Dutasteride intradermal scalp injection therapy

How the drug works

Dutasteride is a drug that belongs to the 5-alpha reductase inhibitor class of drugs. This class of drug is used as a treatment for androgenic alopecia. The drug works by reducing the androgen hormone DHT (Dihydrotestosterone). Reduction of hair follicle exposure to DHT increases the follicular activity and hence increases hair growth and density.

Patients NOT suitable for this treatment

5-alpha-reductase inhibitors result in a decrease in DHT. Since DHT is an important androgen in sexual development, children and women who are pregnant or planning on getting pregnant should avoid use. The 5-alpha-reductase inhibitors should also be avoided in any persons who have had a hypersensitivity to these medications.

Therefore for clarity this treatment is not suitable for the following patients:

1. Pregnant or breastfeeding Women
2. Children
3. Any patient with allergy/hypersensitivity to Dutasteride or the 5 alpha reductase drug class.

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Problems with oral 5 alpha reducatase therapy (Finasteride administered as a once a day tablet)

When this type of medication is taken orally as a tablet the medication results in a global reduction of DHT (Dihydrotestosterone) in the blood. As a result, even though androgenic alopecia (hair loss) will improve, reduction of DHT in the blood is known to cause other undesirable effects.

In MEN these unwanted effects include:

1. Sexual and Erectile dysfunction that may continue after discontinuation of treatment
2. Decreased Ejaculatory Volume, potential male infertility and/or poor seminal quality
3. Decrease in Libido (sex drive) even after the discontinuation of the treatment
4. Gynecomastia (development of breast tissue)
5. Depression, low mood and anxiety

In WOMEN these unwanted effects include:

1. Birth Defects in women of child bearing age who take oral finasteride
2. Decrease in Libido (sex drive)
3. Mastalgia (Breast pain)
4. Hirsutism (Unwanted hair growth in other areas of the body)
5. Depression, low mood and anxiety

Why do we use Intradermal/mesotherapy Dutasteride injection of the Scalp versus oral finasteride therapy.

Injection of dutasteride has been developed as a new technique for male pattern hair loss MPHL and female pattern hair loss FPHL for the following reasons:

1. Clinical studies have shown that Dutasteride injected directly into the skin of the scalp results in a maintained increase in hair growth. It is more potent and effective than finasteride given as a tablet.

2. It is much safer in both men and women as a treatment for MPHL and FPHL as in its injected form it is absorbed into the bloodstream in very small ammount. Clinical studies measuring the blood concentration of the drug when administered as an injection into the scalp show negligible concentration levels. This is extremely important as these extremely low blood concentrations mean that the risk of developing any adverse effects of this therapy when compared to taking the medication is minimized. As a result the hair restorative benefits of the treatment can be enhanced without experiencing the adverse effects listed above.

3. Even though blood concentration levels are close to non-measurable we do insist on women of child-bearing potential to use birth control and to avoid breastfeeding. Even though it is unlikely with this form of treatment there is a significant risk to the developing child, it is important not to become pregnant during treatment and six months after the discontinuation of the treatment.

4. The treatment can be used safely and repeated in the long term therapy of male and female pattern hair loss (MPHL & FPHL) without any adverse effects.

Individual Patient Protocol

Patient Assessment

Patients will be consulted prior to treatment. Medical History will be taken by your treating Hair Loss London Consultant/ trichologist.

Examination of the scalp and trichoscopy (a special instrument used in the examination of hair follicles and skin) will be performed.

It is normal practice to perform a blood biochemistry and hormonal assay. Your treating Hair Loss London Consultant will send you for a blood test in order to help confirm the cause of your hair loss. This takes the form of a simple blood test after your consultation. The results of this test are available typically in 48 hours.

It is also usual to take a small sample of tissue from the scalp (biopsy) under local anaesthetic to confirm diagnosis. This is a quick procedure and pain is minimal (needle prick and sting for 3 seconds). This biopsy will help in confirming the type of hair loss you are suffering from.

It is important that these steps are followed prior to commencing treatment. This is because dutasteride injections must be administered appropriately. If history, examination, blood test and biopsy indicate hair loss pathology that is not suitable you may be referred for appropriate treatment of the diagnosed condition.

Non-Scarring Hair Loss (Hair follicles structurally present – potential for regrowth)

Z

Telogen Effluvium

Z

Anagen Effluvium

Z

Alopecia Areata

Z

Ophiasic Alopecia Areata

Z

Trichotillomania

Z

Traction Alopecia

Z

Tinea capitis

Scarring Alopecia (hair follicles replaced with scar tissue – no potential for hair regrowth)

Z

Lichen Planopilaris (LPP)

Z

Fibrosing Alopecia in androgenic pattern

Z

Central Centrifugal Cicatricial Alopecia (CCCA)

Z

Folliculitis Decalvans

Z

Discoid Lupus

Z

Dissecting cellulitis

Z

Frontal Fibrosing Alopecia (FFA)

As can be seen, hair loss has many potential causes. It is therefore extremely important that appropriate medical history and examination are undertaken by an experienced professional. Blood tests and biopsy are an essential part of confirming the diagnosis and administering appropriate treatment.

Injection and treatment Protocol

Depending on hair loss type and extent your hair loss expert/trichologist will determine the protocol for treatment. This will include the following.

1. Initial dutasteride injection frequency – This will usually be monthly or three monthly

2. Follow-up and maintenance – This is usually a maintenance treatment performed every 3-6 months to maintain the effects of treatment.

3. Additional oral medication – if your hair loss expert feels appropriate special low dose minoxidil tablets will be given to help supplement and enhance the dutasteride scalp injection therapy. These are specially formulated with tailored doses for each patient to minimize side effects and balance efficacy.

4. Topical minoxodil treatment can also be prescribed as a treatment instead of tablets if oral minoxidil is determined as inappropriate or the patient wishes to avoid this.

5. PRP (Platelet Rich Plasma) injections may also be recommended as an additional maintenance therapy.

Monitoring and Follow Up/Maintenance Injection

Routine follow-up is required as despite the fact that Dutasteride Scalp injection therapy has a relatively long half-life, eventually the anti-androgenic effect declines over time. Follow up and examination with your Hair Loss London Consultant will allow determination of how often the procedure needs to be repeated in order to maintain efficacy. This can vary between 3-6 months.

The follow-up visit allows the Hair Loss London Consultant to screen for any adverse effects and maintain patient safety whilst undergoing treatment.

A typical follow-up visit will include trichoscopy examination and assessment of treatment efficacy. Repeat blood tests may be occasionally necessary for screening especially if you have been recommended oral medications to supplement your dutasteride injection therapy.

Review and comparison of Dihydrotestosterone (DHT) blockers therapy.

Overview

DHD is the most potent hormone among the androgens and is considered a pure androgen as it cannot convert into oestrogen. It is formed primarily in peripheral tissues of the body where is exert its effects. Testosterone converts into DHT by the action of the 5A reductase enzyme at the target tissues. It plays a vital role in its sexual development of the males. DHT promote prostate growth sebaceous gland activity male pattern baldness call mom and the body, facial and pubic hair growth. This hormone, however, does not seem to play any significant role in normal female Physiology.

Hair grows in cycles anagen (growth phase), catagen (regressing) and telogen (resting stage). DHT (dihydrotestosterone) binds to androgen receptors of susceptible hair follicles, activates the genes responsible for shortening the anagen (growing phase) and gradually changing large terminal follicles to miniaturized follicles. With each successive cycle of the hair growth, hair becomes finer (smaller in diameter), shorter (the life spam of the hair becomes shorter), and as a result the quality of the hair changes.

The amount of hair in telogen (resting phase) increases compared to those in anagen (growing phase). As a results visual thinning of the hair and hair shedding. This happens in both condition of Male Pattern Hair Loss (MPHL) and Female Pattern Hair Loss (FPHL).

Treatment with DHT blocking therapy is the most effective treatment for MPHL. The main culprit for male pattern hair loss Is an androgenic steroid the hydro testosterone [DHT] common which promotes hair miniaturisation via is actions on androgen dash sensory receptors. For FPHL androgen activity is weaker therefore women experience just thinning of the hair compared to men that can go complete bold in the top area for the scalp.

The DHT blockers therapy is listed from most potent to least potent.

Most potent DHT blocking therapy are Dutasteride and Finasteride, both are 5-alpha-reductase inhibitors designed to decrease the production of DHT. The main difference between Finasteride and Dutasteride is that Finasteride is selective for type II 5-alpha-reductase while Dutasteride inhibits both type I and II 5-alpha-reductase, which makes it more potent.

Adverse effects of this treatment.

Research and clinical experience have reported side- effects of 5-alpha-reductase. These side-affects are primarily sexual and include erectile dysfunction, decreased ejaculatory volume, a decrease in libido, as well as gynecomastia. In rare instances the side effects may persist after treatment is discontinued.

It is also possible that 5-alpha-reductase inhibitors are associated with decreased fertility.

Since DHT is an important androgen in sexual development, children and women who are pregnant or planning on getting pregnant should avoid use.

Considering all of the above the delivery route of the Dutasteride and Finasteride treatment is the most important factor to reduce or avoid altogether any potential side effects and at the same time to maximise the treatment success.

Since Dutasteride Is the most potent DHT inhibitor and give the best results for hair growth, the injections intradermal level Is most effective treatment to achieve the best results with the least side effects.