P#12  Hair Loss In Women With Hyperandrogenism: Response To Finasteride

Kid Wan Shum1, Derek Cullen2 and Andrew Messenger1. 1Dept of Dermatology and 2Endocrinology, Royal Hallamshire Hospital, Sheffield, U.K

Oral finasteride, a type II 5 a-reductase inhibitor developed for the treatment of benign prostatic hyperplasia, has been shown to increase hair growth and slow progression of thinning in men with androgenetic or male pattern balding (Hamilton-type) [Kaufman et al, J Am Acad Dermatol 1998; 39:578-89], but has no effect on hair growth in post-menopausal women with female pattern hair loss (Ludwig-type) [Price et al, J Am Acad Dermatol 2000; 43:768-76]. We describe four cases of hair loss with characteristics of both male and female patterns in women with hyperandrogenism, where finasteride 1.25 mg/day for 24 to 30 months has improved or stabilised the alopecia. Four women aged 66, 60, 40 and 35 years presented with increased facial and body hair and scalp hair loss of between 7 months and 5 years duration. All four patients had increased androgen levels and three also had polycystic ovaries. They were treated with finasteride 1.25 mg/day. Patients 3 and 4 who were still menstruating also took an oral contraceptive pill. Improved hair growth was seen after 6 and 12 months in patients 1 and 4 respectively, with a continued response at 24 and 30 months. Patients 2 and 3 showed stabilisation of hair loss after 6 and 9 months respectively, with improved hair growth at 24 and 30 months. All four patients also reported an improvement in their hirsutism. The finding that finasteride treatment improves patterned hair loss in women with hyperandrogenism but does not affect those post-menopausal women with female pattern hair loss without hyperandrogenism supports the concept that not all types of female hair loss have the same pathophysiology.