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Treatment of hyperandrogenic alopecia in women
Enrico Carmina1, Rogerio A Lobo
1Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy.
Objective:
To determine the effectiveness of various antiandrogens for the treatment of premenopausal women with hyperandrogenic alopecia.
Design:
Randomized, unmasked trial of three treatments in 36 hyperandrogenic women with alopecia and observation, without treatment, in 12 other similar patients.
Setting:
Endocrinologic outpatient practice in Italy.
Participant(S):
A total of 48 hyperandrogenic women with alopecia and 30 age- and weight-matched controls for the assessment of androgen levels.
Intervention(S):
Randomization to cyproterone acetate (50 mg) with ethinyl estradiol (EE) in a reverse sequential regimen; flutamide (250 mg) or finasteride (5 mg) daily; all for 1 year. Twelve similar patients were observed without treatment for 1 year.
Main Outcome Measure(S):
Ludwig scores for hair thinning as well as patient and investigator assessments of treatment effectiveness.
Result(S):
Flutamide resulted in a reduction of 21% in Ludwig scores (2.3 +/- 0.2 to 1.8 +/- 0.1). The other treatment effects were not statistically significant. Patient and investigator assessments showed a similar trend.
Conclusion(S):
Flutamide at a dose of 250 mg daily induced a modest improvement in alopecia after 1 year, whereas cyproterone acetate and finasteride were not effective. Treatment for more than 1 year may be required for better results.