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Expert consensus on the management of Androgenetic Alopecia in India

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eMediNexus Editorial    12 March 2021

Androgenetic alopecia (AGA), also known as androgenic or pattern alopecia – a frequently reported disorder, has a higher incidence in men. AGA has immense psychological effects on the patient, irrespective of the age or stage of baldness. 
 
A recent article published in the International Journal of Trichology presented expert consensus on the management of androgenetic alopecia, with the objective to provide dermatologists with an evidence-based platform for choosing efficacious and safe therapy for patients with AGA
 
Here, key opinions of experts on all aspects of treatment for the effective management of AGA were summarized, as follows:
  • For all patients with suspected AGA, a detailed history must be taken. Patients should be asked direct questions about the age of onset of hair fall, a history of hair fall among relatives (both paternal and maternal), medical conditions – such as metabolic syndrome and insulin resistance, intake of anabolic steroids in the form of pure whey isolates or protein shakes and smoking habits.
  • A good history and clinical examination of the scalp should be done to ascertain the pattern of hair loss—which is adequate for diagnosis. Additional tests such as the hair-pull test, trichoscopy and dermoscopy, and checking the terminal to vellus hair ratio, perifollicular scaling and variation in thickness may also help.
  • Laboratory investigations are generally not required in AGA, more so in males. Females may be investigated to rule out any underlying condition. Scalp biopsy may be done if required to clarify doubts.
  • Nutritional supplements may be prescribed in patients with abnormally high hair loss, telogen effluvium (TE) or malnutrition. Otherwise, minoxidil is the mainstay of therapy for male AGA; it may also be prescribed in female-pattern hair loss (FPHL) with proper counseling. Finasteride 1 mg shows better results than minoxidil with regard to hair regrowth. Platelet-rich plasma (PRP) therapy can be used but only as an adjuvant to minoxidil/finasteride, and not as monotherapy.
  • Counselling is very important in patients undergoing hair transplant. Follicular Unit Transplant (FUT) is currently the gold standard treatment. FUT or follicular unit extraction (FUE) can be chosen by the treating physician based on patient characteristics. Some patients may benefit from a combination of both.
It was also stated that minoxidil treatment should be stopped 15 days before hair transplant as it is a vasodilator and may aggravate bleeding tendency. If the patient is taking anticoagulant and antiplatelet drugs, the physicians opinion should be taken on titration of medication. While post-transplantation, medical therapy should be continued as per the discretion of the treating physician.
 
Source: International Journal of Trichology. 2019 May-Jun; 11(3): 101–106. doi: 10.4103/ijt.ijt_24_19

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