hair growth Archives -

Alopecia areata

This is a type of non-scarring inflammatory hair loss that can afflict anyone of any age. It is characterised by patchy hair loss that usually starts on the head. It can progress to involve the entire scalp, when it is termed Alopecia Totalis, and Alopecia Universalis, when the entire body is involved. It typically occurs during periods of stress.

The cause of Alopecia areata is unknown. What is clear, however, is that it is an auto-immune disorder, i.e. the body for some reason attacks the hair follicle. It rapidly causes the hair to go from anagen to telogen, causing the hairs to fall out over night. Most persons state that they wake up with coin shaped patches of hair loss where the scalp is usually non-tender, non-itchy, non-scaly and smooth or bare. Some report waking up with grey hairs overnight, as the condition preferentially attacks pigmented hairs.

Rapid Regrowth can occur, however, the hair follicles can stay in a permanent state of telogen and this can be quite frustrating.

Treatment of Alopecia areata

Topical Therapy

Persons who have Alopecia areata are usually given anti-inflammatory corticosteroids injected directly into the scalp, eyebrows, or any other area that is affected as well as topical corticosteroid creams to use at home. For persons with limited (small areas affected), this can be suitable. However, for persons with more extensive hair loss, they may require more options.

Another treatment modality that can be considered is Topical Immunotherapy with contact sensitizers. This involves the use of a highly allergenic agent such as Diphencyclopropenone (DCP) or squaric acid dibutylester (SADBE), most commonly used in Canada and Europe. These solutions are used to deliberately create an allergic reaction in the skin. In essence the compound causes the inflammatory cells acting on the hair follicle to be distracted and attack the solutions instead. The hair follicle is then left relatively free and the hair usually starts to regrow within 8-12 weeks. Most persons may need continued application of these agents indefinitely in order to keep their hair.

A newer, more novel therapy is currently undergoing trials in both mouse models and humans. The novel agent is called a JAK inhibitor. JAK enzymes are one part of the complex environment. When activated, they seem to keep the hairs in a dormant state. The inhibitors when taken orally was found to regrow hair in a person who had Alopecia Universalis. Currently, they are testing topical forms of these agents which are showing some promise.

Oral Therapy

Oral medications are used for those who have have not responded to topical therapy or are in need of their hair to grow back for an event. Oral medications that tend to be used include corticosteroids like Prednisone and immunosuppresive agents such as Methotrexate, and Mycophenolate Mofetil. The problem with oral medications is that once they are stopped, the hair tends to fall out again, which is quite frustrating. Patients have the tendency to want to continue them, but the side effect profile of these medications are not worth trying it especially for a condition that can spontaneously resolve on it its own. Prednisone can stunt growth in children or affect development of secondary sexual characteristics such as beards for teenagers. Prolonged use can also cause thinning of the bones and persons on long term Prednisone can develop diabetes or hypertension as well as a host of other issues . Methotrexate can make persons be prone to more infections.

Non medical treatment

Persons are now trying dermal needling and/or Platelet rich plasma for Alopecia areata to see if they would make a difference. Again, these are novel treatment therapies and have not been rigorously examined to see if they truly work.

For those who have failed all of the above, wigs and other hair prostheses are used as camouflage. There are numerous types of wigs available that can be used in different lifestyles.

Here’s an article by the American Academy of Dermatology on Alopecia areata

https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata

February QoM

questiontext \

I heard that if I have Male Pattern Hair Loss and if I start using Rogaine (Minoxidil), I will have to use it forever? Is that true, and why?

answertext

Yes this is true. The main reason for this is that there is no cure for Pattern Hair Loss. The underlying cause is a genetic disorder, and as such would require gene therapy, which does not exist. The medical therapies that exist, including Minoxidil, only reverse the effects of the genes and not the gene itself. Therefore, if you do not continue using the Minoxidil, you will lose the benefits of keeping the regrown hair.

September’s QOM- What is Aminexil?

questiontext

Hi Doc,

Could you give me some information on Aminexil Force R capsules? What is aminexil?

answertext

Hiya!

Aminexil Force R is a relatively new topical hair loss product produced under the L’Oreal group. Aminexil,, 2,4-Diamino pyrimidine-3-oxide, is a derivative of Minoxidil.

Minoxidil

minoxidil

Amenixil

kopexil

It has been marketed as having the same positive effects as Minoxidil, i.e. hair growth, without the side effects. It is also claimed to help prevent fibrosis or scarring around the hair follicles which can be seen in late stage Androgenetic Alopecia. There has only been a few studies done on the efficacy of this molecule. Therefore, it has not been rigorously examined when compared to Minoxidil.

Is it worth trying? Only if you have already exhausted available topical and oral options.

Treatment of Male Pattern Hair Loss

Treatment options for Male Pattern Hair Loss are quite limited. With more men seeking treatment, and plenty start suffering from hair loss at quite young ages, more research is being placed on reversing or slowing this frustrating condition.

Treatment of Male Pattern Hair Loss are mainly divided in to three: Topical, Oral, and Surgical

Topical Treatment of Male pattern Hair Loss

Topical Minoxidil

This is the mainstay of treatment for Male Pattern Hair Loss. Studies have shown that 5% Minoxidil prolongs the anagen phase and thickens the hair fibre. The exact mechanism by which it does this is still unknown. It takes 4-6 months before results can be seen. It is up to 60-70 % effective in the crown and 30-40% effective in the front of the scalp. The brand is Rogaine and it comes in 2 forms- solution and foam. There are many generic brands available and quite a few countries that provide it OTC.

In Europe, OTC caffeine based products are available in shampoo and lotion form. Caffeine has been shown to increase the anagen phase. The studies have been found to be encouraging.

Oral Treatment of Male Pattern Hair Loss

The two main medications used are Finasteride and Dutasteride. Both are used off-label from their intended use, which is for the treatment of Benign Prostatic Hypertension.

Finasteride (Propecia or Proscar) help to stop the conversion of Testosterone to Dihydrotestosterone by the enzyme 5 alpha reductase. Fiansteride takes up 4 months before results can also be seen. It has a slightly greater efficacy compared to Rogaine. Together with Minoxidil, there is increased benefit to the patient. Most persons can start off with Minoxidil and Finasteride added to see if there is any more improvement.

Dutasteride (Avodart) is a more potent form of Finasteride because it acts on the many forms of the enzyme. It is 95% effective compared to the 50-70% seen with Finasteride. However, it has 5 times more the effects of side effects compared to Finasteride. The main concerns for both Finasteride and Dutasteride include: decreased libido, decreased power of orgasm/ejaculation, erectile dysfunction, and depression. For Finasteride, this is quite low, but much higher in Avodart. The side effects usually go away after cessation of the medication, however, it should note that many men who start this medication are already at risk of having these issues.

Surgical Treatment of Male Pattern Hair Loss

The ultimate treatment of this condition is Hair Transplantation. It involves permanent removal of hair from the back of the scalp, which is less likely to be affected by the condition. These are then transplanted to the front of the scalp and will take and grow keeping their inherent properties from where they are coming from. There are two main types: Follicular Transplant (strip harvesting that leaves a visible scar) and Follicular Unit Extraction (individual harvesting of hair follicles). Hair growth is not immediate. It takes about 4-6 for the transplanted hairs to start growing, and up to a year for it to be noticeable.

Surgical treatment is limited to how much hair is present in the donor site. There are many factors that can cause decreased hair growth. However, up to 99% of the hairs transplanted usually grow.

Treatment of Male Pattern Hair Loss is limited but promising as there are many new treatment therapies such as Stem Cell Therapy are actively being investigated.

Male Pattern Hair Loss

Male Pattern Hair Loss or Androgenetic Alopecia is the most common type of hair loss found in men. Up to 80% of men will experience some level of hair loss by their 70s. Most will discover their hair loss in their 30s and 40s however, quite a number may start long before in their teens.

So what causes Male Pattern Hair Loss?

Male Pattern Hair Loss is due to the activity of a hormone Dihydrotestosterone, a potent androgen (male hormone). The hair follicle in affected men is more sensitive to this hormone. There are several genes responsible for the condition and they can be inherited from either the mother, father, or both. This hormone is made from Testosterone under the action of the enzyme, 5-alpha reductase. Dihydrotestosterone latches onto the receptors in the hair follicle and causes a decreased anagen (hair growth) along with reduction in the size of the hair follicle. The hairs become progressively thinner and more vellus-like.

Stages of Male Pattern Hair Loss

There are several stages of Male Pattern Hair Loss. The main staging system used is the Norwood Hamilton Scale for Hair Loss in men.

norwood-hamilton

Which stage do you fall under?

Next month: Treatment options