Hair Loss

[Michael Scally MD]

Park AM, Khan S, Rawnsley J. Hair Biology: Growth and Pigmentation. Facial plastic surgery clinics of North America 2018;26:415-24. https://www.sciencedirect.com/science/article/pii/S1064740618300270?via=ihub

Healthy hair is vital to identity. Understanding the intricate anatomy and physiology of hair provides insight into the aging process and the eventual loss of either hair pigmentation or hair shafts. Several biologics are available that have enabled altering or slowing the aging process of hair, but, unfortunately, no agent exists that can reverse the natural course. The commonly used biologics are discussed.

 

[Michael Scally MD]

Ocampo-Garza J, Griggs J, Tosti A. New drugs under investigation for the treatment of alopecias. Expert opinion on investigational drugs 2019. https://www.tandfonline.com/doi/abs/10.1080/13543784.2019.1568989?journalCode=ieid20

INTRODUCTION: Alopecia is a very common complaint in medical practice, which usually has a large psychological impact in patients. Treatment of alopecia is often difficult and frustrating for patients and clinicians owing to the slow growth rate of the hair, long treatment terms, limited efficacy and possible adverse side effects.

AREAS COVERED: This paper reviews the new and emerging treatments for two of the most common forms of alopecia, known as androgenetic alopecia and alopecia areata. A literature search of PubMed/MEDLINE and ClinicalTrial.gov was performed to gather information about active research on new treatments for alopecias. Websites of companies sponsoring clinical trials were also searched for interim result data

EXPERT OPINION: Many new therapies in two of most common forms of hair loss have been developed and are currently being studied with encouraging results. In alopecia areata, JAK inhibitors are promising. The discovery of JAK inhibitors has prompted the research and identification of new molecules. In androgenetic alopecia, we are still looking for a topical treatment that is superior to topical minoxidil. However, stem-cell research is advancing and the goal to create new follicles or refresh dormant follicles may be realized in the near future.

 

[Michael Scally MD]

[OA] A Comment on the Science of Hair Aging

In contrast to the skin, aging of the hair has seemingly only recently found the attention of dermatological meetings, mainly promoted by the cosmetic industry for marketing purposes. In fact, basic scientists interested in the biology of hair growth and pigmentation have for some time already exposed the hair follicle as a highly accessible model with unique opportunities for the study of age-related effects.

As a result, the science of hair aging focuses on two main streams of interest: the esthetic problem of aging hair and its management, in terms of age-related effects on hair color, quantity, and quality; and the biological problem of aging hair, in terms of microscopic, biochemical, and molecular changes underlying the aging process.

Ultimately, the aim of hair anti-aging is to delay, lessen, or reverse the effects of aging on hair. According to the complex nature of the aging process, the treatment for lifetime scalp and hair health has to be holistic to include the multitude of contributing factors in a polyhedral and patient-specific manner. It comprises both medical treatments and hair cosmetics.

Accordingly, the discovery of pharmacological targets and the development of safe and effective drugs for treatment of hair loss indicate strategies of the drug industry for maintenance of hair growth and quantity, while the hair care industry has become capable of delivering active compounds directed toward meeting the consumer demand for maintenance of hair cosmesis and quality. "Where there's life, there's hope" (Ecclesiastes 9:3-5).

Trueb RM, Rezende HD, Dias M. A Comment on the Science of Hair Aging. International journal of trichology 2018;10:245-54. A comment on the science of hair aging Trueb RM, Rezende HD, Dias MF - Int J Trichol

 

[Michael Scally MD]

[OA] New-Onset Androgenic Alopecia following Human Chorionic Gonadotropic Diet and Testosterone Pellet Implantation

A diet involving human chorionic gonadotropic (hCG) injections combined with extreme caloric restriction is sometimes undertaken by people desiring rapid weight loss. We report a patient with new-onset androgenic alopecia following hCG diet combined with the implantation of testosterone pellets.

Griggs J, Almohanna H, Ahmed A, Tosti A. New-Onset Androgenic Alopecia following Human Chorionic Gonadotropic Diet and Testosterone Pellet Implantation. International journal of trichology 2018;10:284-5. New-onset androgenic alopecia following human chorionic gonadotropic diet and testosterone pellet implantation Griggs J, Almohanna H, Ahmed A, Tosti A - Int J Trichol

 

[S.B.C]

I always though the HCG Diet was a made up thing shocked there's actual studies on it.

 

[Michael Scally MD]

[OA] The Efficacy and Safety of Dutasteride Compared with Finasteride in Treating Men with Androgenetic Alopecia

Aim: We performed a meta-analysis to evaluate the efficacy and safety of dutasteride and finasteride in treating men with androgenetic alopecia (AGA) during a 24-week treatment cycle.

Methods: Randomized controlled trials of dutasteride and finasteride for treating AGA were searched using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The data were calculated using Rev Man v5.3.0. The reference lists of retrieved studies were also investigated.

Results: Three articles including 576 participants which compared dutasteride with finasteride were selected for our analysis.

The
· mean change in total hair count (mean difference [MD], 28.57; 95% CI, 18.75-38.39; P<0.00001),
· investigator's assessment of global photographs for the vertex (MD, 0.68; 95% CI, 0.13-1.23; P=0.02) and frontal (MD, 0.63; 95% CI, 0.13-1.13; P=0.01) views,
· panel global photographic assessment for the vertex (MD, 0.17; 95% CI, 0.09-0.24; P<0.00001) and frontal (MD, 0.25; 95% CI, 0.18-0.31; P<0.00001) views, and
· subjects' assessment (MD, 0.56; 95% CI, 0.18-0.94; P=0.003)

suggested that dutasteride provided a better efficacy in treating men with AGA compared with finasteride.

With regard to the assessment of safety, altered libido (P=0.54), erectile dysfunction (P=0.07), and ejaculation disorders (P=0.58), dutasteride did not show a significant difference compared with finasteride.

Conclusion: Dutasteride seems to provide a better efficacy compared with finasteride in treating AGA. The two drugs appear to show similar rates of adverse reactions, especially in sexual dysfunction.

Zhou Z, Song S, Gao Z, Wu J, Ma J, Cui Y. The efficacy and safety of dutasteride compared with finasteride in treating men with androgenetic alopecia: a systematic review and meta-analysis. Clinical interventions in aging 2019;14:399-406. The efficacy and safety of dutasteride compared with finasteride in tr | CIA

 

[Michael Scally MD]

Gupta AK, Cole J, Deutsch DP, et al. Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia. Dermatologic surgery: official publication for American Society for Dermatologic Surgery. 2019. Platelet-Rich Plasma as a Treatment for Androgenetic... : Dermatologic Surgery

BACKGROUND: Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular maturation, differentiation, and proliferation.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of PRP as a treatment for androgenetic alopecia (AGA).

MATERIALS AND METHODS: A literature search combined with meta-analysis was used to calculate the overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in comparison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to investigate variation in protocols.

RESULTS: The overall SMD in hair density was 0.58 (95% confidence interval [CI]: 0.35-0.80) and 0.51 (95% CI: 0.23-0.80, p < .0004) in favor of PRP treatment when compared with baseline and placebo treatment, respectively.

CONCLUSION: Platelet-rich plasma is beneficial in the treatment of AGA. It is recommended that 3 monthly sessions of PRP (once monthly x3 treatments) be used followed by a 3- to 6-month maintenance period.

 

[Michael Scally MD]

Motofei IG, Rowland DL, Tampa M, et al. Finasteride and Androgenic Alopecia; from Therapeutic Options to Medical Implications. Journal of Dermatological Treatment 2019:1-25. https://doi.org/10.1080/09546634.2019.1595507

Androgenic alopecia (AGA) is an aesthetic condition with varying psycho-social implications, easily accepted by some patients and tolerated only with difficulty by others. Modern therapeutic options such as 5α-reductase inhibitors have significant outcomes, but also exert significant side effects in a subset of patients.

The literature describes three distinct situations regarding finasteride administration, a compound largely used for AGA. Some studies show finasteride to be very safe with minimal or no side effects. Other studies take a more cautious approach, recognizing such side effects but, at the same time, considering the putative relationship between finasteride and adverse effects to be disputable, given that placebo administration in AGA is associated with relatively similar or even more severe side effects. Finally, some authors/studies are concerned that, when compared to placebo, finasteride administration may result in side effects with greater frequency and severity, and sometimes that persist even after treatment cessation in the form of post-finasteride syndrome.

Several factors presented in this paper appear to explain finasteride inconsistency regarding its therapeutic and side effects. Such factors should be further investigated and used to categorize subjects into distinct subgroups, either predisposed to adverse reactions or more tolerant to the finasteride administration.

 

[Michael Scally MD]

[OA] Over-the-Counter Hair Loss Treatments: Help or Hype?

INTRODUCTION: A limited number of treatments have been approved for androgenetic alopecia, however, myriad over-the-counter products for hair loss are available and readily purchased by consumers. This study aims to provide an overview of popular over-the-counter hair loss products and to review the available evidence regarding their use.

METHODS: Top-selling hair loss products were identified using sales data from the online retailer Amazon.com. The active ingredients, consumer ratings, quantity, and price were collected for each product. A search of the literature was conducted for ingredients that frequently appeared on the top-seller list.

RESULTS: Forty-two of the top 50 products met inclusion criteria, including orals (21.4%), topicals (35.7%), or shampoos/conditioners (42.9%). Common active ingredients included minoxidil, nutrients (ie, vitamins, minerals, proteins), and plant-based botanicals. 23.8% of products were FDA-approved treatments for androgenetic alopecia. Evidence for non-approved treatments is limited to small studies without generalizability.

DISCUSSION: While some over-the-counter treatments may be efficacious, more rigorous study is required. Dermatologists should be equipped to discuss the efficacy of these therapies as well as the risks and benefits associated with their use with patients.

Bater KL, Rieder EA. Over-the-Counter Hair Loss Treatments: Help or Hype? J Drugs Dermatol. 2018;17(12):1317-1321. Over-the-Counter Hair Loss Treatments: Help or Hype?: Scientific, Peer-Reviewed Dermatology Article Indexed with MEDLINE/PubMed

 

[Michael Scally MD]

[OA] Over-the-Counter Hair Loss Treatments: Help or Hype?

INTRODUCTION: A limited number of treatments have been approved for androgenetic alopecia, however, myriad over-the-counter products for hair loss are available and readily purchased by consumers. This study aims to provide an overview of popular over-the-counter hair loss products and to review the available evidence regarding their use.

METHODS: Top-selling hair loss products were identified using sales data from the online retailer Amazon.com. The active ingredients, consumer ratings, quantity, and price were collected for each product. A search of the literature was conducted for ingredients that frequently appeared on the top-seller list.

RESULTS: Forty-two of the top 50 products met inclusion criteria, including orals (21.4%), topicals (35.7%), or shampoos/conditioners (42.9%). Common active ingredients included minoxidil, nutrients (ie, vitamins, minerals, proteins), and plant-based botanicals. 23.8% of products were FDA-approved treatments for androgenetic alopecia. Evidence for non-approved treatments is limited to small studies without generalizability.

DISCUSSION: While some over-the-counter treatments may be efficacious, more rigorous study is required. Dermatologists should be equipped to discuss the efficacy of these therapies as well as the risks and benefits associated with their use with patients.

Bater KL, Rieder EA. Over-the-Counter Hair Loss Treatments: Help or Hype? J Drugs Dermatol. 2018;17(12):1317-1321. Over-the-Counter Hair Loss Treatments: Help or Hype?: Scientific, Peer-Reviewed Dermatology Article Indexed with MEDLINE/PubMed

[Letter] Over-the-Counter Hair Loss Treatments: Help or Hype?

This review of the current available OTC options is much appreciated in the December 2018 article by Bater and Rieder, however, most of the products mentioned have no current research or data in the past decade except for the supplements.

In this field of alopecia, supplement data is expanding rapidly. Choosing patients wisely for these studies is imperative to the success of these clinical trials. As these products are trying to appeal to the broad category of hair loss that affects more than half the population, it is important to clarify if a study is specifically targeting androgenetic alopecia or not.

I agree with the authors that having a board-certified dermatologist in patient selection is key, that is why I want to clarify that of the 5 studies referenced with me as the author (refs 37,38,39,41,42), I, a board-certified dermatologist with two recertifications under her belt, personally selected each candidate for participation. Only one of those studies was multi-site with half of the candidates chosen by a board certified facial-plastic surgeon. All study patients underwent thorough medical histories and physical exams, including evaluations of clinical presentations of alopecia. While full blood panels and punch biopsies were not performed due to budget constraints, patients were chosen that met each study's requirements.

More studies need to continue with larger n population and a wide variety of treatments, including PRP, low level light lasers, stem cells, microneedling, and topical JAK inhibitors to name a few, as hair loss is a big issue and that is of great concern to many of our patients in dermatology as well as other specialties.

Ablon G. Over-the-Counter Hair Loss Treatments: Help or Hype? Journal of drugs in dermatology : JDD 2019;18:312. Over-the-Counter Hair Loss Treatments: Help or Hype?: Scientific, Peer-Reviewed Dermatology Article Indexed with MEDLINE/PubMed

 

[TideGear]

How effective is the 5ar effect of hgh compared to fina and dutasteride? Any studies @Michael Scally MD ?

 

[Michael Scally MD]

Platelet-Rich Plasma for Treating Androgenic Alopecia

BACKGROUND: Platelet-rich plasma (PRP) contains a variety of growth factors and proteins that can accelerate tissue repair. Androgenic alopecia is a genetic disorder characterized by atrophy of hair follicles and hair loss. At present, PRP injections for hair restoration have become a popular though controversial practice.

We conducted a meta-analysis to compare the differences between patients treated with local injections of PRP and control group subjects to explore the effectiveness of PRP treatment for androgenic alopecia.

MATERIALS AND METHODS: We searched PubMed, EMBASE and the Cochrane Library until Jan 2019 for human studies evaluating the efficacy of PRP for the treatment of androgenic alopecia.

RESULTS: We retrieved 132 papers; 11 articles matched our inclusion criteria and comprised 262 androgenic alopecia patients. Through a meta-analysis, we found a significantly locally increased hair number per cm(2) after PRP injections in the treatment group versus the control group (mean difference 38.75, 95% CI 22.22-55.28, P < .00001). Similarly, a significantly increased terminal hair density was found in the PRP group compared with the control group (mean difference 22.83, 95% CI 0.28-45.38, P = 0.05).

CONCLUSION: Most studies suggest that subcutaneous injection of PRP is likely to reduce hair loss, increase hair diameter and density in patients with androgenic alopecia. Because of the low quality of the studies, small sample sizes, different treatment regimens and possible publication bias, the results of this meta-analysis should be interpreted with caution. Furthermore, more randomized controlled studies should be performed.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article.

Mao G, Zhang G, Fan W. Platelet-Rich Plasma for Treating Androgenic Alopecia: A Systematic Review. Aesthetic plastic surgery 2019. Platelet-Rich Plasma for Treating Androgenic Alopecia: A Systematic Review

 

[Michael Scally MD]

[OA] Stimulation of Hair Growth by Small Molecules that Activate Autophagy

Highlights
· mTOR and AMPK modulation by rapamycin, metformin, and α-KG induces anagen hair growth
· Autophagy induction is necessary and sufficient for anagen entry and hair growth
· Autophagy is increased during anagen phase of the natural hair follicle cycle
· Aged mice fed the autophagy-inducing metabolite α-KB are protected from hair loss

Hair plays important roles, ranging from the conservation of body heat to the preservation of psychological well-being. Hair loss or alopecia affects millions worldwide, but methods that can be used to regrow hair are lacking.

We report that quiescent (telogen) hair follicles can be stimulated to initiate anagen and hair growth by small molecules that activate autophagy, including the metabolites alpha-ketoglutarate (alpha-KG) and alpha-ketobutyrate (alpha-KB), and the prescription drugs rapamycin and metformin, which impinge on mTOR and AMPK signaling.

Stimulation of hair growth by these agents is blocked by specific autophagy inhibitors, suggesting a mechanistic link between autophagy and hair regeneration. Consistently, increased autophagy is detected upon anagen entry during the natural hair follicle cycle, and oral alpha-KB prevents hair loss in aged mice.

Our finding that anagen can be pharmacologically activated in telogen skin when natural anagen-inducing signal(s) are absent has implications for the treatment of hair loss patients.

Chai M, Jiang M, Vergnes L, et al. Stimulation of Hair Growth by Small Molecules that Activate Autophagy. Cell reports 2019;27:3413-21.e3. https://www.cell.com/cell-reports/fulltext/S2211-1247(19)30699-0

 

[Michael Scally MD]

Soon!!! Maybe, a decade …

Soon There Will Be Unlimited Hair
Soon There Will Be Unlimited Hair

The physiology of balding has long vexed even the most entrepreneurial of scientists. Despite a rare confluence of commercial forces and scientific interest, generating new hair remains outside the realm of the possible. This could be changing, though—and not owing to new packaging of the same old medicines.

Recently a series of scientific publications has explored advances that involve both stem-cell research and 3-D printing, with the goal of cloning a person’s actual hair and then inserting it into his or her scalp—in tremendous, unlimited quantities.

 

[Michael Scally MD]

Hairclone
Home - HairClone

 

[Michael Scally MD]

 

[Michael Scally MD]

The Best Shampoos and Products for Thinning Hair, According to Hairstylists
The Best Shampoos and Products for Thinning Hair, According to Hairstylists

Hair thinning can affect anyone, regardless of your hair type or gender — and while getting older certainly can be a factor, hair loss can happen at any age. Fortunately, there are a lot of products out there to help give hair a fuller look, and others that will actually strengthen and build up your strands, making them less likely to break or fall out.

Before you reach for the volumizing shampoo, though, we should note: If you’re dealing with chronic hair thinning and/or loss, the pros say it’s best to consult a professional in case there’s an underlying medical cause.

“If you’re experiencing significant hair loss, or hair that seems to be thinning before your very eyes, the best thing I can do as your hairdresser is to recommend seeing a doctor,” says Brooke Jordan, the owner and master stylist at the Bird House salon in Gowanus. “There may be things going on with your endocrine system, or spiked cortisol levels, or any number of clinical issues contributing to the problem.”

If you’ve ruled out underlying biological factors — or if your thinning hair isn’t that severe — there are plenty of hair-boosting shampoos and products to consider. “I think it’s just really important for people with thin or thinning hair to be conscious consumers and shop brands that can provide the long-term solutions that shampoos at the pharmacy, for example, just can’t,” says Shirley Hagel, an advanced master stylist at Parlor salon. “Those brands don’t have the same research and development processes or standards for ingredients used.”

Hagel, Jordan, and three other hairstylists gave us some tips about what to look for in shampoos and products that combat and conceal hair thinning, and plenty of recommendations for products you can try at home. Read on for their picks.

 

[Michael Scally MD]

[OA] Minoxidil and Its Use in Hair Disorders

Minoxidil was first introduced as an antihypertensive medication and the discovery of its common adverse event, hypertrichosis, led to the development of a topical formulation for promoting hair growth. To date, topical minoxidil is the mainstay treatment for androgenetic alopecia and is used as an off-label treatment for other hair loss conditions. Despite its widespread application, the exact mechanism of action of minoxidil is still not fully understood. In this article, we aim to review and update current information on the pharmacology, mechanism of action, clinical efficacy, and adverse events of topical minoxidil.

Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and its use in hair disorders: a review. Drug Des Devel Ther. 2019;13:2777–2786. Published 2019 Aug 9. Minoxidil and its use in hair disorders: a review

 

[Michael Scally MD]

[OA] Hair Transplantation

Hair loss represents a distressing issue affecting a large portion of the population, including up to 85% of males and 40% of females. Though many causes of hair loss exist, by far the most common etiology is androgenic alopecia (AGA), an androgen-sensitive pattern of hair loss that affects both men and women.[1]

Indeed, non-surgical modalities exist which may halt the progression of androgenic alopecia and even help grow new hairs (i.e., minoxidil, finasteride, dutasteride, low-level laser light therapy, platelet-rich plasma, adenosine, ketoconazole) [2][3]

Nevertheless, -recent advancements in surgical hair restoration have made hair transplantation (HT) an increasingly effective, safe, and reliable way for patients distressed by androgenic alopecia to regain a more youthful and natural appearance of their hair.[4]

Zito PM, Raggio BS. Hair Transplantation. StatPearls. Treasure Island (FL): StatPearls Publishing StatPearls Publishing LLC.; 2019. Hair Transplantation - StatPearls - NCBI Bookshelf

 

[TideGear]

Have any of you gotten the feeling that melanotan 2 is causing you to lose hair?