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hair loss treatment at the Proctor clinic

Androgen responsive genes as they affect hair growth

European Journal of Dermatology. Volume 11,304

Summary

Author(s) : M.E. Sawaya,et al

Summary : Finasteride is an effective treatment for men with androgenetic alopecia (AGA) as it restores hair regrowth. Caspases regulate programmed cell death. Caspases may mediate the hair regrowth cycle. ... Very little information is available regarding the role of caspases present in human hair follicles in normal scalp and in pattern hair loss. We have analyzed the family of caspases in men with normal scalp and in men with malepattern hair loss before and after 6 months treatment with 1 mg oral finasteride treatment. snip... This study indicates caspase 3 is of primary importance in normal hair homeostasis and that DHT may be signaling greater expression of caspases, inducing apoptosis in androgenetic alopecia. In conclusion, DHT may selectively regulate the caspase genes which play an important role in signaling programmed cell death, affecting the hair regrowth cycle.

Dr Proctor treats hair loss

Khaitan BK, Mittal R, Verma KK. Extensive alopecia areata treated with betamethasone oral mini-pulse therapy: An open uncontrolled study. Indian J Dermatol Venereol Leprol 2004;70:350

Hair loss due to alopecia areata responds to daily oral corticosteroids. snip... AIM: To evaluate the efficacy of oral mini-pulse therapy in extensive hair loss due to alopecia areata. METHODS: It is an open study on sixteen adolescents and adults with alopecia areata treated with oral mini-pulse therapy for a minimum period of six months.snip... RESULTS: Seven patients showed an excellent hair regrowth response and five patients had good hair regrowth. Two patients (12.5%) had unsatisfactory response and another two (12.5%) had no hair regrowth. There were insignificant / minimal side effects. CONCLUSION: Oral mini-pulse therapy with betamethasone is a safe and effective therapeutic modality for extensive alopecia areata.

Edited for hair loss treatment blog

Minoxidil stimulates hair regrowth. Scalp biopsies in topical minoxidil treatment for hair loss reveal enlargement of "miniaturized" hair follicles and longer duration of the hair growth cycle.

Link: http://www.drproctor.com

Hair Loss and Hair loss treatment at the Proctor clinic

Information on hair loss treatment, a blog, etc.

Skin Pharmacol. 1994;7(1-2):5

Mechanisms regulating human hair regrowth.Sawaya ME.

edited for blog application

The human hair follicle cycles in active regrowth and resting phases controlled by a complex network of biochemical processes, yet to be fully understood. ..snip... The levels of these enzymes differed between men and women, and from frontal versus occipital sites within the same patient, indicating that similar steroid mechanisms may be taking place in men and women, but the amount or level of enzymes vary, perhaps explaining why men have more severe patterns of hair loss than women. snip..

J Am Acad Dermatol.
1987;16:657

Action of topical minoxidil

.Uno H, Cappas A, Brigham P

Edited
.
Minoxidil on hair regrowth was studied in the frontal bald scalp of stump-tailed macaques....regrowth of hair follicular regrowth is stimulated when treatment with minoxidil is reinstituted. Hair regrowth was more prominent in the early stage of baldness among younger macaques than in baldness of longer duration in older animals. snip... Minoxidil's essential action in hair re growth may be as a vasodilator. However, a direct action on the hair follicle cannot be ruled out considering uptake and conversion of the drug to minoxidil sulfate within the hair follicle itself.

Dermatol Clin. 1987;5(3):565

Hair loss in systemic disease.

Spencer LV, Callen JP.

A careful history and examination of shed hairs will reveal the etiology of most causes of hair loss due to systemic processes. Telogen effluvium is preceded by a severe systemic stress occurring at least two months prior to the loss of normal club hairs. Most other causes of hair loss involve damage to the hair follicle, which leads to the shedding of dystrophic, brittle anagen hairs. A history of drug ingestion or nutritional compromise or concurrent symptoms suggestive of a genetic, endocrinologic, collagen vascular, or infectious etiology will lead to an accurate diagnosis

Vet Rec. 1986;119:621

An investigation into the aetiology of 'wool slip': alopecia in ewes which are housed and shorn in winter.

Morgan KL,et al

Alopecia in housed ewes which are shorn in winter, 'wool slip', was investigated by taking wool and blood samples, skin scrapings and biopsies from affected and unaffected animals. Epidemiological information was also obtained from farm records, and reports from a local weather station. No pathological lesions were seen and no ectoparasites or forage mites were seen in wool samples or skin scrapings. ..snip... A comparison of the mean temperatures during years of summer and winter shearing suggested that cold stress alone was not involved. Skin biopsies revealed that the wool follicles of affected animals were in an early regrowth phase (anagen) whereas those of unaffected animals were in the inactive phase (telogen). The clinical and histological signs of the disease were similar to those seen experimentally when corticosteroids are used as chemical depilatory agents. It is suggested that wool slip is due to the high levels of corticosteroids which occur as a result of the combination of housing and shearing and on this basis methods of control are proposed.

Ann Nutr Metab. 1997;41(6):376-81

Effect of experimental zinc deficiency on thyroid gland in guinea-pigs.

Gupta RP, et al

Zinc deficiency was produced experimentally in guinea-pigs fed on a diet containing 1.03 mg Zn/kg over a period of 45 days. Clinical signs exhibited in Zn-deficient (ZnD) animals were depression with abnormal posture, scaly skin lesions on various parts of the body, oedematous swelling on hind limbs and marked alopecia (hair loss). There was no effect on food intake. Serum studies in ZnD group revealed significant decreases in the concentrations of Zn from 20 days onwards, and tri-iodo-thyronine (T3) and thyroxine (T4) from 30 days onwards. Thyroid glands of ZnD animals were smaller in size and pale or whitish pale in colour. Histopathologically, these glands showed changes of atrophy and degeneration in the follicles. It could be concluded that the depletion in serum T3 and T4 due to Zn deficiency was related to thyroid lesions.

Z Hautkr. 1990 Dec;65(12):1080-4

Objective assessment of therapeutic hair growth--methods, possibilities and problems

Schell H.

With regard to hair regrowth induced by therapeutics, we have to consider various aspects of the activity of the hair follicle. This means that a study on the efficacy of hair growth therapeutics requires a selective investigation of different kinds of follicular activity. The decision which of the non-invasive, semi-invasive or invasive techniques available should be applied in a specific case depends on the reliability of the method in relation to the technical requirement, on the one hand, and the acceptance by the volunteer as well as the clinical type and degree of hair loss, on the other. Trichorhizogram results as the only means of evaluating the efficacy of hair growth therapeutics seem problematical, since an increase of the anagen rate does not absolutely correlate with a prolongation of the anagen phase.

Int J Dermatol. 1983 May;22(4):245-6.

Photochemotherapy and alopecia areata.

Amer MA, El Garf A.

Four of ten patients with hair loss due to alopecia areata (plaque and totalis types) showed some hair regrowth after PUVA therapy using a light box with peak emission 365 nm. Because PUVA may have long term side effects, this therapy should be reserved for patients resistant to other treatments.

Z Hautkr. 1979 May 15;54(10):426-9.
DNCB treatment of Alopecia Areata

Happle R.
Long-term treatment of alopecia areata with dinitrochlorobenzene is effective. During the last two and a half years, 227 patients who suffered, in the majority of cases, from total or subtotal hair loss, were treated by this method. Unilateral application of DNCB induced unilateral regrowth of hair in 88% of these patients. Under continuous treatment of both sides of the head, this initial response was followed by complete regrowth of hair in 78%. The same result could be obtained by application of squaric acid dibutylester, another potent contact allergen. This indicates that the essential mechanism is contact allergy. Possibly, the regrowth of hair is due to the induction of local nonspecific immunosuppression.

Med Hypotheses. 2004;62(1):112-5.

Ketocazole as an adjunct to finasteride in the treatment of male pattern hair loss
Hugo Perez BS.

Dihydrotestosterone (DHT) binding to androgen receptors (AR) in hair follicles is commonly accepted as the first step leading to the miniaturizing of follicles associated with pattern hair loss. Ketoconazole has been clinically shown to be effective in the treatment of AGA. In this paper, evidence is presented to support the hypothesis that ketoconazole 2% shampoo has a local disruption of the DHT pathway. It is proposed that using ketoconazole 2% shampoo as an adjunct to finasteride treatment could lead to a more complete inhibition of DHT and thus better treat AGA.

Nature. 1998 Feb 5;391(6667):537, 539. Human genetics. Hair apparent.
Davies K.
PMID: 9468131

Loss of hair

Hannuksela M.

Duodecim. 2000;116(7):729-35. Review. Finnish.

Review on Hair Loss, diagnosis and treatment

Dermatol Clin. 1998 Apr;16(2):341-56.

Hair regrowth. Therapeutic agents.
Shapiro J, Price VH.

Today there are new classes of hair growth promotors with proven efficacy. This article reviews the current state of the art agents for treatment of two of the most common forms of hair loss encountered in clinical practice, androgenetic alopecia and alopecia areata. Current therapeutic strategies are based on recent advances in the understanding of disordered hair growth. Practical treatment protocols are presented.

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.

Rev Med Brux. 2004 Sep;25(4):A277-81.

Androgenetic alopecia

Hair Loss Blog

del Marmol V, Jouanique C.
Service de Dermatologie, Hôpital Erasme, ULB, Bruxelles.

The physiopathology of androgenetic alopecia (pattern hair loss ) is linked to the action of the androgens of the bulbs pilairs of the scalp. The action of these androgens can be associated with the level of hormones in circulation and with the genetic predisposition which will influence the activity of these androgens at the periphery. The classifications of the evolution of alopecia will be done following Norwood for the male and following Ludwig for the female. Hormonal investigation will be effectuated on the female only in the case of research on or the identification of hyperandrogenia; this is essential in order to direct the therapy. The diagnose and the therapeutic follow-up are essentially clinical but can be assisted by a trichogram which will show-up the miniaturisation process of androgenetic alopecia and the telogen effluvium of the affected areas. The treatment of alopecia can be local or general. The local treatment will use a lotion of minoxidil 2 to 5% whether the patient is male of female. On males, an inhibitor of the 5 alpha reductase 2, finasteride, has shown its efficiency at a dose of 1 mg/day. On females oestroprogestatives will be used, if they are not counter-advised, associated with an anti-androgen: either cyproterone acetate or spironolactone. A therapeutic evaluation will be made after 6 months of treatment.

Hair Loss Blog

Am J Clin Dermatol. 2000 Mar-Apr;1(2):101-5

Alopecia areata. Pathogenesis, diagnosis, and therapy.

Papadopoulos AJ, Schwartz RA, Janniger CK.

New Jersey Medical School, Newark, New Jersey, USA.

Alopecia areata is a common form of non-scarring alopecia (hair loss) that appears equally in males and females of any age, although children and adolescents are more commonly affected. The disorder is usually characterized by limited alopecic patches on the scalp, but more severe forms may affect the entire scalp (alopecia totalis) or body (alopecia universalis). Characteristic nail changes may also accompany hair loss. Alopecia areata has been linked with certain human leukocyte antigen (HLA) class II alleles, indicating a probable autoimmune etiology. Current research implicates T lymphocytes in the pathogenetic mechanism of disease. Other autoimmune diseases are also linked with alopecia areata. The diagnosis of alopecia areata is usually made clinically, although a biopsy is diagnostic for this condition. Treatment is challenging and aims at the regrowth of hair in affected individuals. Intralesional corticosteroid injections are widely used in mild disease. Topical anthralin and minoxidil may also be clinically efficacious. Topical sensitizers, such as squaric acid dibutlyester and diphenyl-cyclopropenone, are sometimes employed. Various therapies for the disease may have efficacy in different patients, making a universal treatment algorithm difficult to implement. Patients should be handled on an individual basis, with the final outcome based on the cosmetic regrowth of hair. Maintenance therapy is also important in patients that do achieve acceptable regrowth, necessitating a highly motivated patient and good rapport with the treating physician.

Nippon Yakurigaku Zasshi. 2002 Mar;119(3):167-74

Hair regrowth effect of minoxidil

Otomo S.

The length and size of hair are depend on the anagen term in its hair cycle. It has been reported that the some cell growth factors, such as VEGF, FGF-5S, IGF-1 and KGF, induce the proliferation of cells in the matrix, dermal papilla and dermal papillary vascular system and increase the amount of extra cellular matrix in dermal papilla and then maintain follicles in the anagen phase. On the other hand, negative factors, like FGF-5, thrombospondin, or still unknown ones, terminate the anagen phase. If the negative factors become dominant against cell proliferation factors according to fulfilling some time set by the biological clock for hair follicles, TGF beta induced in the matrix tissues evokes apoptosis of matrix cells and shifts the follicles from anagen to catagen. Androgenetic alopecia is caused by miniaturizing of hair follicles located in the frontal or crown part of scalp and are hereditarily more sensitive to androgen. In their hair cycles, the androgen shortens the anagen phase of follicles and shifts them to the catagen phase earlier than usual. The mode of action of the hair growth effect of minoxidil is not completely elucidated, but the most plausible explanation proposed here is that minoxidil works as a sulfonylurea receptor (SUR) activator and prolongs the anagen phase of hair follicles in the following manner: minoxidil (1) induces cell growth factors such as VEGF, HGF, IGF-1 and potentiates HGF and IGF-1 actions by the activation of uncoupled SUR on the plasma membrane of dermal papilla cells, (2) inhibits of TGF beta induced apoptosis of hair matrix cells by opening the Kir 6.0 channel pore coupled with SUR on the mitochondrial inner membrane, and (3) dilates hair follicle arteries and increases blood flow in dermal papilla by opening the Kir 6.0 channel pore coupled with SUR on the plasma membrane of vascular smooth muscle cells.

J Am Acad Dermatol. 2002 Sep;47(3):377-85

A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men.

Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, Trancik RJ.

Hair loss Blog

BACKGROUND: Topical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in individuals with androgenetic alopecia (AGA). Results can be variable, and historical experience suggests that higher concentrations of topical minoxidil may enhance efficacy. OBJECTIVE: The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of men with AGA. METHODS: A total of 393 men (18-49 years old) with AGA applied 5% topical minoxidil solution (n = 157), 2% topical minoxidil solution (n = 158), or placebo (vehicle for 5% solution; n = 78) twice daily. Efficacy was evaluated by scalp target area hair counts and patient and investigator assessments of change in scalp coverage and benefit of treatment. RESULTS: After 48 weeks of therapy, 5% topical minoxidil was significantly superior to 2% topical minoxidil and placebo in terms of change from baseline in nonvellus hair count, patient rating of scalp coverage and treatment benefit, and investigator rating of scalp coverage. Hair count data indicate that response to treatment occurred earlier with 5% compared with 2% topical minoxidil. Additionally, data from a patient questionnaire on quality of life, global benefit, hair growth, and hair styling demonstrated that 5% topical minoxidil helped improve patients' psychosocial perceptions of hair loss. An increased occurrence of pruritus and local irritation was observed with 5% topical minoxidil compared with 2% topical minoxidil. CONCLUSION: In men with AGA, 5% topical minoxidil was clearly superior to 2% topical minoxidil and placebo in increasing hair regrowth, and the magnitude of its effect was marked (45% more hair regrowth than 2% topical minoxidil at week 48). Men who used 5% topical minoxidil also had an earlier response to treatment than those who used 2% topical minoxidil. Psychosocial perceptions of hair loss in men with AGA were also improved.

Am Fam Physician. 2003 Jul 1;68(1):93-102.

Common hair loss disorders.

Springer K,et al

Hair loss (alopecia) affects men and women of all ages and often significantly affects social and psychologic well-being. Although alopecia has several causes, a careful history, dose attention to the appearance of the hair loss, and a few simple studies can quickly narrow the potential diagnoses. Androgenetic alopecia, one of the most common forms of hair loss, usually has a specific pattern of temporal-frontal hairloss in men and central thinning in women. The U.S. Food and Drug Administration has approved topical minoxidil to treat men and women, with the addition of finasteride for men. Telogen effluvium is characterized by the loss of "handfuls" of hair, often following emotional or physical stressors. Alopecia areata, trichotillomania, traction alopecia, and tinea capitis have unique features on examination that aid in diagnosis. Treatment for these disorders and telogen effluvium focuses on resolution of the underlying cause.

Hair Loss Blog

Acta Derm Venereol. 1983;63(3):268-9

Reversal of androgenic alopecia by minoxidil: lack of effect of simultaneously administered intermediate doses of cyproterone acetate.

Vermorken AJ.

A male volunteer with frontal alopecia (male pattern hair loss) was treated simultaneously with 20 mg cyproterone acetate and 5 mg minoxidil topically (daily). During treatment with both drugs, new hair regrowth was observed on the alopecic scalp. The new hair was lost after discontinuing minoxidil treatment, although cyproterone acetate treatment was continued.

Br J Dermatol. 1987 Dec;117(6):759-63.

Response to minoxidil in severe alopecia areata correlates with T lymphocyte stimulation.
Fiedler-Weiss VC, Buys CM.

Mitogen-induced T cell blastogenesis was determined in 47 patients with severe alopecia areata, before and after treatment with topical 5% minoxidil, and compared with control values. The group of 36 responders, who demonstrated terminal hair regrowth, showed significantly increased lymphocyte stimulation with concanavalin A and PHA before treatment, which decreased towards control values following hair regrowth. Lymphocytes from non-responders showed no significant differences from controls either before or after treatment. The results suggest that enhanced T cell blastogenesis may predict the response of severe alopecia areata to topical 5% minoxidil therapy.

Curr Pharm Des. 1999 Sep;5(9):707-23.

Current aspects of antiandrogen therapy in women.
Diamanti-Kandarakis E.

Hair Loss blog

Androgenic manifestations in appearance cause not only social and psychological distress for many women, but serious skin, reproductive and metabolic abnormalities as well. Antiandrogen therapy is one of the most promising therapies to treat androgenic disorders. Clinical studies with a variety of agents, including spironolactone, cyproterone acetate, flutamide and finasteride have now proven their utility in the treatment of hirsutism, acne, androgenic alopecia Hair loss and ovulatory dysfuntion in hyperandrogenic women. Comparative clinical studies, especially with low-dose regimens, suggest that these hair loss treatment agents are well tolerated and have the potential for broader clinical utility.

Int J Cosmet Sci. 2002 Feb;24(1):17-23

Causes of hair loss and the developments in hair rejuvenation.

Rushton DH, Norris MJ, Dover R, Busuttil N.

Hair is considered to be a major component of an individual's general appearance. The psychological impact of hair loss results in a measurably detrimental change in self-esteem and is associated with images of reduced worth. It is not surprising that both men and women find hair loss a stressful experience. Genetic hair loss is the major problem affecting men and by the age of 50, up to 50% will be affected. Initial attempts to regenerate the lost hair have centred on applying a topical solution of between 2% to 5% minoxidil; however, the results proved disappointing. Recently, finasteride, a type II 5alpha reductase inhibitor has been found to regrow a noticeable amount of hair in about 40% of balding men. Further developments in treatments have lead to the use of a dual type I and type II inhibitor where 90% of those treated regrow a noticeable amount of hair. In women the major cause of hair loss before the age of 50 is nutritional, with 30% affected. Increased and persistent hair shedding (chronic telogen effluvium) and reduced hair volume are the principle changes occurring. The main cause appears to be depleted iron stores, compromised by a suboptimal intake of the essential amino acid l-lysine. Correction of these imbalances stops the excessive hair loss and returns the hair back to its former glory. However, it can take many months to redress the situation.

Hair Loss Blog

Cleve Clin J Med. 1989 Mar-Apr;56(2):149-54.

Extensive alopecia areata. Results of treatment with 3% topical minoxidil.

Ranchoff RE, Bergfeld WF, Steck WD, Subichin SJ.

A 3% topical minoxidil solution was used to treat 31 normotensive persons (13 male, 18 female) with extensive alopecia areata. After 15 months, three patients (14%) had 75%-100% regrowth, 13 (59%) had some form of regrowth, and nine (41%) had no regrowth. In the initial three-month double-blind portion of the study, minoxidil was not shown to be more effective than placebo. Biopsy specimens from eight patients who underwent biopsy prior to treatment, after three months, and posttreatment showed no significant change in peribulbar or perivascular inflammation. Prominent, new anagen follicles were observed. The 3% topical minoxidil was generally well tolerated and skin irritation was minimal. Blood pressure monitoring revealed no significant changes in diastolic or systolic pressures. Minoxidil is a relatively safe treatment for extensive alopecia areata and may be effective in the treatment of some cases of recalcitrant disease.

Int J Dermatol. 2008 Aug;47(8):850-2.

Treatment of persistent alopecia areata with sulfasalazine.

Rashidi T, Mahd AA.

BACKGROUND: Alopecia areata is an autoimmune disease with no definitive treatment for hair loss, and some cases persist despite standard therapies. Sulfasalazine has been reported to show success in the treatment of persistent cases of alopecia areata. Objective To assess the efficacy of sulfasalazine in cases of recalcitrant alopecia areata that do not respond to topical and intralesional corticosteroids, 5% minoxidil, or psoralen plus ultraviolet-A (PUVA) therapy. METHODS: Thirty-nine patients with persistent alopecia areata received 3 g of oral sulfasalazine for 6 months, and terminal hair regrowth was quantified as no response, moderate response, or good response. RESULTS: A good response occurred in 10 of the 39 patients (25.6%), a moderate response in 12 (30.7%), and a poor or no response in 17 (43.5%). CONCLUSION: Sulfasalazine can be used as an alternative drug in patients with persistent alopecia areata.

Ann Oncol. 1994 Oct;5(8):769-70.

Minoxidil (Mx) as a prophylaxis of doxorubicin--induced alopecia.

Rodriguez R, Machiavelli M, Leone B, Romero A, Cuevas MA, Langhi M, Romero Acuña L, Romero Acuña J, Amato S, Barbieri M, et al.

BACKGROUND: Minoxidil (Mx) is known to induce hair growth in men with male-pattern baldness. Based on this potential, the effectiveness of Mx 2% topical solution was evaluated in cancer patients (pts) to prevent doxorubicin-induced alopecia. PATIENTS AND METHODS: 48 female pts with different types of solid tumors treated with doxorubicin-based chemotherapy in a dose range of 50-60 mg/m2/cycle were randomly assigned to receive Mx 2% topical solution or placebo. RESULTS: 88% and 92% of pts in both arms showed severe alopecia (p = ns). No adverse effects were observed. CONCLUSION: In this study Mx 2% topical solution was non-toxic but was not effective in the prevention of chemotherapy-induced alopecia.

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J Am Acad Dermatol. 1993 May;28(5 Pt 1):755-63.

Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia.
Whiting DA.

University of Texas, Southwestern Medical Center, Dallas.

BACKGROUND: Vertical sections of small scalp biopsy specimens are often inadequate for the diagnosis of male pattern androgenetic alopecia (MPAA). Quantitative analysis of follicular structures in horizontal sections can provide more information. OBJECTIVES: Our purpose was to establish better diagnostic criteria by comparing horizontal and vertical sections of scalp biopsy specimens from MPAA and normal control subjects and to determine the predictive value of horizontal sections, by relating counts of follicular structures in MPAA to subsequent hair regrowth from topical minoxidil therapy. METHODS: Paired 4 mm punch biopsy specimens were taken from 22 normal control subjects and 106 patients with MPAA, for horizontal and vertical sectioning. In horizontal sections, hair bulbs, terminal anagen, catagen and telogen hairs, telogen germinal units, and vellus hairs were counted, as were follicular units and stelae. RESULTS: The diagnosis of MPAA was confirmed by finding decreased terminal hairs and increased stelae and vellus hairs. The average horizontal section contained 22 terminal and 13 vellus hairs, a 1.7:1 ratio. Changes compatible with MPAA were found in most vertical and horizontal sections, but horizontal sections were required for follicular counts and showed terminal:vellus hair ratios diagnostic of MPAA in 67% of cases. Of 44 patients treated with topical minoxidil, five with less than 2 follicular structures/mm2 showed no hair regrowth, 32 with 2 to 4 follicular structures/mm2 showed regrowth in 72%, and seven with more than 4 follicular structures/mm2 showed regrowth in 86% of cases. In MPAA with no significant inflammation, regrowth occurred in 77% of cases, versus 55% in cases with significant inflammation. CONCLUSION: Horizontal sections of scalp biopsy specimens in MPAA provide more diagnostic information than vertical sections and appear to have a predictive value for hair regrowth.

Link: http://www.drproctor.com

Dermatol Surg. 2001 Aug;27(8):739-43. LinksElliptografting: the right fit.
Sadick N.
Department of Dermatology, Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University, New York, New York, USA.

BACKGROUND: A number of new recipient grafting techniques have evolved employing micrografting, minigrafting, and follicular unit technologies as larger hair transplantation sessions incorporating smaller grafts have evolved. OBJECTIVE: To introduce a new recipient graft device-the elliptograft-and compare it to standard circular minigrafts and laser-generated slot grafts. METHODS: A blinded study was performed of 30 patients (mean age 44 years) with grades II-V male pattern Norwood or medium Ludwig female pattern androgenetic alopecia. Ten patients were transplanted with the second-generation elliptograft punch, 10 were treated with 2 mm circular minigrafts, and 10 were transplanted with the recipient sites created by the hybrid Er:YAG/CO2 laser in a slot configuration. The front three rows in each patient were transplanted utilizing No-Kor needle-generated micrografts in all three patient study subgroups. RESULTS: Comparable hair growth density was achieved utilizing conventional circular minigraft, freehand laser slit, and elliptograft technologies. Healing time was slightly prolonged in the laser transplant subgroup; however, the time for initial hair growth was comparable in all three patient populations. Aesthetic improvement was judged superior in the elliptograft population by blinded physician observers, which correlated with good patient satisfaction. CONCLUSION: Combined micro-mini elliptografting utilizing the newly described elliptograft punch produces excellent hair density correlated with high patient satisfaction.

Link: http://www.drproctor.com

Curr Med Res Opin. 2009 Jul;25(7):1811-20. Attitudes, behaviors, and expectations of men seeking medical treatment for male pattern hair loss: results of a multinational survey.

Cash TF.

OBJECTIVES: The study's objectives were to characterize the concerns and self-treating efforts of men seeking medical treatment for male pattern hair loss (MPHL) and to describe their expectations and actual experiences of a physician consultation. METHODS: The online survey in six countries (United States, France, Germany, Spain, Japan, and Korea) involved 604 men (25-49 years old) self-identifying with MPHL. RESULTS: Approximately 75% of the study's treatment-seeking men were concerned, very concerned, or extremely concerned about their hair loss; 96% were at least somewhat concerned. This high level of concern translated into multiple information-seeking actions (53.9% reported two or three actions; 24.6% reported four or five actions) and multiple self-treatments prior to physician consultation. Only 16% of the sample had not tried any treatment. Many treatment-motivated men with MPHL were uncomfortable (21%) or only moderately comfortable (37%) consulting with a physician and delayed this consultation. Factors motivating men with MPHL to consult a physician included a concern about worsening hair loss (82%), a desire to benefit from physicians' treatment expertise (85%) or physician-prescribed products (75%), and dissatisfaction with non-prescription products (73%). Expectations for the physician's treatment actions were met less often than was desired, resulting in dissatisfaction among one-fourth of the men. Dissatisfaction stemmed from lack of specific treatment recommendations (66%), unanswered questions (54%), and a perception that the doctor was uncomfortable or uninterested in discussing their hair loss (52%). Potential study limitations included self-identification of MPHL, reliance on respondents' recall, and a lack of verification of professed future physician consultations. CONCLUSIONS: The typical man seeking MPHL treatment has significant concerns about the condition and has already engaged in considerable efforts to obtain information and to self-treat. Individualized consideration of attitudes, concerns, self-treating efforts, and expectations is crucial for effective management of men seeking medical treatment for MPHL.

PMID: 19514838

Link: http://www.gohair.com

Endocr Rev. 2000 Aug;21(4):363-92. Role of hormones in pilosebaceous unit development.

Deplewski D, Rosenfield RL.

Androgens are required for sexual hair and sebaceous gland development. However, pilosebaceous unit (PSU) growth and differentiation require the interaction of androgen with numerous other biological factors. The pattern of PSU responsiveness to androgen is determined in the embryo. Hair follicle growth involves close reciprocal epithelial-stromal interactions that recapitulate ontogeny; these interactions are necessary for optimal hair growth in culture. Peroxisome proliferator-activated receptors (PPARs) and retinoids have recently been found to specifically affect sebaceous cell growth and differentiation. Many other hormones such as GH, insulin-like growth factors, insulin, glucocorticoids, estrogen, and thyroid hormone play important roles in PSU growth and development. The biological and endocrinological basis of PSU development and the hormonal treatment of the PSU disorders hirsutism, acne vulgaris, and pattern alopecia are reviewed. Improved understanding of the multiplicity of factors involved in normal PSU growth and differentiation will be necessary to provide optimal treatment approaches for these disorders.

Link: http://www.hair-loss-treatment.com

Endocrinol Metab Clin North Am. 2007 Jun;36(2):379-98.

Otberg N, Finner AM, Shapiro J.

Androgenetic alopecia (AGA), or male pattern hair loss, affects approximately 50% of the male population. AGA is an androgen-related condition in genetically predisposed individuals. There is no treatment to completely reverse AGA in advanced stages, but with medical treatment (eg, finasteride, minoxidil, or a combination of both), the progression can be arrested and partly reversed in the majority of patients who have mild to moderate AGA. Combination with hair restoration surgery leads to best results in suitable candidates. Physicians who specialize in male health issues should be familiar with this common condition and all the available approved treatment options.

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.

trans-3,4'-Dimethyl-3-hydroxyflavanone (t-flavanone) is a synthetic compound withhair 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 oft-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.

Eur J Med Genet. 2009 Jan-Feb;52(1):53-8., Clinical and genetic heterogeneity in keratosis follicularis spinulosa decalvans.

Castori M, Covaciu C, Paradisi M, Zambruno G.

Keratosis follicularis spinulosa decalvans (KFSD) is an uncommon genodermatosis mainly characterized by follicular hyperkeratosis, progressive cicatricial alopecia and photophobia. Although an excess of affected males and linkage studies strongly suggest an X-linked pattern of inheritance, an apparently rarer autosomal dominant form with prominent follicular inflammation has also been postulated. We report on a three-generation family with five affected individuals and male-to-male transmission. In addition to widespread keratosis pilaris,cicatricial alopecia and eye involvement, our patients show diffuse facial erythema, recurrent folliculitis, enamel hypoplasia, and thickened nails. A literature review of the last 50 years identified 43 additional KFSD cases. X-linked inheritance is demonstrated in two pedigrees by linkage studies and suspected in five. An autosomal dominant pattern is confirmed in three families, including ours, by male-to-male transmission and considered likely in four. Marked facial erythema, extensive folliculitis, onychodystrophy and multiple
caries are frequently reported in the autosomal dominant variant, while palmo-plantar keratoderma and early onset seem more typical of the X-linked form.Moreover, three sporadic male patients showing additional multisystemic abnormalities might be explained by an X-linked contiguous-gene syndrome.

Semin Cutan Med Surg. 2009 Jun;28(2):109-14.

Approach to hair loss in women of color.

Fu JM, Price VH.

Department of Dermatology, University of California, San Francisco, CA 94115,
USA.

Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent
history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will
guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with
appropriate education of the public and medical establishment.

hair loss Treatment

Practical management of hair loss.
Shapiro J, Wiseman M, Lui H.
Division of Dermatology, University of British Columbia (UBC), Vancouver. shapiro@interchange.ubc.ca

OBJECTIVE: To describe an organized diagnostic approach for both nonscarring and scarring alopecias to help family physicians establish an accurate in-office diagnosis. To explain when ancillary laboratory workup is necessary to confirm the diagnosis. QUALITY OF EVIDENCE: Current diagnostic and therapeutic interventions for hair loss are based on randomized controlled studies, uncontrolled studies, and case series. MEDLINE was searched from January 1966 to December 1998 with the MeSH words alopecia, hair, and alopecia areata. Articles were selected on the basis of experimental design, with priority given to the most current large multicentre controlled studies. Overall global evidence for therapeutic intervention for hair loss is quite strong. MAIN MESSAGE: The most common forms of nonscarring alopecias are androgenic alopecia, telogen effluvium, and alopecia areata. Other disorders include trichotillomania, traction alopecia, tinea capitis, and hair shaft abnormalities. Scarring alopecia is caused by trauma, infections, discoid lupus erythematosus, or lichen planus. Key to establishing an accurate diagnosis is a detailed history, including medication use, systemic illnesses, endocrine dysfunction, hair-care practices, and family history. All hair-bearing sites should be examined. A 4-mm punch biopsy of the scalp is useful, particularly to diagnose scarring alopecias. Once a diagnosis has been established, specific therapy can be initiated. CONCLUSIONS: Diagnosis and management of hair loss is an interesting challenge for family physicians. An organized approach to recognizing characteristic differential features of hair loss disorders is key to diagnosis and management.

Hair Loss Blog

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