Treatment of hyperandrogenic alopecia in women

Objective: To determine the effectiveness of various antiandrogens for the treatment of premenopausal women with hyperandrogenic alopecia. Design: Randomized, unmasked trial of three treatments in 36 hyperandrogenic women with alopecia and observation, without treatment, in 12 other similar patients. Setting: Endocrinologic outpatient practice in Italy. Participant(s): A total of 48 hyperandrogenic women with alopecia and 30 age- and weight-matched controls for the assessment of androgen levels. Intervention(s): Randomization to cyproterone acetate (50 mg) with ethinyl estradiol (EE) in a reverse sequential regimen; flutamide (250 mg) or finasteride (5 mg) daily; all for 1 year. Twelve similar patients were observed without treatment for 1 year. Main Outcome Measure(s): Ludwig scores for hair thinning as well as patient and investigator assessments of treatment effectiveness. Result(s): Flutamide resulted in a reduction of 21% in Ludwig scores (2.3 +/- 0.2 to 1.8 +/- 0.1). The other treatment effects were not statistically significant. Patient and investigator assessments showed a similar trend. Conclusion(s): Flutamide at a dose of 250 mg daily induced a modest improvement in alopecia after 1 year, whereas cyproterone acetate and finasteride were not effective. Treatment for more than 1 year may be required for better results.