Alopecia areata and Finasteride

Alopecia areata (AA) is a type of autoimmune disease characterized by hair loss that has a variable presentation and course. Some patients exhibit spontaneous remission, while others progress to develop total loss of scalp and body hair. The current therapy for AA is not curative, but rather aimed at controlling or limiting the pathogenic process. Intralesional corticosteroids (ILCs) are used frequently in alopecia areata. Their use was first described in 1958, with the use of hydrocortisone.

Steroids with low solubility are preferred for their slow absorption from the injection site, promoting maximum local action with minimal systemic effect. Immunosuppression is the main mechanism of action. Corticosteroids suppress the T-cell-mediated immune attack on the hair follicle. Preparations used include triamcinolone acetonide, triamcinolone hexacetonide, and hydrocortisone acetate. Triamcinolone acetonide is the preferred intralesional product because it is less atrophogenic than triamcinolone hexacetonide.

The efficacy of ILCs injection is variable depending on the patient population treated. The efficacy appears to be greatest in certain groups of patients including those with less than 75% scalp hair loss, children, and those with a shorter duration of hair loss. Patients with extensive alopecia areata, rapidly progressive disease, and greater than two years’ duration of the current episode, respond poorly to ILCs. Patients with exclamation point hairs and a positive hair pull test respond better to ILCs, as these reflect the active inflammation of the follicles. It is difficult to evaluate the efficacy of ILCs in alopecia areata, as it is known to show spontaneous remission.

Finasteride is available on private prescription from your GP. It comes as a tablet that you take every day. It works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size.

Studies have suggested Finasteride can increase the number of hairs people have (hair count) and can also improve how people think their hair looks. It usually takes three to six months of continuously using Finasteride before any effect is seen. The balding process usually resumes within six to 12 months if treatment is stopped. Side effects for Finasteride are uncommon. Less than one in 100 men who take finasteride experience a loss of sex drive (libido) or erectile dysfunction (the inability to get or maintain an erection).