Androgenic Alopecia

Resumen para el Paciente

¿Está esto autorizado por FDA para este uso?

Not FDA-cleared for androgenic alopecia. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, 2004). Use here is investigational.

¿Qué evidencia existe?

Tier C (investigational). Two small single-arm case series report modest trichoscopic hair-density increases (about 3 to 7 percent) after 6 monthly sessions; there are no randomized controlled trials. Evidence-based options with FDA approval and decades of data are topical minoxidil 2 percent / 5 percent (men and women), oral finasteride 1 mg (men), oral dutasteride (off-label, robust evidence), low-level laser therapy devices, and platelet-rich plasma injections. Hair transplantation is the definitive option for advanced loss.

Riesgos principales

• Bleeding from bite sites on the scalp for 6 to 24 hours after detachment
• Bruising and tenderness over the scalp for 5 to 10 days
• Local skin infection or, rarely, Aeromonas infection
• Allergic reaction to leech saliva (uncommon)
• Temporary telogen effluvium (stress-related shedding) at the application sites
• Cosmetic visible small scars at bite sites
• Wasted time and money if used INSTEAD OF proven minoxidil, finasteride, or transplantation

Quién no debería considerar esto

• Patients with active scalp infection, seborrheic dermatitis, or psoriasis at proposed sites
• Patients within 3 months of a hair transplant procedure
• Patients on anticoagulants, with hemophilia, or with severe anemia
• Patients with undiagnosed hair loss (need to rule out telogen effluvium, alopecia areata, scarring alopecia)
• Patients who have not tried evidence-based first-line therapy (minoxidil for both sexes; finasteride for men)
• Patients with active scalp malignancy or atypical nevi at proposed sites

Qué preguntar a su clínico

• Has my hair loss been confirmed as androgenic alopecia (Norwood scale for men, Ludwig for women)?
• Have I tried topical minoxidil (5 percent) consistently for at least 6 months?
• Am I a candidate for oral finasteride (men) or dutasteride / spironolactone (women off-label)?
• Have I considered low-level laser therapy, PRP, or hair transplantation?
• What is the realistic effect size with leech therapy versus proven options?
• What is the practitioner's experience and Aeromonas-prevention plan?
• What is the cost compared to evidence-based therapy?

Cuándo buscar atención urgente

• Spreading redness, warmth, pus, or red streaks on the scalp (cellulitis)
• Bleeding from a bite site lasting more than 24 to 48 hours
• Fever above 38.0 C / 100.4 F or chills
• Sudden patchy hair loss with smooth bald patches (alopecia areata — needs dermatology evaluation)
• Scalp scarring, redness, or pain with hair loss (scarring alopecia — needs urgent dermatology evaluation)
• Hives, throat tightness, or breathing difficulty