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Clinical Endocrinology (1997) 47, 759-761
Letters to the Editors
"Beneficial effect of spironolactone on androgenic alopecia"
"Sirs, Spironolactone, an established anti-hypertensive agent, has a
marked anti-androgenic activity, which has been exploited for the
treatment of hirsutism and acne. These are the commonest skin
manifestations of mild to moderate androgen excess in women of
reproductive age. Androgenic alopecia, the loss of scalp hair occurring
in genetically predisposed subjects, is also related to raised androgen
bioactivity. Drugs with anti-androgen action have been extensively
employed for the treatment of hirsutism and acne with fairly good results
although the evaluation procedures usually employed have been recently
criticized. On the other hand, the usefulness of these agents in treating
androgenic alopecia has never been properly assessed. We have recently
had the chance to evaluate the effects of spironolactone (100 mg twice
daily for six months) on the rate of scalp hair loss and the distribution
of hair root phases in 4 young patients, 18-23 years of age (2 women,
cases a,b and 2 men, cases c,d) with partial androgenic alopecia.
"Measurement of androgens and sex hormone binding globulin, were
performed in all patients and ovarian ultrasound assessment was performed
in the female patients. Furthermore, measurements of hair loss after
daily washing for 10 days and hair phase evaluation with trichograms were
carried out before, after 6 months on spironolactone and 3-4 months after
its withdrawal. Unit area trichogram provides a proportional assessment
of the 4 phases of scalp hair (anagen, catagen, telogen and dysmorphic).
"No marked changes in the endocrine parameters were observed as a
result of treatment, with serum testosterone being slightly elevated in
one of the female patients both of whom had polycystic ovary syndrome. A
marked reduction in the rate of daily hair loss and an improvement in the
trichogram score were noted during treatment, in all 4 cases, but with a
partial relapse following its cessation (Table 1).
"This improvement was shown by a 50.0 to 62.9% decline in hair loss
in the 4 patients, compared to their pre-treatment assessments. In terms
of trichogram score changes, an increase in anagen phase was noted during
treatment (from 22.0 to 84.5% over basal evaluation percentage) whereas
the proportion of dysmorphic hairs during treatment was markedly lower
than pre-treatment values in all 4 cases. Post-treatment evaluation
showed a considerable degree of relapse in anagen hair (from 17.0 to
43.8% over treatment values), although a fair part of the improvement was
retained. No adverse effects, particularly on the menstrual cycle, sperm
count or sexual activity were noted. However, it should be pointed out
that spironolactone may cause erectile inadequacy in other patients. A
fall in blood pressure was noted in all patients, who were normotensive,
and no change in renal or liver function was recorded. The beneficial
effect of spironolactone on scalp hair was probably mediated through its
anti-androgenic action mainly at the level of pilosebaceous unit. Recently
such an effect has been also demonstrated for the 5alpha-reductase
inhibitor finasteride.
"It is concluded that, in view of the beneficial effects noted in
these cases, spironolactone may be a useful agent for restraining scalp
hair loss in androgenic alopecia. However, a properly designed clinical
trial would be necessary to prove this conclusively."
D.A. Adamopoulos, M. Karamertzanis, S. Nicopoulou and A. Gregoriou
Endocrine Department, Elena Venizelou Hospital, Athens 115 21, Greece
Table 1 Mean daily hair loss and scalp hair trichograms.
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.................. Hair loss ..........Trichogram phases* (%)
Treatment ... number/day .....I.........II.......III........IV
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before......case a ...156 .... 42 ...... 4 ..... 29 ...... 25
..................... b .. 204 .... 33 ...... 7 ..... 32 ...... 28
..................... c ... 60 .... 50 ...... 0 ..... 31 ....... 19
..................... d .. 140 .... 41 ...... 4 ..... 29 ....... 26
during .... case a ... 98 .... 58 ..... 3 ...... 26 ...... 13
..................... b ...103 ... 61 ..... 4 ..... 27 ........ 8
..................... c ... 30 .... 61 ..... 1 ..... 31 ........ 7
..................... d ... 88 .... 55 ..... 5 ..... 25 ....... 15
after ...... case a ... 130 ... 47 ......
4 ...... 35 ...... 14
..................... b ... 180 ... 49 ...... 6 ...... 33 ..... 12
..................... c .... 50 ... 55 ...... 3 ...... 31 ..... 11
..................... d ... 106 ... 48 ...... 6 ...... 29 ..... 17
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*I anagen, II catagen,
III telogen, IV dysmorphic.
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