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ANDROGENETIC ALOPECIA Exploring causes, psychological effects, with Western and Chinese Medicine approach Yohanes Silih I11107004

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slide Androgenetic Alopecia

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ANDROGENETIC ALOPECIAExploring causes, psychological effects, with Western and

Chinese Medicine approach

Yohanes SilihI11107004

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ABSTRACT

• Alopesia androgenetik keadaan kehilangan rambut kepala yang berlangsung secara lambat dan progesif, sering dimaksudkan pada kebotakan pola laki-laki (male pattern balding).

• Alopesia androgenetik berefek pada psikologis penderita.

• Terapi alopesia dengan pendekatan barat finasteride dan minoxidil penurunan jumlah DHT; latihan; diet rendah lemak, menghindari stress dan diet rendah gula.

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• Tradisional Chinese Medicine (TCM) alopesia androgenetic berkaitan dengan panas (api) yang membangkitkan angin, stasis darah/qi pada pembuluh lokal, defisiensi qi, darah dan ketidakcukupan nutrisi untuk rambut.

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PENDAHULUAN

• Alopesia androgenetik, meskipun telah dipelajari sekian lama, masih belum terlalu dipahami dan masih belum didapatkan terapi yang efektif, yang mungkin berkaitan dengan kurangnya edukasi awal dan kurangnya penggunaan terapi non-farmakologis.

• Alopesia androgenetik selain berkaitan dengan faktor pertambahan usia, juga berkaitan dengan faktor stress, depresi, negative self image.

• Pengobatan dengan pendekatan Barat dan Cina masing2 memiliki perbedaan yang unik yaitu secara farmakologis dan akupuntur baik lokal maupun sistemik.

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EPIDEMIOLOGI

• alopesia androgenetik dialami 40 juta laki di Amerika, 20 juta perempuan di Amerika: 15% pramenopause dan 50% menopause.

• Insidensi tertinggi pada kaukasia, Asia dan Afrika-amerika; terendah pada penduduk asli amerika dan eskimo.

• Kaukasia memiliki resiko 4 kali lebih besar dibandingkan afrika amerika.

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Pola Kebotakan

• Kebotakan pola laki-laki dimulai pada kedua pelipis dan menipis pada puncak kepala. Kadang2 bisa menjadi kebotakan total.

• Pola kebotakan laki-laki, menurut skala Norwood-Hamilton dibagi menjadi 7 kategori:– Tipe 1: tidak ada kehilangan rambut– Tipe 2: sedikit kehilangan pada garis frontal– Tipe 3: kehilangan lebih lanjut pada frontal, tipe 3 vertex

frontal dan vertex.– Tipe 4,5,6: kehilangan rambut lebih lanjut.– Tipe 7: rambut yang tersisa hanya pada bagian oksipital.

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• Pola kebotakan pada wanita, berdasarkan skala Ludwig yang dibagi menjadi 4 kategori: tipe 1-3, tipe lanjut dan tipe frontal.

• Pola lebih lanjut: tidak ada rambut pada bagian puncak kepala.

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ETIOLOGI

• Kombinasi antara efek endrogen pada individu yang memiliki predisposisi genetik yang diturunkan oleh salah satu atau kedua orang tua.

• Usia awal: bisa terjadi kapan saja setelah pubertas, sering pada dekade kedua. Pada wanita 40% terjadi pada dekade ke-6.

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Pendekatan Barat

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PATOGENESIS

• Alopesia androgenetik berkaitan dengan androgen, terutama Dihydrotestosterone (DHT).

• Pengaruh testosteron: prenatal & postnatal• pengaruh DHT: prenatal & postnatal.

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• Alopesia androgenetik cenderung diturunkan, tapi hal ini masih belum terlalu dipahami.

• Beberapa teori menyebutkan hal ini berkaitan kromosom X dan bersifat maternal.

• Alopesia dapat mengenai wanita kapan saja, yang mungkin berkaitan dengan aksi hormon2 saat hamil, menopause, kista ovarium, kelainan tiroid, anemia.

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• In 2005 Nothen et al began research on the genetics of bald men. The study consisted of several hundred balding and non-balding men. He compared their androgen receptor genes which are located on the X chromosome.

• The conclusion was that a genetic variation triggers baldness.

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• Female androgenetic alopecia has been reported in patients with complete androgen insensitivity syndrome (a genetic defect whereby the penis does not develop and the child appears to be born a girl but is genetically a male). This suggests that there are more factors than androgen action, be it either systemic or external, present in contributing to androgenetic alopecia.

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• One of the most common causes of hair loss in pre-menopausal women is a nutritional deficiency of depleted iron stores.

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Terapi

• Farmakologi• Transplantasi rambut• Cosmetic aids• Perubahan gaya hidup dan Nutrisi.

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FARMAKOLOGI

• Finasteride (propecia) first line therapy, penghambat 5 alfa reduktase.– used as first-line treatment.– It is about 80% effective. If no regrowth occurs after

12 months it is used in combination w/Minoxidil• Minoxidil (rogaine) vasodilator.– 50% effective in the frontal and vertex areas.– Minoxidil 2% topical treatment is the primary

treatment for women with a 19% response rate.

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Lifestyle dan Nutrisi

• Zinc, vitamin B6, asam azelaic penghambat 5 alfa reduktase: kerang, seafood, hati, daging merah, poultry, pumpkin seeds.

• Menghindari makanan berminyak, bran (kulit padi), brown bread, alkohol dan kopi.

• Lifestyle: olahraga rutin, diet rendah lemak dan kalori, menurunkan kadar insulin dan menghindari stress.

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Pendekatan Cina

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• Studi di cina mendapatkan etiologi dan hubungan antara organ zhangfu dengan kerontokan rambut, khususnya ginjal.

• Teknik akupuntur dapat memperbaiki kerontokan rambut mekanisme belum sepenuhnya dipahami.

• Titik akupuntur pada meridian paru-paru detoksifikasi dan regulasi sistem endokrin.

• Titik meridian ginjal mengatur sistem endokrin dan sistem genitounarius.

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• Ginjalsex drive, fertility, reproduction, growth, nerve function, memory, bone production, urination, and will power.

• Strong kidneys also express abundance of thick, lustrous, and colorful head hair.

• If kidneys are not working optimally (either by a deficiency or obstruction) the patient will encounter alopecia or premature hair loss.

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• In 1997, Emil Ilieve et al investigated a link of auricular tenderness to pathology of the body and a rapid indication for the cause of hair loss.

• Its consisted of 120 patients with androgenetic alopecia (109 male and 11 female). The aim was to investigate bilateral auricular points in those with alopecia and to determine the therapeutic effects of treating tender ear points.

• Results showed participants had different combinations of tender ear points but that different specific groups of ear points were routinely found in the majority of participants.

• One participant noted a reduction in hair loss from 150 to 60-70 hairs per day after a series of 15 treatments

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• A study by Jiang et al emphasizes that hair loss is an effect of the following three conditions: (1) an excess of heat/fire giving rise to wind; (2) qi and blood stasis in the local channels and collaterals that lead to blockage and malnourishment of the hair; and, (3) deficiency of qi, blood, and essence failing to nourish the hair.

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• Heat/fire is caused from depressed emotions or excessive consumption of hot and spicy foods that can generate heat in the blood which if exuberant can generate wind. The upward rising of wind leads to a malnourishment of the scalp by blood and yin, which causes hair loss.

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• Qi and blood stasis is caused from liver qi stagnation, physical trauma to the head or chronic disease entering the collaterals that can all cause local or systemic qi and blood stasis in the channels and collaterals resulting in blood stasis at the hair pores.

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• Qi, blood, essence deficiency is caused from chronic illness, congenital or acquired weakness of the Kidneys (e.g. poor constitution, frequent childbirth, excessive sexual activity, overwork) that can damage qi, blood and essence (jing) which in turn cannot nourish the hair roots and cause hair loss.

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• Treatment was comprehensive and consisted of several steps including plum-blossom needling, application of fresh ginger to stimulate the hair follicles, stimulating Huatojiaji points, and then applying local treatment.

• Non-scarring alopecia have good prognosis with up to 80% of participants being treated successfully.

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• A study and patent invented by Chun, Pil H. [4] suggests specific and unique acupuncture techniques (with or without electrical stimulation) for the treatment of male and female androgenetic alopecia.

• Chun patented a technique using 12 acupuncture points inserted with double tonification and double sedation techniques and stimulated with electrical current that shows significant results in the regrowth of hair.

• The 12 points include: Zhongfeng (LV 4), Hegu (LI 4), Zhubin (KI 9), Sanyinjiao (SP 6), Qihai (CV 6), Zhongwan (CV 12), Zusanli (ST 36), Taibai (SP 3), Taiyuan (LU 9), Yuji (LU 10), Shaofu (HE 8), and Xingjian (LV 2).

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• Complete statistical analysis was not reported and would be very beneficial in this study.

• If this study and patent can demonstrate an accurate, effective acupuncture treatment plan, independent of race, ethnicity, age, sex, or other clinical manifestations, then it implies that one diagnosis will respond to a “prescriptive” acupuncture treatment.

• This treatment strategy can be the door opener for many people interested in using acupuncture as an effective, low cost, drug- and side-effect-free treatment for medical conditions that are widely encountered.

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CONCLUSION

• The greatest conclusion these studies suggest is that proper education, psychological support, lifestyle, diet, and exercise changes are necessary in the prevention and treatment of androgenetic alopecia.

• The psychological effects of hair loss are significant: ranging from low self-esteem, depression, worry, negative self-image, limited sexual activity, to fearing that your future is out of control and hopeless

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• Western medicine studies focus on treating androgenetic alopecia by lowering the amount of dihydrotestosterone to stop hair loss or regrow hair once it has disappeared with using finasteride and minoxidil.

• The patent and effectiveness of acupuncture diagnosis for androgenetic alopecia is very exciting.

• The link between iron levels in Western medicine and kidney dysfunction in Chinese medicine is very interesting.

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