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."

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.

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.

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

Dermatol Clin.1990;8:367

Hair loss treatment with minoxidil

DeVillez RL.

Topical minoxidil is a hair loss treatment agent that stimulates the hair follicle..... Less than 5% of the applied dose is absorbed. The therapeutic effect on hair regrowth is demonstrated for pattern hiar loss in males and females, by a computer-assisted image analysis counting technique of nonvellus hairs from a photographic print. Patients with severe alopecia areata respond poorly to topical minoxidil treatment. 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 .

Rev Stomatol Chir Maxillofac. 2007;108:411

Skin expansion in cicatricial alopecia of the scalp

Drissi Qeytoni H, et al

INTRODUCTION: Skin expansion technique used to increase the hair surface available at the scalp level was a major breakthrough in the surgical treatment of important cicatricial alopecia. This article had for aim to define the importance and limits of this technique in the treatment of hair loss. snip.. The rate of major complications leading to total failure of the process reached 5.5%. The final result was considered good in 90% of the cases. DISCUSSION: The results demonstrate that skin expansion technique is a simple, reliable, and efficient method in the healing of important cicatricial hair loss of scalp. It enables a wider use of the classical local flap technique, by expanding the surface and vascularization allowing for a direct suturing of the donor site. Skin expansion holds an important place in the treatment of significant skin cicatricial alopecia, since it represents the only surgical solution when the alopecia area exceeds 50 cm2.

Hair regrowth blog

Dr Proctor treats hair loss

Semin Cutan Med Surg. 2009;28:11

Chemotherapy-induced hair loss.
Trüeb RM.

Few dermatologic conditions carry as much emotional distress as chemotherapy-induced hair loss (CIA). The prerequisite for successful development of strategies for CIA prevention is the understanding of the pathobiology of CIA. The incidence and severity of CIA are variable and related to the particular chemotherapeutic protocol. CIA is traditionally categorized as acute diffuse hair loss caused by dystrophic anagen effluvium; however, CIA presents with different clinical patterns of hair loss. When an arrest of mitotic activity occurs, obviously numerous and interacting factors influence the shedding pattern. The major approach to minimize CIA is by scalp cooling. Unfortunately, most published data on scalp cooling are of poor quality. Several experimental approaches to the development of pharmacologic agents are under evaluation and include drug-specific antibodies, hair regrowth cycle modifiers, cytokines and growth factors, antioxidants, inhibitors of apoptosis, and cell-cycle and proliferation modifiers. Ultimately, the protection should be selective to the hair follicle; for example, topical application, such that the anticancer efficacy of chemotherapy is not hampered. Among the few agents that have been evaluated so far in humans, AS101 and minoxidil were able to reduce the severity or shorten the duration of CIA, but could not prevent CIA.

Br J Dermatol.2009;161:228

Epidermal stem cells: practical perspectives and potential uses.
Abbas O, Mahalingam M.

Blog edited

.....the epidermis and the hair follicle undergo a perpetual cycle of regrowth, regression and rest. Stem cells in the epidermis not only ensure the maintenance of epidermal homeostasis and hair regeneration and regrowth, but also contribute to repair of the epidermis after injury. These stem cells lie within specific niches in the hair follicle and the epidermis. The availability of monoclonal antibodies that can be used on formalin-fixed paraffin-embedded tissue has greatly facilitated the use of this methodology as an adjunct to uncovering stem cell niches. In this review, we attempt to provide an overview of the potential markers available to identify and study stem cells in an effort to providing a better understanding of the pathogenesis of skin diseases including disorders of hair loss and malignancies. The potential uses of these markers in prognosis and in expanding the therapeutic options in several disorders, such as in >hair loss treatment, will also be addressed.

Exp Dermatol. 1998;7:289

Equine alopecia areata autoantibodies target multiple hair follicle antigens and may alter hair growth. A preliminary study.Tobin DJ, et al

Several cases of hair loss due to an alopecia areata like disease exist in mammalian species.....snip... The current preliminary study was conducted to determine whether a horse with AA-like hair loss contained circulating antibodies to HE The pathogenic potential of these antibodies was examined by passive transfer into anagen skin of C57BL/ 10 black mice. snip... IgG fractions of serum obtained from an "AA" horse and from a normal control horse were injected into anagen murine skin. Histologically, normal hair regrowth was observed in mice injected with normal equine IgG. By contrast, hair did not re-grow in an area around the injection site of AA-treated mice even 13 weeks after first injection. This skin contained telogen follicles, most often without associated shafts, despite the presence of anagen HF in the remaining dorsum skin. While this study is preliminary, it demonstrates for the first time that antibodies to HF antigens are a feature of AA-like hair loss in horses...snip... Further, we provide in this pilot study preliminary evidence that such antibodies may disrupt hair re-growth when passively transferred into mice, supporting the view that anti-HF antibodies in AA may have pathogenic potential.

Vet Rec.1988 19;123:533

Folic acid therapy for alopecia in a Charolais calf.
Bouvet A, et al

A ... Charolais calf which had a history of progressive hair loss and clinical signs, including crusts and brown patches similar to those in folic acid deficiency syndrome in man, was subjected to folic acid therapy. Daily oral administration of folic acid (1 mg/kg/day) resulted in the gradual disappearance of the crusts and patches within two weeks and a steady growth of hair and recovery to a normal state within two months. Folic acid, which is required for cellular turnover in a variety of tissues and organs including the hair follicle, may serve as an effective therapeutic agent in some types of hair loss....

J Invest Dermatol. 2009 May;129(5):1243-57. Epub 2008 Dec 4.

Hair follicle stem cell-specific PPARgamma deletion causes scarring alopecia.
Karnik P, et al

Primary cicatricial or scarring alopecias (CA) are a group of inflammatory hair loss disorders characterized by the permanent destruction of the hair follicle. The current hair loss treatment options are ineffective in controlling disease progression largely because the molecular basis for CA is not understood. Microarray analysis of the lymphocytic CA, Lichen planopilaris (LPP), compared to normal scalp biopsies identified decreased expression of genes required for lipid metabolism and peroxisome biogenesis. Immunohistochemical analysis showed progressive loss of peroxisomes, proinflammatory lipid accumulation, and infiltration of inflammatory cells followed by destruction of the pilosebaceous unit. The expression of peroxisome proliferator-activated receptor (PPAR) gamma, a transcription factor that regulates these processes, is significantly decreased in LPP. Specific agonists of PPARgamma are effective in inducing peroxisomal and lipid metabolic gene expression in human keratinocytes. Finally, targeted deletion of PPARgamma in follicular stem cells in mice causes a skin and hair phenotype that emulates scarring hair loss. These studies suggest that PPARgamma is crucial for healthy pilosebaceous units and it is the loss of this function that triggers the pathogenesis of LPP. We propose that PPARgamma-targeted therapy may represent a new strategy in the treatment of scaring alopecias.

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....

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

Transplantation. 1987;44(1):83

Long-term survival of skin allografts in rats treated with topical cyclosporine.

Lai CS,et al

Treatment with topical cyclosporine (CsA) was studied in skin allografts from Buffalo to Lewis rats. ....snip.. Most grafts were rejected when CsA blood levels fell below 200 ng/ml. Direct administration of topical CsA onto the allografts resulted in longer survival compared with those applied on the normal recipient skin 6 cm distal to the allografts, with both high and low doses. Locally high concentrations of CsA in allografts may play an important role in prolongation of graft survival. Minimal cell infiltration and loss of hair follicles were the main histological features in long-surviving allografts (greater than 120 days).

J Cutan Pathol.Oct;13(5):363

Markers of immunologic injury in progressive alopecia areata

.Peereboom-Wynia JD, et al

In a selected group of 8 patients with progressive hair loss due to alopecia areata (AA) leading to AA universalis, immunological aspects (in the peripheral blood and the tissue) were studied during the period of the initial attack of the disease. The peripheral T-cell helper/suppressor ratio appeared not to be a reliable parameter for the disease activity. The intrabulbar and peribulbar distribution of T-cells, Langerhans cells and of HLA-DR expression in and around the anagen hair follicles in the progressive areas of the disease (region of exclamation-mark hairs) may suggest a T-cell-mediated injury primarily in the peribulbar regions of the follicles. The data presented tend to support the possibility that in the early development of AA, the dermal pailla (capillary network?) may be the prime target of immunologic injury. Hair regrowth

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

Arch Dermatol Res. 1977;258:33-40.

Ultrastructure of the contrasting types of keratinization seen in the tail epidermis of the laboratory mouse

Spearman RI, Hardy JA.

The mouse tail epidermis undergoes contrasting forms of keratinization. Around the hair follicle there is a granular layer containing keratohyalin granules, and nuclei are absent from the horny layer. In the scale regions keratohyalin is not formed and nuclear remnants are retained in the horny cells as in parakeratosis generally. These findings from light microscopy were confirmed by transmission electron microscopy. ...snip... The change from living epidermal cells to dead keratinized cells was abrupt in both the follicular and scale regions. In both sites the plasma membranes of the horny cells were thickened and there was a cytoplasmic meshwork of microfibrils in the cells.

hair loss and hair regrowth

Dermatol Surg. 1997 Sep;23(9):785-99.

The aesthetics of follicular transplantation.

Bernstein RM,

BACKGROUND: Follicular transplantation is a method of hair restoration surgery that uses hair in its naturally occurring groups, called follicular units. Using the follicular unit exclusively in the transplant, the surgeon can create hair patterns that closely mimic nature. OBJECTIVE: To focus on various aesthetic aspects of the follicular transplantation procedure including hair distribution, hairline design, and crown restoration. Racial variations that affect the transplant will also be examined. METHODS: Follicular transplantation is performed according to techniques detailed in a previous publication (Bernstein et al. Int J Aesthet Rest Surg 1995; 3: 119-32). RESULTS: Excellent cosmetic results can be achieved when aesthetic decisions are made that allow the surgeon to recreate hair patterns already provided by nature. A case study will be presented. CONCLUSIONS: The small size of follicular implants enables the surgeon great versatility in their placement. Follicular transplantation will ensure a natural looking transplant if used with good aesthetic judgment and careful planning.