B2.1 Effect of minoxidil 2% versus cyproterone acetate treatment on female androgenetic alopecia : a randomised trial to select the best indications for each treatment.

Reygagne P Sabouraud Center, Saint Louis Hospital, Paris.

Female androgenetic alopecia (FAGA) is most of the time isolated, but can be associated with hyperseborrhoea or others symptoms of hyperandrogenism. The only approved treatment for FAGA is topical 2% minoxidil (M2%), but antiandrogen therapies are widely used, specially in case of biological or clinical hyperandrogenism associated. In Europe the most common antiandrogen is cyproterone acetate (CA). To compare efficacy of CA and efficacy of M 2%, and to select the best indications for CA treatment and M2% treatment we conducted a 12 month controlled randomized trial. 66 women with FAGA, Ludwig’s stage 1 or 2, aged 18 to 35 were included in this study. 33 received M2% (1 Ml twice a day) and a combined oral contraceptive consisting of ethinyl oestradiol 35mg/day and gestodene 75mg/day, for 21 of every 28 days (Moneva®, Schering Laboratories); 33 received CA 50mg/day for 20 of every 28 days (Androcur®, Schering Laboratories) and a combination of ethinyl oestradiol 35mg/day and CA 2mg/day (Diane 35®, Schering Laboratories), for 21 of every 28 days. Hair count and anagen hairs were evaluated with a phototrichogram on a 0,36 cm2 square area at baseline, month 3 and month 6.The primary criteria was number of hairs > 40 mm. Total number of hairs and hairs in anagen or telogen phase were secondary outcome parameters. Cosmetic efficacy, hair loss, hair regrowth, and hyperseborrhoea were parameters evaluated by patients themselves. After 12 months, a mean reduction of 2,4 hairs of diameter < 40mm was observed in the CA group, and a mean increase of 6,5 (+12,2%) in the M 2% group (p<0,001 Wilkinson test). Total number of hairs was closely correlated with number of hairs of diameter <40mm: After 12 months, a mean reduction of 0,2 hairs of total number of hair (-0,3%) was observed in the CA group, and a mean increase of 7,7 (+11,4%) in the M 2% group (p<0,001). However when menstrual cycle irregularities were present increased of hair was similar in both groups (+2,4 hairs = 3,4%), and reduction of hyperseborrhoea, and patient‘s satisfaction were higher in CA group. On the other hand, in absence of menstrual cycle irregularities or if the body mass index is low the hair growth is much higher in the M2% group. In conclusion, M2% is probably preferable alone, or with a combined oral contraceptive, but without CA when alopecia is isolated. CA can be recommanded only when there is menstrual cycle irregularities, hyperseborrhoea; elevated BMI, hirsutism, or other symptoms of hyperandrogenism. In case of hyperandrogenism combining treatment with CA and M2% could be suggested to treat all symptoms and provide better cosmetic results.