Seyed Jafari S Morteza, Heidemeyer Kristine, Hunger Robert E, de Viragh Pierre A
Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.
J Clin Med. 2024 May 23;13(11):3052. doi: 10.3390/jcm13113052.
The most common type of alopecia in women is female androgenetic alopecia (FAGA), characterized by progressive hair loss in a patterned distribution. Many oral therapies, including spironolactone (an aldosterone antagonist), androgen receptor blockers (e.g., flutamide/bicalutamide), 5-alpha-reductase inhibitors (e.g., finasteride/dutasteride), and oral contraceptives, target the mechanism of androgen conversion and binding to its respective receptor and therefore could be administered for the treatment of FAGA. Despite significant advances in the oral treatment of FAGA, its management in patients with a history of gynecological malignancies, the most common cancers in women worldwide, may still be a concern. In this review, we focus on the safety of antiandrogens for the treatment of FAGA patients. For this purpose, a targeted literature review was conducted on PubMed, utilizing the relevant search terms. To sum up, spironolactone seems to be safe for the systemic treatment of FAGA, even in high-risk populations. However, a general uncertainty remains regarding the safety of other medications in patients with a history of gynecologic malignancies, and further studies are needed to evaluate their long-term safety in patients with FAGA and risk factors to establish an optimal risk assessment and treatment selection protocol.
女性最常见的脱发类型是女性雄激素性脱发（FAGA），其特征是头发呈进行性、有规律分布的脱落。许多口服疗法，包括螺内酯（一种醛固酮拮抗剂）、雄激素受体阻滞剂（如氟他胺/比卡鲁胺）、5α-还原酶抑制剂（如非那雄胺/度他雄胺）以及口服避孕药，都是针对雄激素转化及其与各自受体结合的机制，因此可用于治疗FAGA。尽管FAGA的口服治疗取得了重大进展，但对于有妇科恶性肿瘤病史（全球女性中最常见的癌症）的患者，其治疗管理可能仍是一个问题。在本综述中，我们重点关注抗雄激素药物治疗FAGA患者的安全性。为此，利用相关检索词在PubMed上进行了针对性的文献综述。综上所述，螺内酯似乎对FAGA的全身治疗是安全的，即使在高危人群中也是如此。然而，对于有妇科恶性肿瘤病史的患者，其他药物的安全性仍普遍存在不确定性，需要进一步研究以评估它们在FAGA患者及有风险因素患者中的长期安全性，从而建立最佳的风险评估和治疗选择方案。
