| BackgroundAndrogenetic Alopecia(AGA)is a common alopecia.Male patients are mainly manifested in the frontal regression and(or)thinning and shortening in the top area.In female patients,the hair is sparse at the top of the head,and the hair lines is preserve integrity.According to Zhang Jianzhong's epidemiological statistics on AGA in China,the prevalence rate of male and female is 21.3% and 6% respectively.It is believed that the disease is an androgen dependent polygenic disease.The main pathoge nesis is to increase the activity of 5 alpha reductase in the top of the head,to make more testosterone to be dihydrotestosterone,causing hair follicle miniaturization,hair gradually soften and shedding.Mental factors,stress and bad habits can promote and aggravate the disease.Androgenic alopecia does not affect the health of the body,but affects the appearance.It has a great psychological impact on some patients,and affects the quality of life.With the development of economy,more and more attention has been paid to AGA.There are many classification methods for classification of AGA.Hamilton,Norwood,Savin,Bouhanna,Koo,Olsen are all proposed for the classification of male AGA.In the female AGA classification,Ludwig,Olsen,Tajima M,and other classification methods have been put forward.N-H classification(Norwood-Hamilton classification,N-H)for male classification and Ludwig classification for female classification is the most commonly used classification method.However,N-H classification is more complex in clinical application,it is difficult to remember,and there is no progressive relationship between different types.The classification of different sex AGA can only be classified by their respective classification methods.Neither of the two classification methods has included any female patients with female pattern hair loss and female patients with male AGA.In India,18% of men and 11.1% of men in South Korea showed as female pattern hair loss.They could not be classified by the above two classifications.In recent years,domestic scholars have gradually paid attention to the BASP classification method,and the applicability of the BASP typing of Yang Shuxia in China was studied by 5 dermatologists.272 AGA patients were classified by BASP classification and N-H classification,which showed that the consistency of BASP classification was high and the applicability was good.Some scholars used this classification for clinical research of AGA,with BASP classification,but they did not had large sample of AGA.Since the treatment of minoxidil in patients with hypertension in 1980 was found to have a hairy phenomenon,a gradual study was developed to develop minoxidil solution for the treatment of hair loss.But the curative effect is no t satisfied,can not reach the satisfied effect.The use of finasteride in the treatment of benign prostatic hyperplasia(BPH)in Department of Urology revealed that the bald spot was growing again.Later studies found that finasteride(1mg)has a good effect on MAGA,which can achieve cosmetic results,but it needs long-term use.There are many ways for MAGA treatment,but the curative effect is not satisfied.At present,the most effective way to treat MAGA is oral finasteride combined with minoxidil for external use.In recent years,studies abroad have shown that the curative effect of different parts is inconsistent,and the curative effect at the top is better than that of the bilateral frontal and temporal angles.The domestic Hu Ruiming used the N-H classification to analyze the efficacy of the forehead and top alopecia patients.The same conclusion is that the curative effect of the top is better than the double temporal angle,but the sample had not enlarge.To understand the characteristics of alopecia in Chinese MAGA patients,the applicability of BASP typing and the difference of therapeutic response at different locations.The clinical data of 1270 patients who were classified by N-H and BASP classification from 2008 to 2017 were analyzed retrospectively.objective To understand the patterns of Chinese men(MAGA),compare the applicability of N-H classification and BASP typing,and the difference of therapeutic response at different locations.research method1.Selected from the First Affiliated Hospital of Guangzhou Medical University,,and 1270 cases of male patients with complete data.2.Among the 1270 patients,430 patients(33.5%)had been treated for 3 months or more.The 7 grade scoring method was used to evaluate the curative effect.Three subtypes were grouped according to the double frontal angle(M),all top(F),and the posterior top(V)in the BASP classification.Each subtype was then divided into 3 groups according to the severity.Serum DHT levels were monitored every 3 months.The efficacy was assessed by patient,physician grading and radiography.3.Drug use scheme:430 cases were treated with finasteride(Propecia,1mg),oral administration of daily,5% Minoxidil,1ml bid external application and He-Ne laser.According to the changes in the BASP classification of the patients,the self evaluation and(or)of the patients,the doctors were evaluated by the 7 grade score method: significantly reduced(1),moderate decrease(2),mild decrease(3),no change(4 points),mild improvement(5 points),moderate improvement(6),and significant improvement(7).Effective rate =(mild improvement + moderate improvement + obvious improvement)/ total number of cases,significant efficiency = obvious improvement / total number of cases.Results 1.BASP classification and Norwood-Hamilton classification(1)Norwood-Hamilton classification :Among the 1270 cases of MAGA,995(78.35%)could be classified,125(9.84%),100 III(7.87%),386(30.39%),148(11.65%),V,VI,VII,VII,VII,IIIa,IVa,and IVa.(1.65%)28 cases(2.20%)(2.20%)at grade Va.The majority of them are III-vertex and IV.275 cases(21.65%)could not be classified by N-H classification,of which 240 cases(18.89%)had diffuse sparsity in the top of the whole top,and the hairline had no regression;35 cases(2.76%)had hair sparsity at the small area at the top,and the hair line was not moved back.(2)BASP classification:There were 358 cases(28.19%)in 1270 cases,275 cases(21.65%)in special type,637 cases(50.16%)in basic type and special type.The majority of F1 and M1V1 types are accounted for as follows:Basic type: M subtypes: M0 in 31 cases(2.44%),M1 in 125 cases(9.84%),M2 in 122 cases(9.60%),and M3 in 3 cases(0.24%).C subtypes: C1 in 9 cases(0.71%),C2 in 28 cases(2.20%),C3 in 22 cases(1.73%).Type U: U1 was found in 4 cases(0.31%),U2 in 11 cases(0.87%),and U3 in 3 cases(0.24%).Special type: F subtype: F1 in 139 cases(10.94%),F2 in 81 cases(6.38%),F3 in 20 cases(1.57%).V subtypes: V1 in 19 cases(1.50%),V2 in 8 cases(0.63%),V3 in 1 cases(0.08%).Basic type + special type:There are 100 cases(7.87%),50 cases(3.94%)in M1F2,10 in M1F3(0.79%),138 in M1V1(10.87%),23 in M1V2(1.81%),1 in M1V2(0.08%),M2F1 in 54 cases,M2V1 in M2F3.M3F35 cases,M3V1 0 cases,M3V2 in 8 cases(0.63%),M3V3 in 26 cases(2.05%),C1F1 in 1 cases(0.08%),C1F2 in 3 cases(0.24%),C1F3 0 cases(0%),C1V1 have 2 cases(1.58%),C1V2 has 1 cases,C1V3 M3V2 cases.M1V1,M1,F1 and M2 are the main types.There were 928 cases(73.07%)of hair loss involving "M",554 cases(43.62%)of F site,and 358 cases(28.19%)of V site.1270 cases of male androgenetic alopecia were found in 17(1.34%)with bilateral temporal hair loss.2.period of treatment and curative effect(1)Of the 1270 patients,430 cases were treated for 3 months,the curative effect score was 5.19 + 1.21255 cases(52.33%)were effective,61 cases(14.19%)were markedly effective.For 338 patients who had been treated for 6 months,the curative effect score was 5.89 + 1.16,229 cases(67.75%)were effective,141 cases were markedly effective(41.72%).For 216 patients who had been treated for 9 months,the curative effect score was 6.10 + 1.02166 cases effective(76.85%),98 cases markedly effective(45.37%).For 144 patients who had been treated for 12 months,the curative effect score was 6.30 + 1.00130 cases effective(90.28%),85 cases markedly effective(59.03%).For 83 patients who had been treated for 18 months,the curative effect score was 6.41 + 0.83,77 cases were effective(92.77%),46 cases were markedly effective(45.37%).For 46 patients who had been treated for 24 months or more,the curative effect score was 6.54 + 0.84,43 cases were effective(93.02%),32 cases were markedly effective(69.57%).The curative effect was positively correlated with the treatment time(chi 2 =71.015,correlation coefficient r=0.221,P < 0.001).(2)the effect of different parts:The therapeutic time of M site treatment in 3,6,9,12 months were 4.65,5.11,5.30 and 5.51 respectively.The effective patients were 105(35.71%),120(52.40%),87 cases(57.62%),and cases respectively.The therapeutic time of F site treatment in 3,6,9,12 months were 5.37,6,6.10 and 6.12 respectively.The effective patients were 189(64.73%),190(84.44%),88.89%,and 120.The scores of V sites in the treatment of 3,6,9,and 12 months were 5.27,5.79,5.96 and 6 respectively.The effective participants were 125(65.10%),120(80.54%),85 cases(85.86%),and cases respectively.The effective rates of M,F and V in treatment of 3,6,9 and 12 months were positively correlated with treatment time(correlation coefficient r was 0.214,0.273,0.201).(3)The comparison of the curative effect of different parts:The curative effect of group F and group M in the treatment of 3,6,9 and 12 months had statistical difference(P < 0.05).The curative effect of group F was better than that of group M,and the curative effect of group V and M in 3,6,9 and 12 months was statistically different(P < 0.05).The curative effect of group V was better than that of the M group;F group and V group were treated for 3,6 months,9 months,and V.There was no significant difference in the effect of month(P > 0.05).conclusion1.The main male AGA patients in China mainly affects the both prefrontal and top area,the BA type has 358 cases(28.19%),the special type is 275 cases(21.65%),the mixed type has 637 cases(50.16%),the most typing in BASP is mainly M1V1?M1?M2 ?F1and M1F1;and the III-vertex and IV class in the N-H classification method,and the BASP classification method is more suitable.It is used in the classification of MAGA in China.2.The therapeutic effect of MAGA mainly with finasteride was positively correlated with the treatment time,and the curative effect of the top(F)and the back(V)was higher than that of the double frontal temporal horn(M). |
PDF Full Text Request