피나스테라이드: 프로페시아,핀페시아,프로스카,핀카등 전세계 피나스테리드계열 제네릭의약품 정보.
두타스테라이드: 아보다트, 제네릭아보다트 정보/ 미녹시딜정 : 먹는 미녹시딜 / 스피로놀락톤:알닥톤,스피로닥톤
미녹시딜 5%액 : 로게인,리게인, 잔드록스,마이녹실,스칼프메드등 minoxidil계열의 정보
기타의약품:시메티딘,로아큐탄,스티바A(트레티노인),다이안느, 드로겐정, 판토가
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전체[미녹시딜액] [re] 이거 어떻게 읽으라구여~~영어 모르는데~~~
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>혹시 참고가 될까 해서 글 올립니다.
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>아래글은 NEJM vol 341, 964-973 Dr. Vera H. Price, M.D. ( UCSF ) 님의 글입니다.
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>이 논문에 여성의 경우 치료법도 같이 있는데, 그 부분은 제가 생각했습니다.
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>제가 찾아본 논문중에 가장 임펙트 펙트 높은 저널이고 그 유명한 UCSF소속 교수님의
>리뷰인걸로 봐서, 참고가 될 듯해서요.
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>Finasteride와 Minoxidil에 관한 부분은 많은 도움이 되네요.
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>특히 아래 제가 특별히 발취한 문장인데요,
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>Men using minoxidil who wish to take finasteride should continue to apply minoxidil for at least four months after starting finasteride to prevent the loss of hair that occurs after the cessation of minoxidil treatment (Figure 3).
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>미녹시딜사용하다 프로페시아 복용으로 방법을 전환하시는 분들 특히 주의해야겠네요.
>저도 몰랐는데, 이 논문 읽다가 알았거든요. should continue to apply minoxidil for at least four months.
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>had better 도 아니고 , SHOULD 라는 걸 명심하셔야 할듯 ^^.
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>Androgenetic Alopecia
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>Androgenetic alopecia is hereditary thinning of the hair induced by androgens in genetically susceptible men and women.7,8 This condition is also known as male-pattern hair loss or common baldness in men and as female-pattern hair loss in women. Thinning of the hair usually begins between the ages of 12 and 40 years in both sexes, and approximately half the population expresses this trait to some degree before the age of 50.9,10 The pattern of inheritance is polygenic.11,12
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>Pathophysiology
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>In susceptible hair follicles of the scalp, dihydrotestosterone binds to the androgen receptor, and the hormone-receptor complex then activates the genes responsible for the gradual transformation of large, terminal follicles to miniaturized follicles.13,14,15,16 With successive hair cycles, the duration of anagen shortens and the follicles become smaller, producing shorter, finer hairs that cover the scalp poorly. These miniaturized hairs of various lengths and diameters are the hallmark of androgenetic alopecia.8,10,17 At the same time, the number of follicles per unit of area remains the same.
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>Dihydrotestosterone is formed by the peripheral conversion of testosterone by 5-reductase. There are two isoforms of 5-reductase — type 1 and type 2 — which, together with other enzymes, regulate specific steroid transformations in the skin. Young men and young women with androgenetic alopecia have higher levels of 5-reductase, more androgen receptors, and lower levels of cytochrome P-450 aromatase, which converts testosterone to estradiol, in hair follicles in the frontal region of the scalp than in the occipital region.18 The various clinical patterns of androgenetic alopecia in men and women may reflect quantitative differences in the levels of 5-reductase, the number of androgen receptors, and the levels of aromatase in specific regions of the scalp at various ages.
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>Treatment in Men
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>In men, androgenetic alopecia ranges from the bitemporal recession of hair, to thinning of the frontal and vertex regions of the scalp, to complete baldness and loss of all hair except the occipital and temporal fringes. In some cases, men have diffuse thinning all over the scalp. The pattern of hair loss, combined with onset at an early age and the presence of miniaturized hairs, supports the diagnosis.
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>The goal of therapy is to increase coverage of the scalp and to retard further hair thinning. In the United States, oral finasteride, at a dose of 1 mg per day, and topical solutions of 5 percent and 2 percent minoxidil are currently the only drugs approved for promoting hair growth in men with androgenetic alopecia. Both drugs can increase coverage of the scalp by enlarging existing hairs, and both retard further thinning, in both the vertex and the frontal regions. However, neither drug restores all the hair, and the response differs among men. A good candidate for treatment has definite thinning and many miniaturized hairs. If thinning is minimal, the main perceived response may be retardation of further thinning. Neither drug benefits men who are completely bald or those with bitemporal recession without visible hair. In general, treatment for 6 to 12 months is needed to improve scalp coverage. Continued treatment is needed to maintain benefit; if treatment is stopped, the benefits will be lost within 6 to 12 months and hair density will be the same as it would have been without treatment.
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> Finasteride
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>Finasteride is a competitive inhibitor of type 2 5-reductase and inhibits the conversion of testosterone to dihydrotestosterone.19,20,21,22 The rationale for the use of finasteride to treat male-pattern hair loss is based on the absence of androgenetic alopecia in men with congenital deficiency of type 2 5-reductase19,23,24,25,26 and the presence of increased 5-reductase activity and dihydrotestosterone levels in hair follicles of men with balding scalps.16,18,27,28 Finasteride rapidly lowers serum and scalp dihydrotestosterone levels by more than 60 percent. It has no affinity for the androgen receptor and therefore does not interfere with the actions of testosterone (Table 1), and it has no androgenic, estrogenic, progestational, or other steroidal effects.16,19
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> Table 1. Selective Actions of Testosterone and Dihydrotestosterone.
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>In three randomized, double-blind, placebo-controlled studies, a total of 1879 men who were 18 to 41 years old with mild to moderately severe thinning of the hair but not complete baldness received oral finasteride at a dose of 1 mg per day or placebo for one year.29,30,31 Two of these studies enrolled a total of 1553 men with loss of hair predominantly at the vertex, and the third enrolled 326 men with predominantly frontal hair loss. As compared with placebo, finasteride significantly increased hair counts and improved scalp coverage, as was evident in photographs of both vertex and frontal regions.29,30,31
>In the men with hair loss at the vertex, the initial treatment was continued for a second year, but some men who received placebo for the first year were given finasteride and some who initially received finasteride were given placebo in the second year (Figure 2). In the second year, hair counts remained stable at the increased level in the men who continued to receive finasteride. Hair counts decreased in the men who were switched from finasteride to placebo after one year, whereas the counts increased in those switched from placebo to finasteride. There was a progressive increase in scalp coverage, as determined by global photographs of the scalp, in 66 percent of the finasteride group, as compared with 7 percent of the placebo group, after two years.29 These results indicate that the number of responding hairs is established after about one year and that continued treatment increases the length, diameter, and pigmentation of these hairs so that coverage of the scalp increases.
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> Figure 2. Change in the Mean (±SE) Hair Count from Base Line (Month 0) at the Anterior Leading Edge of the Vertex Thinning Area in Men Given 1 mg of Finasteride or Placebo Daily for 24 Months.
>In the second year, some men who received placebo during the first 12 months were given finasteride and some who initially received finasteride were given placebo. The dotted line indicates no change. Adapted from Kaufman et al.29 with the permission of the publisher.
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>After two years of treatment with finasteride, about two thirds of men have improved scalp coverage, about one third have the same amount of hair as they did at the outset, and about 1 percent lose hair. Since the miniaturization of follicles occurs over the course of many years, reversal of this process also takes many years. With treatment for more than two years, the clinical impression is that scalp coverage continues to increase; five-year controlled studies are in progress to verify this impression. It is not known to what extent follicles will enlarge, and there is no way to identify the men who will have the best response.
>In December 1997, 1-mg tablets of finasteride were approved by the Food and Drug Administration (FDA) for the treatment of androgenetic alopecia in men. It is to be given once daily, with or without food. No dosage adjustments are needed on the basis of age or renal function. It is metabolized in the liver and should be used with caution in men with abnormal liver function. In men who are 60 years of age or older, finasteride may not be an effective treatment for male-pattern hair loss, because type 2 5-reductase activity in the scalp may not be as high as in younger men. This decreased activity may partly explain why there have been few reports of reversal of male-pattern hair loss in men who were predominantly in their 60s and 70s and who were treated with 5 mg of finasteride daily for benign prostatic hyperplasia.
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>Finasteride at a dose of 1 mg daily is safe and well tolerated. The only adverse effects in the clinical trials, which included 1879 men, were reversible and were reported by slightly more men in the finasteride than in the placebo group; these effects included decreased libido in 1.8 percent of the men in the finasteride group, as compared with 1.3 percent in the placebo group; erectile dysfunction in 1.3 percent and 0.7 percent, respectively; and ejaculatory dysfunction in 1.2 percent and 0.7 percent.31 These sexual adverse effects gradually disappeared during prolonged treatment and disappeared in days or weeks after treatment was discontinued.
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>In men 18 to 41 years old who were taking 1 mg of finasteride daily, serum prostate-specific antigen levels decreased by 0.2 ng per milliliter,31 which was not a clinically important reduction. However, in older men with benign prostatic hyperplasia, finasteride at doses of 1 mg or 5 mg daily decreases serum prostate-specific antigen levels by about 50 percent. In older men who are taking finasteride, the results of a prostate-specific antigen test should be doubled to compensate for the effect of the drug.32,33,34
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> Minoxidil
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>Minoxidil promotes hair growth when it has been affected by various conditions, including androgenetic alopecia. It increases the duration of anagen and enlarges miniaturized and suboptimal follicles, irrespective of the underlying cause. For example, in addition to its effectiveness in patients with androgenetic alopecia, minoxidil promotes hair growth in patients with alopecia areata, congenital hypotrichosis, and loose anagen syndrome. Minoxidil was developed to treat hypertension, and this aspect of the drug's action is the one that is best understood. It is a potassium-channel opener and vasodilator. Its mechanism of action with respect to the stimulation of hair growth is not known, but it appears to be independent of vasodilatation.35,36,37,38 The addition of minoxidil to cultures of hair follicles increases survival.35
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>A 2 percent solution of topical minoxidil was approved by the FDA in 1988 for promoting hair growth in men with androgenetic alopecia. Its efficacy was established in a 12-month placebo-controlled study of 2294 men who were 18 to 50 years old and had mild-to-moderate thinning of the hair at the vertex. Treatment with minoxidil significantly increased hair counts.10,39,40,41 Histologic studies confirmed that minoxidil increases the diameter of the hair shaft.42
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>In 1997, a 5 percent solution of topical minoxidil was approved by the FDA as an over-the-counter treatment for promoting hair growth. In a 48-week study of twice-daily treatment with the 5 percent solution, the 2 percent solution, or placebo in 393 men who were 18 to 49 years old and had mild-to-moderate thinning at the vertex, hair counts were 45 percent higher among the 157 men in the group receiving 5 percent minoxidil than among the 158 men in the group receiving 2 percent minoxidil and almost five times as high as those among the 78 men in the placebo group.43
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>The efficacy of drugs that stimulate hair growth can also be assessed by clipping and weighing hair grown in a small, marked area on the scalp.44,45 This method was used in a 96-week double-blind study of four groups of nine men with androgenetic alopecia.45 Three groups received one of the following: 5 percent topical minoxidil, 2 percent topical minoxidil, or placebo; the fourth group received no treatment. Hair samples were taken from the frontal area of the scalp. After 96 weeks, treatment was stopped and the men were followed for 24 more weeks. Both solutions of minoxidil were significantly superior (P< 0.05) to placebo or no treatment in promoting hair growth and slowing hair loss, with the 5 percent solution having the greater efficacy (Figure 3); the placebo and untreated groups had a steady decrease in hair weight of about 6 percent per year. In the groups receiving minoxidil, the peak hair weight was followed by a similar small decline during this period. Nevertheless, the hair weight in the minoxidil groups was about 30 percent greater than that in the placebo and untreated groups. The rapid loss of hair weight after treatment with minoxidil was stopped (Figure 3) confirms its substantial growth-promoting effect.
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> Figure 3. Mean Percent Change in Hair Weight per Square Centimeter of Scalp from Base Line (Week 0) among Men with Androgenetic Alopecia Who Received 5 Percent Minoxidil, 2 Percent Minoxidil, Placebo, or No Treatment for 96 Weeks.
>The dotted line indicates no change, and the vertical arrow at 96 weeks marks the cessation of treatment. Adapted from Price et al.45 with the permission of the publisher.
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>Minoxidil initially causes a surge of growth in miniaturized hairs (Figure 3). These hairs continue to have a shortened growth cycle and fall out quickly, which explains the temporary increase in shedding that patients may notice after 10 to 12 weeks of therapy.
>One milliliter of minoxidil solution must be applied twice daily to achieve and then maintain efficacy.46 The solution is applied to the scalp and spread lightly with a finger; massage is not needed. Spray applicators are not recommended, because most of the solution reaches the hair rather than the scalp. Men using minoxidil who wish to take finasteride should continue to apply minoxidil for at least four months after starting finasteride to prevent the loss of hair that occurs after the cessation of minoxidil treatment (Figure 3).45 The combined use of minoxidil and finasteride has not been studied in humans, but in a study in stumptail macaques the effect of minoxidil and finasteride combined was greater than the effect of either drug alone.47
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>The adverse effects of topical minoxidil are mainly dermatologic. Irritation of the scalp, including dryness, scaling, itching, and redness, occurs in approximately 7 percent of patients who use the 2 percent solution and in more of those who use the 5 percent solution because of its higher content of propylene glycol. Minoxidil or the formulated solution may also cause allergic contact dermatitis or photoallergic contact dermatitis.48,49,50 Hypertrichosis is another dermatologic adverse effect, which occurs in women but is rare in men.
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>Neither the 5 percent nor the 2 percent solution of minoxidil alters systolic or diastolic blood pressure, pulse rate, or body weight when applied twice daily.43,51 With the 5 percent solution, the mean serum level of minoxidil is 1.2 ng per milliliter, well below the level of 20.0 ng per milliliter at which minimal hemodynamic changes in pulse rate and blood pressure occur.51
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