February 21st, 2010
Dermatologica. 1987;175 Suppl 2:36-41.
Topical minoxidil in extensive alopecia areata
Price VH.
Perhaps the most intriguing aspect of topical minoxidil is the fact that this drug can promote hair regrowth in two unrelated conditions: alopecia areata (AA) and androgenetic alopecia (male pattern hair loss). The two conditions have quite different underlying mechanisms. In AA, hair follicles respond to some signal or cell injury by entering a state of aborted cyclical activity; this state can reverse itself spontaneously, or it can be temporarily circumvented with nonspecific immunomodulating agents. In androgenetic alopecia, genetically marked hair follicles undergo progressive, androgen-mediated miniaturization; antiandrogens have been conventionally sought to intercept this process. It is not known how minoxidil promotes hair regrowth except that living follicles capable of stimulation and hypertrophy are required. It may be that minoxidil influences some fundamental signal to the follicular apparatus, irrespective of the pathophysiology involved. We have used topical minoxidil solution in 90 patients, aged 7-63 years, with extensive AA affecting 25-100% of the scalp. One study was double-blind, and placebo-controlled for an entire year. Minoxidil-treated patients responded better than placebo-treated patients. Both 3 and 5% topical minoxidil solutions have been used, and treatment with the 3% solution has continued for up to 3 years. snip..While topical minoxidil is not very effective for those with 100% scalp hair loss, it is an effective, easy and safe treatment for those with AA affecting 25-99% of the scalp.
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December 2nd, 2009
Steroidogenic enzymes in skin
European Journal of Dermatology. 11, Number 4, 293
Summary
Author(s) : S. Andersson,
The gonadal synthesis of testosterone from cholesterol involves four enzymes, namely, cytochrome P-450 side-chain cleavage enzyme, cytochrome P-450 17a-hydroxylase/lyase, 3b-hydroxysteroid dehydrogenase, and 17b-hydroxysteroid dehydrogenase. A significant part of the plasma-borne testosterone is converted in androgen target tissues, such as the skin, to the more potent androgen dihydrotestosterone by the steroid 5a-reductase type 1 and type 2 isoenzymes. Dihydrotestosterone, which binds to the nuclear androgen receptor with much greater affinity than testosterone, is the androgen responsible for a process leading to androgenetic alopecia. Consequently, the 5a-reductase inhibitor finasteride was developed and has proven efficacious in promoting hair regrowth. snip…. Aberrant expression of one or more of these enzymes, could conceivably result in increased scalp dihydrotestosterone levels, and possibly, acceleration of the balding process in genetically predisposed men and women.
Keywords : 17b-HSD, 3a-HSD, 3b-HSD, 5a-reductase, dihydrotestosterone, hair loss. hair regrowth
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November 27th, 2009
J Androl. 2008;29:514
The effect of 5 alpha-reductase inhibitors on erectile function.
Canguven O, Burnett AL.
Conclusions ( edited for hair loss blog use)
…”Finasteride and dutasteride are approved for use in the treatment of men with symptomatic BPH and pattern hair loss and are also under study in ongoing prostate cancer prevention trials. It was shown that treatment with 5ARIs results in a reduction in median serum DHT levels by 60%–93% after 2 years. According to 13 randomized studies in which finasteride was used alone, erectile problems occurred in 3% of the men studied long term. This percentage of ED would seem minimal, and it is also noteworthy that this adverse event diminished by half over time in men taking finasteride. Randomized controlled studies report the rates of erectile dysfunction to be between 0.8%–15.8%. The placebo effect demonstrated by Mondaini and associates has to be taken into account when relating the effects of 5ARIs to ED. On the other hand, ejaculation disorders (premature or retarded) related to the use of these inhibitors has not been reported in detail. This outcome should be better described in further studies.
Although there are controversial studies, as a best example we should look for 5 -reductase–deficient men whose mean plasma DHT levels are significantly lower when compared with those in normal subjects. More remarkably, the subjects have normal erections directed towards females, although they have low DHT levels (Imperato-McGinley et al, 1974).
Previous studies have shown that there does not seem to be a strong cause-and-effect relationship between serum androgen concentrations and erectile function; even in severely hypogonadal men, the erectile response is not always lost, and T treatment of hypogonadal men with ED does not necessarily restore lost erectile function (Mills and Lewis, 1999). Studies also verified that MENT, which is resistant to 5 -reductase, is able to provide physiological and behavioral androgen replacement in hypogonadal men and may provide indirect evidence that 5 -reduction is not required for mediation of the influence of T on these behaviors in men.
Testosterone and dihyrotestosterone perform vital functions in various organs….. DHT is more active in prostate than T. This may be due to the fact that DHT is largely a paracrine hormone and exerts effects in tissues of its origin. On the other hand, T is more relevant than DHT in erectile function, which requires central and peripheral androgenic activity. T exerts both humoral endocrine and local paracrine effects.
Snip…. It is likely that androgens are vital for the development, maintenance and function of penile tissue and regulation of erectile physiology. However, the critical androgenic substance for these effects is most likely T rather than DHT.
Dr Proctor comments: It is likely the fact that testosterone is more important than DHT for erectile function helps keep down side-effects in use of finasteride (propecia) for hair loss treatment.
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November 26th, 2009
Khaitan BK, et al Indian J Dermatol Venereol Leprol 2004;70:350
….Nine patients had alopecia universalis and one had alopecia totalis. The earliest regrowth of hair on the scalp was seen at 1 month. Cosmetically acceptable hair regrowth was seen at 2-8 months. This meant that the regrowth covered cosmetically important areas like scalp, eyebrows and in male patients, moustache and beard, showing terminal hair on >75% of the affected area. The dose of betamethasone was tapered step-wise by 1 mg per dose every month once cosmetically acceptable regrowth was achieved. The eyebrows and eyelashes began to respond in 1-4 months (mean 2 months). Hair growth over the extremities started in about 3-4 months.
At the end of 6 months, 7 patients (43.7%) showed an excellent response [Figure - 1], [Figure - 2] after which the dose of betamethasone was tapered step-wise and finally stopped. In the subsequent follow-up (5 to 8 months) there was a relapse in 1 patient after 2 months of stoppage of treatment and OMP had to be restarted. Another patient showed scanty re-growth of hair on the eyebrows. Five (31.2%) patients showed a good response after 6 months of therapy [Figure - 3], [Figure - 4]. Betamethasone was continued in these patients in the same doses (5 mg) for another 2 months and then gradually tapered and finally stopped. There has been no relapse in this group of patients. Two (12.5%) patients showed an unsatisfactory response at the end of 6 months. The dosage was tapered in next two months to 3 mg of betamethasone and was continued till one year and then tapered off in the next 3 months. Further improvement was not significant. The remaining two (12.5%) patients were non-responders and both had alopecia universalis. In one of them there was growth of a few vellus hair.
The best treatment response was seen on the scalp. The extremities and eyebrows still showed a few remaining areas of hair loss and required further topical treatment with corticosteroids with variable response. The side effects noted were cushingoid facies and weight gain in 2 patients and acneiform eruption in 2 patients. Three patients complained of mild gastric discomfort which responded to antacids and H2 blockers. At present there are 12 patients who are off treatment since 5 to 8 months and there has been no relapse.
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November 15th, 2009
Dermatologica. 1987;175:19
Hair follicle biology and topical minoxidil: possible mechanisms of action.
Headington JT.
How minoxidil stimulates hair regrowth remains undetermined. ..snip…. Possible sites of direct drug action include either the dermal papilla of the follicle or hair matrix cells. Morphometric studies of control scalp biopsies taken from young male patients with androgenetic alopecia (male pattern hair loss) reveal that the primary morphologic event is miniaturization of terminal hair follicles…accompanied by shortening of the hair growth cycle ..snip…There has been no suggestion in any morphologic studies of minoxidil-treated patients for development of new follicles (f. Because dermal papilla of the hair follicle apparently controls both growth and differentiation of hair matrix cells ….snip…,
edited for hair loss treatment blog use
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November 11th, 2009
Br J Dermatol. 1978;99(4):371
The long term effect of repeated pluckings on the function of the mouse vibrissal hair follicles.
Ibrahim L, Wright EA.
Single mouse vibrissae were plucked repeatedly at the same time of the cycle (10–15 days after eruption) for ten successive hair regrowth cycles from eight individual follicles. After three hair pluckings the first grey whisker appeared, after six pluckings all were grey. Two follicles stopped producing whiskers after seven pluckings and another two after the 8th. Henceforth only 50% of the follicles continued producing whiskers until the end of the experiment. All the follicles which ceased to produce whiskers had a keratogenous cyst occupying most of the hair follicle in direct contact with the dermal papilla. In all cases the isolated dermal papilla was condensed and rounded in shape. Both loss of pigment and cyst formation could be due to the mechanical damage in the hair follicle caused by repeated plucking.
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November 2nd, 2009
Hair Loss Treatment at the Proctor clinic
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November 1st, 2009
Arch Dermatol Res. 1978;263:297-306.
The histodynamic of alopecia areata in the dependence on the griseofulvin-induced epithelial proliferation
Franz E.
The histodynamic of hair loss due to alopecia areata–without or with the medicamentous induction of the hair regrowth respectively–was investigated comparatively. 1. Griseofulvin induced an epithelial proliferation in alopecia areata associated hair loss, which is noticeable in the surface epithelium as well as in the follicular epithelium. 2. Under the influence of griseofulvin a deeper penetration of the follicles into the fatty tissue–in connexion with a cutan-subcutaneous volume increase–results; at the same time the supra- and infraseboglandular follicular areas are lengthened. snip…..
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October 29th, 2009
Hair loss Treatment at the Proctor clinic.
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