Androgenic alopecia

Kosa je atribut ljepote čovjeka i njezin gubitak ili stanovite promjene u strukturi i obojenosti vlasi smatraju se prvenstveno estetskim nedostatkom koji moţe uzrokovati brojne psihosocijalne tegobe kod oboljelih. Razlog gubitka kose mogu biti nasljedna sklonost, emocionalni stres, toksični utjecaji i autoimuni procesi, kao i agresivni tretmani vlasišta, neki medikamenti, opekline, zračenja i odreĎena koţna oboljenja. Androgena alopecija se javlja u oba spola i smatra se odgovornom za gotovo 95% slučajeva gubitka kose. Danas je poznato da dihidrotestosteron (DHT), aktivni oblik testosterona, pridonosi razvitku androgene alopecije kod genetski predodreĎenih osoba. Učestalost alopecije je relativno velika pa su za rješavanje tog problema podjednako zainteresirane i kozmetička i farmaceutska industrija. Veliki broj različitih lijekova i dodataka prehrani koristi se u terapiji androgene alopecije. Od lijekova se u oba spola koriste minoksidil i finasterid (najčešće korišteni; topikalno, androgena alopecija), dutasterid i azelatna kiselina (peroralno; off label), diaminopirimidin oksid i Spectral DNC (topikalno; androgena alopecija), ketokonazol (topikalno; off label) i retinoična kiselina (peroralno; off label). U farmakološkoj terapiji androgene alopecije kod ţenskog spola koriste se ciproteron acetat (peroralno; androgena alopecija i androgenizacija), spironolakton i cimetidin (oba peroralno; off label). Od ostalih preparata koriste se emu ulje (topikalno) te zeleni čaj, ekstrakt sabal palme, vitamini B skupine (ponajprije B6) te oligoelementi (ţeljezo, cink i bakar) peroralno. Minoksidil je vazodilatator (bivši antihipertenziv), danas primarno indiciran za terapiju androgene alopecije. Finasterid je specifični kompetitivni inhibitor 5α-reduktaze koji se koristi u terapiji androgene alopecije. Sabal palma je uspješan antiandrogen sličnog djelovanja kao i finasterid, a emu ulje emolijens sa sposobnošću poticanja proliferacije stanica. Vitamin B6 se pokazao korisnim u liječenju androgene alopecije i akni. Polisorbati potiču povišenje histamina kao jedno od mehanizama poticanja rasta kose. Retinoična kiselina u kombinaciji s minoksidilom potiče umjereni rast kose, a azelatna kiselina, kao kompetitivni inhibitor 5α-reduktaze takoĎer koristi terapiji androgene alopecije uz terapiju akni i drugih koţnih problema. Drugi lijekovi poput ciproteron acetata, spironolaktona, cimetidina i ketokonazola takoĎer imaju antiandrogeno djelovanje u peroralnoj terapiji. U nekim su se slučajevima Spectral DNC, cink, nezasićene masne kiseline, imunosupresivi, iritansi i PUVA terapija pokazali uspješnima u terapiji androgene alopecije.Many people view their hair as an important part of their identity, so hair loss can represent a source of number of psychosocial problems in patients. Hair loss can be caused by various factors, including hereditary preference, emotional stress, toxic effects and autoimmune processes as well as aggressive hair treatments,some medications, burns,and certain skin diseases. Androgenetic alopecia accounts for 95% of all hair loss in both male and female population. It is known that dihydrotestosterone (DHT), active form of testosterone, contributes to the development of androgenic alopecia in genetically predetermined persons. This problem is of great interestfor both pharmaceutical and cosmetic industry. A variety of substances can be used in therapy of androgenetic alopecia. The most important drugs used for both genders are minoxidil and finasteride (the most commonly used; topically, androgenetic alopecia), dutasteride and azelaic acid (orally, off label), diaminopyrimidin oxide and Spectral DNC (topically, androgenetic alopecia), ketoconazole (topically, off label), and retinoic acid (orally, off label). In female androgenetic alopecia therapy are also being used cyproterone (orally; androgenetic alopecia), spironolactone and cimetidine (both orally; off label). Some food supplements such as emu oil (topically), and green tea, Saw palmetto, vitamin B6 and oligoelements (Fe, Zu, Zn) are also being used as a part of the androgenetic alopecia oral therapy. Minoxidil is a vasodilator previously usen as an antihypertensive agent, but today is primarily indicated for the topical treatment of androgenic alopecia.Finasteride is a specific inhibitor of5α-reductase which is also being used orally in androgenetic alopecia therapy. Saw palmetto (Serenoa repens L.) is an effective antiandrogenwhich acts in a similar way that finasteride does. Emu oil is an excellent emollient withproven skin cell proliferation properties. Vitamin B6 appears to have an importantrole in the treatment of androgen related disorders such as acne and androgenetic alopecia.Polysorbates cause histamine release which is thought to be the main mechanism which promotes hair growth. Retinoic acid (tretinoin) alone or in combination withminoxidil can result in moderate to good hair growth. Azelaic acid is a competitive inhibitorof 5α-reductase and is commonly used in the treatment of acne and other skinconditions. Some drugs like cyproterone,spironolactone, cimetidine and ketoconazolealso have antiandrogenic activity used in oral form. In some cases Spectral DNC, zinc, unsaturated fatty acids, immunosuppressive drugs, irritants and PUVA treatment have been proven useful as well