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Actas Dermosifiliogr. 2011 Oct 7.

Scarring Alopecia.

Abal-Díaz L, et al

Abstract

Scarring alopecia refers to a group of disorders of various etiologies that cause permanent hair loss. In this article, we focus on primary cicatricial alopecia, a group of diseases in which the hair follicle is the main target of the inflammatory process. These disorders are currently classified as lymphocytic, neutrophilic, or mixed according to the cells that make up the inflammatory infiltrate. The pathogenesis of the majority of these conditions is not fully understood and they may have similar clinical features, often making it necessary to perform 1 or more skin biopsies in order to reach a diagnosis. Management depends on early and accurate diagnosis and aggressive treatment in some cases in order to prevent follicular destruction and scarring.

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J Med Case Reports. 2011 Nov 30;5(1):557. [Epub ahead of print]

Bupropion for the treatment of fluoxetine non-responsive trichotillomania: a case report.

Rajshekhar B, Y SS.

ABSTRACT:

INTRODUCTION:

Trichotillomania, classified as an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders, is characterized by the recurrent pulling out of one’s hair, resulting in noticeable hair loss. The condition has a varied etiology. Specific serotonin reuptake inhibitors are considered the treatment of choice; however some patients fail to respond to this class of drugs. A few older reports suggest possible benefit from treatment with bupropion.

CASE PRESENTATION:

A 23-year-old Asian woman with fluoxetine non- responsive trichotillomania was treated with sustained release bupropion (up to 450mg/day) and cognitive behavior therapy. She demonstrated clinically significant improvement on the Clinical Global Impression - Improvement scale by week 13. The improvement persisted throughout the 12-month follow-up period.

CONCLUSIONS:

The present case report may be of interest to psychiatrists and dermatologists. Apart from the serotonergic pathway, others, such as the mesolimbic pathway, also appear to be involved in the causation of trichotillomania. Bupropion may be considered as an alternative pharmacological treatment for patients who do not respond to specific serotonin reuptake inhibitors. However, this initial finding needs to be confirmed by well designed double-blind placebo controlled trials.

Edited for hair loss blog

Treat Hair Loss

Dr Proctor’s comment: The Immune cells involved in hair loss due to alopecia areata may be just the opposite of what everyone thought.

Exp Dermatol. 2010 Aug;19(8):e347-9.

An unexpected twist in alopecia areata pathogenesis: are NK cells protective and CD49b+ T cells pathogenic?

Kaufman G, et al

Abstract
Natural killer (NK) cells have become a recent focus of interest in alopecia areata (AA) research. To further investigate their role in an established mouse model of hair loss due to AA, lesional skin from older C3H/HeJ mice with AA was grafted to young C3H/HeJ female mice, and NK cells were depleted by continuous administration of rabbit anti-asialo GM1. As expected, this significantly reduced the number of pure NK cells in murine skin, as assessed by NKp46 quantitative immunohistochemistry. Quite unexpectedly, however, the onset of hair loss in C3H/HeJ mice was accelerated, rather than retarded. NK cell depletion was accompanied by a significant increase in the number of perifollicular CD49b+T cells in the alopecic skin of anti-asialo GM1-treated mice. These findings underscore the need to carefully distinguish in future AA research between pure NK cells and defined subsets of CD49b+ lymphocytes, as they may exert diametrically opposed functions in hair follicle immunology and immunopathology.

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Rev Med Liege. 2010;65(5-6):413-9.

Diagnostic defects and therapeutic set-backs in hair disorders

Piérard-Franchimont C, Quatresooz P, Piérard GE.

CHU du Sart Tilman et Sauvenière, Service de Dermatopathologie, Belgique.

Modisfied and edited for hairloss blog

Abstract

Hair loss, also called hair effluvium is often considered as an ancillary complaint. However, this situation is quite common in both genders. It is part of numerous clinical presentations in internal medicine and dermatology. Obviously, any correlation between a biologic abnormality and hair loss does not prove a relationship of causality. In absence of pathogenic diagnosis and causality criteria, chances are low to control adequately hair effluvium by a treatment given by the whims of fate. In addition, the risk and frequency of therapeutic inertia are increased. When the hair loss is not controlled and/or compensated by regrowth of new hairs, several types of alopecia inexorably develop.

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Rev Med Liege. 2010;65(5-6):413-9.

Diagnostic defects and therapeutic set-backs in hair disorders

Piérard-Franchimont C, Quatresooz P, Piérard GE.

CHU du Sart Tilman et Sauvenière, Service de Dermatopathologie, Belgique.

Modisfied and edited for hai rloss blog

Abstract

Hair loss, also called hair effluvium is often considered as an ancillary complaint. However, this situation is quite common in both genders. It is part of numerous clinical presentations in internal medicine and dermatology. Obviously, any correlation between a biologic abnormality and hair loss does not prove a relationship of causality. In absence of pathogenic diagnosis and causality criteria, chances are low to control adequately hair effluvium by a treatment given by the whims of fate. In addition, the risk and frequency of therapeutic inertia are increased. When the hair loss is not controlled and/or compensated by regrowth of new hairs, several types of alopecia inexorably develop.

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Hair Loss Treatment at the Proctor Clinic

Endocrinology. 2010 May;151(5):2373.

A mouse model of androgenetic alopecia.
Crabtree JS,
Wyeth

Abstract
Androgenetic alopecia (AGA), commonly known as male pattern baldness, is a form of hair loss that occurs in both males and females. Although the exact cause of AGA is not known, it is associated with genetic predisposition through traits related to androgen synthesis/metabolism and androgen signaling mediated by the androgen receptor (AR). Current therapies for AGA show limited efficacy and are often associated with undesirable side effects. A major hurdle to developing new therapies for AGA is the lack of small animal models to support drug discovery research. Here, we report the first rodent model of AGA. Previous work demonstrating that the interaction between androgen-bound AR and beta-catenin can inhibit Wnt signaling led us to test the hypothesis that expression of AR in hair follicle cells could interfere with hair growth in an androgen-dependent manner. Transgenic mice overexpressing human AR in the skin under control of the keratin 5 promoter were generated. Keratin 5-human AR transgenic mice exposed to high levels of 5alpha-dihydrotestosterone showed delayed hair regeneration, mimicking the AGA scalp. This effect is AR mediated, because treatment with the AR antagonist hydroxyflutamide inhibited the effect of dihydrotestosterone on hair growth. These results support the hypothesis that androgen-mediated hair loss is AR dependent and suggest that AR and beta-catenin mediate this effect. These mice can now be used to test new therapeutic agents for the treatment of AGA, accelerating the drug discovery process.

edited for hair loss blod
hair loss treatment hair regrowth

J Am Acad Dermatol. 2010 Jul 7.

Androgenetic alopecia ( pattern hair loss ) and cardiovascular risk factors in men and women: A comparative study.
Arias-Santiago S, et al

Abstract
Numerous studies in recent decades have associated male androgenetic alopecia (AGA) or pattern hair loss with the risk of cardiovascular disease. However, only 3 studies have addressed this association in female patients. Most studies considered the risk of myocardial infarction or mortality as a result of heart disease, without analyzing cardiovascular risk factors. OBJECTIVES: The objectives of this study were to analyze the presence of cardiovascular risk factors included in the Adult Treatment Panel-III criteria for metabolic syndrome, the prevalence of carotid atheromatosis, hormonal (aldosterone, insulin, testosterone, and sex hormone-binding globulin) factors, and acute phase reactant (C-reactive protein, fibrinogen, D-dimers, erythrocyte sedimentation rate) variables in male and female patients with AGA and in a control group, and to analyze differences among the groups. METHODS: This case-control study included 154 participants, 77 with early-onset AGA (40 male and 37 female) and 77 healthy control subjects (40 male and 37 female) from the dermatology department at a university hospital in Granada, Spain. RESULTS: Metabolic syndrome was diagnosed in 60% of male patients with AGA (odds ratio [OR] = 10.5, 95% confidence interval [CI] 3.3-32.5), 48.6% of female patients with AGA (OR = 10.73, 95% CI 2.7-41.2), 12.5% of male control subjects, and 8.1% of female control subjects. Atheromatous plaques were observed in 32.5% of male patients with AGA (OR = 5.93, 95% CI 1.5-22.9) versus 7.5% of male control subjects (P = .005) and 27% of female patients with AGA (OR = 4.19, 95% CI 1.05-16.7) versus 8.1% of female control subjects (P = .032). Aldosterone and insulin levels were significantly higher in the male and female patients with AGA versus their respective control subjects. Mean values of fibrinogen were significantly higher in male patients with AGA, whereas values of fibrogen, C-reactive protein, and D-dimers were significantly higher in female patients with AGA versus their respective control subjects. LIMITATIONS: The study of a wider sample of patients with AGA would confirm these findings and allow a detailed analysis of the above factors as a function of the degree of alopecia or between menopausal and premenopausal women. CONCLUSION: The determination of metabolic syndrome and ultrasound study of the carotid arteries may be useful screening methods to detect risk of developing cardiovascular disease in male and female patients with early-onset AGA and signal a potential opportunity for early preventive treatment. Copyright © 2009 American Academy of Dermatology, Inc.

Edited for hair loss and hair loss treatment blog

Br J Dermatol. 2010 Mar 19

Type 1 interferon signature in the scalp lesions of alopecia areata.
Ghoreishi M, et al

Summary Background: Auto-immune attack of the bulbar region of anagen phase hair follicles by CD8(+) T cells and Th-1 cytokines has been proposed to result in hair loss in alopecia areata. The initiating stimuli are unknown. As interferon alpha therapy may trigger hair loss due to alopecia areata, we propose that type 1 interferons are involved in the induction of disease. Objectives: To compare lesional scalp from patients with hair loss due to alopecia areata to scalp lesions of cutaneous diseases associated with local type 1 interferon related protein expression. Methods: Lesional scalp of patients with alopecia areata, discoid lupus erythematosus, lichen planopilaris and male pattern hair loss was examined by immunohistochemistry for expression of the type I interferon-inducible MxA, the chemokine receptor CXCR3, and the cytotoxic proteins granzyme B and TiA-1. Results: MxA was expressed in the intra-dermal and subcutaneous compartments of the hair follicle including sebaceous glands in inflammatory alopecia areata similar to lesions of cicatricial alopecia (discoid lupus erythematosus, lichen planopilaris) but not in the epidermal compartment of alopecia areata, and not at all in non-inflammatory alopecia areata or androgenetic alopecia. The location of CXCR3 expressing cells correlated with MXA expression. The inflammatory cells around the hair follicle in alopecia areata included a lower number of granzyme B(+) and TiA-1(+) cells compared to cicatricial alopecia and demonstrated predominant TiA-1(+) expression. Conclusions: We demonstrate the expression of type 1 interferon related proteins in the inflammatory lesions of AA. The distribution pattern of the interferon signature and cytotoxicity-associated proteins in hair loss due to alopecia areata differs from cicatricial alopecia.

Hair Loss Treatment at the Proctor Clinic.

J Dermatol Sci. 2010;58:43–54.

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Laminin-511, inducer of hair regrowth, is down-regulated and its suppressor in hair growth, laminin-332 up-regulated in chemotherapy-induced alopecia
Hisayoshi Imanishi

Chemotherapy-induced alopecia (hair loss) occurs frequently in patients using anticancer agents [1]. For example, the incidence of CIA in patients treated with paclitaxel (PTX), docetaxel (TXT) and etoposide (VP-16) is 87.7, 78.4, and 75.7% respectively [2]. These chemotherapeutic drugs are known to lead to hair loss in anagen (anagen effuvium) by inducing apoptosis of hair matrix cells. Previous studies have identified two distinct chemotherapy-induced hair follicle dystrophies, termed the dystrophic catagen and the dystrophic anagen pathways. The dystrophic catagen pathway occurs in response to a higher dose of chemotherapeutic drugs than the dystrophic anagen pathway. Hair follicles that have progressed along the dystrophic catagen pathway exhibit abnormal distributions of melanin pigments. The hair roots in the affected follicles taper off and are without the typical club-shaped morphology. The dystrophic anagen pathway is triggered by lower doses of chemotherapeutic drugs and consequently results in a milder impairment in hair elongation. During the dystrophic anagen pathway the hair shaft is shed and the follicle undergoes a so-called “incomplete recovery”. The follicle regenerates but with a faulty hairshaft and then undergoes a complete catagen-telogen transition to enter a “secondary recovery” phase [9]. In the latter pathway, miniaturization of the hair, atrophy of hair matrix, and abnormality in the distribution of melanin pigments have been observed [8].A number of procedures and reagents have been used in attempts to ameliorate the effects of CIA. These include scalp tourniquets, scalp cooling, scalp hypothermia and treatment with tocopherol and minoxidil. Unfortunately, the success of these treatments is quite limited. Thus, there remains a need for new therapies for patients afflicted with CIA. The development of such new therapies would be facilitated by a better understanding of the molecular mechanisms that underlie hair loss in CIA. To this end we have analyzed the expression of certain extracellular matrix proteins in a mouse model of CIA. In our study, we focused on laminin-332 and -511 since there is accumulating evidence that these laminin heterotrimers are key regulators of hair growth [18]. Specifically, it has been reported that the skin of day 16.5 embryonic mice lacking the á5 subunit of laminin-511 contains fewer hair germs compared to wild type controls. In addition, Gao et al. have presented data indicating that laminin-511 is essential for the transduction of crucial morphogenetic signals that regulate ciliary function and dermal papilla cell maintenance during hair downgrowth. Moreover, we have presented evidence that laminin-511 supports hair growth while laminin-332 antagonizes such effects in an in vitro model [18]. The data we present here indicate that chemotherapeutic agents affect the dynamics of laminin-511 and -332 in the hair growth cycle. Furthermore, our data indicate that intradermal injection of laminin-511 may prevent CIA.

Hair loss treatment

J Cosmet Dermatol.2009;8:83

Pattern hair loss and its treatment in males:
El-Domyati M, et al

Male pattern hair loss is a common disorder of hair, resulting from genetic, endocrine, and aging factors leading to follicular miniaturization. Inflammation is a potential player in this process. AIMS: To study the histopathological and ultrastructural changes occurring in male androgenetic alopecia (AGA) or pattern hair loss. Patients/methods Fifty-five subjects were included in this study. Skin biopsies were subjected to examination, staining for collagen I and ultrastructural study. The frontal balding area showed an increase in telogen hairs and a decrease in anagen/telogen ratio and terminal/vellus hair ratio. Follicular inflammation was almost a constant feature and showed a significant inverse correlation with perifollicular fibrosis. Follicular inflammation plays a role in pattern hair loss in early cases. Over time, thickening of perifollicular sheath takes place due to increased deposition of collagen. This produces fibrosis, and sometimes complete destruction of the affected follicles in advanced cases of hair loss.

Edited for Hair regrowth blog

Hair loss treatment and hair regrowth

The therapeutic effect of the enzyme inhibitors on the treatment of androgenetic alopecia ( male pattern hair loss ) such as finasteride, is proven. in this study, serial measurements of hair count and terminal hair increase showed that increasing in total hair count and terminal hair regrowth in both treatment groups was significant. The total hair in both groups demonstrated significant regrowth differences between first referral and 6 months after treatment, this indicates the therapeutic efficacy of both drugs in hair loss. The regrowth of terminal hairs in finasteride gel group was always more than the finasteride tablet group, until third month of therapy. However, hair regrowth was similar in both groups during the fourth month of treatment. At 5 th and 6 th months, the terminal hair counts were more in the group who were receiving tablets, thus explaining the efficacy of the tablet during treatment….”

edited for hair loss and hair regrowth and hai rloss treatment blog

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April 19, 2010 Lab News Daily (edited)

Hair-Regrowth Gene Identified

Leif Carlsson

“Activation of the gene Lhx2 leads to increased hair regrowth. This is shown by Leif Carlsson’s research team at Umeå Univ. in an article in the latest Web edition of the respected scientific journal PLoS Genetics. The findings partly refute earlier research results in the field. snip….

After the regrowth phase, hair formation ceases, and the follicle recedes and enters a period of rest. After a period of rest, a new growth period starts, and the old hair is ejected and lost from the body. The reason for this complex regulation of hair growth is not understood, but it has been suggested that it makes it possible to adjust hair growth to the season.

In the present study Carlsson’s research team identifies the transcription factor Lhx2 as an important regulator of hair formation. The Lhx2 gene is active during the hair follicle’s regrowth phase and is turned off during the resting period. The scientists have been able to show that Lhx2 is functionally involved in the formation of hair, as hair follicles in which Lhx2 has been inactivated cannot produce hair. Moreover, the activation of the Lhx2 gene in hair follicles has been shown to activate the regrowth phase and hence the formation of hair. Thus, Lhx2 is a gene that is important for the regulation of hair regrowth.

In contrast to previously published research findings from other teams of scientists, Leif Carlsson and his colleagues found that Lhx2 is primarily expressed outside the so-called bulge region of the hair follicle, where the follicle’s stem cells are found. The Umeå researchers have also shown that Lhx2 is necessary for the hair follicle’s growth (anagen) phase to proceed and for the hair follicle’s structuring. Moreover, transgenic expression of Lhx2 after birth is sufficient to activate the growth phase and stimulate hair regrowth.

These findings allow for an alternative interpretation of the function of Lhx2 in hair follicles compared with previous results. Lhx2 is expressed periodically, primarily in precursor cells that are distinct from the cells in the bulging region of the follicles. It is a factor that is necessary for hair to be formed and to regrow. “

Bimatoprost in the treatment of eyelash hair loss.
Law SK.

hair loss treatment blog

Eyelashes hypotrichosis is indicated by an inadequate regrowth of eyelash hair. Hypertrichosis of eyelashes,snip…Recently, the US Food and Drug Administration approved Latisse(®) (bimatoprost 0.03% solution), identical to the ophthalmic solution for glaucoma treatment, for increasing eyelash hair length, thickness and darkness in patients with hypotrichosis of the eyelashes. When prostaglandin and prostamide analogs interact with the prostanoid receptors in the hair follicle, this most likely stimulates the resting follicles (telogen phase) to growing follicles (anagen phase). Prostaglandin and prostamide analogs may also prolong the anagen phase of eyelashes, leading to an increase of eyelash length. Although bimatoprost is effective in promoting increased regrowth of healthy eyelashes and adnexal hairs, its effectiveness in patients with eyelash hair loss due to alopecia areata is debatable and its protective effect is not yet studied in patients with eyelash hair loss from radiation or chemotherapy….. However, other ocular or systemic side effects associated with ophthalmic prostaglandin and prostamide analogs may occur when instilled on the surface of the eye, and patients must be informed and monitored.

Med Hypotheses. 2009 Dec;73:1035.

The most efficient follicular regenerating unit and the smallest follicular regenerating unit: potential treatments for hair loss.

Wang S, et al

Abstract
Hair loss affects many people, especially adult males. An effective treatment is hair transplantation which involves harvesting hair grafts from a donor site and relocating them to a bald site. However, this traditional method, equivalent to one-to-one transplantation, simply redistributes hair rather than increases the number of existing hairs. Although hair transplantation is actually the transplantation of hair follicle (HF), it has been confirmed that whole HFs could be reformed from parts of HFs containing different constituents, implying the existence of more efficient and smaller HF regenerating units in a whole HF. Thus we hypothesize that the most efficient follicular regenerating unit (EFRU) and the smallest follicular regenerating unit (SFRU) could be found in whole HFs. As a result, the one-to-many hair transplantation would be achieved in clinic. One-to-many means to double or triple the number of hairs. In order to test and verify the hypothesis, we design a method called hair follicle micro-dissection (HFM) which aims to help find the regenerating units and increase the number of hair for transplantation. The postulation may provide a more mature and realistic treatment for hair loss if it proved to be practical.

key words: hair loss hair regrowth minoxiidl finasteride propecia hair treansplantation

FASEB J. 2009 Dec 21.

Identification of novel hair-regrowth inducers by means of connectivity mapping.

Ishimatsu-Tsuji Y,et al

The aim of this study was to identify novel inducers of hair regrowth using gene expression profiling at various stages of hair-growth induction. First, we analyzed gene expression at the onset of hair growth in mice induced by cyclosporin A (CsA), a well-known hair-growth inducer, using DNA microarray analysis. The results unveiled genes involved in the step-by-step progression of hair regrowth, including increases in melanin biosynthesis and decreases in immune response at d 2 and the subsequent stimulation of cell proliferation at d 4, followed by the up-regulation of hair specific keratins at d 7 after CsA treatment. With the use of the connectivity map (Cmap), agents that had a similar “gene signature” to that of the profiles of CsA-treated mice were identified. Several agents, including CsA, were identified by the Cmap and were evaluated for hair induction activity in vivo. One of the proposed agents, fluphenazine (from the d 2 signature) actually induced hair growth in vivo, and the subsequent application of 5 mM iloprost (from the d 4 signature) significantly enhanced the hair-growth effect of fluphenazine. From these results, Cmap analysis was proven to be a useful method that connects gene expression profiles of complicated biological processes, such as hair-regrowth induction, to effective agents for hair loss treatment.

Edited for hair loss treatment and regrowth blog

Clin Genet.2009;76:332
Hereditary hair loss and the ancient signaling pathways that regulate ectodermal appendage formation.

Van Raamsdonk CD.

Epidermal appendages such as hair, teeth, and nails, begin with ectodermal thickening. This placode arises from a primary induction signal sent from the underlying mesenchyme to the overlying epidermis. In mammals, the precise arrangement of hair follicles is due to the amount and distribution of signals that promote and inhibit hair placode formation. Continued development of a hair follicle after placode formation requires a complex cross-talk between the mesenchyme and epidermis. Here, I will review recent studies in humans and mice that have increased our understanding of the role of these signaling pathways in normal development and in hereditary hair loss syndromes. The study of normal hair development and regrowth may suggest ways to restore or eliminate hair and might identify possible targets for the treatment of basal cell carcinoma, a cancer which strongly resembles embryonic hair follicles.

Biol Trace Elem Res. 2010 Jan 5

Fluorine-Induced Apoptosis and Lipid Peroxidation in Human Hair Follicles In Vitro.
Wang ZH, et al

edited for hair loss treatment blogs

Fluoride is an essential for human body; however, exposure to high amounts of fluoride is correlated with hair loss. To date, little is known about the mechanism(s) of how fluoride affects hair follicles. Here, we demonstrated that sodium fluoride (NaF) significantly inhibited hair regrowth, but low NaF showed little influence. Moreover, treatment with high levels of NaF resulted in a marked increase in terminal dUTP nick end labeling-positive cells in the outer layer of the outer root sheath, the dermal sheath, and the lower bulb matrix surrounding dermal papilla. Furthermore, the enhanced apoptosis was coupled with an increased oxidative stress manifested as higher malondialdehyde content. Additionally, the presence of selenium considerably antagonized the effects of middle NaF on hair follicles, with regard to either the suppression of hair regrowth or the induction of oxidative stress and apoptosis. In conclusion, exposure to high levels of fluoride compromises hair regrowth…. .

Clin Interv Aging. 2006 June; 1(2): 121¨C129.

Pharmacologic interventions in aging hair
Ralph Trieb

Edited exerpt

Photoprotection of hair and scalp

…. Topically applied UV protectors may offer the best way to protect skin against sunburn and the chronic pathologic effects of UVR. Their use on the hair-bearing scalp is problematic, unless complete baldness is present. Although hats provide the best protection of the scalp from UVR, not all patients find them convenient or acceptable for this purpose. While protection of the hair against photodamage has been extensively studied, there are no data on photoprotection of the hair-bearing scalp. It has been found that hair dyes may protect hair against photodamage; recent experimental work indicate that cinnamidpropyltrimonium chloride, a quaternized UV absorber, delivered from a shampoo system, is suitable for photoprotection of hair, while simultaneously providing an additional conditional benefit on hair; and solid lipid nanoparticles have been developed as novel carriers of UV blockers for the use on skin and hair, while offering photoprotection on their own by reflecting and scattering UVR. Finally, systemic photoprotection has been the focus of more recent investigation, in as much as this would overcome some of the problems associated with the topical use of sunscreens: Preclinical studies illustrate photoprotective properties of supplemented antioxidants, particularly beta-carotene (pro-vitamin A), ¦Á-tocopherol, and L-ascorbate (vitamin C). snip…Recent advances in the care of aging hair and scalp are anti-aging compounds. Due to water dilution and short contact time, anti-aging compounds do not have any effect in shampoos….snip..

…..In the course of hormonal anti-aging protocols containing recombinant human growth hormone at the Palm Springs Life Extension Institute, Chein (1998) reports improvement of hair thickness and structure in 38% of patients, in some cases darkening of hair, and in few increased hair regrowth. It is noteworthy that in primary growth hormone insensitivity, hair growth, and hair structure (but not hair color) have been shown to be impaired.

Dr Proctor’s note: We discovered and patented the hair-regrowth stimulating effects of antioxidants decades ago.

J Eur Acad Dermatol Venereol. 2009

Latanoprost in the treatment of eyelash hair loss in alopecia areata universalis.

Modified and edited for hair loss treatment blog

Coronel-Pérez IM, et al

Abstract Objectives The aim of this study was to test the efficacy of latanoprost in eyelash alopecia areata (AA). Design This study is a 2-year prospective, non-blinded, non-randomized, bilateral eyelash alopecia controlled study. Setting The setting of this study was Trichology Unit, Virgen Macarena University Hospital, Seville, Spain. Patients We conducted a survey of 54 subjects with AA universalis treated with the protocol of the Trichology Unit of our Department.
Control group comprised 10 subjects who received injections of 0.5 mg/cm(2) of triamcinolone acetonide (TAC) in their eyebrows and 1 mg/cm(2) of TAC injections in affected scalp. The treatment group included 44 subjects who received the same treatment as the control group in scalp and eyebrows but they also applied a drop of latanoprost 0.005% (50 mug/mL) ophthalmic solution in their eyelid margins every night. Subjects were reviewed every 3 months for 2 years. Results Forty subjects finished the study and four subjects were lost to follow-up. In the treatment arm of this study, the course was well tolerated and uncomplicated. Both investigators and patients evaluated the regrowth. The results we obtained were: complete hair regrowth in 17.5%, moderate regrowth in 27.5%, slight regrowth in 30% and without response in 25%. Moderate and total hair regrowth constituted a cosmetically acceptable response. The treatment was continuous and the response remained without any side effects. No patients had cosmetically acceptable eyelash regrowth in the control group. Conclusions Latanoprost may be an effective drug in the treatment of eyelash AA because it induces acceptable responses (total and moderate) in 45% of the patients. A formal, blinded prospective unilateral controlled study will permit further understanding about this promising therapeutic agent for eyelash AA.

Modified and edited for hair loss treatment blog

Curr Opin Otolaryngol Head Neck Surg. 2009;17:287

edited for conciseness.

An update on hair restoration therapy.
Lee TS, Minton TJ.

This study is aimed towards clinicians involved in hair restoration. We review recent literature on this topic. RECENT FINDINGS: Recent studies discussed in this article focus on various aspects of follicular unit transplant surgery, including hairline design and associated complications. In addition, a relatively new surgical technique termed follicular unit extraction (FUE) is discussed. Larger series in FUE have recently been published, adding to the growing body of literature on this technique. SUMMARY: Follicular unit strip surgery continues to be the gold standard of hair replacement technique. FUE has been used by several authors with success and further refinements may increase its utility in hair restoration surgery.

edited for hair loss blog

Arch Dermatol Res. 2006;298:131

Induction of cellular immunity against hair follicle melanocyte causes hair loss.
Nagai H, et al

Hair loss due to Alopecia areata is an autoimmune disease. Although it has been hypothesized that the autoimmunity is mediated by T cells and that hair follicle melanocyte is one of the targets, definitive evidence is lacking. We here demonstrate that AA-like lesions can be induced in mice by inducing CD8(+) T-cell-mediated immunity to hair follicle melanocytes. We found that hair loss was induced in mice-bearing interleukin-12-producing B16 melanoma cells by the depletion of CD4(+) T cells, accompanied by vitiligo-like coat color change. The alopecic lesions varied in size from pachy to extensive. In many instances, hair loss developed and was followed by the regrowth of white hairs. Histological analysis revealed that mononuclear cells infiltrated in and around the bulb region of hair follicles. Furthermore, immunohistochemical examination clearly showed the intra-follicular infiltration of CD8(+) T cells. Neither the vitiligo-like coat color nor AA-like lesions were induced when CD8(+) T cells were codepleted. These observations indicate that the induction of CD8(+) T-cell-mediated immunity against hair follicle melanocytes causes alopecia. It is thought that there are many types of AA with different mechanisms, targets etc. Although hair follicle melanocytes have long been thought to be one of the targets of AA, evidence to support the hypothesis is sparse. Therefore, we believe that our observation is significant to support the hypothesis.

Proc Natl Acad Sci U S A. 1988;85:7739

Evidence that the effector mechanism of skin allograft rejection is antigen-specific.
Rosenberg AS, Singer A.

edited for hair loss blog

In vivo rejection responses are initiated by specific T-cell recognition of foreign antigens…., but it is not certain if the effector mechanism mediating the actual tissue injury is also antigen-specific. snip… Trunk skin from B6 in equilibrium with A/J allophenic mice was grafted onto immunoincompetent mice and allowed to heal and regrow hair that was both black and white, reflecting the genetic mosaicism of the allophenic grafts. One month after engraftment, the H-2b nude animals were reconstituted with syngeneic H-2b T cells reactive against H-2a allodeterminants. An obvious rejection response ensued involving antigen-nonspecific inflammatory destruction of the epidermis and complete hair loss. Despite the intensity of the nonspecific inflammatory response, the foreign skin grafts survived. Importantly, the allophenic grafts regrew hair and the predominant color of that hair was black, providing visual proof that syngeneic B6 melanocytes and hair follicle cells had not been destroyed. Thus, these results demonstrate that although the intense inflammatory component of skin graft rejection responses is capable of damaging superficial epidermal cells nonspecifically, it does not cause rejection of skin allografts. Rather, rejection of skin allografts is mediated by antigen-specific effector T cells that assess individual cells within the dermis of the graft for expression of foreign histocompatibility antigens.

Link: http://www.drproctor.com

Hair Loss Treatment at the Proctor Clinic

J Am Acad Dermatol. 2009;6:592.e1-9.

Comparison of topical bexarotene 1% gel for alopecia areata.

Talpur R, et al

Alopecia areata, hair loss caused by T-cell infiltrates, is refractory to therapy. Bexarotene, a retinoid X receptor is a selective retinoid, induces T-cell apoptosis. OBJECTIVE: We sought to determine the safety, including the dose-limiting toxicities with adverse events, and efficacy, ie, response rate, of bexarotene in alopecia areata. METHODS: We conducted a trial of 1% bexarotene gel applied twice daily for 6 months. RESULTS: In all, 42 patients with alopecia totalis , alopecia universalis, or alopecia areata applied 1% bexarotene gel for 24 weeks. Five of 42 had 50% or more partial hair regrowth on the treated side, and 6 of 42 on both sides including 3 complete responders. In all, 31 patients had mild irritation; 4 had grade-3 irritation. LIMITATIONS: This design cannot differentiate between drug-induced and spontaneous regrowth. Topical bexarotene 1% application is well tolerated and possibly effective. A randomized placebo-controlled trial should be conducted.

Exp Dermatol. 2008;17:793

The C3H/HeJ mouse and DEBR rat models for alopecia areata…

Jing Sun, M.D., et eal

The C3H/HeJ inbred mouse strain and the Dundee Experimental Bald Rat (DEBR) strain spontaneously develop hair loss due to adult onset alopecia areata (AA), a cell mediated disease directed against actively growing hair follicles. The low frequency of AA and the inability to predict the stage of AA as it evolves in the naturally occuring C3H/HeJ model of AA can be converted into a highly predictable system by grafting full thickness skin from AA affected mice to normal haired mice of the same strain. The rat DEBR model develops spontaneous AA at a higher frequency than in the mouse model but they are more expensive to use in drug studies due to their larger size. Regardless of the shortcomings of either model, these rodent models can be used succesfully to screen novel or approved drugs for efficacy to treat human AA. Since the pathogenesis of AA follows the canonical lymphocytic co-stimulatory cascade in the mouse AA model, it can be used to screen compounds potentially useful to treat a variety of cell mediated diseases. Efficacy of various agents can easily be screened by simply observing the presence, rate, and cosmetic acceptability of hair regrowth. More sophisticated assays can refine how the drugs induce hair regrowth and evaluate the underlying pathogenesis of AA. Some drugs commonly used to treat human AA patients work equally as well in both rodent models validating their usefulness as models for drug efficacy and safety for human AA.

Keywords: alopecia areata, hair loss treatment, animal model, review, diphenylcyclopropenone, squaric acid dibutyl esterase,

Alopecia areata targets hair follicles in the actively growing (anagen) phase of the hair cycle. It is often associated with other systemic cell mediated diseases (2)…..Human AA involves patchy hair loss from any hair-bearing region of the body that may progress to total body hair loss. AA may wax or wane on different sites, or the same site, or frequently it will spontaneously resolve with no treatment. AA most commonly affects the scalp but other body regions may also be affected. Extensive or total hair loss involving the scalp is termed alopecia totalis. AA affecting sites in addition to the bald scalp is termed AT/AU or alopecia universalis (AU) if the entire body is affected. This spontaneous, patchy, potentially reversible, non-scarring, hair loss has been the focus of medical research for over 100 years. Only recently however, with access to many new biomedical and molecular tools, have efforts been made to clarify the pathogenesis, and treatment of hair loss due to alopecia areata.

Changing trends in hair restoration surgery

Mysore Venkataram

edited exerpt: “…The term androgenetic alopecia (pattern baldness) has evolved from its dependence on the twin factors of androgens and genetic background. Pattern hair loss is probably multifactorial and may be inherited as an autosomal dominant trait with variable penetrance. The responsible genes have not yet been identified.

Although the term is used for both males and females, there are considerable differences between the sexes. Male pattern alopecia (hair loss) often presents in the first decade after puberty and is characterized by deep bitemporal recession and balding of the vertex, whereas female pattern hair loss is more diffuse, without bitemporal recession.

It is doubtful whether the hair loss seen in women is primarily androgen dependent and it is possible that several other factors may be responsible; hence the term ‘female pattern hair loss (FPHL)’ is preferred to the term androgenetic alopecia when referring to women with this type of alopecia. One noteworthy feature in both female and male pattern hair loss is that occipital scalp is spared of this process and the hairs in this region persist for life…”

Can Vet J. 2009;50:511

Hair loss in a blue Doberman pinscher crossbreed
Roberta Perego, et al

..A blue Doberman pinscher crossbreed was presented…because of progressive coat abnormalities, in particular, flank alopecia (hair loss ) and pruritus. The dog had not been vaccinated regularly or exposed to antiparasitic prophylaxis. snip… Until the appearance of the first dermatological clinical signs, the dog had had no previous history of illness. The changes in the dog’s skin, in particular a bilaterally symmetrical loss of hair with pruritus on the flanks, had been seen from about 18 mo of age. Oral antibiotic therapy with amoxicillin/clavulanate (Synulox; Pfizer Italia Srl., Latina, Italy), 25 mg/kg bodyweight (BW), PO, q12h for 3 wk had resulted in a partial resolution of the pruritus, without improvement in the density of the coat.

Ferrous Ferric Chloride Stimulates the Skin Cell Function and Hair Growth in Mice

Tomohisa Hirobe

It is not known whether FFC stimulates the proliferation and differentiation of mammalian skin cells as well as hair regrowth in vivo. To answer this question, FFC-containing skin lotions (FFC Super Essence Plain® and Moisture® Type, Akatsuka Co.) were painted on the dorsal skin of newborn C57BL/10JHir (B10) mice and tested for their proliferation- and differentiation-stimulating effects on keratinocytes, fibroblasts, and melanocytes as well as for their stimulating effects on the hair growth. This treatment stimulated the proliferation and differentiation of epidermal keratinocytes, dermal fibroblasts, and epidermal and dermal melanocytes in the skin as well as hair regrowth. From 2 to 3 weeks after birth B10 mice generally lose their hairs except those on the head at the telogen stage of the hair growth cycle. The treatment with FFC inhibited the alopecia hair-loss. FFC can stimulate hair regrowth, and, in addition, can inhibit the alopecia hair-loss.

Edited for hair loss treatment blog

Hair loss blog

Dr Proctor treats hair loss

Pediatr Dermatol.2009;26:547

308-nm excimer laser for the treatment of alopecia areata in children.
Al-Mutairi N.

Alopecia areata (AA) is a common skin disease which is characterized by nonscarring localized or diffused hair loss. In this study we assessed the efficacy of 308-nm Excimer laser in the treatment of alopecia areata in children. A total of 9 children with 30 recalcitrant patches alopecia areata and two children with alopecia areata totalis were enrolled in this study which included seven male and four female patients, aged between 4 and 14 years and the durations of their disease were between 7 and 25 months. snip… Only four patients with scalp lesions showed a recurrence of hair loss after 6 months post laser treatment. So, 308-nm Excimer laser is considered an effective safe treatment option for patchy alopecia areata in children.

Edited for blog use

Clin Pharm. 1987;6:386

Topical minoxidil treatment for hair regrowth.

Rumsfield JA, et al

The pathogenesis of hair loss, the postulated mechanisms of minoxidil action on hair regrowth, and clinical trials, …snip… Improved hair growth occurred after four to six months of therapy; twice-daily treatment seems to be indicated. …. in androgenetic alopecia (male-pattern baldness),…(and) For alopecia areata, which involves hair loss on the body or scalp, usually patchy and of sudden onset, no reliable treatment has been found, although minoxidil treatment may be efficacious in some patients. Minoxidil has generated new interest in hair-loss research. The etiology of hair loss must be better understood before more effective treatments can be designed.

Evid Based Complement Alternat Med. 2009

Inhibition of Inflammatory Gene Expression in Keratinocytes Using a Composition Containing Carnitine, Thioctic Acid and Saw Palmetto Extract.
Chittur S, et al

Chronic inflammation of the hair follicle (HF) is considered a contributing factor in the pathogenesis of androgenetic alopecia (AGA) or pattern hair loss. Previously, we clinically tested liposterolic extract of Serenoa repens (LSESr) and its glycoside, beta-sitosterol, in subjects with AGA and showed a highly positive response to treatment. In this study, we sought to determine whether blockade of inflammation using a composition containing LSESr as well as two anti-inflammatory agents (carnitine and thioctic acid) could alter the expression of molecular markers of inflammation in a well-established in vitro system. Using a well-validated assay representative of HF keratinocytes, specifically, stimulation of cultured human keratinocyte cells in vitro, we measured changes in gene expression of a spectrum of well-known inflammatory markers. Lipopolysaccharide (LPS) provided an inflammatory stimulus. In particular, we found that the composition effectively suppressed LPS-activated gene expression of chemokines snip..associated with pathways involved in inflammation and apoptosis. Our data support the hypothesis that the test compound exhibits anti-inflammatory characteristics in a well-established in vitro assay representing HF keratinocyte gene expression. These findings suggest that 5-alpha reductase inhibitors combined with blockade of inflammatory processes could represent a novel two-pronged approach in the treatment of AGA with improved efficacy over current modalities.

J Am Acad Dermatol. 2009;61:529

Melanocytes: a possible autoimmune target in alopecia areata.

Trautman S, et al

Blog notes: Hair loss in alopecia areata often involves depigmentation of hair in the affected area.

J Dermatol. 1991;18:714

Hair regrowth on nude mice due to cyclosporin A.
Watanabe S, et al

One of the most common dermatological side effects of cyclosporin A is increased hair regrowth. Similar hair regrowth was noted in nude mice….. The aim of the present study was to further investigate the stimulation of hair growth on nude mice not only by oral administration of CsA but also by topical and subcutaneous administration of CsA. Young BALB/c female nude mice were treated for 3 or 4 weeks with … applications of CsA dissolved in olive oil at various doses. The hair of CsA-treated mice appeared to regrow from 7 days after the treatment, even at low doses. Induced hair growth was dose-dependent and became clearly obvious 3 weeks after the treatment. The stimulation of hair growth was not restricted to the site of topical application. The distribution of the new hair depended on the natural pattern of hair growth in the mice. However, there was no hair regrowth in the control mice which were given only olive oil. snip… The hair growth in the CsA-treated mice stopped after cessation of the treatment…Subsequent retreatment with CsA resulted in further regrowth of the hair.

edited

This is not really related much to hair loss treatment. However, Dr. Proctor and his coworkers developed the first organic semiconductor electronic device. This “gadget is now on the exclusive “Smithsonian chips” list of historic semiconductor devices and othe material related to the development of modern semiconductors and integrated circuits.

Aesthetic Plast Surg.2005;29:325

Extensive traction alopecia (hair loss) attributable to ponytail hairstyle and its treatment with hair transplantation.
Ozçelik D.

PMID: 16044234

Clin Endocrinol (Oxf). 1990 Jan;32(1):1-12.

Plasma C19 steroid sulphate levels and indices of androgen bioavailability in female pattern androgenic alopecia.
Montalto J,et al

Female pattern androgenic alopecia (pattern hair loss) is a relatively common endocrine abnormality in premenopausal women. … snip… The nature of the hyperandrogenism associated with AA may thus only be revealed by a comprehensive plasma androgen and androgen sulphate profile, which may explain apparently aberrant data for a given patient. In addition, 5-ADIOL-S and 3 alpha-DIOL-S may serve as excellent plasma markers of both the existence of the disorder and the efficacy of hair loss treatment.

J Drugs Dermatol. 2009;8:758

Alopecia areata treated with efalizumab: a case with significant hair regrowth after long-term therapy.
Smith JR, et al

Efaluzimab has recently been described as a treatment for hair loss due to alopecia areata. Conflicting reports and studies have spurred discussion as to whether efaluzimab is an effective treatment of alopecia areata. Proposed mechanisms for this immune-modifying agent have suggested that efficacy is derived from efaluzimab’s effects on T cells. However, a recent molecular study found no alteration in T cell action around hair follicles at six months of treatment and thus the study concluded that efaluzimab was not an effective hair loss treatment. This article describes a nine-year-old male with recalcitrant alopecia totalis for seven years who had been nonresponsive to therapeutic intervention. He was started on efaluzimab for severe atopic dermatitis and began to regrow scalp hair at one year of treatment. This discussion suggests that longer treatment durations may be needed for hair regrowth to be seen in some patients.

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LOPEZ B., Contribution on the etiopathogenesis and treatment of alopecia areata. I. Introduction; clinical examination data and determination of basal metabolism. Actas Dermosifiliogr.1951;42:589-604.

Dr Proctor comments: an early paper on the treatment of hair loss due to alopecia areata.

Link: http://www.drproctor.com

Dermatol Surg. 2009 Aug 5

Contemporary Hair Transplantation.

Avram M, Rogers N.

BACKGROUND The field of hair transplantation surgery has evolved considerably over the last quarter century. Performed correctly, the cosmetic results of contemporary hair transplantation are virtually undetectable in women and men. Large, pluggy “punch grafts” have been replaced with natural-appearing follicular unit grafts, which maintain their existing anatomy and with proper technique can match the orientation of surrounding hair follicles. OBJECTIVE To review all of the steps involved in hair transplantation surgery and to provide an overview of medications used in conjunction with transplantation to help prevent hair loss. MATERIALS, METHODS, AND RESULTS The authors review key aspects of the consultation, physical examination, selection of appropriate candidates, excision of donor area, hairline design, graft creation and placement, and postoperative instructions. The role of medications such as minoxidil and finasteride in preventing ongoing hair loss is an essential part of the treatment plan. For nonsurgical candidates, other treatments such as wigs, hairpieces, and camouflages are reviewed. Future trends may involve the use of low-level laser light therapy, dutasteride, and cloning of follicles. CONCLUSION Patients and physicians alike are pleased with the results of contemporary hair transplantation, and physicians can now recommend the procedure without reservation. The authors have indicated no significant interest with commercial supporters.

slingtly edited for hair loss blogspot

Lymphokine Cytokine Res.
IL-1 alpha inhibits human hair regrowth

edited for blog use

We investigated the effect of IL-1 alpha on hair regrowth and hair fiber production. In the presence of 10 ng/ml IL-1 alpha, the growth of cultured human hair follicles ceased within 2-4 days, whereas control hair follicles grew for a period of 7-10 days. IL-1 alpha also inhibited hair fiber growth, but with an onset which occurred 3 days later than that of follicle regrowth inhibition. ..snip..The selective PKC inhibitor augmented IL-1-induced inhibition of hair regrowth, but did not itself affect hair growth. These findings indicate that IL-1 alpha exerts a rapid antiproliferative effect on hair follicles, and that inhibition of hair fiber growth is a secondary response. Thus, IL-1 may play a role in the pathophysiology of inflammatory hair loss conditions. snip

J Am Acad Dermatol. 2009;61(3):529

Melanocytes: a possible target in alopecia areata.

Trautman S, Thompson M, Roberts J, Thompson CT.

Why hair turns white in hair loss secondary to alopecia areata

Dermatol Clin. 1987;5(3):467

The biology of hair

Ebling FJ.

(edited for hair loss blog)

Hair is a product of small pits in the skin known as hair follicles. The most important feature of hair follicles is that their activity is intermittent; each active phase or anagen is succeeded by a transitional phase (catagen) and a resting phase (telogen), during which the fully formed “club hair” is retained for a period and then shed. The growth of facial, body, axillary, and pubic hair depends on androgens. Facial hair and body hair require high levels of testosterone and its conversion to 5-alpha-dihydrotestosterone. Pubic and axillary hair follicles require much lower levels of hormone, and 5-alpha-reduction appears to be unnecessary. Paradoxically, male pattern hair loss and its female equivalent also require androgen for their manifestation. The differing lengths of hair in the various regions of the body result largely from differences in the duration of anagen hair and only to a small extent from differences in the rates of growth. Some hair loss from the scalp can be characterized in terms of the hair regrowth cycle, and some involves long-term changes in the follicular architecture. Thus postfebrile and postpartum alopecias are telogen effluvia that involve shedding of club hairs, whereas drug-induced hair loss and alopecia areata involve shearing and loss of growing hairs. Male pattern baldness and female diffuse pattern baldness involve gradual shortening of the periods of anagen and shrinkage of the hair follicles over a long term.

J Am Acad Dermatol.Oct;15(4 Pt 1):571

Structural and functional changes of normal aging skin.

Fenske NA, Lober CW.

Solar-induced cutaneous changes are more prevalent and profound in older persons and, thus, are often inappropriately attributed to the aging process, per se. Structural and functional alterations caused by intrinsic aging and independent of environmental insults are now recognized in the skin of elderly individuals. Structurally the aged epidermis likely becomes thinner, the corneocytes become less adherent to one another, and there is flattening of the dermoepidermal interface. The number of melanocytes and Langerhans cells is decreased. The dermis becomes atrophic and it is relatively acellular and avascular…snip… There is a progressive reduction in the density of hair follicles per unit area on the face and scalp, independent of male-pattern alopecia. The hair shaft diameter is generally reduced but in some areas, especially the ears, nose, and eyebrows of men and the upper lip and chin in women, it is increased as vellus hairs convert to cosmetically compromising terminal hairs. Functional alterations noted in the skin of elderly persons include a decreased growth rate of the epidermis, hair, and nails, delayed wound healing, reduced dermal clearance of fluids and foreign materials, and compromised vascular responsiveness. Eccrine and apocrine secretions are diminished. The cutaneous immune and inflammatory responses are impaired, particularly cell-mediated immunity. Clinical correlates of these intrinsic aging changes of the skin include alopecia, pallor, xerosis, an increased number of benign and malignant epidermal neoplasms, increased susceptibility to blister formation, predisposition to injury of the dermis and underlying tissues, delayed onset and resolution of blisters and wheals, persistent contact dermatitis, impaired tanning response to ultraviolet light, increased risk for wound infections, prolongation of therapy necessary for onychomycosis, and thermoregulatory disturbances.

Hair regrowth and hair loss treatment

Curr Probl Dermatol.1983;11:171

A sensitive assay for the enzyme activity in hair follicles and epidermis that catalyses the peptidyl-arginine-citrulline post-translational modification.

Rogers GE, Rothnagel JA.

In 1977, Rogers et al described an enzymic activity in hair follicles that converts arginine to citrulline in situ in proteins. The protein precursor substrate in the hair follicle was identified as trichohyalin in the inner root sheath and medulla. …snip… The possibility of further improvement of the procedure is being investigated, including using other, related substrates. Using the assay, the enrichment and properties of the enzyme are under study in the richly medullated follicles of the guinea pig. The enzyme has an apparent Km of 18 mM for Bz-14C-arg and an absolute requirement for Ca2+ with a broad maximum around 10 mM. It is stable at +4 degrees C and -80 degrees C for at least four weeks and can be freeze-dried with some activity loss.

edited

Hair loss blog

J Toxicol Environ Health. 1977 Dec;3(5-6):859-69.

Alopecia induced by inhalation exposure to phenyl glycidyl ether.

Lee KP, et al

Rats and dogs were exposed to heated phenyl glycidyl ether (310 degrees C) vapor at average levels of 1.3, 5.0, and 11.8 ppm (v/v) for 6 hr/day, 5 days/wk, for 90 days. No adverse effects were observed in the dogs and rats other than alopecia in rats at the dose levels of 5.0 and 11.8 ppm. Microscopically, the skin lesions revealed slight acanthosis, hyperkeratosis, and occasional patchy parakeratosis in the epidermis. Follicular keratin plugs were observed with hyperkeratosis of epithelium in the hair follicles and sebaceous glands. Inflammatory reaction was mainly confined to the perifollicular region and affected the hair follicles, resulting in atrophy. The number of hair follicles in the resting stage appeared to increase. The hair shafts revealed impairment of keratinization and fragmentation. Extracted hairs showed an increase in the number of dystrophic follicles and constricted or broken hair shafts.

Hautarzt. 1992 Aug;43(8):505-8.

Loose anagen hair

Trüeb RM, Burg G.

We report on a 5-year-old girl whose hair could be pulled out with no effort and without causing pain. Occipital alopecia in a patchy pattern and with no sign of scalp inflammation or scarring was noted. A trichogram from the clinically involved area disclosed a striking predominance of anagen hair with absence of external root sheaths. Histological examination of the hair suggests abnormal premature keratinization of the inner root sheath, resulting in the loss of its anchoring function between the hair shaft and the follicle. Zaun first reported this new type of hair loss in children in 1984. The name loose anagen hair of childhood has recently been suggested for this disease. The differential diagnosis includes hair loss due to alopecia areata, trichotillomania, and congenital hypotrichosis.

Br J Dermatol. 1997 Nov;137(5):699-702.

A non-steroidal antiandrogen, on human hair production by balding scalp grafts maintained on testosterone-conditioned nude mice.

De Brouwer B, et al

Human hair regrowth can be monitored for several months after the transplantation of scalp samples from men with androgen-dependent alopecia (hair loss) on to female nude mice. Hair production from balding sites has been shown to be inhibited in testosterone-conditioned nude mice. We used this recently reported model to study the effect of a new non-steroidal antiandrogen-RU58841-on human hair growth. Twenty productive scalp grafts from balding men were maintained for 8 months after grafting on to nude mice, and hair production was monitored monthly for 6 months. All mice were conditioned by the topical application of testosterone (testosterone propionate, 300 micrograms in 10 microL; 5 days/week) on the non-grafted flank. The scalp samples were divided equally according to the estimated hair production potential, which was based on the amount of hair present on the scalp samples before grafting. Each of the two equal groups of grafts was further allocated at random to be treated topically (5 days/week) with blinded solutions of either RU58841 1% in ethanol, or ethanol as a control. Twenty-eight active follicles appeared on the 10 control grafts. Among them only two follicles (7%) initiated a second hair cycle. However, the 10 RU58841-treated grafts bore a total of 29 active follicles, and eight of them (28%) showed a second cycle. The values for the linear hair growth rates (LHGR) were significantly higher in the RU58841-treated group. Recycling and increased LHGR indicate a positive action for RU58841 on human hair growth from balding samples grafted on to testosterone-conditioned nude mice, and encourage a clinical trial to evaluate its potential in the treatment of androgen-dependent alopecia.

hair loss treatment

Int J Dermatol. 1995 Aug;34(8):542-5.

Antismooth muscle and antiparietal cell antibodies in Indians with alopecia areata.

Kumar B, et al.

BACKGROUND: hai rloss in Alopecia areata is suspected to be an autoimmune disease. We studied 104 consecutive patients with alopecia areata for the presence of autoantibodies and associated autoimmune diseases. METHODS: A detailed history and examination was carried out in all patients to look for associated atopy, diabetes mellitus, hypertension, rheumatoid arthritis, vitiligo, lupus erythematosus, and thyroid disorders, etc. in the patients or their family members. Venous blood for estimation of fasting and postprandial blood glucose was collected in 30 patients, especially in those with family history of diabetes mellitus. Antimitochondrial (AMA), antismooth muscle (SMA), antinuclear antibodies (ANA), antiparietal cell antibody (PCA), and antibody against thyroid microsome (TMA) were detected employing indirect immunofluorescence on a composite section of rat liver, stomach, kidney, and human thyroid. Skin biopsy was processed for direct immunofluorescence by a conventional technique. RESULTS: Disseminated discoid lupus erythematosus, lichen planus, urticaria, psoriasis, and seronegative spondylarthritis were associated with alopecia areata in one case each. Antismooth-muscle-antibodies and PCA were found in 36 (34.6%) and 44 (42.3%) patients respectively, followed by TMA in 8 (7.7%), AMA in 6 (5.7%), antithyroglobulin antibodies in 3 (2.8%), and ANA in 2 (1.9%) patients. The incidence of SMA was higher in men with alopecia areata. Direct immunofluorescence carried out in 24 patients did not reveal significant findings, except for occasional immunoglobulin deposits around hair follicles and blood vessels. CONCLUSION: Alopecia areata in India is associated more often with antismooth muscle and antiparietal cell antibodies.

Arch Dermatol. 1992 Oct;128(10):1349

Loose anagen hair as a cause of hereditary hair loss in children.Baden HP,et al

BACKGROUND AND DESIGN–The loose anagen hair syndrome is a recently described disorder with enhanced hair loss in which anagen hairs can be painlessly pulled from the scalp. RESULTS–In three families, we have observed an autosomal dominant form of inheritance. We have confirmed that the extracted bulbs consist only of cortical cells and that the hair shafts have an abnormal shape. Using routine light and electron microscopy, we observed disadhesion between all layers of the follicle and within some layers and premature keratinization of the inner root sheath of the follicle. In addition, abnormal maturation of the various layers was observed at the electron microscopic level, including regions of the cortex that contained decreased numbers of filaments. The disorder appears to be cyclic, since relatively normal and markedly affected regions of the shaft can be observed within a single follicle. CONCLUSIONS–Possible mechanisms responsible for the disease include abnormal intercellular signaling and disturbances of desmosomal components and/or cadherins.

Lab Invest. 1991 Nov;65(5):588-600.

Hairpatches, a single gene mutation characterized by progressive renal disease and alopecia in the mouse.

Shultz LD, et al

A new murine mutation, hairpatches (Hpt), is on chromosome 4, 18.1 recombination units distal to brown near the interferon alpha and beta chain structural gene complex. On the inbred HPT/Le strain background, Hpt is semi-dominant, and Hpt/Hpt mice die in utero by 6 to 8 days of gestation. Such death in utero is associated with abnormalities of embryonic ectodermal derivatives. However on the segregating hybrid background, Hpt is a fully dominant mutation. HPT/Le Hpt/+ mice can be recognized by 3 to 4 days of age by patches of lightly pigmented skin. These mice show reduced numbers of hair follicles, abnormalities in hair follicle structure, and patchy absence of hair throughout life. By 2 weeks of age, abnormal hair follicle development is accompanied by thickening of the epidermis, reduction in levels of subcutaneous fat, and dermal inflammation. Progressive glomerulosclerosis, resulting in chronic kidney failure, is accompanied by increases in glomerular mesangial matrix, deposition of immune complexes, and glomerular enlargement. Scanning electron microscopic studies revealed abnormalities of podocytes including disorganization, swelling, and fusion of the foot processes. Increase in serum blood urea nitrogen levels accompanies conspicuous renal histopathologic changes. Cardiovascular changes in Hpt/+ mice are evidenced by hypertrophy of the left heart ventricle. Increased systolic blood pressure in these animals was found by 3 months of age. Anemia occurs in Hpt/+ mice by 40 weeks. The Hpt/+ mutation provides a valuable new animal model for chronic kidney disease accompanied by skin abnormalities and ventricular hypertrophy. The pathologic changes caused by this mutation are similar to those reported in affected family members with a newly described autosomal dominant human disease.

J Immunol. 1982 Dec;129(6):2673-7.

The effect of hypophysectomy on thymic aging in mice.

Harrison DE, Archer JR, Astle CM.

Surgical removal of the pituitary (hypophysectomy) followed by endocrine supplementation in middle-aged rats has been reported to reverse immunologic decline with age. We attempted to confirm and extend these reports by using a well-defined and readily available mouse model system. Hypophysectomy and endocrine supplementation in 8- to 9-mo-old C57BL/6J (B6) male retired breeder mice improved some, but not all, T dependent immune functions tested at 15 mo of age. In hypoxed mice, spleen cell proliferation in response to phytohemagglutinin (PHA) in vitro, and delayed type hypersensitivity (DTH) responses to sheep red blood cells (SRBC) measured by footpad swelling improved to levels shown by young controls. Direct anti-SRBC plaque-forming cell (PFC) responses by spleen cells, and serum agglutination responses against SRBC were not improved. Hypoxed mice had larger thymuses and much higher ratios of cortex-medulla areas than did age-matched controls. Hair regrowth after shaving was much faster in hypoxed mice. Nevertheless, hypophysectomy reduced mean and maximum longevities. These results conflict in several ways with the previously reported studies in rats, in which direct PFC responses and maximum longevities were improved by this treatment. There have been no previous studies of the effect of hypophysectomy and endocrine supplementation on thymic aging in mice, nor has it previously been reported that this treatment causes improvements in PHA and DTH responses and in thymic morphology. These effects show that at least some aging processes are reversible in aging individuals. They also suggest that hypophysectomy of middle-aged mice will be useful for studying neuroendocrine and thymic interactions that occur during the aging process.

hair loss blogs

Arch Dermatol. 1978 Jul;114(7):1036-8.

Treatment of alopecia areata with dinitrochlorobenzene
.
Daman LA, Rosenberg EW, Drake L.

Persistent refractory alopecia areata in 26 patients was treated topically with dinitrochlorobenzene (DNC. Sixteen patients have had excellent regrowth of hair loss; three patients could either not be initially sensitized or an adequate allergic contact dermatitis on the scalp did not develop. Two patients discontinued therapy within two months; hair regrowth did not develop in five patients despite an adequate trial. Augmentation of the T-lymphocyte pool via DNCB sensitization and challenge may become effective therapy for some patients with severe alopecia areata.

CNS Drug Rev. 2006 Spring;12(1):53-76.

A new look at the 5alpha-reductase inhibitor finasteride.
Finn DA, Beadles-Bohling AS, Beckley EH, Ford MM, Gililland KR, Gorin-Meyer RE, Wiren KM.

Finasteride is the first 5alpha-reductase inhibitor that received clinical approval for the treatment of human benign prostatic hyperplasia (BPH) and androgenetic alopecia (male pattern hair loss). These clinical applications are based on the ability of finasteride to inhibit the Type II isoform of the 5alpha-reductase enzyme, which is the predominant form in human prostate and hair follicles, and the concomitant reduction of testosterone to dihydrotestosterone (DHT). In addition to catalyzing the rate-limiting step in the reduction of testosterone, both isoforms of the 5alpha-reductase enzyme are responsible for the reduction of progesterone and deoxycorticosterone to dihydroprogesterone (DHP) and dihydrodeoxycorticosterone (DHDOC), respectively. Recent preclinical data indicate that the subsequent 3alpha-reduction of DHT, DHP and DHDOC produces steroid metabolites with rapid non-genomic effects on brain function and behavior, primarily via an enhancement of gamma-aminobutyric acid (GABA)ergic inhibitory neurotransmission. Consistent with their ability to enhance the action of GABA at GABA(A) receptors, these steroid derivatives (termed neuroactive steroids) possess anticonvulsant, antidepressant and anxiolytic effects in addition to altering aspects of sexual- and alcohol-related behaviors. Thus, finasteride, which inhibits both isoforms of 5alpha-reductase in rodents, has been used as a tool to manipulate neuroactive steroid levels and determine the impact on behavior. Results of some preclinical studies and clinical observations with finasteride are described in this review article. The data suggest that endogenous neuroactive steroid levels may be inversely related to symptoms of premenstrual and postpartum dysphoric disorder, catamenial epilepsy, depression, and alcohol withdrawal.

Am Fam Physician. 1999 Apr 15;59(8):2189-94, 2196.

Scow DT, Nolte RS, Shaughnessy AF.

Harrisburg Family Practice Residency, PA 17105-8700, USA.

Two drugs are available for the treatment of balding in men. Minoxidil, a topical product, is available without a prescription in two strengths. Finasteride is a prescription drug taken orally once daily. Both agents are modestly effective in maintaining (and sometimes regrowing) hair that is lost as a result of androgenic alopecia. The vertex of the scalp is the area that is most likely to respond to treatment, with little or no hair regrowth occurring on the anterior scalp or at the hairline. Side effects of these medications are minimal, making them suitable treatments for this benign but psychologically disruptive condition.

Clin Dermatol. 1988 Oct-Dec;6(4):159-62.

Animal models of alopecia.

Holland JM.

Section on Pathology and Toxicology Research, Upjohn Company, Kalamazoo, Michigan.

A genetic model of androchronogenic alopecia has yet to be described in the rat or mouse, two of the better characterized species. It may be relevant that the best current animal model of androchronogenic alopecia, the stumptailed macaque, is a primate. The age of onset and the pattern of hair loss closely resemble human male-pattern baldness and morphologically, as well as mechanistically, may be analogous to the corresponding process in humans. Since genetically controlled regional hairlessness is a phenomenon relatively unique to Homo sapiens, it may be too much to expect to find an analogous process among rodents.

Br J Dermatol. 2005 Mar;152(3):466-73.

Treatment of female pattern hair loss with oral antiandrogens.

Sinclair R, Wewerinke M, Jolley D.

BACKGROUND: It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy. OBJECTIVES: To evaluate the efficacy of oral antiandrogen therapy in the management of women with FPHL using standardized photographic techniques (Canfield Scientific), and to identify clinical and histological parameters predictive of clinical response. METHODS: For this single-centre, before-after, open intervention study, 80 women aged between 12 and 79 years, with FPHL and biopsy-confirmed hair follicle miniaturization were photographed at baseline and again after receiving a minimum of 12 months of oral antiandrogen therapy. Forty women received spironolactone 200 mg daily and 40 women received cyproterone acetate, either 50 mg daily or 100 mg for 10 days per month if premenopausal. Women using topical minoxidil were excluded. Standardized photographs of the midfrontal and vertex scalp were taken with the head positioned in a stereotactic device. Images were evaluated by a panel of three clinicians experienced in the assessment of FPHL, blinded to patient details and treatment and using a three-point scale.

RESULTS: As there was no significant difference in the results or the trend between spironolactone and cyproterone acetate the results were combined. Thirty-five (44%) women had hair regrowth, 35 (44%) had no clear change in hair density before and after treatment, and 10 (12%) experienced continuing hair loss during the treatment period. Ordinal logistic regression analysis to identify predictors of response revealed no influence of patient age, menopause status, serum ferritin, serum hormone levels, clinical stage (Ludwig) or histological parameters such as T/V ratio or fibrosis. The only significant predictor was midscalp clinical grade, with higher-scale values associated with a greater response.

CONCLUSION: Eighty-eight percent of women receiving oral antiandrogens could expect to see no progression of their FPHL or improvement. High midscalp clinical grade was the only predictor of response identified. A placebo-controlled study is required to compare this outcome to the natural history of FPHL.

Hair loss and hair loss treatment blog

J Dermatol. 2002 Aug;29(8):489-98.

Comparative efficacy of various treatment regimens for androgenetic alopecia in men.

Khandpur S, Suman M, Reddy BS.

Department of Dermatology and S.T.D., Maulana Azad Meical College and Associated Lok Nayak Hospital, New Delhi, India.

Our understanding of the aetiology of androgenetic alopecia (AGA) has substantially increased in recent years. As a result, several treatment modalities have been tried with promising results especially in early stages of AGA. However, as far as has been ascertained, there is no comprehensive study comparing the efficacy of these agents alone and in combination with each other. One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups. Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair regrowth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.

Br J Dermatol. 2003 Aug;149(2):354-62.

The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial.

Berger RS, et al

BACKGROUND: Recent studies of antidandruff shampoos or tonics containing antifungal or antibacterial agents produced effects suggestive of a potential hair growth benefit. OBJECTIVES: The purpose of this 6-month, 200-patient, randomized, investigator-blinded, parallel-group clinical study was to assess the hair growth benefits of a 1% pyrithione zinc shampoo. The efficacy of a 1% pyrithione zinc shampoo (used daily), was compared with that of a 5% minoxidil topical solution (applied twice daily), a placebo shampoo and a combination of the 1% pyrithione zinc shampoo and the 5% minoxidil topical solution. METHODS: Two hundred healthy men between the ages of 18 and 49 years (inclusive) exhibiting Hamilton-Norwood type III vertex or type IV baldness were enrolled. Total hair counts, the primary efficacy measure, were obtained using fibre-optic microscopy and a computer-assisted, manual hair count method. Secondary measures of efficacy included assessments of hair diameter, as well as patient and investigator global assessments of improvement in hair regrowth. These were based on photographs of the scalp using both midline and vertex views. RESULTS: Hair count results showed a significant net increase in total visible hair counts for the 1% pyrithione zinc shampoo, the 5% minoxidil topical solution, and the combination treatment groups relative to the placebo shampoo after 9 weeks of treatment. The relative increase in hair count for the 1% pyrithione zinc shampoo was slightly less than half that for the minoxidil topical solution and was essentially maintained throughout the 26-week treatment period. No advantage was seen in using both the 5% minoxidil topical solution and the 1% pyrithione zinc shampoo. A small increase in hair diameter was observed for the minoxidil-containing treatment groups at week 17. Assessments of global improvements by the patients and investigator generally showed the benefit of 5% minoxidil. The benefit of the 1% pyrithione zinc shampoo used alone tended to be apparent only to the investigator. CONCLUSIONS: Hair count results show a modest and sustained improvement in hair regrowth with daily use of a 1% pyrithione zinc shampoo over a 26-week treatment period.

Arch Dermatol. 1999 Oct;135(10):1223-6.

Acquired progressive kinking of the hair: clinical features, pathological study, and follow-up of 7 patients.

Tosti A, Piraccini BM, Pazzaglia M, Misciali C.

BACKGROUND: Acquired progressive kinking of the hair (APKH) is a relatively rare condition, with fewer than 20 cases reported in the literature. Whether APKH is a separate entity or a variety of androgenetic alopecia is still controversial. This study reviews the clinical and pathological features and long-term follow-up of 7 patients with APKH. OBSERVATIONS: Since January 1989, we have diagnosed APKH in 7 males aged 15 to 22 years. All patients had strong family history for androgenetic alopecia. Hair kinking affected the frontotemporal region and/or the vertex where the hair appeared curly, frizzy, and lusterless. The pathological features of the affected scalp were consistent with the diagnosis of the early stages of androgenetic alopecia. In all patients, APKH evolved into androgenetic alopecia during the follow-up period. Mean follow-up was 4.5 years (range, 2-9 years). Treatment with topical minoxidil did not prevent development of hair thinning in the scalp areas affected by hair kinking. CONCLUSIONS: The term acquired progressive kinking of the hair encompasses a number of conditions characterized by acquired curling of the scalp hair. Acquired hair kinking on the androgen-dependent areas of the scalp represents a modality of onset of androgenetic alopecia associated with poor prognosis.

Dermatol Surg. 2000;26(6):555-61.

male and female androgenetic alopecia.

Bouhanna P.

edited

Hair Loss Blogs

BACKGROUND: Various classifications of male androgenetic alopecia or “pattern hair loss” are known….. A more objective, accurate, and detailed approach to classifying baldness is needed. OBJECTIVE: To propose a dynamic multifactorial classification of certain parameters that can be quantitated and computerized. METHODS: A multifactorial classification has been developed to study parameters such as fixed distances of the face, scalp mobility and thickness, and covering power of hair. This includes density, caliber, shape, length, growth rate, and hair color.

RESULTS: Classification proved to be efficient during the fluctuations of different parameters in hormonal and minoxidil treatments. It also helps to determine surgical indications of hair transplant and the stage of baldness. CONCLUSION: This approach will lead to a better evaluation of the evolution of androgenetic alopecia in both sexes, either spontaneously or under treatment.

Psychol Rep. 1989 Aug;65(1):323-30.

Why men with hair loss go to the doctor.

Passchier J, Rijpma SE, Dutrée-Meulenberg RO, Verhage F, Stolz E.

Consultations, motives, experience, and attitudes were explored in 201 men with alopecia androgenetica who had two years before shown interest in hair loss treatment using minoxidil. During the past two years, one-third consulted a professional on account of hair loss. General practitioners were consulted by 60% and other professionals by about 75%. The main motive for the consultation was hair treatment, which was offered to half of the consulting subjects. Medical professionals were generally considered to be more suitable than other professionals for consultation on minoxidil treatment. The perceived chance of the treatment being successful and the amount of hair problems experienced seemed more important factors for consulting than the views on the suitability of a professional or the extent of baldness. There were indications that subjects who consulted both general practitioners and other professionals had also more general problems.

Hair Loss Blog

Hair Loss Blog

Clin Exp Dermatol. 1989 Jan;14(1):40-6.

Quantitative assessment of 2% topical minoxidil in the treatment of male pattern baldness.

Rushton DH, Unger WP, Cotterill PC, Kingsley P, James KC.

Forty-seven men with male pattern baldness were treated in a double-blind clinical trial with topical 2% minoxidil or placebo. Twelve were randomly selected for quantitative hair measurement using the unit area trichogram and visual counting. There was no significant difference after 6 or 12 months of treatment with a 2% minoxidil solution for total hair density (THD; hair cm-2), meaningful hair density (MHD; hair greater than 40 microns in diameter greater than 30 mm in length cm-2), per cent of hair in the anagen growth phase, or the per cent of meaningful hair in the anagen growth phase. Significantly fewer hairs were recorded with the visual hair counting method, compared to values obtained from adjacent sites with the unit area trichogram. In addition, a significantly larger mean total hair count was recorded by an experienced observer, compared to an inexperienced observer. Increased pigmentation was observed within the vellus hair population of treated subjects. Our findings indicate that minoxidil appears unlikely to affect the long-term course of male pattern baldness. However, we found no significant deterioration in total hair density, or meaningful hair density in treated subjects, suggesting minoxidil may have a prophylactic effect. Further long-term studies employing the unit area trichogram are required to evaluate this finding.

Formation of hair structures suitable for implantation
Regen Med. 2008 Sep;3(5):683-92.

Hair morphogenesis in vitro: formation of hair structures suitable for implantation.

Qiao J, Turetsky A, Kemp P, Teumer J.

Intercytex, Innovation House, Crewe Road, Manchester, M23 9QR, UK.

AIM: To develop a construct through which implanted follicular cells will efficiently cause hair regeneration for the treatment of androgenetic alopecia.

MATERIALS & METHODS: Follicular dermal and epidermal cells isolated from embryonic mouse skin were formed into aggregates. The aggregates were incubated in culture for 5-7 days and then implanted intradermally into athymic mice. RESULTS: During culture, mixed cell aggregates developed into hair-like structures, termed ‘proto-hairs’. Proto-hairs contained structures that resembled normal hair components, such as dermal papillae, hair matrix and rudimentary hair
shafts. When implanted into mouse skin, they developed further into mature hair follicles capable of prolonged growth. CONCLUSION: Mixed aggregates of murine follicular cells have the ability to develop in culture into proto-hairs that
retain the ability to fully develop into hair follicles after implantation. Proto-hairs from human cells could provide a convenient and practical means by which follicular cells could be implanted for efficient hair regeneration to treat hair loss.

Minoxidil and Pyrithione zinc

Br J Dermatol. 2003 Aug;149(2):354-62.

The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial.

Berger RS, Fu JL, Smiles KA, Turner CB, Schnell BM, Werchowski KM, Lammers KM.

BACKGROUND: Recent studies of antidandruff shampoos or tonics containing antifungal or antibacterial agents produced effects suggestive of a potential hair growth benefit. OBJECTIVES: The purpose of this 6-month, 200-patient, randomized, investigator-blinded, parallel-group clinical study was to assess the hair growth benefits of a 1% pyrithione zinc shampoo. The efficacy of a 1% pyrithione zinc shampoo (used daily), was compared with that of a 5% minoxidil topical solution (applied twice daily), a placebo shampoo and a combination ofthe 1% pyrithione zinc shampoo and the 5% minoxidil topical solution.

METHODS: Two hundred healthy men between the ages of 18 and 49 years (inclusive) exhibiting Hamilton-Norwood type III vertex or type IV baldness were enrolled. Total hair counts, the primary efficacy measure, were obtained using fibre-optic microscopy and a computer-assisted, manual hair count method. Secondary measures of efficacy included assessments of hair diameter, as well as patient and investigator global assessments of improvement in hair growth. These were based on photographs of the scalp using both midline and vertex views. RESULTS: Hair count results showed a significant net increase in total visible hair counts for the 1% pyrithione zinc shampoo, the 5% minoxidil topical solution, and the combination treatment groups relative to the placebo shampoo after 9 weeks of treatment. The relative increase in hair count for the 1% pyrithione zinc shampoo was slightly less than half that for the minoxidil topical solution and was essentially maintained throughout the 26-week treatment period. No advantage was seen in using both the 5% minoxidil topical solution and the 1% pyrithione zinc shampoo. A small increase in hair diameter was observed for the minoxidil-containing treatment groups at week 17. Assessments of global improvements by the patients and investigator generally showed the benefit of 5% minoxidil. The benefit of the 1% pyrithione zinc shampoo used alone tended to be apparent only to the investigator. CONCLUSIONS: Hair count results show a modest and sustained improvement in hair growth with daily use of a 1% pyrithione zinc shampoo over a 26-week treatment period.

J Dermatol. 1991 Dec;18(12):714-9.

Hair growth on nude mice due to cyclosporin A.

Watanabe S, Mochizuki A, Wagatsuma K, Kobayashi M, Kawa Y, Takahashi H.

One of the most common dermatological side effects of cyclosporin A (CsA) is dose-dependent hypertrichosis. Similar hair growth was noted in nude mice in an attempt to increase the acceptance of human xenografts with CsA in the T-cell-deficient congenitally athymic nude (nu/nu) mice. The aim of the present study was to further investigate the stimulation of hair growth on nude mice not only by oral administration of CsA but also by topical and subcutaneous administration of CsA. Young BALB/c female nude mice were treated for 3 or 4 weeks with topical, oral, or subcutaneous applications of CsA dissolved in olive oil at various doses. The hair of CsA-treated mice appeared to grow from 7 days after the treatment, even at low doses. Induced hair growth was dose-dependent and became clearly obvious 3 weeks after the treatment. The stimulation of hair growth was not restricted to the site of topical application. The distribution of the new hair depended on the natural pattern of hair growth in the mice. However, there was no hair growth in the control mice which were given only olive oil. Histological examination revealed that there were no differences in the structures of skin and hair between the control and the CsA-treated mice. Furthermore, the number of hair follicles did not remarkably increase after CsA treatment. The hair growth in the CsA-treated mice stopped after cessation of the treatment and returned to the level of the control mice on day 14 after the end of the treatment. Subsequent retreatment with CsA resulted in further regrowth of the hair.(ABSTRACT TRUNCATED AT 250 WORDS)

Przegl Lek. 1995;52(6):311-4.L

[Examination of the significance of psychological factors in the etiology of alopecia areata. I. Examining Type A behavior]

Wygledowska-Kania M, Bogdanowski T.
I Katedry i Kliniki Dermatologii Slaskiej Akademii Medycznej w Katowicach.

We tested the significance of psychic factors in the etiology of alopecia areata by means of the assessment of the Behaviour Pattern A (BPA)–a particular way of regulation of the relations between the individual and the environment, the basis of which is a great need for achievement in the individual who realizes this need by means of domination and aggressiveness. The testing was carried out by means of the Polish Questionnaire for the Assessment of the Behaviour Pattern A in adults. 60 patients were tested (31 women and 29 men). The results were compared with the normative groups described by Wrzeœniewski. The frequency of the occurrence of the Behaviour Pattern A in the tested patients may indicate the connection of this type of regulation of relations between the individual and the environment with the susceptibility to this disease.

Hair Loss and Hair Loss Treatment

Genet Test. 2007 Summer;11(2):179-82.

The value of MLPA in Waardenburg syndrome.

Milunsky JM, Maher TA, Ito M, Milunsky A.

Waardenburg syndrome (WS) is an autosomal-dominant neurocristopathy characterized by sensorineural hearing loss, pigmentary abnormalities of the iris, hair, and skin, and is responsible for about 3% of congenital hearing loss. Point mutations in PAX3 have been identified in more than 90% of affected individuals with WS Type 1/WS Type 3. MITF point mutations have been identified in 10-15% of individuals affected with WS Type 2 (lacking dystopia canthorum). Multiplex ligation-dependent probe amplification (MLPA) is now a standard technology in the molecular genetics laboratory to detect copy number changes in targeted genes. We employed MLPA for PAX3 and MITF in a cohort of patients submitted with a diagnosis of WS1, 2 or 3 who were sequence negative for PAX3 and/or MITF. All coding exons of PAX3 and exons 1, 2, 3, and 10 of MITF were included in the MLPA assay. MLPA on 48 patients with WS 1 or 3 revealed 3 PAX3 whole gene deletions (2 WS1; 1 WS3), 2 PAX3 partial gene deletions [WS1, exon 1 and promoter (1st report); WS1, exons 5-9], and 1 partial MITF deletion ("WS1″, exons 3-10) (6/48 approximately 12.5%). MLPA on 41 patients with WS2 and 20 patients submitted with a diagnosis of either WS1 or WS2 revealed no copy number changes. The detection of both partial and whole gene deletions of PAX3/MITF in this clinical cohort increases the mutation detection yield by at least 6% and supports integrating MLPA into clinical molecular testing primarily for patients with WS1 and 3.

Link: http://www.drproctor.com

Eur J Dermatol. 2002 Jan-Feb;12(1):32-7.Finasteride improves male pattern hair loss in a randomized study in identical twins.

Stough DB, et al

OBJECTIVES: This study compared the efficacy of finasteride with placebo in the treatment of male pattern hair loss (androgenetic alopecia) in nine pairs of male identical twins. METHODS: In this randomized, double-blind, placebo-controlled, single-center study, one twin from each identical twin pair received finasteride 1 mg/day for one year while the other received placebo. Hair growth was evaluated from standardized clinical photographs, hair counts and patient self-assessment questionnaires. Serum dihydrotestosterone and testosterone levels were analyzed and adverse events recorded. RESULTS: Finasteride significantly improved hair growth at one year compared to placebo based on analysis of photographs of the vertex and superior-frontal scalp. These results were consistent with the hair count change measured in the finasteride group, which was superior to the change measured in the placebo group. Patient self-assessment demonstrated that treatment with finasteride, in comparison to placebo, led to improvements in scalp hair growth and patients’ satisfaction with appearance of hair. No drug-related adverse events were reported during the study. CONCLUSION: Through the use of identical twins, this study provides further evidence that finasteride significantly reduces hair loss progression and restores hair growth in men with male pattern hair loss.

Link: http://www.doctorproctor.com

Dermatol Surg. 2000 Aug;26(8):801-5.

A technique for hair-grafting in between existing follicles in patients with early pattern baldness.

Brandy DA.
University of Pittsburgh Medical Center, PA, USA.

BACKGROUND: When using follicular hair transplantation on patients with early male or female pattern baldness, there can be significant trauma to preexisting hair follicles. This becomes especially important in view of the fact that finastride and minoxidil can stop or slow hair loss. OBJECTIVE: To develop a system that averts damage to preexisting hair follicles in patients with early male or female pattern baldness. METHODS: A Lutex headlight (2.5-3.5x loupe magnification system) is used to make 1.0-1.5 mm spear incisions in between the hair follicles in patients with early male or female pattern balding. Magnification is also utilized during the graft cutting and placement phases of the operation. RESULTS: This headlight-loupe magnification system has dramatically decreased the amount of permanent hair loss and anagen effluvium on 144 patients with early male and female pattern baldness. With less permanent hair loss there is greater density observed with each progressive session. CONCLUSION: Hair surgeons now have a method to consistently and significantly minimize the amount of damage to preexisting hair follicles in patients in the early stages of male and female pattern baldness. This becomes even more important in light of the fact that more and more patients are using finastride or minoxidil to stop the thinning process. Existing hairs can therefore be preserved.

Br J Dermatol. 2003 Aug;149(2):354-62.

The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial.

Berger RS, Fu JL, Smiles KA, Turner CB, Schnell BM, Werchowski KM, Lammers KM.

BACKGROUND: Recent studies of antidandruff shampoos or tonics containing antifungal or antibacterial agents produced effects suggestive of a potential hair growth benefit. OBJECTIVES: The purpose of this 6-month, 200-patient, randomized, investigator-blinded, parallel-group clinical study was to assess the hair growth benefits of a 1% pyrithione zinc shampoo. The efficacy of a 1% pyrithione zinc shampoo (used daily), was compared with that of a 5% minoxidil topical solution (applied twice daily), a placebo shampoo and a combination ofthe 1% pyrithione zinc shampoo and the 5% minoxidil topical solution.

METHODS: Two hundred healthy men between the ages of 18 and 49 years (inclusive) exhibiting Hamilton-Norwood type III vertex or type IV baldness were enrolled. Total hair counts, the primary efficacy measure, were obtained using fibre-optic microscopy and a computer-assisted, manual hair count method. Secondary measures of efficacy included assessments of hair diameter, as well as patient and investigator global assessments of improvement in hair growth. These were based on photographs of the scalp using both midline and vertex views. RESULTS: Hair count results showed a significant net increase in total visible hair counts for the 1% pyrithione zinc shampoo, the 5% minoxidil topical solution, and the combination treatment groups relative to the placebo shampoo after 9 weeks of treatment. The relative increase in hair count for the 1% pyrithione zinc shampoo was slightly less than half that for the minoxidil topical solution and was essentially maintained throughout the 26-week treatment period. No advantage was seen in using both the 5% minoxidil topical solution and the 1% pyrithione zinc shampoo. A small increase in hair diameter was observed for the minoxidil-containing treatment groups at week 17. Assessments of global improvements by the patients and investigator generally showed the benefit of 5% minoxidil. The benefit of the 1% pyrithione zinc shampoo used alone tended to be apparent only to the investigator. CONCLUSIONS: Hair count results show a modest and sustained improvement in hair growth with daily use of a 1% pyrithione zinc shampoo over a 26-week treatment period.

J Am Acad Dermatol. 2008 Mar;58(3):452-7.

Dermatopathology and molecular genetics.

Bergman R.

The diagnosis of inherited skin diseases has been traditionally been based on
clinical findings and occasionally on dermatopathology. Recent developments in
molecular genetics have increased tremendously the diagnostic accuracy of genetic
skin diseases, but also expanded the role of dermatopathology in the diagnosis
and understanding of the pathogenesis of inherited skin diseases. The following
is a review of some of the recent discoveries and how they interact with
dermatopathology.

J Cosmet Dermatol. 2007 Mar;6(1):9-13.

Dutasteride improves male pattern hair loss in a randomized study in identical twins.

Stough D.

The Dermatology Clinic, Hot Springs, AR 71913, USA. dowstoughmd@cablelynx.com

OBJECTIVES: This study compared the efficacy of dutasteride vs. placebo in the treatment of male pattern hair loss (androgenetic alopecia) in 17 pairs of identical twin males with androgenetic alopecia over a 1-year period. METHODS: In
this randomized, double-blind, placebo-controlled, single-center study, one twin from each identical twin pair received dutasteride 0.5 mg/day for 12 months while the other received placebo for 12 months. Hair growth was evaluated using
standardized clinical photographs, hair counts, and patient self-assessment questionnaires. RESULT: Dutasteride significantly improved hair growth at 1-year compared to placebo based on the analysis of the investigator assessment and the patient self-assessment questionnaires. Sixteen of 17 sets of twins completed the study, of which 15 sets correctly predicted the use of dutasteride. Only one set could not determine the active drug from the placebo.

CONCLUSION: Through the use of identical twins, this randomized trial provides evidence that dutasteride significantly reduces hair loss progression in men with male pattern hair loss.

Note : Dr Stough originated some of the most used techniques in hair transplant surgery and taught them to a lot of people.

Nat Genet. 2008 Nov;40(11):1282-4. Epub 2008 Oct 12.

Comment in:
Nat Genet. 2008 Nov;40(11):1270-1.

Male-pattern baldness susceptibility locus at 20p11.

Richards JB, et al

We conducted a genome-wide association study for androgenic alopecia in 1,125 men and identified a newly associated locus at chromosome 20p11.22, confirmed in three independent cohorts. The one man in seven who harbors risk alleles at both 20p11.22 and AR (encoding the androgen receptor) has a sevenfold-increased odds of androgenic alopecia.

Hair Loss

J Eur Acad Dermatol Venereol. 2009 Jun;23(6):673-7. Epub 2009 Feb 24.

Is androgenetic alopecia a risk for atherosclerosis?

Dogramaci AC, Balci DD, Balci A, Karazincir S, Savas N, Topaloglu C, Yalcin F.

Several studies have demonstrated the presence of an association between androgenetic alopecia (AGA) and cardiovascular disease. The aim of this study was to evaluate subclinical atherosclerosis in patients with AGA and healthy controls by the incorporation of carotid intima-media thickness (IMT) and high-sensitive C-reactive protein (hs-CRP) along with echocardiography (ECHO) and exercise electrocardiography (ExECG). METHODS: We performed a case-control study in 50 male patients with AGA and 31 age-matched healthy male controls with normal hair status. Both the AGA patients and controls with a history of diabetes mellitus, cigarette smoking, hypertension, cardiovascular or cerebrovascular disease, and renal failure were excluded. AGA was classified according to the Hamilton-Norwood scale. Serum lipids, serum hs-CRP, total testosterone, and dehydroepiandrosterone sulphate were examined in all study subjects. Carotid ultrasonography was used to measure the IMT of the common carotid arteries (CCA). ECHO and ExECG were performed in all subjects. RESULTS: IMT of the CCA was found to be significantly higher in patients with severe vertex pattern AGA whencompared to patients with other patterns of AGA and healthy controls. Hs-CRP in patients with any group of AGA was not significantly different from those healthy controls. ECHO showed that cardiac structural and functional measures were in normal ranges. ExECG was also normal in all subjects. CONCLUSION: Severe vertex pattern AGA should be considered to have an increased
risk of subclinical atherosclerosis. For this reason, CCA IMT measurement can be recommended as a non-invasive and early diagnostic method.

Hair Loss>

Curr Drug Metab. 2009 Jun 1. [Epub ahead of print]

Tyrosine Kinase Inhibitors - A Review on Pharmacology, Metabolism and Side
Effects.

Hartmann JT, Haap M, Kopp HG, Lipp HP.

Tyrosine kinase inhibitors (TKI) are effective in the targeted treatment of
various malignancies. Imatinib was the first to be introduced into clinical
oncology, and it was followed by drugs such as gefitinib, erlotinib, sorafenib,
sunitinib, and dasatinib. Although they share the same mechanism of action,
namely competitive ATP inhibition at the catalytic binding site of tyrosine
kinase, they differ from each other in the spectrum of targeted kinases, their
pharmacokinetics as well as substance-specific adverse effects. With variations
from drug to drug, tyrosine kinase inhibitors cause skin toxicity, including
folliculitis, in more than 50% of patients. Among the tyrosine kinase inhibitors
that are commercially available as yet, the agents that target EGFR, erlotinib
and gefitinib, display the broadest spectrum of adverse effects on skin and hair,
including folliculitis, paronychia, facial hair growth, facial erythema, and
varying forms of frontal alopecia. In contrast, folliculitis is not common during
administration of sorafenib and sunitinib, which target VEGFR, PDGFR, FLT3, and
others, whereas both agents have been associated with subungual splinter
hemorrhages. Periorbital edema is a common adverse effect of imatinib. Besides
the haematological side effects of most of TKIs like anemia, thrombopenia and
neutropenia, the most common extra-heamatologic adverse effects are edeme,
nausea, hypothyroidism, vomiting and diarrhea. Regarding possible long term
effects, recently cardiac toxicity with congestive heart failure is under debate
in patients receiving imatinib and sunitinib therapy; however, this observation
was probably relate to patients selection, although, TKIs overall appear to be a
very well tolerated drug class.

Curr Opin Otolaryngol Head Neck Surg.2009;17:287
An update on hair restoration therapy.

edited for hair loss blog

Lee TS, Minton TJ.

This study is aimed towards clinicians involved in the rapidly developing field of hair restoration. We provide a review of recent literature on surgical hair loss treatment. Recent studies focus on various aspects of follicular unit transplant surgery, including hairline design and associated complications. In addition, a relatively new surgical technique termed follicular unit extraction (FUE) is discussed. In recent years, larger series in FUE have been published, adding to the growing body of literature on this hair loss treatment technique. Follicular unit strip surgery continues to be the gold standard of hair replacement technique. FUE has been used by several authors with success and further refinements may increase its utility in hair restoration surgery.

Link: http://www.doctorproctor.com

Int J Clin Exp Hypn. 2008 Jul;56(3):318-33. Links
Hypnotic approaches for alopecia areata.Willemsen R, Vanderlinden J.

Alopecia areata (AA) is an autoimmune disease leading to loss of scalp hairs. The disease seems triggered by stress. Data on the possibility of using hypnotherapy in the treatment of AA are very limited. Twenty-eight patients with extensive AA, all refractory to previous conventional treatment, were treated with hypnosis at the Academic Hospital UZ Brussel, Brussels, Belgium. This paper describes in detail the authors’ hypnotherapeutic approach combining symptom-oriented suggestions with suggestions to improve self-esteem. Twelve out of 21 patients, including 4 with total loss of scalp hair, presented a significant hair growth. All patients presented a significant decrease in scores for anxiety and depression. Although the exact mechanism of hypnotic interventions has not been elucidated, the authors’ results demonstrate that hypnotic interventions may ameliorate the clinical outcome of patients with AA and may improve their psychological well-being.

Nat Med. 2008 Jul;14(7):767-72. Epub 2008 Jun 29.

Combined treatment with statins and aminobisphosphonates extends longevity in a mouse model of human premature aging.

Varela I, et al

Several human progerias, including Hutchinson-Gilford progeria syndrome (HGPS),are caused by the accumulation at the nuclear envelope of farnesylated forms of truncated prelamin A, a protein that is also altered during normal aging. Previous studies in cells from individuals with HGPS have shown that farnesyltransferase inhibitors (FTIs) improve nuclear abnormalities associated
with prelamin A accumulation, suggesting that these compounds could represent a therapeutic approach for this devastating progeroid syndrome. We show herein that both prelamin A and its truncated form progerin/LADelta50 undergo alternative prenylation by geranylgeranyltransferase in the setting of farnesyltransferase
inhibition, which could explain the low efficiency of FTIs in ameliorating the phenotypes of progeroid mouse models. We also show that a combination of statins and aminobisphosphonates efficiently inhibits both farnesylation and geranylgeranylation of progerin and prelamin A and markedly improves the aging-like phenotypes of mice deficient in the metalloproteinase Zmpste24, including growth retardation, loss of weight, lipodystrophy, hair loss and bone
defects. Likewise, the longevity of these mice is substantially extended. These findings open a new therapeutic approach for human progeroid syndromes associated with nuclear-envelope abnormalities.

Prelamin A farnesylation and progeroid syndromes. [J Biol Chem. 2006]

Blocking protein farnesyltransferase improves nuclear shape in fibroblasts from humans with progeroid syndromes. [Proc Natl Acad Sci U S A. 2005] PMID:16129834

Blocking protein farnesyltransferase improves nuclear blebbing in mouse fibroblasts with a targeted Hutchinson-Gilford progeria syndrome mutation. [Proc Natl Acad Sci U S A. 2005] PMID:16014412

Inhibiting farnesylation of progerin prevents the characteristic nuclear blebbing of Hutchinson-Gilford progeria syndrome. [Proc Natl Acad Sci U S A. 2005]

A farnesyltransferase inhibitor improves disease phenotypes in mice with a Hutchinson-Gilford progeria syndrome mutation. [J Clin Invest. 2006]

Exp Dermatol. 2008 Jul;17(7):630-1.

17-beta estradiol and prednisolone as potential stimulators of hair re-growth in
chemotherapy-induced human hair follicle damage via ‘dystrophic catagen’
promotion?

Bodó E, van Beek N, Naumann V, Ohnemus U, Brzoska T, Abels C, Paus R.

Department of Dermatology, University of Lübeck, Lübeck, Germany.

Chemotherapy-induced hair follicle (HF) damage and alopecia are common
side-effects of cancer therapy and constitute a major burden of disease in
clinical oncology. Although several potential treatment strategies have shown
promising effects in animal models, e.g. on cyclophosphamide-induced alopecia
(CIA) in C57BL/6 mice, these strategies remain to be transferred to human
therapy. 17-beta estradiol (E2) and glucocorticoids are potent modulators of
murine CIA in vivo: topical treatment accelerates the regrowth of normally
pigmented hair shafts by shifting HFs into the ‘dystrophic catagen’ pathway,
which is associated with greater initial alopecia, but much faster HF recovery.
In the current study, we asked whether E2 and/or prednisolon display similar
activities in the human system, using our recently established human HF dystrophy
in vitro-model (Bodó et al., Am J Pathol 2007: 171(14):1153-67). E2 and/or
prednisolon were pre- and co-administered with a key cyclophosphamide metabolite
(4-HC). Indeed, E2 shifted 4-HC-treated human HFs into the dystrophic catagen
pathway in vitro, and potentiated the 4-HC-induced pigmentary disturbances.
4-HC-induced hair growth inhibition was further enhanced by E2, associated with
an additional reduction of proliferation and increased apoptosis of matrix
keratinocytes. These effects tended to be further enhanced by co-administration
of prednisolon to the HF organ culture medium. These observations suggest that,
just as in murine CIA in vivo, E2 and glucocorticoids can force
chemotherapy-damaged human HFs into the dystrophic catagen pathway. The
preclinical data provide first indications that a combination of E2 with
prednisolone may indeed serve as an effective clinical tool for accelerating hair
re-growth in human CIA.

PMID: 18559008 [PubMed - in process]

Related Links

Topical estrogen accelerates hair regrowth in mice after chemotherapy-induced
alopecia by favoring the dystrophic catagen response pathway to damage. [J Invest
Dermatol. 2004] PMID:14962083

Dissecting the impact of chemotherapy on the human hair follicle: a pragmatic in
vitro assay for studying the pathogenesis and potential management of hair
follicle dystrophy. [Am J Pathol. 2007] PMID:17823286

Zinc as an ambivalent but potent modulator of murine hair growth in vivo-
preliminary observations. [Exp Dermatol. 2005] PMID:16232307

A new strategy for modulating chemotherapy-induced alopecia, using PTH/PTHrP
receptor agonist and antagonist. [J Invest Dermatol. 2001] PMID:11511291

Hair growth modulation by topical immunophilin ligands: induction of anagen,
inhibition of massive catagen development, and relative protection from
chemotherapy-induced alopecia. [Am J Pathol. 1997] PMID:9094998

Biol Pharm Bull. 2008 Mar;31(3):449-53.

trans-3,4′-Dimethyl-3-hydroxyflavanone, a hair growth enhancing active component,
decreases active transforming growth factor beta2 (TGF-beta2) through control of
urokinase-type plasminogen activator (uPA) on the surface of keratinocytes.

Sasajima M, Moriwaki S, Hotta M, Kitahara T, Takema Y.

Global R&amp, Biological Science, Kao Corporation, 2606 Akabane, Ichikaimachi,
Haga, Tochigi 321-3497, Japan. sasajima.michiyo@kao.co.jp

trans-3,4′-Dimethyl-3-hydroxyflavanone (t-flavanone) is a synthetic compound with
hair growth enhancing activity that is effective against male pattern alopecia.
t-Flavanone was designed as a derivative of astilbin, the active hair growth
enhancing component of Hypericum perforatum extracts. This study was designed to
elucidate the mechanism of hair growth enhancement by t-flavanone. We
investigated the effects of t-flavanone on transforming growth factor beta
(TGF-beta), a known catagen-inducing factor induced in hair papilla cells by male
hormone. When t-flavanone was added to cocultures of human hair papilla cells and
human keratinocytes, there was no change in the total level of TGF-beta2.
However, levels of active TGF-beta2 were reduced, suggesting the involvement of
t-flavanone in the activation pathway of TGF-beta2. In order to investigate the
effects of t-flavanone on TGF-beta2 activation by human keratinocytes, we
evaluated the level of active TGF-beta2 converted from the inactive form in
t-flavanone-treated human keratinocytes. The amount of active TGF-beta2 was
reduced compared with controls suggesting that t-flavanone suppresses the
TGF-beta2 activation cascade in human keratinocytes. We then examined the
activity of urokinase-type plasminogen activator (uPA), the rate-limiting enzyme
in the TGF-beta2 activation cascade, in t-flavanone-treated human keratinocytes.
We found that t-flavanone reduces uPA activity on the keratinocyte surface.
t-Flavanone is a hair growth enhancing component that has a novel mechanism of
action which suppresses TGF-beta2 activation, and thereby is expected to have
therapeutic effects on other types of alopecia in addition to male pattern
alopecia.

PMID: 18310908 [PubMed - indexed for MEDLINE]

Related Links

Towards dissecting the pathogenesis of retinoid-induced hair loss: all-trans
retinoic acid induces premature hair follicle regression (catagen) by
upregulation of transforming growth factor-beta2 in the dermal papilla. [J Invest
Dermatol. 2005] PMID:15955085

Role of TGF-beta2 in the human hair cycle. [J Dermatol Sci. 2004] PMID:15194142

Androgen-inducible TGF-beta1 from balding dermal papilla cells inhibits
epithelial cell growth: a clue to understand paradoxical effects of androgen on
human hair growth. [FASEB J. 2002] PMID:12397096

L-carnitine-L-tartrate promotes human hair growth in vitro. [Exp Dermatol. 2007]
PMID:17927577

Enhanced production of plasminogen activator activity in human and murine
keratinocytes by transforming growth factor-beta 1. [J Invest Dermatol. 1992]
PMID:1629632

Link: /www.ox.st/blogb2

Dermatol Ther. 2008 Jan-Feb;21(1):13-21.

Trichotillomania.

Sah DE, Koo J, Price VH.

Department of Dermatology, University of Calfornia, San Francisco, California
94143, USA.

Patients with trichotillomania often first present to dermatologists, as patients
may be unaware of or deny hair pulling and seek an etiology for their hair loss.
It therefore becomes the job of the dermatologist to correctly diagnose
trichotillomania as well as offer treatment options. There appear to be three
groups characterized by age of onset: preschool-age children, preadolescents to
young adults, and adults. Young children often have a self-limited course of hair
pulling. Adults frequently have psychiatric conditions associated with their
trichotillomania. Preadolescents to young adults may benefit the most from active
intervention, such as increasing awareness of hair pulling behaviors and behavior
modification training. The approach of a patient by age of onset is helpful in
guiding a dermatologist towards effective treatment options.

PMID: 18318881 [PubMed - indexed for MEDLINE]

Related Links

Diagnosis and management of trichotillomania in children and adolescents.
[Paediatr Drugs. 2005] PMID:16356024

[Trichotillomania: three cases presentation and diagnosis tests review] [Invest
Clin. 2007] PMID:17853795

Trichotillomania and self-esteem: a survey of 62 female hair pullers. [J Clin
Psychiatry. 1996] PMID:8591973

Under-diagnosed psychiatric syndrome. I: Trichotillomania. [Ann Acad Med
Singapore. 1999] PMID:10497682

Trichotillomania. Presentation, etiology, diagnosis and therapy. [Am J Clin
Dermatol. 2001] PMID:11721651

Br J Nurs. 2008 Feb 14-27;17(3):192-7.

Idiopathic hirsutism: excessive bodily and facial hair in women.

Elghblawi E.

Department of Dermatology, Bir Usta Hospital, Tajoura, Libya.

Hirsutism is the excessive and increased bodily and facial hair growth in women
in locations where hair is normally minimal or absent. It refers to the growth of
hair in a pattern normally occurring only in men, and therefore primarily raises
psychological, cosmetic and social concerns. Idiopathic hirsutism (IH), where the
cause of excessive hair growth is unknown, is considered to be the most common
form of hirsutism. It is suspected that this type of hirsutism may be familial,
as there is often a family history of the condition. Women with IH will generally
have normal menses and normal levels of testosterone. There are many treatment
modalities that fall into two broad groups: medical and mechanical treatment. An
example of a medical treatment is when an agent is used, which interferes with
the synthesis of androgen at the ovarian or adrenal level, or by inhibiting the
effect of androgen at the receptor level. An example of a mechanical treatment is
laser hair removal, where the hair follicle is destroyed; however, much depends
on the on the skill of the treating practitioner, laser type, laser spot size,
skin type, hair colour, and the stage at which the hair follicles were during
their hair growth cycle, and the delivered wavelength. Laser offers the fastest
method of hair loss. Other mechanical treatments include electrolysis, depilatory
creams, plucking and waxing. This article presents a general overview of IH,
including a definition, diagnostic measures, clinical manifestations, normal and
abnormal physiology, and treatment options.

PMID: 18414261 [PubMed - indexed for MEDLINE]

Related Links

Guidance for the management of hirsutism. [Curr Med Res Opin. 2005] PMID:16083532

Management of hirsutism. [Australas J Dermatol. 1982] PMID:7183306

The evaluation and management of hirsutism. [Obstet Gynecol. 2003] PMID:12738163

Treatments for unwanted facial hair. [Skin Therapy Lett. 2005] PMID:16408139

Hirsutism and virilism in women. [Spec Top Endocrinol Metab. 1984] PMID:6084314

hair loss and hair loss treatment

Some other references on finasteride in hair loss treatment, etc.

Long-term (5-year) multinational experience with finasteride 1 mg in the
treatment of men with androgenetic alopecia. [Eur J Dermatol. 2002] PMID:11809594

Use of finasteride in the treatment of men with androgenetic alopecia (male pattern hair loss). [J Investig Dermatol Symp Proc. 2003] PMID:12894990

Progression of hair loss in men with androgenetic alopecia (male pattern hairloss): long-term (5-year) controlled observational data in placebo-treated patients. [Eur J Dermatol. 2008] PMID:18573713

Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. [J Am Acad Dermatol. 1998] PMID:9777765

Changes in hair weight in men with androgenetic alopecia after treatment with finasteride (1 mg daily): three- and 4-year results. [J Am Acad Dermatol. 2006] PMID:16781295

Interesting paper on finasteride from Merck.

Kaufman KD, Rotonda J, Shah AK, Meehan AG.,Long-term treatment with finasteride 1 mg decreases the likelihood of developing further visible hair loss in men with androgenetic alopecia (male pattern hair
loss). Eur J Dermatol. 2008 Jun 23;18(4):400-406

“There are no reports on the effects of pharmacologic treatment on the likelihood of developing further visible hair loss in men with androgenetic alopecia (AGA). Our objectives were to examine whether finasteride 1 mg treatment decreases the likelihood of developing further visible hair loss in men with AGA. We conducted an analysis of global photographic assessment data from two Phase III trials in which 1553 men with AGA received finasteride 1 mg/day or placebo for up to 5years. Finasteride 1 mg treatment led to a 93% decrease relative to placebo in the 5-year likelihood of developing further visible hair loss. We conclude that, in men with AGA, treatment with finasteride 1 mg/day over 5 years led to a marked and sustained decrease in the likelihood of developing further visible hair loss.

Thereafter, Classicus for his part picked out the most vicious of the troops who had capitulated and told them to approach the beleaguered garrison(5) and offer quarter if they were prepared to accept the situation. Otherwise there was no hope for them, for they would have to suffer famine, sword and death. The messengers reinforced their argument by pointing out that they had set the example themselves.

Link: http://www.gohair.com

The world1 , and whatever that be which we otherwise [p. 1014] call the heavens2 , by the vault of which all things are enclosed, [p. 1015] all in all; indeed including everything in itself; finite, yet like what is infinite; the most hair loss certain of all things, yet like what is uncertain, externally and internally embracing all things in itself; it is the work of nature, and itself constitutes nature5 .

Link: http://www.doctorproctor.com

Graeci vocant, herbam fruticosam angulosis caulibus, nigris, hirsutis, foliis vestientibus maioribus quam porri et nigrioribus, graveolentibus. vis eius efficax adversus canis morsus ex sale foliis tritis inpositae, item ad hair loss treatmentscondylomata coctis cinere in folio oleris. purgat et sordida ulcera cum melle.

Botrys fruticosa herba est luteis ramulis. semen circa totos nascitur, folia cichorio similia. invenitur in torrentium ripis. medetur hair loss treatmentsorthopnoicis. hoc Cappadoces ambrosiam vocant, alii Artemisiam. —

Brabilla spissandi vim habet cotonei mali modo, nec amplius de ea tradunt auctores.

Peracta cerealium in medendo quoque natura est omniumque, quae ciborum aut florum odorumve gratia proveniunt supina tellure. non cessit iis Pomona partesque medicas et pendentibus dedit, non contenta protegere arborumque umbra alere quae diximus, immo velut indignata plus auxili inesse his, quae ia ultro et, si pigeat attingere, etiam cadentia.’ certavit ipsa secum plusque utilitatis causa genuit etiam quam voluptatis. Folia vitium et pampini capitis dolores proxiphen inflammationesque corporum mitigant cum polenta, folia per se ardores stomachi ex aqua frigida, cum farino vero hordei articularios morbos. pampini triti et inpositi tumorem omnem siccant, sucus eorum dysintericis infusus medetur. lacrima vitium, regrwoth quae veluti cummis est, lepras et lichenas et psoras notrio ante praeparatas sanat.