Zusammenfassung
Die androgenetische oder anlagebedingte Alopezie ist die häufigste Form des Haarausfalls. Hier hat sich ein integratives Behandlungskonzept bewährt. Neben den zwei Hauptfaktoren genetische Prädisposition und Androgene, die die hormonelle Therapie in den Mittelpunkt stellen, werden auch verschiedene Nebenfaktoren wie Seborrhö und Kolonisation, Vaskularisierung und Gefäßversorgung sowie Mikroinflammation und Fibrosierung als therapeutische Ansatzpunkte genutzt. So unterstützen antientzündliche, antifibrotische und antimikrobiell wirkende Substanzen den Erfolg der hormonellen Therapie und erhöhen den Therapieerfolg und die Zufriedenheit der meist recht anspruchsvollen Patienten. Die vorliegende Arbeit gibt einen Überblick über die verschiedenen Pathomechanismen des anlagebedingten Haarausfalls und die hierauf basierenden therapeutischen Ansatzpunkte.
Abstract
Androgenetic alopecia or genetic hair loss is the most common form of hair loss. An integrative treatment concept has proved to be a reliable therapeutic strategy. Therefore, treatment strategies not only focus on the two main factors “genetic predisposition” and “androgens” but also include other adjacent factors, such as seborrhoea and colonization, vascularization and vascular supply, as well as microinflammation and fibrosis, which also require therapeutic measures. Antiinflammatory, antifibrotic, and antimicrobial substances support the success of the hormonal therapy, as well as satisfying the needs of demanding patients. This article presents an overview of the different pathomechanisms of androgenetic alopecia and subsequent therapeutical strategies.
Literatur
1
Hamilton J B.
Patterned hair loss in man: types and incidence.
Ann N Y Acad Sci.
1951;
53
708-728
2
Ludwig E.
Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex.
Br J Dermatol.
1977;
97
247-254
3
Olsen E A.
The midline part: an important physical clue to the clinical diagnosis of androgenetic alopecia in women.
J Am Acad Dermatol.
1999;
40
106-109
4
Sawaya M, Price V.
Different levels of 5α-reductase type I and II, aromatase, and androgen receptor in hair follicles of women and men with androgenetic alopecia.
J Invest Dermatol.
1997;
109
296-300
5 Orfanos C E, Garbe C (Hrsg). Häufige Haarkrankheiten. In: Therapie der Hautkrankheiten. Springer Verlag 2002: 1396-1422
6
Kozlowska U, Blume-Peytavi U, Kodelja V, Sommer C, Goerdt S, Jablonska S, Orfanos C E.
Vascular endothelial growth factor induced by proinflammatory cytokines (IL-1α, β) in cells of the human pilosebaceous unit.
Dermatology.
1998;
196
89-92
7
Lattanad A, Johnson W C.
Male pattern alopecia. A histopathologic and histochemical study.
J Cutaneous Pathology.
1975;
2
58-70
8
Arck P C, Handjiski B, Hagen B, Hagen E, Joachim R, Klapp B F, Paus R.
Indications for a „brain-hair follicle axis (BHA)“: inhibition of keratinocyte proliferation and up-regulation of keratinocyte apoptosis in telogen hair follicles by stress and substance P.
FASEB J.
2001;
15
2536-2538
9
Kozlowska U, Blume-Peytavi U, Kodelja V, Sommer C, Majewski S, Jablonska S, Goerdt S, Orfanos C E.
Vascular endothelial growth factor expression in various compartments of the human hair follicle.
Arch Derm Res.
1998;
290
661-668
10
Lachgar S, Monkadiri H, Jonca F, Charveron M, Bouhaddioui N, Gall Y, Bonafe J L, Plouet J.
Vascular endothelial factor is an autocrine growth factor for hair dermal papilla cells.
J Invest Dermatol.
1996;
106
17-23
11
Wolf R, Schönfelder G, Paul M, Blume-Peytavi U.
Nitric oxide in the human hair follicle: Constitutive and dihydrotestosterone induced nitric oxide synthase expression and NO production in dermal papilla cells, .
J Mol Med.
2002;
in press
12
Orfanos C E, Vogels L.
Local therapy of androgenetic alopecia with 17 alpha-estradiol. A controlled randomized double-blind study.
Dermatologica.
1980;
161
124-132
13
Oh H S, Smart R C.
An estrogen receptor pathway regulates the telogen-anagen hair-follicle transition and influences epidermal cell proliferation.
N Proc Acad Sci.
1996;
93
12 525-12 530
14
Smart R C, Oh H S.
On the effect of estrogen receptor agonists and antagonists on the mouse hair follicle cycle.
J Invest Dermatol.
1998;
111
175
15
Kaufman K D, Olsen E A, Whiting D. et al .
Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group.
J Am Acad Dermatol.
1998;
39
578-589
16
Price V H, Roberts J L, Hordinsky M. et al .
Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia.
J Am Acad Dermatol.
2000;
43
768-776
17
Lachgar S, Charveron M, Gall Y, Bonafe J L.
Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells.
Br J Dermatol.
1998;
38
407-411
18
Connors T J, Cooke T E, De Launey W E. et al .
Australian trial of topical minoxidil and placebo in early male pattern baldness.
Australas J Dermatol.
1990;
31
17-25
19
de Groot A C, Nater J P, Herxheimer A.
Minoxidil for male-pattern baldness.
Lancet.
1987;
2
563
20
de Groot A C, Nater J P, Herxheimer A.
Minoxidil: hope for the bald?.
Lancet.
1987;
1
1019-1022
21
Koperski J A, Orenberg E K, Wilkinson D I.
Topical minoxidil therapy for androgenetic alopecia. A 30-month study.
Arch Dermatol.
1987;
123
1483-1487
22 Data on file (data on file, Vichy-Cosmétique Active Deutschland/L'Oréal).
23
Herel H, Gollnick H, Matthies C, Baumann I, Orfanos LE.
Low dosage retinol and L-cystine combination improve alopecia of the diffuse type following long-term oral administration.
Hautarzt.
1989;
40 (8)
490-495
Prof. Dr. Ulrike Blume-Peytavi
Klinik für Dermatologie, Venerologie und Allergologie · Kompetenzzentrum für Haare und Haarerkrankungen am Universitätsklinikum Charité ·
Humboldt-Universität zu Berlin · Schumannstr. 20/21 · 10117 Berlin