Meta-analysis of 308-nm excimer laser therapy for alopecia areata.

Background: Alopecia areata (AA) is an autoimmune disease that can result in spontaneous hair loss. Currently, there is no US Food and Drug Administration (FDA) approved treatment, however new treatments are being investigated. Excimer laser and excimer lamp treatment have been suggested and have the benefit of mild/few adverse effects.Methods: A literature search and meta-analysis was performed to investigate the efficacy of the excimer laser and lamp for treatment of AA. Results: No controlled trials were found which utilized the 308-nm excimer lamp. Four controlled trials (N = 105) testing the efficacy of the 308-nm excimer laser were identified. When laser treatment was compared to control measured through the number of responders to treatment, the standardized mean difference was 18.37 (95% CI: 3.28, 102.77) in favor of treatment (p < .0009, I2 = 36%). Conclusion: Our results suggest that use of the 308-nm excimer laser can be effective in AA therapy however more studies are required observing both the 308-nm excimer laser and lamp.

Meta-analysis of photobiomodulation for the treatment of androgenetic alopecia.

BACKGROUND: Androgenetic alopecia (AGA) is a condition that affects most people at some point in their life, yet few treatments are available. Use of photobiomodulation is ideal due to the safety profile and lack of serious adverse effects. Therefore, the efficacy of photobiomodulation for AGA therapy was investigated. METHODS: A meta-analysis was used to elucidate treatment efficacy. Additionally, a sub-analysis was performed to determine if the type of device used or if use of lasers versus light emitting diodes (LEDs) significantly impacted results. RESULTS: Using hair density (hairs/cm2) as a measure of efficacy, the standardized mean difference (SMD) was 1.02 (95% CI: 0.68, 1.36) in favor of treatment over control (15 studies, pooled N = 795, p < .00001). Subgroup analysis comparing comb-style devices versus helmet/hat-style devices did not reveal a significant difference (p = .08). A second subgroup analysis suggested that laser treatment was significantly more effective (p = .009) than a combination of laser/LED treatment although the combination treatment was still significantly better than control treatment. DISCUSSION: Meta-analysis results suggest that photobiomodulation could be used to effectively treat AGA. Specific device recommendations should be based on use of lasers versus LEDs and not the style (comb/hat/helmet) of the device.

Finasteride for androgenetic alopecia is not associated with sexual dysfunction: a survey-based, single-centre, controlled study.

BACKGROUND: The occurrence of sexual dysfunction side-effects associated with finasteride use in men with androgenetic alopecia (AGA) is thought to be less prevalent than is publicized. There is a need to investigate sexual dysfunction among finasteride users with population-based controls. OBJECTIVE: To evaluate the presence of sexual dysfunction in men using finasteride or not using finasteride. METHOD: Adult men visiting a dermatologist's office for any reason were asked to complete a survey including a modified version of the Arizona Sexual Experience Scale (ASEX) to assess the presence of sexual dysfunction with and without finasteride use. RESULTS: Data from 762 men aged 18-82 were collected: 663 finasteride users and 99 non-finasteride users. There were no significant differences between finasteride users and non-user controls in reporting sexual dysfunction using the ASEX. Regression analysis indicated that self-reporting libido loss and reduced sexual performance, not finasteride use, predict a higher ASEX score. CONCLUSION: The use of finasteride does not result in sexual dysfunction in men with AGA. These data are consistent with other large survey-based controlled studies.

Assessing dutasteride-associated sexual dysfunction using the U.S. Food and Drug Administration Adverse Event Reporting System.

BACKGROUND: Incidences of sexual dysfunction due to the use of 5 α-reductase inhibitors have been suggested. Despite low sexual dysfunction reported in clinical trials, an analysis of the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database revealed a significant disproportionality in the reporting of sexual dysfunction with the use of finasteride. Therefore, it is likely that a similar relationship with dutasteride may exist. OBJECTIVE: To determine whether dutasteride use leads to a higher risk of sexual dysfunction compared to a baseline risk for all other drugs using the FAERS database. METHODS: A case by non-case disproportionality approach was used whereby a reporting odds ratio (ROR) with 95% confidence interval (CI) was calculated. Cases of dutasteride-associated sexual dysfunction were compared to a reference risk of sexual dysfunction for all other drugs in the database. RESULTS: A significant disproportionality in reporting of sexual dysfunction with the use of dutasteride was observed. The disproportionality was present for all age ranges except for 31-45 years where there were few overall reports of adverse events. LIMITATIONS: Adverse events can be underreported, and selection bias is inherent in the FAERS. CONCLUSION: Dutasteride use is associated with an increase in reports of sexual dysfunction.

Assessing finasteride-associated sexual dysfunction using the FAERS database.

BACKGROUND: Postmarketing reports suggest that finasteride causes sexual dysfunction despite a low incidence reported in clinical trials. Therefore, the extent of risk remains unknown. OBJECTIVE: To determine whether the risk of sexual dysfunction is higher among individuals treated with finasteride compared to a baseline risk for all other drugs using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. METHODS: A case by non-case disproportionality approach was used whereby a reporting odds ratio (ROR) with 95% confidence interval (CI) was calculated. The National Ambulatory Medical Care Survey (NAMCS) was used to confirm results. RESULTS: A significant disproportionality in reporting of sexual dysfunction with the use of finasteride was observed whether finasteride was indicated for hair loss (ROR = 138.17, 95% CI: 133.13, 143.4), prostatic hyperplasia (ROR = 93.88, 95% CI: 84.62, 104.16) or any indication (ROR = 173.18, 95% CI: 171.08, 175.31). When these results were stratified by age, disproportionality was strongest at 31-45 years. CONCLUSION: Use of finasteride has led to an increase in reports of sexual dysfunction where it is believed to be the primary suspect.

Meta-analysis of efficacy of platelet-rich plasma therapy for androgenetic alopecia.

BACKGROUND: Platelet-rich plasma (PRP) therapy is used as an off-label treatment for androgenetic alopecia (AGA); however, published efficacy evidence is still preliminary. OBJECTIVE: Conduct a meta-analysis of current trial data to estimate efficacy. METHODS: Thirteen studies which investigated the use of PRP for treatment of AGA were identified from the literature. A meta-analysis was used to analyze results from four trials (N = 60) where sufficient quantifiable data extraction was possible. All 13 studies were analyzed qualitatively. RESULTS: When comparing PRP treatment to baseline, the overall standardized mean difference was 0.51 [95% confidence interval (CI): 0.14, 0.88; I2 = 0%] in favour of PRP treatment. CONCLUSION: Preliminary results suggest that the investigation of PRP for the treatment of AGA is promising. Controlled trials with quantifiable measures of treatment success are now required to confirm these results.

Efficacy of tofacitinib in treatment of alopecia universalis in two patients.

BACKGROUND: Autoimmune-triggered non-scarring hair loss is a feature of alopecia areata (AA). Initially patchy and often self-limited, severe hair loss forms include the complete loss of scalp hair or alopecia totalis (AT) and complete loss of all hair or alopecia universalis (AU). For AT and AU a reliable treatment has remained elusive. The targeted kinase inhibitor tofacitinib, in current use for treatment of other immune diseases, has been hypothesized as a viable option for AA, AT and AU therapy and a few case reports support this. OBJECTIVE: Our study aims to provide evidence for the effectiveness of tofacitinib in the treatment of AU. METHODS: Two patients diagnosed with long-term AU were prescribed tofacitinib citrate at a dosage of 5 mg twice daily and observed for eight months. RESULTS: In the first patient, beard growth was significant by 3 months of treatment. By 6 months of treatment, hair growth was apparent throughout the entire body. By 8 months of treatment, scalp hair continued to grow longer and thicker. In addition, eyelashes and eyebrows were established. In the second patient, a noticeable increase in scalp hair was present just 1 month into treatment. By 4 months into treatment, significant scalp regrowth was observed as well as eyelash, eyebrow and beard regrowth. Axillary hair regrowth and isolated leg hair was noted by 8 months. CONCLUSION: In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side-effects. We recommend that further study be required to establish safety and confirm efficacy.