Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N.

Abstract

Background: Female pattern hair loss affects many women; its pathogenetic basis has been held to be similar to men with common baldness. Objective: The objective of this study was to determine the role of immunity and inflammation in androgenetic alopecia in women and modulate therapy according to inflammatory and immunoreactant profiles. Materials and Methods: 52 women with pattern hair loss (AA) underwent scalp biopsies for microscopic assessment and immunofluroescent studies. In 18 patients, serologic assessment for antibodies to androgen receptor, estrogen receptor and cytokeratin 15 was conducted. Results: A lymphocytic folliculitis targeting the bulge epithelium was observed in many cases. Thirty-three of 52 female patients had significant deposits of IgM within the epidermal basement membrane zone typically accompanied by components of complement activation. The severity of changes light microscopically were more apparent in the positive immunoreactant group. Biopsies from men with male pattern hair loss showed a similar pattern of inflammation and immunoreactant deposition. Serologic assessment for antibodies to androgen receptor, estrogen receptor or cytokeratin 15 were negative. Combined modality therapy with minocycline and topical steroids along with red light produced consistent good results in the positive immunoreactant group compared to the negative immunoreactant group. Conclusion: A lymphocytic microfolliculitis targeting the bulge epithelium along with deposits of epithelial basement membrane zone immunoreactants are frequent findings in male pattern hairloss and could point toward an immunologically driven trigger. Cases showing a positive immunoreactant profile respond well to combined modality therapy compared to those with a negative result. J Drugs Dermatol. 2011;10(12):1404-1411.

J Ethnopharmacol. 2011 Sep 21. [Epub ahead of print]

Fructus panax ginseng extract promotes hair regeneration in C57BL/6 mice.

Park S, Shin WS, Ho J.

Radix panax ginseng (Panax ginseng C.A. Meyer, Araliaceae, RPG) has been documented to possess hair growth activity and widely used to treat alopecia, while no report has been issued to date on the effect of Fructus panax ginseng (FPG) on hair regeneration.

MATERIALS AND METHODS:

To investigate the effects of FPG extract on the proliferation of human hair dermal papilla cells (DPCs) and on the promotion of hair regeneration in C57BL6 mice, cell proliferation was evaluated in cultured DPC by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and measured the expressions of Bcl-2 and Bax by immunoblot assay. We also compared the effects of topical FPG extract (1 and 10mg/ml, 100ìl/d) with the effects of minoxidil as a positive control (5%, 100ìl/d) or vehicle control (30% ethanol) on the depilation-induced hair cycling in 7 week-old-C57BL/6 mice.

RESULTS:

FPG extract significantly increased the proliferation of DPCs in dose and time dependent manners (P<0.05, P<0.01 and P<0.001). FPG extract also enhanced Bcl-2 expression and decreased Bax expression compared with control (P<0.01). Moreover, significant elongations of anagen phase during hair cycle after application of FPG were evaluated by photographical and histological observations.

CONCLUSIONS:

FPG extract improves the cell proliferation of human DPCs through anti apoptotic activation. Topical administration of FPG extract might have hair regeneration activity for the treatment of hair loss.

Slightly edited for hair loss blog use

J Drugs Dermatol. 2011 Nov 1;10(11):1308-12.

Hair Regrowth Following a Wnt- and Follistatin Containing Treatment: Safety and Efficacy in a First-in-Man Phase 1 Clinical Trial.

Zimber MP, et al

Abstract

Research has shown the importance of follistatin, Wnt 7a, and wound healing growth factors on the stimulation of bulge cells and inter-follicular stem cells to induce hair growth. We have studied the effects of a bioengineered, non-recombinant, human cell-derived formulation, termed Hair Stimulating Complex (HSC), containing these factors to assess its hair growth activity in male pattern baldness. HSC showed in vitro Wnt activity and contained follistatin, KGF, and VEGF. The clinical study was a double-blind, placebo-controlled, randomized single site trial and was designed to evaluate safety of the HSC product and assess efficacy in stimulating hair growth. All 26 subjects tolerated the single, intradermal injection of HSC procedures well, and no signs of an adverse reaction were reported. Histopathological evaluation of the treatment site biopsies taken at 22 and 52 weeks post-treatment revealed no abnormal morphology, hamartomas, or other pathological responses. Trichoscan image analysis of HSC-treated sites at 12 and 52 weeks showed significant improvements in hair growth over the placebo. At the initial 12-week evaluation period, HSC-treated sites demonstrated an increase in hair shaft thickness (6.3%±2.5% vs. -0.63%±2.1%; P=0.046), thickness density (12.8%±4.5% vs. -0.2%±2.9%; P=0.028), and terminal hair density (20.6±4.9% vs. 4.4±4.9%; P=0.029). At one year, a statistically significant increase in total hair count (P=0.032) continued to be seen. These results demonstrate that a single intradermal administration of HSC improved hair growth in subjects with androgenetic alopecia and is a clinical substantiation of previous preclinical research with Wnts, follistatin, and other growth factors associated with wound healing and regeneration. J Drugs Dermatol. 2011;10(11):1308-1312.

Slightly edited for hair loss blog use.

Cutan Ocul Toxicol. 2011 Sep 23

Central chorioretinopathy associated with topical use of minoxidil 2% for treatment of baldness.

Scarinci F, et al

Abstract

Purpose: Minoxidil is one of the drugs approved for the treatment of androgenetic alopecia or male pattern hair loss. This article presents a case of central serous chorioretinopathy after application of topical minoxidil solution. Methods: We examined a 37-year-old man who complained of a positive relative scotoma, metamorphopsia and impaired dark adaptation involving the right eye. The patient reported an 8 month history of daily topical use but denied previous treatment with other drugs. Dilated fundus examination of right eye revealed central swelling located over the macula. Optical coherence tomography showed the presence of subretinal fluid. Fluorescein angiography disclosed one focal hyperfluorescent spot in the foveal area with minimal pigmentary changes limitated to that area. The patient was diagnosed with central serous chorioretinopathy (CSC) potentially related to an 8 month topical minoxidil solution administration. One month after the drug was discontinued, normal findings were found upon reexamination. The patient reported no previous episode of CSC. Conclusion: Major systemic side effects from topical solution of minoxidil are rare. To our knowledge, this is the first reported case of a central serous chorioretinopathy associated with long-term use of this drug.

Hair loss hair loss treatment and hair regrowth

Introduction.5á-reductase inhibitors (5á-RIs), finasteride and dutasteride, have been approved for treatment of lower urinary tract symptoms, due to benign prostatic hyperplasia, with marked clinical efficacy. Finasteride is also approved for treatment of hair loss (androgenetic alopecia). Although the adverse side effects of these agents are thought to be minimal, the magnitude of adverse effects on sexual function, gynecomastia, depression, and quality of life remains ill-defined.

Aim.  The goal of this review is to discuss 5á-RIs therapy, the potential persistent side effects, and the possible mechanisms responsible for these undesirable effects.

Methods.  We examined data reported in various clinical studies from the available literature concerning the side effects of finasteride and dutasteride.

Main Outcome Measures.  Data reported in the literature were reviewed and discussed.

Results.  Prolonged adverse effects on sexual function such as erectile dysfunction and diminished libido are reported by a subset of men, raising the possibility of a causal relationship.

Conclusions.  We suggest discussion with patients on the potential sexual side effects of 5á-RIs before commencing therapy. Alternative therapies may be considered in the discussion, especially when treating androgenetic alopecia. Traish AM, Hassani J, Guay AT, Zitzmann M, and Hansen M. Adverse side effects of 5á-reductase inhibitors therapy: Persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med 2011;8:872–844.

5á-Reductase inhibitor therapy: Should physicians be concerned with persistent diminished libido, erectile dysfunction and depression in a subset of patients?

Background: 5á-reductase inhibitors have been approved for treatment of androgenetic alopecia and benign prostatic hypertrophy (BPH) with marked clinical efficacy. The magnitude of adverse effects of these agents on sexual function and quality of life varies considerably among patients and remains in question. However, to what extent 5á-redctase inhibitor therapy adversely affects sexual function, depression and quality of life is yet to be addressed? More importantly, should physicians be concerned regarding these adverse effects, especially when treating benign conditions of androgenetic alopecia and BPH?

Abdulmaged M. Traish, John Hassani, Andre T. Guay, Michael Zitzmann, Michael L. Hansen
journal of men's health
October 2010 (Vol. 7, Issue 3, Page 307)

Evidence-Based Dermatology: Review Efficacy and Safety of Finasteride Therapy for Androgenetic Alopecia A Systematic Review

José Manuel Mella, MD; María Clara Perret, MD; Matías Manzotti, MD; Hugo Norberto Catalano, MD, PhD; Gordon Guyatt, MD, PhD

Arch Dermatol. 2010;146(10):1141-1150. doi:10.1001/archdermatol.2010.256

Context Androgenetic alopecia is the most common form of alopecia in men.

Objective To determine the efficacy and safety of finasteride therapy for patients with androgenetic alopecia.

Data Sources: MEDLINE, EMBASE, CINAHL, Cochrane Registers, and LILACS were searched for randomized controlled trials reported in any language that evaluated the efficacy and safety of finasteride therapy in comparison to treatment with placebo in adults with androgenetic alopecia.

Study Selection and Data Extraction: Two reviewers independently evaluated eligibility and collected the data, including assessment of methodological quality (Jadad score). Outcome measures included patient self-assessment, hair count, investigator clinical assessment, global photographic assessment, and adverse effects at short term (12 months) and long term (24 months). Heterogeneity was explored by testing a priori hypotheses.

Data Synthesis: Twelve studies fulfilled the eligibility criteria (3927 male patients), 10 of which demonstrated a Jadad score of 3 or more. The proportion of patients reporting an improvement in scalp hair was greater with finasteride therapy than with placebo treatment in the short term (relative risk [RR], 1.81 [95% confidence interval (CI), 1.42-2.32]; I2, 64%) and in the long term (RR, 1.71 [95% CI, 1.15-2.53]; I2, 16%); both results were considered to have moderate-quality evidence. The number needed to treat for 1 patient to perceive himself as improved was 5.6 (95% CI, 4.6-7.0) in the short term and 3.4 (95% CI, 2.6-5.1) in the long term. Moderate-quality evidence suggested that finasteride therapy increased the mean hair count from baseline in comparison to placebo treatment, expressed as a percentage of the initial count in each individual, at short term (mean difference [MD], 9.42% [95% CI, 7.95%-10.90%]; I2, 50%) and at long term (MD, 24.3% [95% CI, 17.92%-30.60%]; I2, 0%). Also, the proportion of patients reported as improved by investigator assessment was greater in the short term (RR, 1.80 [95% CI, 1.43-2.26]; number needed to treat, 3.7 [95% CI, 3.2-4.3]; I2, 82%) (moderate-quality evidence). Moderate-quality evidence suggested an increase in erectile dysfunction (RR, 2.22 [95% CI, 1.03-4.78]; I2, 1%; number needed to harm, 82.1 [95% CI, 56-231]) and a possible increase in the risk of any sexual disturbances (RR, 1.39 [95% CI, 0.99-1.95]; I2, 0%). The risk of discontinuing treatment because of sexual adverse effects was similar to that of placebo (RR, 0.88 [95% CI, 0.51-1.49]; I2, 5%) (moderate-quality evidence).

Conclusion: Moderate-quality evidence suggests that daily use of oral finasteride increases hair count and improves patient and investigator assessment of hair appearance, while increasing the risk of sexual dysfunction.

J Am Acad Dermatol. 2010 Sep 29.

Iron deficiency and diffuse nonscarring scalp alopecia in women: More pieces to the puzzle.
St Pierre SA, et al

Abstract
The relationship between nonscarring scalp alopecia ( hair loss ) in women and iron deficiency continues to be a subject of debate. We review the literature regarding the relationship between iron deficiency and nonscarring scalp alopecia and describe iron-dependent genes in the hair follicle bulge region that may be affected by iron deficiency. We conclude with a description of our approach to the diagnosis and treatment of nonscarring alopecia in women with low iron stores. Limitations include published studies with small numbers of patients, different study designs, and absence of randomized, controlled treatment protocols. Additional research regarding the potential role of iron during the normal hair cycle is needed, as is a well-designed clinical trial evaluating the effect of iron supplementation in iron-deficient women with nonscarring alopecia.

Copyright © 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Edited for hair loss blod

International Journal of Dermatology, 10/05/2010

Farshi S et al. – No significant statistical difference was observed with respect to gender before and after azathioprine treatment. Treatment with azathioprine as a systemic monotherapy clinically produces relevant improvement in moderate–to–severe hair loss due to alopecia areata. Generally azathioprine is a low–cost and well–tolerated drug and with controlled studies on larger number of patients, long–term efficacy and safety of this treatment should be investigated.

Edited for hair loss treatment blog

Regen Med. 2009;4:667

Hair follicle neogenesis induced by cultured human scalp dermal papilla cells.
Qiao J,-et al

AIM: To develop a method by which human hair follicle dermal papilla cells can be expanded in vitro while preserving their hair-regrowth potential for use in follicular cell implantation, a cellular therapy for the treatment of hair loss. ...snip..

RESULTS: ....( Hair follicle ) cultures from numerous donors reproducibly resulted in an expansion that averaged approximately five population doublings per passage. Furthermore, the cells consistently induced hair formation in an in vivo graft assay. Grafted DP cells appeared in DP structures of newly formed hairs, as well as in the dermal sheath and in the dermis surrounding follicles. Induced hair follicles persisted and regrew after being plucked 11 months after grafting. A process for the propagation of human DP cells has been developed that provides significant expansion of cells and maintenance of their hair-regrowth inductive capability, overcoming a major technical obstacle in the development of follicular cell implantation as a treatment for hair loss.

Edited for hair loss treatment blog use.