Hair Loss

[MesomorphosisGuy]

"Men undergoing oral finasteride therapy may see cosmetically acceptable hair regrowth response, especially in the first 2 years of therapy, but for the majority of patients, these results are not long lasting and some individuals become resistant to therapy, and others show no hair growth response at all."

Oh, really? And where are the sources of these claims? Perhaps the largest study on finasteride up-to-date (Kaufman et al. 2008) says that "The percent of patients developing further visible hair loss in the placebo group versus the
finasteride group, respectively, was 13% versus 1% at one year, 69% versus 9% at 3 years, and 75% versus 10% at 5 years for those patients remaining on treatment in the extension phase."

So, after 5 years, only 10% men on finasteride were losing hair.

The longest study of 118 men lasting 10 years (Rossi et al. 2011) showed that only 14% men on finasteride worsened, 65% remained stable, and 21% further improved even after 5 years.

As usually, the above mentioned claim is based on a graph randomly picked up from the internet and taken out of context. Great science!

 

[Michael Scally MD]

Castro RF, Azzalis LA, Feder D, et al. Safety and efficacy analysis of liposomal insulin-like growth factor-1 in a fluid gel formulation for hair-loss treatment in a hamster model. Clin Exp Dermatol. Safety and efficacy analysis of liposomal insulin-like growth factor-1 in a fluid gel formulation for hair-loss treatment in a hamster model - Castro - 2012 - Clinical and Experimental Dermatology - Wiley Online Library

Insulin-like growth factor (IGF)-1 has shown some interesting results in studies examining its use as a hair-loss treatment. IGF-1 works by regulating cellular proliferation and migration during the development of hair follicles. Hepatotoxicity and myelotoxicity were evaluated in hamsters (Mesocricetus auratus) after topical application of the liquid gel vehicle (placebo), 1% IGF-1 or 3% IGF-1. No significant difference in the levels of aspartate aminotransferase or alanine aminotransferase was found between the control and treated groups. ELISA did not shown any increase in the plasma level of IGF-1. A haematopoietic niche was found, but it was not associated with myelotoxicity. Efficacy was determined by dermatoscopy analysis of hair density and microscopy analysis of hair diameter, with hair found to be thicker and with more rapid growth in the 3% group than in either the 1% group or the control group. These results strongly suggest that liposomal IGF-1 in a liquid gel formulation is a safe and efficient treatment for hair loss.

 

[Michael Scally MD]

Donovan J, Shapiro RL, Shapiro P, Zupan M, Pierre-Louis M, Hordinsky MK. A review of scalp camouflaging agents and prostheses for individuals with hair loss. Dermatol Online J 2012;18(8):1. 1. A review of scalp camouflaging agents and prostheses for individuals with hair loss

Hair loss is a common problem for both men and women and may impact negatively on self-esteem. A variety of medical and surgical treatment options are available depending on the type of alopecia. Many patients also seek the advice of their physicians about options to hide or reduce the appearance of hair loss with hair prostheses (wigs, hairpieces, and extensions) or hair camouflaging agents (hair fibers, powder cakes, lotions, sprays, hair crayons, and scalp tattooing). Herein, we review current methods to hide or reduce the appearance of hair loss and discuss their associated costs, advantages, and disadvantages. Knowledge of products available to cover scalp, eyebrow, and eyelash hair loss may not only better equip clinicians to respond to questions from concerned patients, but may provide additional options to help these patients best cope with their hair loss.

 

[Michael Scally MD]

The Search for a Baldness Cure
Researchers Target Vitamin D to Coax Dormant Follicles to Grow Hair; Early Promise, But Years to Go
The Search for a Baldness Cure - WSJ.com

 

[Michael Scally MD]

Park PJ, Moon BS, Lee SH, et al. Hair growth-promoting effect of Aconiti Ciliare Tuber extract mediated by the activation of Wnt/beta-catenin signaling. Life Sci. ScienceDirect.com - Life Sciences - Hair growth-promoting effect of Aconiti Ciliare Tuber extract mediated by the activation of Wnt/?-catenin signaling

AIMS: The activation of Wnt/beta-catenin signaling pathway plays an important role in hair follicle morphogenesis by stimulating bulge stem cells. This study was to obtain the activator of Wnt/beta-catenin signaling pathway from natural products and to determine whether this activator can induce anagen hair growth in mice.

MAIN METHODS: To identify materials that activate Wnt/beta-catenin signaling pathway, 800 natural product extracts were screened using pTOPFlash assay and neural progenitor cells (NPC) differentiation assay. A selected extract was further tested for its effects on alkaline phosphatase (ALP) activity in human immortalized dermal papilla cells (iDPC) and the proliferation in iDPC and immortalized rat vibrissa DPCs (RvDP). Finally, hair growth-promoting effects were evaluated in the dorsal skin of C57BL/6 mice.

KEY FINDINGS: Aconiti Ciliare Tuber (ACT) extract was one of the most active materials in both pTOPFlash and NPC differentiation assays. It promoted the differentiation of NPC cells even under proliferation-stimulating conditions (basic fibroblast growth factor: bFGF). It also increased ALP activity and proliferation of iDPC in dose-dependent manners, and it stimulated induction of the anagen hair growth in C57BL/6 mice. These results suggest that ACT extract activates the Wnt/beta-catenin signaling pathway by enhancing beta-catenin transcription and has the potential to promote the induction of hair growth via activation of the stem cell activity of the dermal papilla cells.

SIGNIFICANCE: This is the first report indicating benefits of ACT extract in hair loss prevention by triggering the activation of Wnt/beta-catenin signaling pathway and induction of the anagen hair growth in mice.

 

[Michael Scally MD]

Inui S, Itami S. Androgen actions on the human hair follicle: perspectives. Exp Dermatol. Androgen actions on the human hair follicle: perspectives - Inui - 2012 - Experimental Dermatology - Wiley Online Library

Androgens stimulate beard growth but suppress hair growth in androgenetic alopecia (AGA). This condition is known as 'androgen paradox'. Human pilosebaceous units possess enough enzymes to form the active androgens testosterone and dihydrotestosterone. In hair follicles, 5alpha-reductase type 1 and 2, androgen receptors (AR) and AR coactivators can regulate androgen sensitivity of dermal papillae (DP). To regulate hair growth, androgens stimulate production of IGF-1 as positive mediators from beard DP cells and of TGF-beta1, TGF-beta2, dickkopf1 and IL-6 as negative mediators from balding DP cells. In addition, androgens enhance inducible nitric oxide synthase from occipital DP cells and stem cell factor for positive regulation of hair growth in beard and negative regulation of balding DP cells. Moreover, AGA involves crosstalk between androgen and Wnt/beta-catenin signalling. Finally, recent data on susceptibility genes have provided us with the impetus to investigate the molecular pathogenesis of AGA.

 

[Michael Scally MD]

Khidhir KG, Woodward DF, Farjo NP, et al. The prostamide-related glaucoma therapy, bimatoprost, offers a novel approach for treating scalp alopecias. The FASEB Journal. The prostamide-related glaucoma therapy, bimatoprost, offers a novel approach for treating scalp alopecias

Balding causes widespread psychological distress but is poorly controlled. The commonest treatment, minoxidil, was originally an antihypertensive drug that promoted unwanted hair. We hypothesized that another serendipitous discovery, increased eyelash growth side-effects of prostamide F2?-related eyedrops for glaucoma, may be relevant for scalp alopecias. Eyelash hairs and follicles are highly specialized and remain unaffected by androgens that inhibit scalp follicles and stimulate many others. Therefore, we investigated whether non-eyelash follicles could respond to bimatoprost, a prostamide F2? analog recently licensed for eyelash hypotrichosis. Bimatoprost, at pharmacologically selective concentrations, increased hair synthesis in scalp follicle organ culture and advanced mouse pelage hair regrowth in vivo compared to vehicle alone. A prostamide receptor antagonist blocked isolated follicle growth, confirming a direct, receptor-mediated mechanism within follicles; RT-PCR analysis identified 3 relevant receptor genes in scalp follicles in vivo. Receptors were located in the key follicle regulator, the dermal papilla, by analyzing individual follicular structures and immunohistochemistry. Thus, bimatoprost stimulates human scalp follicles in culture and rodent pelage follicles in vivo, mirroring eyelash behavior, and scalp follicles contain bimatoprost-sensitive prostamide receptors in vivo. This highlights a new follicular signaling system and confirms that bimatoprost offers a novel, low-risk therapeutic approach for scalp alopecias.

 

[Michael Scally MD]

Vogel JE, Jimenez F, Cole J, et al. Hair Restoration Surgery: The State of the Art. Aesthet Surg J. http://aes.sagepub.com/content/early/2012/10/09/1090820X12468314.abstract (Hair Restoration Surgery)

Hair restoration is a highly sophisticated subspecialty that offers significant relief to patients with hair loss. An improved understanding of the aesthetics of hair loss and cosmetic hair restoration, hair anatomy and physiology, and the development of microvascular surgical instrumentation has revolutionized the approach to surgical hair restoration since the original description. Additional elements that contribute to the current state of the art in hair restoration include graft size, site creation, packing density, and medical control of hair loss. The results of hair restoration are natural in appearance and are provided with a very high level of patient satisfaction and safety. This aspect of cosmetic surgery is a very welcome addition to a traditional aesthetic practice and serves as a tremendous source for internal cross-referral. The future of hair restoration surgery is centered on minimal-incision surgery as well as cell-based therapies.

 

[Michael Scally MD]

Bansal M, Manchanda K, Pandey SS. Role of caffeine in the management of androgenetic alopecia. Int J Trichology 2012;4(3):185-6. http://www.ijtrichology.com/article.asp?issn=0974-7753;year=2012;volume=4;issue=3;spage=185;epage=186;aulast=Bansal (Role of caffeine in the management of androgenetic alopecia Bansal M, Manchanda K, Pandey SS - Int J Trichol)

Androgenetic alopecia (AGA) is hereditary and androgen-dependent, progressive thinning of the scalp hair that follows a defined pattern. It is a common dermatological problem affecting both men and women, with significant negative impact on their social and psychological well being. [1] It commonly begins by 20 years of age and affects nearly 50% of men by the age of 50 years. [1] Its etiopathogenesis is mainly androgen dependent and modulated via the testosterone metabolite dihydrotestosterone (DHT) and the expression of hair follicle-related androgen receptor. [2]

The genetic factors also have been implicated in the pathogenesis of AGA. [2] Patients afflicted with AGA suffer from severe impairment of quality of life and thus treatment of this condition is mandatory, requiring long-term treatment with chief concerns about the efficacy and safety of the product used. Currently only oral finasteride and topical minoxidil are approved for treatment of AGA. [3],[4]

Recently, certain newer advances have shown caffeine to have beneficial effects in patients suffering from AGA. The proposed mechanism which would counteract DHT-induced miniaturization of the hair follicle include inhibition of phosphodiesterase by caffeine, which increases cAMP levels in cells and therefore promotes proliferation by stimulating cell metabolism. [5]

A study conducted by Fischer et al. used hair organ culture model to investigate the effects of testosterone and caffeine on hair follicle growth stimulation. This in vitro study used scalp biopsy samples from male AGA patients which were cultivated using different concentrations of testosterone and/or caffeine for a period of 120-192 hours. Addition of caffeine in concentrations of 0.001% and 0.005% were found to counteract the suppressive effects of testosterone on hair growth, with a higher hair shaft elongation seen at 120 h after caffeine administration, compared to control group. This in vitro study thus clearly demonstrates that caffeine is a stimulator of human hair growth which may have importance in the treatment of AGA. [5]

Brandner et al. proved by their double-blind placebo-controlled trial that caffeine application causes a substantial reduction in the transepidermal water loss in men compared to women, thus improving barrier function in men. [6] Regarding the route of delivery of caffeine, hair follicles are considered an important route for drug delivery. A recent study which assessed the follicular penetration of topical caffeine in hair follicles proved hair follicles to be faster route of drug delivery for topically applied drugs. [7] An important requirement for the treatment of AGA is follicular drug delivery. A recent study assessed the follicular penetration of caffeine on topical application in a shampoo formulation for 2 min and showed that penetration via hair follicles was faster and higher compared with the interfollicular route and that hair follicles were the only pathway for faster caffeine absorption during the first 20 min after application. [8]

The beneficial effects of topical application of caffeine in AGA can thus be attributed to inhibition of phosphodiesterase, improvement in barrier function, follicular penetration, stimulation and promotion of hair growth. Thus it appears to be a useful adjuvant in the management of AGA. However, further studies need to be done to confirm and establish the role of caffeine in management of AGA.

 

[Michael Scally MD]

Tanglertsampan C. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil / 0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. J Med Assoc Thai 2012;95(10):1312-6. http://jmat.mat.or.th/index.php/jmat/article/view/2144 (Efficacy and Safety of 3% Minoxidil versus Combined 3% Minoxidil / 0.1% Finasteride in Male Pattern Hair Loss: A Randomized, Double-Blind, Comparative Study | Tanglertsampan | Journal of the Medical Association of Thailand)

BACKGROUND: Topical minoxidil and oral finasteride have been used to treat men with androgenetic alopecia (AGA). There are concerns about side effects of oral finasteride especially erectile dysfunction.

OBJECTIVE: To compare the efficacy and safety of the 24 weeks application of 3% minoxidil lotion (MNX) versus combined 3% minoxidil and 0.1% finasteride lotion (MFX) in men with AGA.

MATERIAL AND METHOD: Forty men with AGA were randomized treated with MNX or MFX. Efficacy was evaluated by hair counts and global photographic assessment. Safety assessment was performed by history and physical examination.

RESULTS: At week 24, hair counts were increased from baseline in both groups. However paired t-test revealed statistical difference only in MFX group (p = 0.044). Unpaired t-test revealed no statistical difference between two groups with respect to change of hair counts at 24 weeks from baseline (p = 0.503). MFX showed significantly higher efficacy than MNX by global photographic assessment (p = 0.003). There was no significant difference in side effects between both groups.

CONCLUSION: Although change of hair counts was not statistically different between two groups, global photographic assessment showed significantly greater improvement in the MFX group than the MNX group. There was no sexual side effect. MFX may be a safe and effective treatment option.

 

[Millard]

Tanglertsampan C. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil / 0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. J Med Assoc Thai 2012;95(10):1312-6. http://jmat.mat.or.th/index.php/jmat/article/view/2144 (Efficacy and Safety of 3% Minoxidil versus Combined 3% Minoxidil / 0.1% Finasteride in Male Pattern Hair Loss: A Randomized, Double-Blind, Comparative Study | Tanglertsampan | Journal of the Medical Association of Thailand)

BACKGROUND: Topical minoxidil and oral finasteride have been used to treat men with androgenetic alopecia (AGA). There are concerns about side effects of oral finasteride especially erectile dysfunction.

OBJECTIVE: To compare the efficacy and safety of the 24 weeks application of 3% minoxidil lotion (MNX) versus combined 3% minoxidil and 0.1% finasteride lotion (MFX) in men with AGA.

MATERIAL AND METHOD: Forty men with AGA were randomized treated with MNX or MFX. Efficacy was evaluated by hair counts and global photographic assessment. Safety assessment was performed by history and physical examination.

RESULTS: At week 24, hair counts were increased from baseline in both groups. However paired t-test revealed statistical difference only in MFX group (p = 0.044). Unpaired t-test revealed no statistical difference between two groups with respect to change of hair counts at 24 weeks from baseline (p = 0.503). MFX showed significantly higher efficacy than MNX by global photographic assessment (p = 0.003). There was no significant difference in side effects between both groups.

CONCLUSION: Although change of hair counts was not statistically different between two groups, global photographic assessment showed significantly greater improvement in the MFX group than the MNX group. There was no sexual side effect. MFX may be a safe and effective treatment option.

What does this mean "no statistical difference" BUT "global photographic assessment showed significantly greater improvement in the MFX group"?

 

[Michael Scally MD]

What does this mean "no statistical difference" BUT "global photographic assessment showed significantly greater improvement in the MFX group"?

[The paper did not provide pictures! The full-text paper is available as a pdf link. http://jmat.mat.or.th/index.php/jmat/article/viewfile/2144/2122 ]

Global Photographic Assessment

Global photographs were taken using a digital camera. A panel of three doctors who were blinded to the treatment conducted clinical assessments using 7-point scale, greatly decreased (-3), moderately decreased (-2), slightly decreased (-1), no change (0), slightly increased (+1), moderately increased (+2) and greatly increased (+3).


Global Photographic Assessment

Mean scores awarded by three doctors using 7-point scale at six months after treatments were 1.84 +/- 0.79 and 1.02 =/- 0.69 in MFX and MNX groups respectively (Table 4). There was statistical difference between these groups (p = 0.003).

 

[Millard]

Topical finasteride certainly sounds like a better option especially if it really is significantly better than minoxidil only. I'm surprised such a lotion hasn't been marketed before (or has it?). I know bodybuilders have crushed Proscar tablets for this purpose years ago.

 

[Michael Scally MD]

Park KY, Kim HK, Kim BJ, Kim MN. Letter: Platelet-Rich Plasma for Treating Male Pattern Baldness. Dermatologic Surgery 2012;38(12):2042-4. Letter: Platelet-Rich Plasma for Treating Male Pattern Baldness - Park - 2012 - Dermatologic Surgery - Wiley Online Library

 

[Michael Scally MD]

Zhang NN, Park DK, Park HJ. Hair growth-promoting activity of hot water extract of Thuja orientalis. BMC Complement Altern Med 2013;13(1):9. BMC Complementary and Alternative Medicine | Abstract | Hair growth-promoting activity of hot water extract of Thuja orientalis

BACKGROUND: Thuja orientalis has been traditionally used to treat patients who suffer from baldness and hair loss in East Asia. The present study sought to investigate the hair growth-promoting activity of T. orientalis hot water extract and the underlying mechanism of action.

METHODS: After T. orientalis extract was topically applied to the shaved dorsal skin of telogenic C57BL/6 N mice, the histomorphometric analysis was employed to study induction of the hair follicle cycle. To determine the effect of T. orientalis extract on the telogen to anagen transition, the protein expression levels of beta-catenin and Sonic hedgehog (Shh) in hair follicles were determined by immunohistochemistry.

RESULTS: We observed that T. orientalis extract promoted hair growth by inducing the anagen phase in telogenic C57BL/6 N mice. Specifically, the histomorphometric analysis data indicates that topical application of T. orientalis extract induced an earlier anagen phase and prolonged the mature anagen phase, in contrast to either the control or 1% minoxidil-treated group. We also observed increases in both the number and size of hair follicles of the T. orientalis extract-treated group. Moreover, the immunohistochemical analysis reveals earlier induction of beta-catenin and Shh proteins in hair follicles of the T. orientalis extract-treated group, compared to the control or 1% minoxidil-treated group.

CONCLUSION: These results suggest that T. orientalis extract promotes hair growth by inducing the anagen phase in resting hair follicles and might therefore be a potential hair growth-promoting agent.

 

[Michael Scally MD]

Heilmann S, Kiefer AK, Fricker N, et al. Androgenetic alopecia: identification of four genetic risk loci and evidence for the contribution of WNT-signaling to its etiology. J Invest Dermatol. http://www.nature.com/jid/journal/vaop/naam/pdf/jid201343a.pdf

The pathogenesis of androgenetic alopecia (AGA, male-pattern baldness) is driven by androgens, and genetic predisposition is the major prerequisite. Candidate gene and genome-wide association studies have reported that single nucleotide polymorphisms (SNPs) at eight different genomic loci are associated with AGA-development. However a significant fraction of the overall heritable risk still awaits identification. Furthermore, understanding of the pathophysiology of AGA is incomplete, and each newly associated locus may provide novel insights into contributing biological pathways.

The aim of this study was to identify unknown AGA risk loci by replicating SNPs at the twelve genomic loci that showed suggestive association (5 x 10(-8)<P<10(-5)) with AGA in a recent meta-analysis. We analyzed a replication-set comprising 2,759 cases and 2,661 controls of European descent to confirm the association with AGA at these loci. Combined analysis of the replication and the meta-analysis data identified four genome-wide significant risk loci for AGA on chromosomes 2q35, 3q25.1, 5q33.3, and 12p12.1. The strongest association signal was obtained for rs7349332 (P=3.55 x 10(-15)) on chr2q35, which is located intronically in WNT10A. Expression studies in human hair follicle tissue suggest that WNT10A plays a functional role in AGA-etiology.

Thus, our study provides genetic evidence supporting an involvement of WNT-signaling in AGA-development.

 

[Michael Scally MD]

Monselise A, Bar-On R, Chan L, Leibushor N, McElwee K, Shapiro J. Examining the Relationship between Alopecia Areata, Androgenetic Alopecia, and Emotional Intelligence. J Cutan Med Surg 2013;17(1):46-51. http://www.deckerpublishing.com/productdetails.aspx?bjid=339

Background: Emotional stress has been associated with the development of alopecia areata (AA) and androgenetic alopecia (AGA). Emotional intelligence (EI), a component of general intelligence, is thought to govern the recognition, expression, and control of stress and other emotions. People with low EI are unable to adequately control stress in everyday life.

Objective: To investigate EI differences between AA and AGA patients and a control population.

Methods: Thirty-five AGA patients and 42 AA patients, with patchy (n = 28), ophiasis (n = 5), totalis (n = 5), and universalis (n = 4) distribution of hair loss, completed a 133-item Emotional Quotient-Inventory (EQ-I ) psychometric assessment. Scores were compared between AA, AGA, and 77 control subjects obtained from the North American normative population sample on which the psychometric instrument was normed.

Results: Statistically significant differences were found in EI between AA patients and controls with the EQ-I Stress Tolerance scale (p = .005). AGA patients also differed significantly from the controls but to a lesser degree compared toAA patients. In overall EI, there were no apparent differences between AGA and AA patients.

Conclusions: AA and AGA patients exhibit a mild depressive reaction to their condition, with AA patients demonstrating a significantly stronger deficiency in coping with stress than AGA patients. The data support a psychosomatic contribution to AA. Referral of patients for EI assessment and psychosocial counseling could help reduce stress.

 

[plisk]

So has there ever been any literature we can pull info from to understand which synthetic steroids are worse for the hairline?

There's some things that still just don't make sense for me. For example, it's commonly stated that masteron is one of the worst for your hairline because "its DHT bro" - except its not DHT. Its DHT derived, but so is anavar, and I've never seen anyone suggest anavar was aggressive on the hairline.

 

[James23]

So has there ever been any literature we can pull info from to understand which synthetic steroids are worse for the hairline?

There's some things that still just don't make sense for me. For example, it's commonly stated that masteron is one of the worst for your hairline because "its DHT bro" - except its not DHT. Its DHT derived, but so is anavar, and I've never seen anyone suggest anavar was aggressive on the hairline.

DHT does not trigger MPB by virtue of being DHT.

DHT triggers MBP because it is highly androgenic. Synthetic steroids can be even more androgenic than DHT. It doesn't matter whether or not they convert to DHT.

 

[robinjohn12]

Hey

Some steroids really effect the human body but i think whenever user use it first get info and review from expert person so he knows real things and detail about steroids then if he would like to use it he can do it,

thanks