Hair Loss Blog

Peter H. Proctor, PhD,MD

Hair Loss Blog

09/15/09 | by donnaproctorcom

| Categories: Hair Loss Clinic

Hair Loss Blog

Pingbacks:

No Pingbacks for this post yet...

Hair Loss Blog

Linkblog

Hair loss treatment

J Am Acad Dermatol. 1980 Dec;3(6):623-6.

Analysis of hair from alopecia congenita.Baden HP, Kubilus J.

Two patients with alopecia congenita had short vellus hairs of the scalp but some apparently normal-sized hairs in other areas. Both fibrous and matrix proteins were detected in the scalp hairs by polyacrylamide gel electrophoresis (PAGE), and x-ray diffraction analysis revealed a normal alpha pattern. Amino acid analysis showed a decreased cystine content suggesting a quantitative or qualitative change in the matrix component. Scanning electron microscopic examination revealed pits and bulges in the cuticle cells which may be related to wearing a wig. The data suggest a defect in the development of the follicle rather than an abnormality in a component of the hair.

PMID: 7204679

hair loss blog
Dermatol Clin. 1990;8(2):367

The therapeutic use of topical minoxidil.DeVillez RL.

edited for blog use

Topical minoxidil is a hair regrowth stimulating agent that stimulates the hair follicle via the vasoactive metabolite minoxidil sulfate without any evidence of antiandrogen activity or an effect on the immune system. snip.. The most common adverse reactions are limited to irritant and allergic contact dermatitis on the scalp. The use of retinoic acid with topical minoxidil has been disappointing relative to the increase in systemic exposure. The value of topical minoxidil as an adjunct for the hair transplant procedure and its effect on hair loss from chemotherapy are being evaluated.

hair loss treatment
Dermatology on-line journal
Volume 14 Number 7
July 2008

Radiation-induced temporary alopecia after embolization of cerebral aneurysms
Nuria Marti, et al

edited for blog

....Alopecia probably appeared due to prolonged exposure to radiation in the same area of skin (occipital-temporal-parietal) and limited variation in the direction of application. Excluding the diagnosis of alopecia areata may be difficult because the bald patch is devoid of inflammatory signs and hair loss is characterized by dystrophic hair. The localization of the bald patches along the scalp margins with an ophiasis pattern occured because this scalp region received the highest doses of radiation therapy during embolization [2, 3, 5].

Irradiation-induced epilation depends on the high susceptibility of anagen follicles to radiation. Loss of dystrophic hairs (anagen effluvium) due to acute damage to actively dividing matrix cells of anagen follicles is followed by telogen shedding due to premature catagen entry of follicles in late anagen subphases at the time of damage. Complete hair regrowth generally occurs 2 to 4 months after irradiation.
Improvement in male pattern hair loss in men using oral finasteride.
Int J Dermatol. 1999 Dec;38(12):928-30.

Improvement in androgenetic alopecia (male pattern hair loss) in 53-76-year-old men using oral finasteride.
Brenner S, Matz H.

Twenty-eight men with AGA, aged 53-76 years (mean, 65 years), were selected to participate in this trial from a double blind, placebo controlled, multicenter study of subjects with moderate symptoms of BPH. Patients received either finasteride 5 mg or placebo daily for 24 months. Hair counts were performed at entry to the study and at 6, 12, 18, and 24 months. Hair counts were made directly on the scalp in a circular target area 1 in in diameter, located in the center of a template. The template was applied in such a way that its counting window fell on the most balding scalp area, which remained the same for each patient.11 At each hair counting session, patients were asked about side-effects and questioned about their sex life. Time trend and differences between groups were examined using a one-way (treatment) MANOVA with repeated measures (baseline, 6, 12, 18, and 24 months). Additional two-tailed t-tests were performed to compare the two groups at each point of time was considered to be significant.
Hair Loss Treatment at the Proctor Clinic
Hair Loss Treatment at the Proctor Clinic.
Alopecia areata treated with topical minoxidil.
Arch Dermatol. 1984 Apr;120(4):457-63.

Alopecia areata treated with topical minoxidil.

Hair Loss Blog

Weiss VC, West DP, Fu TS, Robinson LA, Cook B, Cohen RL, Chambers DA.

A 1% minoxidil topical solution was used to treat 48 patients with alopecia areata, ie, 24 patients with patchy disease and 24 patients with alopecia totalis or alopecia universalis ( complete hair loss ). Twenty-five patients had terminal hair regrowth; in 11 of the 25 patients, it was cosmetically acceptable. No clinical features of the disease seemed to indicate the likelihood of hair regrowth. Hair regrowth began approximately two months after the initiation of treatment and was not uniformly well maintained after the treatment was terminated. One patient had an allergic contact dermatitis reaction to the minoxidil solution; no systemic side effects were seen. No notable systemic absorption was found in 18 adult patients. Effects on cutaneous blood flow or the immune system or some direct effect on hair follicles are possible mechanisms by which minoxidil therapy might stimulate hair growth.

Hair loss and hair loss treatment
Alopecia areata. Pathogenesis, diagnosis, and therapy.
Am J Clin Dermatol. 2000 Mar-Apr;1(2):101-5

Alopecia areata. Pathogenesis, diagnosis, and therapy.

Papadopoulos AJ, et al

Alopecia areata is a common form of non-scarring alopecia 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.
Androgen-induced hair loss in women
Hautarzt. 1991 Mar;42(3):168-72.

Hyperprolactinemia and hypophyseal hypothyroidism as cofactors in hirsutism and androgen-induced alopecia in women

Schmidt JB, Lindmaier A, Spona J.
II. Universitäts-Hautklinik, Wien.

A more comprehensive hormonal diagnosis than has previously been performed shows that androgen-dependent diseases of hair regrowth are due to more varied hormonal disturbances than elevated androgen serum levels alone. In 46 female patients with androgenic hair loss and 27 patients with hirsutism, the levels of the androgens testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulphate and 17-hydroxyprogesterone and of sex hormone-binding globulin, cortisol, oestradiol and the hypophyseal hormones follicle-stimulating hormone and luteinizing hormone were determined and compared with the hormone levels of 27 female patients without endocrine disorders. Of the androgens, only androstenedione showed a slightly significant elevation in hirsutism. Cortisol was elevated significantly in androgenic hair loss, and with a low degree of significance in hirsutism. In view of the complex hormonal interactions of thyroxin, prolactin and androgens and thyroid hormones the thyrotropin-releasing hormone (TRH)-stimulation test was performed in 38 female patients with androgenic hair loss and 27 with hirsutism, and the results were compared with those recorded in 45 female control persons. The test is based on feedback mechanisms between hypothalamic TRH and hypophyseal TSH and prolactin and peripheral thyroid hormones. Baseline concentrations of TSH prior to stimulation were significantly elevated in hirsutism, while in androgenic hair loss both baseline and stimulated TSH levels were significantly elevated; thus, hypothyroidism is a significant finding in both clinical pictures. snip
Androstendiol in hair loss in women
Gynecol Endocrinol1992;6(2):85-90.

Is 3 alpha, 17 beta-androstanediol-glucuronide a diagnostic marker in women with androgenic manifestations?

Vogt C, et al

3 alpha, 17 beta-androstanediol-glucuronide (Adiol-G) has been described as a marker of local androgen excess due to the increased activity of 5 alpha-reductase in the cells of the hair follicles. In order to test the diagnostic value of Adiol-G, the serum level was compared to that of testosterone, free testosterone, dehydroepiandrosterone sulfate (DHEA-S), androstenedione and to the body mass index in 44 women with androgenic symptoms such as pattern hair loss (Group I), 27 women with menstrual disturbances but no androgenic symptoms (Group II), and 48 healthy women (Group III) who served as controls. ....snip.. When Adiol-G and testosterone were simply classified as 'normal' or 'increased' (Adiol-G 9.4 nmol/l; testosterone greater than 2.4 nmol/l), higher than normal values of the former were found in the presence of normal testosterone in only 4% of the cases. It is concluded that the level of Adiol-G generally parallels that of testosterone. Consequently, it does not seem to be an effective marker of peripheral androgen excess.

Hair loss and hair loss regrowth
Animal model for pattern balding
Arch Dermatol Res. 1989;281(4):247-53.

Animal models of androgen-dependent disorders of the pilosebaceous apparatus. 1. The androchronogenetic alopecia (AGA) mouse as a model for male-pattern baldness.

Matias JR, Malloy V, Orentreich N.

Orentreich Foundation for the Advancement of Science, Inc., Biomedical Research Station, Cold Spring-on-Hudson, NY 10516.

The androchronogenetic alopecia (AGA) mouse if a mutant strain which expresses androgen-dependent baldness. Daily s.c. injection of testosterone (T) induced thinning of the hair coat along the upper dorsum after 4 weeks of treatment. After 12 to 14 weeks this diffuse alopecia eventually eveloped into a bald area which extended to the middorsum. Dihydrotestosterone was more effective than T in stimulating the onset of AGA. In this model, T produced the alopecia by decreasing the rate of hair growth, decreasing the duration of anagen, and markedly prolonging the duration of telogen. When applied topically at a concentration of 5%, cyproterone acetate delayed the progression of the T-mediated hair loss. However, this inhibitory effect occurred through systemic means as evidenced by decrease in the size of the submaxillary gland. Chronic feeding of androgen-treated female AGA mice with a diet containing 0.01% minoxidil also inhibited the development of alopecia. Skin and core temperatures were found to be higher in minoxidil-treated animals than in the placebo-treated controls. Minoxidil at a topical dose of 1% did not produce any effect. Increasing the dose to 2% caused a slight retardation of the development of alopecia. However, a 60% inhibition was observed at a topical dose of 5% minoxidil after 12 weeks of treatmen. The data demonstrate that hair loss in the AGA mouse is androgen dependent and that this mutant strain can serve as a suitable model for the screening of compounds, such as antiandrogens and vasodilators, which may influence the balding process.

Hair Loss blog
Animal model for pattern hair loss and hair loss treatment
Arch Dermatol Res.1989;281:247

Modified for hair loss treatment blog

The androchronogenetic alopecia mouse as a model for male-pattern hair loss.

Matias JR, et al

The AGA mouse expresses androgen-dependent baldness. Daily injection of testosterone (T) induced hair thinning. This diffuse hair loss eventually eveloped into a bald area which extended to the middorsum. Dihydrotestosterone was more effective than T in stimulating the onset of AGA. In this model, T produced the alopecia by decreasing the rate of hair regrowth, decreasing the duration of anagen, and markedly prolonging the duration of telogen. Cyproterone acetate delayed the progression of hair loss...... Chronic feeding of androgen-treated female AGA mice with a diet containing minoxidil also inhibited the development of hair loss. Skin and core temperatures were found to be higher in minoxidil-treated animals than in the placebo-treated controls. Minoxidil at a topical dose of 1% did not produce any effect. Increasing the dose to 2% caused a slight retardation of the development of alopecia. However, a 60% inhibition was observed at a topical dose of 5% minoxidil after 12 weeks of treatmen. The data demonstrate that hair loss in the AGA mouse is androgen dependent and that this mutant strain can serve as a suitable model for the screening of compounds, such as antiandrogens and vasodilators, which may influence the balding process.

Hair Loss blog
Another hair regrowth blog
hair loss treatment blog
childhood acute lymphoblastic leukemia
childhood acute lymphoblastic leukemia
Blood. 1983 Feb;61(2):297-303.

Efficacy and morbidity of central nervous system “prophylaxis” in childhood acute lymphoblastic leukemia: eight years’ experience with cranial irradiation and intrathecal methotrexate.

Inati A, et al

Between 1972 and 1979, 214 children with acute lymphoblastic leukemia and no evidence of central nervous system (CNS) disease prior to CNS prophylaxis were treated with 2400 rad cranial irradiation and concurrent intrathecal methotrexate. Only nine children developed CNS leukemia; five of them in the CNS only and four concurrently in the CNS and another site. Major acute effects of CNS prophylaxis were seizures in seven patients (3%). Sixty-nine children who had a minimum follow-up of 4 yr were evaluable for late effects of therapy. Small cataracts, incomplete hair regrowth, and learning disabilities were noted. The latter occurred in 18% of patients, an incidence similar to that encountered in a normal community of school-age children. However, the incidence of learning disabilities in patients who were under 5 yr of age at the time of diagnosis was much higher, 35%. We conclude that the combination of cranial irradiation and intrathecal methotrexate was highly efficacious. The incidence and severity of neuropsychologic abnormalities, the principal late morbidity of this treatment program, varies among reporting institutions. Prospective longitudinal studies of neuropsychologic function are necessary to better define the incidence of abnormalities. Future programs should attempt to decrease late morbidity, but must also assure equal efficacy and improve overall disease-free survival.
Diffuse hair loss in women
Ther Umsch. 2002 May;59(5):217-22.

Diffuse hair loss in women

Hair Loss Blog

Trüeb RM.

The complaint "Doctor, I am losing my hair" represents a particular challenge to the physician, and involves making a specific diagnosis, selecting an appropriate therapy, and expressing empathy for the patient's anxiety. Diffuse hair loss in women was formerly classified as an entity of its own. Since the identification of female pattern hair loss, most cases have been recognized to be due to androgenetic alopecia, often during phases of life characterized by fluctuations of sexual hormone levels or in connection with intake or cessation of hormonal therapy. The most difficult differential diagnosis includes androgenetic alopecia, chronic telogen effluvium, and psychogenic pseudo efflvuium. Androgenetic alopecia is due to androgen-induced, non-synchronized, progressive shortening of the hair growth cycle and gradually leads to thinning of the central scalp area. Idiopathic chronic telogen effluvium typically occurs in women, starting abruptly without a recognizable initiating factor, and involves the entire scalp area with increased shedding of telogen hair. It is believed to be due to synchronization phenomena of the cyclic hair growth. Psychogenic pseudo effluvium affects fashion-oriented, self-conscious women suffering of a discrepancy between the actual state of their hair and idealized expectations. Later the problem of age-related hair thinning oft becomes a surrogate for the more generalized problem of senescence. Rational therapy of androgenetic alopecia aims at blocking the androgen effect on hair follicles with estrogens and antiandrogens or at pharmacologically reversing vellus hair transformation with topical minoxidil. In contrast, women with idiopathic chronic telogen effluvium should be reassured that their problem is rather a state of exaggerated "hair shedding" than of actual "hair loss".

Hair loss treatment regrowth alopecia antiandrogens minoxidil nano drproctor proxiphen
Ear Hair cell loss
Laryngoscope. 2009;119:202

Hepatocyte growth factor protects auditory hair cells from aminoglycosides.

Kikkawa YS,et al

To examine the effect of hepatocyte growth factor (HGF) for protection of auditory hair cells against aminoglycosides and its molecular mechanisms. Experimental study. We quantitatively assessed protective effects of HGF on mouse cochlear hair cells against neomycin toxicity using explant culture systems. To understand mechanisms of hair cell protection by HGF, we examined the expression of c-Met, HGF receptor, and 4-hydroxynonenal (a lipid peroxidation marker) in the cochlea by means of immunohistochemistry and Western blotting. The application of HGF to cochlear explant cultures significantly reduced the hair cell loss induced by neomycin. Immunohistochemistry showed c-Met expression in normal auditory hair cells, and its increase in response to neomycin-induced damage. Immunostaining for 4-hydroxynonenal suggested that HGF acted by attenuating the lipid peroxidation of auditory epithelia induced by neomycin. CONCLUSIONS: These findings demonstrate that a functional HGF/c-Met coupling is present in the cochlea, and HGF application exerts protective effects on hair cells, indicating the potential of HGF as a therapeutic agent for sensorineural hearing loss.
EGF and hair regrowth
The cutaneous epidermal growth factor network: Can it be translated clinically to stimulate hair growth?
Doru T Alexandrescu MD, et al
Dermatology Online Journal 15:1

Edited Exerpt:

In summary, current data support the fact that EGF is central in the regulation of hair morphogenesis, with its cyclical on/off switch being important for the progression of the hair cycle. Cooperation with other molecules appears to be necessary; the downregulation of some effectors (TGF-á), but synergism with others (FGF-5) result in a longer hair phenotype [17]. On the other hand, continuous expression of EGF, or TGF-á, although producing a wavy phenotype, impedes the growth of hair. Therefore, cyclic variations in the level of EGFR, which is a key intermediate in signal transmission, may result in hair regrowth and produce new hair formation. Conversely, continuous EGFR blockage would interfere with new hair formation and a severe decrement in its function can even result in hair loss. The principle of cycling and maintenance of a low level of hair regrowth stimulation has proven biological relevance. It was demonstrated as a paradigm by the results of studying the stimulation/inhibition for androgenic blockade in prostate cancer through using a LHRH agonist administered continuously and by ensuring contraception through providing uniform levels of the hormones that otherwise produce ovulation when subjected to brisk variations.

© 2009 Dermatology Online Journal
Familial hypogonadotropic hypogonadism with hair loss
Can Med Assoc J. 1979,18;121:428

Familial hypogonadotropic hypogonadism with alopecia.

I S Slti and Z Salem

Edited for hair loss treatment blog

In one family several male and female members had hypogonadism and frontoparietal hair loss, whereas other members with normal sexual development had normal scalp hair. Clinical and laboratory evaluation of three affected young men (two brothers and their cousin) revealed that the hypogonadism was the result of decreased serum concentrations of follicle stimulating and luteinizing hormones. There was no evidence of a deficiency of any other pituitary hormone. Long-term treatment of the three patients with human chorionic gonadotropin resulted in an increase in the serum testosterone concentration, the appearance of male secondary sex characteristics and an increase in the size of the external genitalia.
finasteride for pattern hair loss
"...The size of bald area in tablet and gel groups had significant decrease at fourth month, noting there was no change in gel group, which indicates the greater therapeutic effect of tablet than gel. Although, the total hair regrowth in both groups was significant during the fourth month, in the gel group, we did not find any decrease in the size of hair loss area and consequently the better appearance of person."
Hair follicle genes
J Invest Dermatol. 1993;101:50S

Organization and expression of hair follicle genes.

Rogers GE, Powell BC.

Edited for blog

Several families of proteins are expressed in the growth of hair and an estimated 50-100 proteins constitute the final hair fiber. The cumbersome nomenclature for naming these different proteins has led to a proposal to modify that which is currently used for epidermal keratins. Investigations of the organization of hair genes indicate that the members of each family are clustered in the genome and their expression could be under some general control. Interestingly, the protein called trichohyalin, markedly distinct from the hair proteins, is produced in the inner root sheath cells and the gene for it has been found to be located at the same human chromosome locus as the genes for profilaggrin, involucrin, and loricrin. ...snip..In the sheep, the patterns of expression in hair differentiation are particularly interesting insofar as there are distinct segments of para- and orthocortical type cells that have significantly different pathways of expression. The testing of candidate hair-specific regulatory sequences by mouse transgenesis has produced several interesting hair phenotypes. Transgenic sheep over-expressing keratin genes but showing no hair regrowth change have been obtained and compared with the equivalent transgenic hair-loss mice. Studies of the effects of amino acid supply on the rate of hair regrowth have demonstrated that with cysteine supplementation of sheep a perturbation occurs in which there is a markedly increased level of only one type of mRNA and the ration of para- to orthocortical cells is increased....
Hair growth promoters in pattern hairloss
Hautarzt. 1994 Jun;45(6):360-3

Hair growth promoters in androgenetic alopecia. Expectations and reality

Schell H, Kiesewetter F, Hornstein OP.

Androgenetic hair loss is the most frequent reason for the topical application of hair-growth-promoting agents. Such preparations should arrest or even reverse androgen-induced hair follicle regression as well as prolonging the hair cycles, especially of the shortened anagen phase, and thus protect from increased hair loss. True evidence of drug effects on hair regrowth is problematic, since trichograms, the method chiefly applied by the manufacturers, fail to reveal every factor involved in the follicular activity, especially the duration of anagen stage. For example, an increase in the anagen rate does not always reflect a lengthening of the anagen stage, but may also be due to shortened hair cycles. Accordingly, drug effects on hair growth should be investigated by methods that analyse the cell cycle kinetics. For this approach DNA-flowcytometry of the outer root sheath in plucked anagen hairs and of complete anagen hair bulbs taken by micropreparative techniques from scalp biopsies offers a reproducible method for quick and reliable evaluation of hair growth.