitive inhibitor of the androgen receptor blocking spironolactone are good options for management of androgenic the androgen action on the target tissues [3] . alopecia but topical spironolactone is better than topical finasteride with few side effects when compared to oral Aim of the work: administration. The aim of this study was to evaluate the role Key Words: Alopecia – Finasteride – Spironolactone. and compare the effect of topical finasteride and topical spironolactone in the treatment of (AGA). Introduction ANDROGENETIC Alopecia (AGA) is a slowly Patients and Methods progressive form of hair loss which begins after This is an interventional study was carried out the onset of puberty. It occurs due to underlying at the outpatient clinic of Dermatology, Venereology and Andrology Department, Faculty of Medicine, Correspondence to: Dr. Mousa A.S. Almabrouk, Zagazig University Hospitals in the period from E-Mail: [email protected] June 2018 till December 2018. Thirty two males 1017 1018 Topical Finasteride vs Topical Spironolactone in the Treatment of Androgenetic Alopecia and females patients of different age, duration and In this table, there was no statistically significant grades of AGA were be included in our study. difference in family history, side effects and male patients’ satisfaction between male using Finas- The diagnosis of AGA was clinically established teride and Spironolactone groups. by the characteristic distribution of frontal and vertex hair in males and the Christmas tree pattern Table (2): Comparing trichoscopy baseline and after 6 months of diffuse hair loss at middle hairline in females. between the group using Finasteride and Spironol- It was dermosopically established by the charac- actone group in male patients. teristic hair shaft thickness heterogeneity, peripilar Finasteride Spironolactone brown depressions (peripilar signs) and focal group group 2 p- Variable atrichia and also folliscope established for hair x value density. Cases included in this study had Norwad- No. (8) % No. (8) % Hamilton Scale types I to VII for men and Ebling Hair diameter diversity Scale types I to IV for women. baseline: No 0.0 00.0 0.0 00.0 FET 0.1 Yes 8.0 100.0 8.0 100.0 Results Perpilar sign after A total of 32 participants were enrolled in our baseline: study included sixteen patients (8 males and 8 No 0.0 00.0 0.0 00.0 FET 0.1 Yes 8.0 100.0 8.0 100.0 females) aged 20-60 years. They were treated with topical finasteride solution 0.1% for six months Focal atricha baseline: No 1.0 12.5 0.0 00.0 FET 0.3 and sixteen patients (8 males and 8 females) aged Yes 7.0 87.5 8.0 100.0 20-60 years. They were treated with topical Hair diameter diversity Spironolactone solution 5% for six months. after 6 months: No 1.0 12.5 0.0 00.0 FET 0.1 Table (1) showed that there was no statistically Yes 7.0 87.5 8.0 100.0 significant difference in family history, side effects Perpilar sign after 6 and male patients' satisfaction between male using months: Finasteride and Spironolactone groups. Table (2), No 2.0 25.0 1.0 12.5 FET 0.5 showed that there was no statistically significant Yes 6.0 75.0 7.0 87.5 difference in trichoscopy data baseline and after Focal atricha after 6 6 months between males using Finasteride and months: Spironolactone groups (Table 3), showed that there No 5.0 62.5 4.0 50.0 FET 0.6 Yes 3.0 37.5 4.0 50.0 was no statistically significant difference in family history, side effects and female patients' satisfaction between female using Finasteride and Spironolac- Table (3): Comparing family history, side effects and patients tone groups. satisfaction and between the group using Finasteride and the group using Spironolactone in female pa- Table (4) showed that there was no statistically tients. significant difference in trichoscopy data baseline and after 6 months between females using Finas- Finasteride Spironolactone group group 2 p- Variable x teride and Spironolactone group. value No. (8) % No. (8) % Table (1): Comparing family history, side effects and patients Family history: satisfaction and between the groups using Finas- Negative 1.0 12.5 2.0 25.0 FET 0.5 teride and Spironolactone group in male patients. Positive 7.0 87.5 6.0 75.0 Finasteride Spironolactone Side effects: group group 2 No 7.0 87.5 6.0 75.0 FET 0.5 Variable p-value x Yes 1.0 12.5 2.0 25.0 No. (8) % No. (8) % Patients satisfaction: Family history: No 2.0 25.0 0.0 00.0 2.3 0.3 Negative 2.0 25.0 1.0 12.5 FET 0.5 Satisfied 5.0 62.5 7.0 87.5 Positive 6.0 75.0 7.0 87.5 Very satisfied 1.0 12.5 1.0 12.5 Side effects: No 5.0 62.5 6.0 75.0 FET 0.5 Yes 3.0 37.5 2.0 25.0 In this table, there was no statistically significant Patients satisfaction: difference in family history, side effects and female Not satisfied 3.0 37.5 4.0 50.0 FET 0.5 Satisfied 4.0 50.0 4.0 50.0 patients’ satisfaction between female using Finas- Very satisfied 1.0 12.5 0.0 0.00 teride and Spironolactone groups. Ayman E. Yousef, et al. 1019 Table (4): Comparing trichoscopy baseline and after 6 months while commonest Ebling scale for males after 6 between the group using Finasteride and Spironol- months was grade I (50%) followed by grade II actone group in female patients. (25%). In this study, the commonest Ebling scale Finasteride Spironolactone for females used Spironolactone baseline was grade p- group group χ 2 Variable I and III (37.5%) followed by grade II and IV value No. (8) % No. (8) % (12.5%) while commonest Ebling scale for males after 6 months was grade I (50%) followed by Hair diameter diversity baseline: grade II, (25.0%) no significant statistically signif- No 0.0 0.00 0.0 0.00 FET 1 icant difference in Ebling scale baseline and after Yes 8.0 100.0 8.0 100.0 6 months between female using finasteride and Perpilar sign baseline: spironolactone. Our study shows that decrease in No 0.0 0.00 1.0 12.5 FET 1 signs of androgenic alopecia: (Hair diameter diver- Yes 8.0 100.0 7.0 87.5 sity, peripilar sign and focal atricha), (100.0%) of Focal atricha baseline: the male finasteide group had hair diameter diver- Nao 1.0 12.5 1.0 12.5 FET 1 Yes 7.0 87.5 7.0 87.5 sity baseline while (87.5%) had hair diameter Hair diameter diversity after diversity after 6 months treatment.
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