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http://www.ijdvl.com/article.asp?issn=0 ... Hajheydari
Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia
Results Top
Of the 45 androgenetic alopecia patients who were enrolled, 7 were excluded from the study due to incomplete or discontinuation of the entire study period. The patient's age range was 22.8±3.3 years. The average time of hair loss in patients, were 23.10 ±18.8 months. Seven (18.4%) were married and 31(81.6%) were single. Among referred patients, 31(81.6%) had a positive family history of male alopecia and in 7(18.4%), it was negative. Nineteen patients entered in group A, while 19 in group B randomly.
The average total hair count, terminal hair count and the size of bald area in both groups in the beginning and end of treatment respectively are shown in [Table 1].
There were no significant statistical differences in the terminal hairs, size of alopecia area and hair count between two groups.
In A group (Finasteride gel and placebo tablet), increased terminal hair count were observed at the third month of treatment ( P =0.001), but increased in terminal hair count was shown in the second months in the B group (Finasteride tablet and placebo gel) ( P =0.015). During therapeutic period, the size of alopecia area was not significantly altered in group A, but in group B, the change in size of alopecia area was significant in the fourth month of treatment ( P =0.027). Increased hair count in two groups were significant in 4 months of treatment ( P =0.001, in group A and P =0.000 in group B). Therapeutic response during therapeutic period in both A and B groups was evaluated by scoring system which shown in [Table 2].
Only one of the patients complained the erythema in affected site as a complication of using local finasteride gel that was subsided immediately after discontinuation of the gel. One of the finasteride tablet user described the decreasing libido.
Discussion Top
The results of this study revealed the moderate therapeutic response, but not a good response, in both groups. Comparing finasteride gel 1%, with finasteride tablet (54.5% versus 56%) showed the relatively similar therapeutic response, that was not statistically significant ( P =0.643). 5a-reductase enzyme causes testosterone convertion to di-hydrotestosterone. The therapeutic effect of the enzyme inhibitors on androgenetic alopecia such as finasteride by dose of 1mg orally, has been proven in different studies. [1],[2],[15],[16],[17] In addition, in this study, serial measurements of hair count and terminal hair increase showed that increasing in total hair count and terminal hair in both therapeutic groups between the beginning and end of study was significant. Like other studies, the total hair in both groups, finasteride gel and tablet, demonstrated significant differences between first referral and 6 months after therapy ( P =0.000), this indicates the therapeutic efficacy of both drugs. [1],[10] The terminal hairs in finasteride gel group were always more than the finasteride tablet group, until third month of therapy. However, they were similar in both groups during the fourth month of treatment. At 5 th and 6 th months, the terminal hair counts were more in the group who were receiving tablets, thus explaining the efficacy of the tablet during therapeutic period. [1] The size of bald area in tablet and gel groups had significant decrease at fourth month, noting there was no change in gel group, which indicates the greater therapeutic effect of tablet than gel. Although, the total hair growth in both groups was significant during the fourth month, in the gel group, we did not find any decrease in the size of alopecia area and consequently the better appearance of person.
Over all, in this recent study, by comparing finasteride tablet and gel groups with each other, it was found that in second, third and fourth months of patients being referred, the therapeutic response to the tablet group was better than gel group, but in fifth and sixth months of treatment, the therapeutic response in both groups was the same.
In previous studies, the finasteride tablet efficacy began after third to sixth months of therapy and if the patient had no response after 12 to 24 months, continuation of usage probably did not appear to be effective. [2] In our study, there was no significant positive therapeutic response in both groups; one reason could be the duration of treatment that was only for 6 months, thus, if the duration of treatment was longer, the results could have indicated a better therapeutic effect.
Like other studies, these results show local finasteride gel, [5],[11],[12] has a considerable efficacy and if used for male alopecia patients, who experienced hair loss in recent years, it will be a good replacement of oral therapy, especially in those who worry about oral drug complications.
Finally, we suggest replication study of more samples, with longer period and assessment of patients' satisfaction after treatment.
Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia
Results Top
Of the 45 androgenetic alopecia patients who were enrolled, 7 were excluded from the study due to incomplete or discontinuation of the entire study period. The patient's age range was 22.8±3.3 years. The average time of hair loss in patients, were 23.10 ±18.8 months. Seven (18.4%) were married and 31(81.6%) were single. Among referred patients, 31(81.6%) had a positive family history of male alopecia and in 7(18.4%), it was negative. Nineteen patients entered in group A, while 19 in group B randomly.
The average total hair count, terminal hair count and the size of bald area in both groups in the beginning and end of treatment respectively are shown in [Table 1].
There were no significant statistical differences in the terminal hairs, size of alopecia area and hair count between two groups.
In A group (Finasteride gel and placebo tablet), increased terminal hair count were observed at the third month of treatment ( P =0.001), but increased in terminal hair count was shown in the second months in the B group (Finasteride tablet and placebo gel) ( P =0.015). During therapeutic period, the size of alopecia area was not significantly altered in group A, but in group B, the change in size of alopecia area was significant in the fourth month of treatment ( P =0.027). Increased hair count in two groups were significant in 4 months of treatment ( P =0.001, in group A and P =0.000 in group B). Therapeutic response during therapeutic period in both A and B groups was evaluated by scoring system which shown in [Table 2].
Only one of the patients complained the erythema in affected site as a complication of using local finasteride gel that was subsided immediately after discontinuation of the gel. One of the finasteride tablet user described the decreasing libido.
Discussion Top
The results of this study revealed the moderate therapeutic response, but not a good response, in both groups. Comparing finasteride gel 1%, with finasteride tablet (54.5% versus 56%) showed the relatively similar therapeutic response, that was not statistically significant ( P =0.643). 5a-reductase enzyme causes testosterone convertion to di-hydrotestosterone. The therapeutic effect of the enzyme inhibitors on androgenetic alopecia such as finasteride by dose of 1mg orally, has been proven in different studies. [1],[2],[15],[16],[17] In addition, in this study, serial measurements of hair count and terminal hair increase showed that increasing in total hair count and terminal hair in both therapeutic groups between the beginning and end of study was significant. Like other studies, the total hair in both groups, finasteride gel and tablet, demonstrated significant differences between first referral and 6 months after therapy ( P =0.000), this indicates the therapeutic efficacy of both drugs. [1],[10] The terminal hairs in finasteride gel group were always more than the finasteride tablet group, until third month of therapy. However, they were similar in both groups during the fourth month of treatment. At 5 th and 6 th months, the terminal hair counts were more in the group who were receiving tablets, thus explaining the efficacy of the tablet during therapeutic period. [1] The size of bald area in tablet and gel groups had significant decrease at fourth month, noting there was no change in gel group, which indicates the greater therapeutic effect of tablet than gel. Although, the total hair growth in both groups was significant during the fourth month, in the gel group, we did not find any decrease in the size of alopecia area and consequently the better appearance of person.
Over all, in this recent study, by comparing finasteride tablet and gel groups with each other, it was found that in second, third and fourth months of patients being referred, the therapeutic response to the tablet group was better than gel group, but in fifth and sixth months of treatment, the therapeutic response in both groups was the same.
In previous studies, the finasteride tablet efficacy began after third to sixth months of therapy and if the patient had no response after 12 to 24 months, continuation of usage probably did not appear to be effective. [2] In our study, there was no significant positive therapeutic response in both groups; one reason could be the duration of treatment that was only for 6 months, thus, if the duration of treatment was longer, the results could have indicated a better therapeutic effect.
Like other studies, these results show local finasteride gel, [5],[11],[12] has a considerable efficacy and if used for male alopecia patients, who experienced hair loss in recent years, it will be a good replacement of oral therapy, especially in those who worry about oral drug complications.
Finally, we suggest replication study of more samples, with longer period and assessment of patients' satisfaction after treatment.