Male pattern baldness (MPB) is a progressive condition. The extent of baldness in MPB is described using Norwood classification wherein I is the mildest and VII is the most severe. Male pattern baldness (MPB) begins with the recession of the hairline in front and progresses to involve the hair on the top of the head (mid-scalp) and the back of the head. It is difficult to predict the extent (severity) to which a person with MPB will lose hair and the speed or rate at which the hair would be lost.
We adopt two strategies for the management of MPB. They include those for the prevention of hair loss and those for redistribution of the hair follicles. The former involves medications and the latter is achieved with hair transplantation (surgery).
With the progress of MPB, there are certain changes observed in the appearance of the hair shafts. They become smaller in length and diameter. Hair shafts in the scalp occur in bunches of single, two, three or four shafts. These are referred to as follicular units (FU). In MPB, the average number of shafts in an FU reduce with a predominance of singles and doubles. The number of hair follicular units in a given area (hair shafts per square cm) reduces with the progression of baldness. All of the above changes contribute to the seemingly less dense look with increased visibility of the scalp.
With preventive strategies, we are trying to halt these changes found in the scalp. Prevention is important because this alone tries to preserve the total number of follicular units. Hair transplantation (HT) on the other hand is essentially a redistribution of FU. Hair transplantation does not do anything for preventing the progress of MPB. Both these modalities are adopted together in the management of MPB. The relative importance of prevention versus surgery in a given individual depends on the clinical presentation. In cases of early MPB with ongoing loss, prevention is more important when compared to individuals presenting with a stable pattern of MPB (without significant ongoing loss). In other words, the treatment plan is customized based on the findings seen in an individual. Prevention is undertaken using medications. These include oral and topical (local application) medicines.
Oral medications include, nutritional therapy wherein nutritional supplements are given regularly to take care of the nutritional deficiencies associated with hair loss. The supplements include vitamins, minerals, amino acids, and essential fatty acids.
Another oral medication for MPB is Finasteride. Finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT). In MPB, the hair follicles in the loss prone area of the scalp have an abnormal sensitivity to DHT. The effect of DHT mediates the changes observed in MPB. Finasteride thus helps reduce the effect of DHT on the hair follicular cells. Finasteride is uncommonly associated with loss of libido and associated symptoms. Studies have reported an incidence of these effects of one in fifty individuals. Despite this Finasteride is an important medication for the management of MPB.
Topical Minoxidil is another useful drug in MPB. Minoxidil was first introduced as an oral medicine for the treatment of hypertension. It was soon found to have positive effects on the growth of hair. Minoxidil comes in various strengths. Minoxidil is usually applied twice daily on the scalp. Minoxidil should be allowed to have a scalp contact time of more than an hour before it is washed away. Individuals are asked to apply minoxidil after drying hair following a shower. Minoxidil is useful in the mid-scalp region. Continuous use over a few months is needed before optimal results are seen.
Preventive strategies are important in the management of MPB. They help preserve the existing hair follicles. The use of the medications also needs a high level of motivation and they give the best results with continued use. Both preventive medicines and surgery play an important role in achieving a good outcome in MPB. Both of these strategies are complementary. One can't substitute the other. In other words, a good transplant can't reduce the importance of steps for the prevention of hair loss.
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