In prezent, minoxidilul si finasterida sunt singurele tratamente aprobate de catre FDA pentru MPHL.
FINASTERIDA
Cum functioneaza finasterida?
Este un inhibitor pentru enzima 5a-reductanta de tipul 2. Reduce conversia testosteronului catre DHT.
Care este beneficiul consumarii ei?
In 80% din cazurile celor care iau finasterida, creste semnificativ numarul firelor de par, creste dimensiunea fibrei de par si durata prelungita de crestere a parului este respectata.
Pentru cat timp?
Imbunatatirile nu pot fi percepute decat dupa 6-12 luni de tratament si sunt necesari 2 ani de tratament pentru a atinge nivelul maxim. Tratamentul ar trebui continuat pentru ca beneficiile nu vor fi mentinute dupa intreruperea tratamentului.
In ce zona functioneaza?
Finasterida este mai eficienta asupra vertexului (crestetul capului) si in zona superior-frontala a scalpului. Potentialul sau lucreaza oriunde sunt fire de par miniaturizate.
Care este dozajul recomandat?
1mg/zi, dar cu un dozaj de 0.2mg/zi imbunatatirile semnificative sunt observabile.
Exista reactii in combinatie cu alte medicamente?
Nu exista reactii cunoscute cu alte medicamente.
Exista vreo boala sau conditie pentru care nu pot lua pastilele?
Pastilele ar trebui evitate in cazul pacientilor cu boli de ficat si femeilor gravide.
Care sunt efectele adverse?
Efectele adverse raportate includ scaderea libidoului (1.9%), difunctii erectile (1.3%) si disfunctii ejaculatorii (1%). La unii pacienti, efectele adverse persista in pofida intreruperii medicatiei pentru inca cel putin 3 luni. Desi legatura clara nu a fost determinata, FDA a fost atentionata despre potentialele efecte adverse sexuale in ciuda intreruperii pastilelor. Finasterida reduce nivelul antigenului specific prostatIc (PSA). Ginecomastia a fost raportata in cazuri rare. Un studiu recent a investigat asocierea dintre 5-ARis si cancerul de san la barbati si a relevat lipsa unei asocieri pozitive.
MINOXIDILUL
Cum functioneaza?
Este inca neclar. Poate preveni sau intarzia miniaturizarea foliculara.
Care este dozajul recomandat?
La MPHL, solutia de 5% este superioara celei de 2%. In FHPL, ambele solutii de minoxidil de 1 si 2% cresc numarul firelor de par. Dozajul recomandat este de 1ml (25 de picaturi) pentru ambele formule de 2% si 5% sau jumatate de capac de spuma aplicata de doua ori pe zi.
Pentru cat timp?
Tratamentul este pe termen lung si oprirea minoxidilului va spori caderea parului dependent de minoxidil intre 4 si 6 luni.
Care sunt efectele adverse?
Efectele adverse are minoxidilului includ iritatia pielii, hipertricoza pe fata si maini si tahicardia. Un propilen glicol cu preparare sub forma de spuma de 5% este potențial mai puțin iritant și murdar. Hipertricoza este total reversibila.
Exista vreo boala sau conditie pentru care nu pot folosi minoxidilul?
Minoxidilul nu ar trebui folosit de catre femeile insarcinate sau cele care ajuta la aplicarea lui. De asemenea, ar trebui folosit cu precautie asupra pacientilor cu boli cardiovasculare.
AVODART (DUTASTERIDE)
Cum functioneaza?
Avodartul inhiba ambele tipuri, I si II, ale enzimei 5a-reductanta. Creste numarul firelor de par si greutatea parului, imbunatateste raportul intre anagen si telogen a parului si imbunatateste acoperirea scalpului.
Dozaj
Dutasterida de 0.5 mg/zi se considera a imbunatati sau preveni progresia MPHL.
Efecte adverse
Efectele adverse ale dutasteridei sunt impotenta, scaderea libidoului, sensibilitatea si marirea sanilor si tulburari ale ejacularii.
Există vreo boală sau condiție pentru care nu pot folosi dutasterida?
Datorită îndelungatei jumătăți de viață, barbatii care sunt tratați cu dutasterida nu trebuie să doneze sânge. Acesta nu trebuie utilizat la femeile de varsta reproductiva fără contracepție. Funcția hepatică trebuie monitorizată în timpul tratamentului cu acest medicament.
Calea PG este strans legata de cresterea parului deoarece PGE2 si PGF2a promoveaza cresterea parului , in timp ce PGF2 inhiba cresterea lui. La barbatii cu AGA usoara, s-a aratat ca 0.1% solutia latanoprost (solutie oftalmica), un analog PGF2, creste semnificativ densitatea parului si pigmentarea acestuia.
Ketaconazolul este un agent anti-fungic eficient pentru tratatamentul dermatitei si matretii. Poate stimula cresterea parului. De-obicei este utilizat in combinatie cu alte tratamente AGA.
Plasma bogata in trombocite (PRP) este un preparat autolog din plasma cu trombocite. PRP este adesea folosit in chirurgie cosmetica si releva aspecte ale vindecarii ranilor. Unii chirurgi de transplant de par au utilizat PRP, fie prin stocarea grafturilor din PRP sau prin injectarea PRP in interiorul scalpului inainte de plasarea grafturilor. Datele care sustin stimularea cresterii parului sunt limitate.
Diferite tipuri de produse ce folosesc LLLT sunt disponibile pentru tratamentul adjuvant. Hair Max Laser Comb a fost aprobat de catre FDA pentru tratarea MPHL si FPHL. LLL, in special lungimea de unda 650-900 nm la 5 mW, poate fi un tratament alternativ eficient, folosit singur sau ca tratament ajutator.
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