Alopecia and its Most Common Drug List

Alopecia

Introduction

Across centuries, hair has played an important role in our society. It signifies youthfulness and beauty in women and masculinity and virility in men. It is no surprise that hair loss can become a physically as well as emotionally challenging situation for a person. Losing up to 100 strands of hair in a day is normal. It becomes a problem when the hair starts thinning or bald patches begin to appear or the person completely loses his hair. This can give rise to a situation, known as alopecia.

Alopecia is a condition in which there is hair loss, hair thinning or balding of any form any part of the body where hair is found. It is quite a common problem and affects majority of people across age groups and both genders. 80 percent of men experience hair loss at some point in their lives and a startling 40 percent of women too tend to lose hair too, especially after menopause. Alopecia is broad term which is given to hair loss of any form so alopecia can be of many types

Some of the types of alopecia are:

1.Alopecia areata: a condition in which our immune system starts attacking the hair follicles and results in single or extensive patchy hair loss.

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2. Alopecia totalis: a type of alopecia areata which results in total loss of hair on scalp.

3. Alopecia unversalis: also a type of alopecia areata but in this condition, there is total loss of hair from the body, including from eyebrows and eyelashes.

4. Alopecia barbae: is a type of alopecia areata localized to the beard area, which can manifest as a single or extensive patch.

5. Traction alopecia: occurs when there is excessive tension on hair strands due to certain hairstyles. It is usually observed in women of East Indian and Afro Caribbean origin. If traction alopecia continues for a long period of time, it can pose a hindrance to the development of new hair follicles and result in permanent hair loss.

6. Anagen Effluvium: is the hair loss caused due to chemical exposure like in chemotherapy. It reverses when the exposure is stopped. It begins as patchy loss of hair and can develop into total hair loss.

7. Telogen Effluvium: refers to a type of hair loss in which more than normal amounts of hair fall out every day. In this, there is general thinning of hair and the condition reverses when the causative factors are removed.

8. Androgenetic alopecia: also called male or female pattern baldness, is the most progressive form of alopecia with extreme thinning of hair such that the scalp becomes visible, affecting both men and women. It is thought to be hereditary in nature.

9. Scarring alopecia: also called cicatricial alopecia, in which permanent hair loss occurs due to rare disorders.

Aging and certain diseases like diabetes, lupus and thyroid can also cause hair loss. Even taking some medicines or undergoing chemotherapy for cancer can take a toll on the hair. Stress, family history, low protein diet and poor nutrition too can contribute to hair loss.

Losing hair can be distressful for anyone. But, in its early stages, it can be easily reversed and arrested through medications and lifestyle amendments. However, if left untreated it can progress to a severe clinical scenario leading to permanent bald patches.

Some forms of alopecia can be treated through medicines while as some forms can resolve on their own with time. So, it all depends on the choice of a person whether to seek medical intervention or wait so that our body can resolve the condition on its own.

Symptoms of Baldness

Some of the commonly observed symptoms of baldness are given below:

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  • Gradual thinning of hair on top of head or appearance of circular or patchy bald spots
  • Sudden loosening of hair
  • Full body hair loss
  • Patches of scaling spreading over the scalp
  • Nail changes like pitting, rough and sand papered nails

Drugs Used to Treat Baldness

Hair loss can become an extremely stressing psychological situation for a person. People resort to a number of methods for growing their hair back and stopping hair fall. To aid this process, there a number of drugs available in the market as well that can help the people with alopecia. Some of these drugs are:

1. 5-Alpha Reductase Inhibitors

5-alpha reductase inhibitors prevent conversion of testosterone to DHT (Dihydrotestosterone) by blocking the action of an enzyme 5-alpha-reductase. This causes an increase in the level of testosterone while the levels of dihydrotestosterone decreases.

Although DHT is required for hair growth, it is somehow detrimental for growth of head hair. It is thought to get attached to androgen receptors present on hair follicles and through an unknown mechanism, starts decreasing the size of follicle. This affects hair growth and leads to baldness.

Patients affected by male pattern baldness or androgenic alopecia can use this drug to prevent hair loss. However, hair loss recurs upon discontinuation of the drug. This drug should only be used by males.

Available as: Tablet

  • Generic Name: finasteride
    Brand Name: Propecia
    U.S. FDA Status: Approved
    Availability: Prescription only
    Dosage Form: Tablet
    Indicated in Pregnancy: No
    Alcohol Content: No
    Side Effects: Impotence, decreased libido, chills, confusion, cold sweats and dizziness
  • Generic Name: dutasteride
    Brand Name: Avodart
    U.S. FDA Status: Approved
    Availability: Prescription only
    Dosage Form: Tablet
    Indicated in Pregnancy: No
    Alcohol Content: No
    Side Effects: Abnormal ejaculation, decreased libido, erectile dysfunction, chest pain, irregular heartbeat and breathing

2. Androgen independent hair growth stimulator

Minoxidil, a vasodilator is known to help people with baldness. It works well on both males and females. The drug dilates the blood vessels and increases the flow of blood to the scalp. This helps in hair growth. Also, it causes an increase in the active growth phase of hair follicle and the size of hair follicle.

Discontinuing the use of Minoxidil can lead to recurrence of hair loss. Minoxidil is available in concentration of 2% and 5%. Minoxidil with 5% concentration is slightly better.

Available as: Tablet

  • Generic Name: minoxidil
    Brand Names: Rogaine (2%), Avacor (5%), Good Sense (5%), Rogaine Extra Strength (5%)
    US FDA Status: Approved.
    Availability: Prescription and OTC
    Dosage Form: Topical solution
    Indicated in Pregnancy: No, unless benefits outweigh risks
    Alcohol Content: Traces
    Side Effects: Hives, swelling on face,lips,tongue and throat, scalp irritation, unwanted facial hair growth, change in color or texture of your hair and flushing

3. Androgen Receptor Inhibitor

Anti-androgens or androgen receptor inhibitors are drugs that prevent androgens like dihydrotestosterone (DHT) and testosterone from binding on to the androgen receptors found on the hair follicle., or, decrease the production of androgens in the body. This helps in decreasing the rate of hair fall.

Available as: Tablet

  • Generic name: spironolactone
    Brand Name: Aldactone
    The U.S. FDA Status: Prescription only
    Dosage Form: Tablet
    Indicated in Pregnancy: No. Prescribed only if there is edema during pregnancy
    Alcohol Content: No
    Side Effects: Abdominal cramping, bleeding gums, breast pain, chest pain, chills, dizziness and headache
  • Generic Name: cyproterone acetate
    Brand Name: Androcur
    U.S. FDA Status: UnapprovedAvailability: Not available in the U.S.A.
    Dosage Form: Tablet
    Indicated in Pregnancy: No
    Alcohol Content: No
    Side Effects: Symptoms of osteoporosis, dryness of skin, scalp and hair, lightening of hair color and formation of blood clots

4. Antihistamine as anti-androgentic agent

Cimetidine, an antihistamine, is known to show anti androgenetic property. It inhibits the effect of male sex hormones in the female body. Levels of male hormone, testosterone, can increase in females due to diseases like PCOS. This helps in decreasing the levels of dihydrotestosterone (DHT) in the body. DHT is known to have detrimental effect on hair growth. It reduces the size of hair follicles and leads to baldness. Therefore, by decreasing the levels of DHT, hair fall can be decreased. The result shown by this drug has been promising but is strictly restricted to females only.

Available as: Tablet

  • Generic Name: cimetidine
    Brand Name: Tagamet HB
    U.S. FDA Status: Approved
    Availability: OTC
    Dosage Form: Tablet
    Indicated in Pregnancy: Yes, under careful monitoring
    Alcohol Content: No
    Side Effects: Headache, somnolence, diarrhea, dizziness, slurred speech and lethargy

5. Corticosteroids

Corticosteroids are the class of drugs that acts similar to the hormones secreted by the adrenal glands, cortisone. As per research published by the International Alliance of hair Restoration Surgeons (IAHRS), corticosteroids are prescribed for hair restoration because these drugs have an ability to regulate the body’s inflammatory response, autoimmune disorders and allergic reactions.

Corticosteroid injections are commonly given in the affected area by the dermatologist in order to protect the hair follicles from the attack of immune system. Multiple injections are given into the skin in and around the bald patches on your head. After around 4 weeks of therapy, you can see new hair growing. The treatment however, does not prevent new patches from appearing.

Topical corticosteroid creams can also be applied on the bald patches. They help in decreasing inflammation around hair follicles and assist in hair growth. Studies indicate that use of topical steroids also help in reducing hair loss. The only limiting factor is the absorption of corticosteroid by the scalp.

Oral corticosteroids are not prescribed now for treating baldness due to the associated health risks and side effects on their long-term use. It should be noted that hair regrowth through corticosteroid treatment may fall out after the treatment is stopped.

Available as: Locally injected, oral and topically applied

a. Locally Injected Corticosteroids

Generic Name: triamcinolone acetonide
Brand Name: Kenalog-10
US FDA Status: FDA approved.
Availability: Prescription only
Dosage Form: Injectable
Indicated in Pregnancy: Not Assigned
Alcohol Content: Traces
Side Effects: Redness at site of injection, headache, dizziness, trouble sleeping and weight gain

b. Orally Taken Corticosteroids

Generic Name: prednisone (10-20 mg/day)
Brand Name: Prednisone
US FDA Status: Approved.
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Aggression, agitation, dizziness, headache, irritability, mood changes, numbness in arms, weight gain and shortness of breath

c. Topically Applied Corticosteroids

Generic Name: Triamcinolone acetonide 0.1%
Brand Name: Triderm
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Topical cream
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: Traces
Side Effects: Blistering, crusting, dryness, burning or flaking of skin, irritation, itching and thinning of skin with easy bruising

Generic Name: betamethasone dipropionate 0.05%,
Brand Name: Diprolene
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Ointment
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: Traces
Side Effects: Burning or stinging, itching at site of application, dryness, irritation, thinning of skin with easy bruising and unusually warm skin

Generic Name: fluocinolone acetonide 0.025%
Brand Name: Sylanar
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Topical cream
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: Traces
Side Effects: Body aches, headache, sore throat, acne, burning at root of hair nd skin irritation

Generic Name: clobetasol propionate 0.05%
Brand Name: Clobex
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Topical lotion
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: Yes
Side Effects: Burning at site of application, dry skin, itching, rash and easy bruising thin skin

6. Anti-Psorioatic Agent

These drugs are used in the treatment of hair loss arising due to psoriasis. Anthralin, a well-known antipsoriatic agent, is an antimitotic substance that can be topically applied to bald patches of skin and scalp. Anthralin interferes with the process of mitosis and prevents replication of DNA in cells under its effect. This stops psoriasis from spreading and hair loss is prevented. Anthralin creams are applied once a day on the bald patchy skin. It is washed off after leaving the cream on the skin for 30-60 minutes.

Available as: Topical application

Generic Name: Anthralin
Brand Name: Dritho-Crème 1%, Dritho-Scalp 0.5%, Zithranol-RR 1.2%
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy;
Alcohol Content:
Side Effects:

7. Antibiotic as immunosuppressive and anti-inflammatory agent

(A) Sulfasalazine

It is an antibiotic that is used in extreme cases of alopecia totalis and alopecia universalis, both of which are autoimmune disorders. The drug has shown promising results through its immunomodulatory and anti-inflammatory actions.

Available as: Oral administration

Generic Name: Sulfasalazine
Brand Name: Azulfidine
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Tablet
Indicated in Pregnancy: Yes, only under careful supervision
Alcohol Content: No
Side Effects: Joint pain, fever, headache, skin rash, vomiting, nausea, nosebleeds and pale skin

8. Topical Immunotherapy

This therapy is used in cases of extensive alopecia areata, alopecia universalis and alopecia totalis as all the three conditions are autoimmune disorders. These drugs produce allergic rash or contact dermatitis at the site of application, which helps in growing new hair by altering immune response.

Available as: Oral administration.

Generic Name: cyclosporine
Brand Name: Gengraf
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Capsule
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Hirsutism, hypertension, nephrotoxicity, tremor, Abdominal pain, back pain, blurred vision, chest pain, chills, dizziness, fever, headache, skin rash and sore throat

Generic Name: methoxsalen
Brand Name: Oxsoralen
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Capsule
Indicated in Pregnancy: No
Alcohol Content: No
Side Effects: Itching, nausea, dizziness, headache, nervousness, trouble sleeping and blistering of skin

Generic Name: thalidomide
Brand Name: Thalomid
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Capsule
Indicated in Pregnancy: No
Alcohol Content: No
Side Effects: Anxiety, chest pain, dizziness, fast heartbeat, muscle weakness, numbness and troubled breathing

Some experimental drugs belonging to this class are also being used for treating hair fall. They work by diluting the activity of immune system. These are called contact sensitizers.

Drug: Diphenylcyclopropenone (DPCP)

Generic Name: diphenylcyclopropenone
U.S. FDA Status: Unapproved
Availability: Not available in the market
Dosage Form: Topical solution
Indicated in Pregnancy: No
Alcohol Content: No
Side Effects: Contact utricaria, skin rash, hyperpimentation and white marks

Drug: Dichlorobenzene (DNCB)

Generic Name: dichlorobenzene
U.S. FDA Status: Unapproved
Availability: Not available in the market
Dosage Form: Topical solution
Indicated in Pregnancy: No
Alcohol Content: No
Side Effects: Redness, itching and swelling at site of application.

9. Oral ContraceptivesAlopecia

Women who have polycystic ovary syndrome (PCOS) have hormonal disturbances and their bodies tend to produce more male hormone, testosterone. This causes them to develop a number of symptoms, baldness being one of it. A healthy lifestyle, regular exercise, good diet and nutritional supplement along with medicines are used to manage the symptoms of PCOS. Oral contraceptive pills (OCPs) are prescribed for keeping the hormones in check. They reduce the production of testosterone, other androgens and sex binding globulin (SHBG) by the ovaries. SHBG is a protein that is synthesized by the liver and binds the three hormones, estrogen, dihydrotestosterone and testosterone in both males and females. In women with PCOS, the levels of SHBG is extremely low and therefore the amount of free testosterone in the blood increases, causing baldness and other symptoms.

Through the pill, the production of SHBG increases in the body, which binds the free testosterone and therefore the symptoms subside.

Available as: Oral preparation

Side Effects: Nausea, intermenstrual bleeding, weight gain, headache, decreased libido, mood changes, abnormal vaginal discharge and breast tenderness
Drugs: Following drugs are generally present in combination in OCPs:

  • cyproterone acetate
  • ethinyl estradiol
  • desoestrol
  • drospireone
  • norgestimate

Drug Combination: desogestrel and ethinyl estradiol
Brand: Desogen
The U.S. FDA Status: Discontinued
Dosage Form: Tablet
Indicated in Pregnancy: No
Alcohol Content: No

Drug Combination: desogestrel and ethinyl estradiol
Brand: Ortho-Cept
The U.S. FDA Status: Discontinued
Dosage Form: Oral
Indicated in Pregnancy: No
Alcohol Content: No

Drug Combination: ethinyl estradiol and norgestimate
Brand: Ortho Tri-Cyclen
The U.S. FDA Status: Approved
Dosage Form: Tablet
Indicated in Pregnancy: No
Alcohol Content: No

10. Anti-fungal medicines

Anti-fungal medicines can help in preventing hair loss. Ketoconazole, an anti-fungal medicine is also known to possess property to counteract the effects of dihydrotestosterone, which is known to cause hair loss. It also helps in preventing other scalp infections like dandruff and fungal infections causing hair loss. Another anti-fungal drug, miconazole, is known to possess properties similar to ketoconazole and can also be used for managing hair loss. However, it should be noted that these drugs have not been approved by the U.S. FDA for hair loss treatment and therefore, should only be taken after consulting a dermatologist.

Available As: Topical shampoo and cream
Drug: Ketoconazole
Generic Name: ketoconazole
Brand Name: Nizoral A-D, Nizoral
U.S. FDA Status: Approved
Availability: Prescription and OTC
Dosage Form: Topical Shampoo
Indicated in Pregnancy: No, until benefit outweighs fetal risk
Alcohol Content: No
Side Effects: Nausea, skin rash, tingling sensations and pinpoint red spots on skin

Drug: Miconazole
Generic Name: miconazole nitrate
Brand Name: Miconazole 3 Combination Pack
U.S. FDA Status: Approved
Availability: OTC
Dosage Form: Topical cream
Indicated in Pregnancy: No, until benefit outweighs fetal risk
Alcohol Content: No
Side Effects: Skin rash, burning, blistering, redness and skin irritation

11. Vitamin D supplements

Vitamin D is a fat-soluble vitamin that is required by the body for maintaining bone strength. It helps in absorbing calcium and phosphorus from the food we eat. This vitamin helps in preventing bone disorders such as osteoporosis, osteomalacia and rickets. It also helps in maintaining the health of kidneys and preventing diseases caused due to malfunctioning of thyroid and parathyroid gland. It is synthesized in the skin on exposure to sunlight.

In people suffering from alopecia areata, hair loss occurs when the body’s immune system starts attacking its own hair follicles. Vitamin D plays a role in regulating the function of white blood cells, the soldiers of our immune system. They are the ones that attack the hair follicles and stop their growth. Vitamin D also helps in inhibiting antibody secretion and production of antibody against self-cells in the body, thus downplaying the immune system. [1]

Available as: Oral preparations and Injectable preparations

I. Calcitriol

It is the active form of vitamin D and is beneficial for people with liver or kidney failure.

Drug: Calcitriol
Generic Name: calcitriol
Brand Name: Rocaltrol capsule
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Topical cream
Indicated in Pregnancy: No, until benefit outweighs fetal risk
Alcohol Content: No
Side Effects: Nausea, weakness, headache, constipation, muscle or bone pain, metallic taste

II. Calcipotriene or calcipotriol

It is a synthetic analogue of calcitriol, a form of vitamin D, which is prescribed to patients with psoriasis. People who have hair loss due to psoriasis can benefit from this therapy.

Drug: Calcipotriene or calcipotriol
Generic Name: Calcipotriene or calcipotriol
Brand Name: calcipotriene
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Topical cream
Indicated in Pregnancy: No, until benefit outweighs fetal risk
Alcohol Content: No
Side Effects: Skin irritation, skin rash, swelling and burning

12. Calcineurin Inhibitors:

Calcineurin is an enzyme that activates a type of white blood cells, T-lymphocytes, of the immune system. Calcineurin inhibitors work by suppressing the enzyme and hence preventing the activation of immune system. This is especially beneficial in hair loss occurring due to over activation of immune system. These are a relatively newer entry in the pool of drugs treating alopecia and are not widely available.

Available As: Topical cream, injection, oral capsule and solution

Drug: Tacrolimus
Generic Name: tacrolimus
Brand Name: Protopic
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Topical ointment
Indicated in Pregnancy: No, until benefit outweighs fetal risk
Alcohol Content: No
Side Effects: Skin burning, pruritis, flushing at site of application, sneezing and weakness

Generic Name: cyclosporine
Brand Name: Sandimmune
U.S. FDA Status: Approved
Availability: Prescription only
Dosage Form: Injection
Indicated in Pregnancy: No, unless benefits outweigh risks
Alcohol Content: No
Side Effects: Hirsutism, hypertension, nephrotoxicity, tremor, abdominal pain, back pain, blurred vision, chest pain, chills, dizziness, fever, headache, skin rash and sore throat

OTC Drugs Used

Based on the different regulatory bodies governing in various countries, different drugs are available over-the-counter for treating alopecia. Various OTC drugs for treating alopecia have been summarized in the table below:

Name of the Country

OTC Drug Available

Argentina

Cimetidine

Australia

Cimetidine

Austria

Cimetidine

China

Cimetidine

Denmark

Cimetidine

France

Cimetidine

Italy

Cimetidine

Japan

Minoxidil

Mexico

Cimetidine

Singapore

Cimetidine

South Korea

Cimetidine

Spain

Cimetidine

Switzerland

Minoxidil

The Netherlands

Cimetidine

U.K.

Cimetidine

The U.S.A.

Cimetidine