Hair Loss

Braz J Med Biol Res. 2003 Oct;36(10):1447-54.

The 5 alpha-reductase type 1, but not type 2, gene is expressed in anagen hairs plucked from the vertex area of the scalp of hirsute women and normal individuals.

Oliveira IO, et al
(edited)
…To determine the expression of the genes for type 1 (SDR5A1) and type 2 (SDR5A2) 5alpha-reductase isoenzymes in scalp hairs plucked from 33 hirsute patients (20 with polycystic ovary syndrome and 13 with idiopathic hirsutism) and compare it with that of 10 men and 15 normal women. SDR5A1 and SDR5A2 expression was estimated by RT-PCR using the gene of the ubiquitously expressed protein 2-microglobulin as an internal control. The results are expressed as arbitrary units in relation to beta2-microglobulin absorbance (mean SEM). SDR5A2 expression was not detected in any hair samples analyzed in this study. No differences were found in SDR5A1 mRNA levels between men and normal women (0.78+/-0.05 vs 0.74+/-0.06, respectively). SDR5A1 gene expression in the cells of hair plucked from the scalp of normal women (0.85+/-0.04) and of women with polycystic ovary syndrome (0.78+/-0.05) and idiopathic hirsutism (0.80+/-0.06) was also similar. These results indicate that SDR5A1 gene expression in the follicular keratinocytes from the vertex area of the scalp seems not to be related to the differences in hair growth observed between normal men and women and hirsute patients. Further studies are needed to investigate the expression of the 5 alpha-reductase genes in other scalp follicular compartments such as dermal papillae, and also in hair follicles from other body sites, in order to elucidate the mechanism of androgen action on the hair regrowth process and related diseases such as male pattern hair loss.

It is difficult to predict the effect of minoxidil liniment on hair loss

Anderson C, Berne B, Juhlin L, Skogh M, Strand A, Vahlquist A.

Lakartidningen. 1990 Jan 10;87:16.

PMID: 2405223

JAMA. 1979 Jan 5;241(1):53-4.

Pseudofolliculitis barbae. No ‘pseudoproblem’.

Conte MS, Lawrence JE.

Pseudofolliculitis barbae possibly affects 45% of all black servicemen and is a source of much misunderstanding and social unrest in the military. A recent study of 96 cases of pseudofolliculitis barbae has elucidated a successful shaving technique. It employs a 30-day period of beard regrowth to eliminate ingrown hairs, twice-daily use of a new polyester skin-cleansing pad, and use of solely electric hair clippers for facial hair removal. Ninety-six percent of those using this technique could thereafter conform to the Air Force grooming code.

Arch Dermatol. 1981 Jul;117(7):384-7.

Topical treatment of alopecia areata.
Swanson NA, Mitchell AJ, Leahy MS, Headington JT, Diaz LA.

It has been shown previously that hair loss due to alopecia areata can be treated with dinitrochlorobenzene (DNCB) and other contact allergens. Whether these agents work by inducing immunologic stimulation or simply a nonspecific inflammatory reaction has not been definitively demonstrated. To test the relative importance of these two mechanisms, we have randomly studied 22 patients with alopecia areata to whom either DNCB or croton oil was applied topically. Sixty-three percent of patients without spontaneous regrowth of hair regrew hair after DNCB application. None of those treated with croton oil regrew hair when treated later with DNCB. Therefore, a proved contact allergen was shown to be required for therapeutic success. Patient acceptance of the induced contact dermatitis was excellent. In light of recent data on the mutagenicity of DNCB to bacteria, other contact allergens for topical immunotherapy are being sought.

N Engl J Med. 1994 Jan 13;330(2):120-5.

Finasteride.
Rittmaster RS.
Department of Medicine, Dalhousie University, Halifax, NS, Canada.

PMID: 7505051

Hair loss and hair loss treatment

Unilateral gynecomastia induced by treatment with 1 mg of oral finasteride for hair loss.

Ferrando J, Grimalt R, Alsina M, Bulla F, Manasievska E.

Arch Dermatol. 2002 Apr;138(4):543-4.

Eur J Dermatol. 2002 Jan-Feb;12(1):38-49.

Long-term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia.
Finasteride Male Pattern Hair Loss Study Group.

BACKGROUND: Finasteride 1 mg (Propecia) is indicated for the treatment of men with androgenetic alopecia (male pattern hair loss, MPHL). However, the long-term (> 2 years) efficacy and safety of finasteride in this population has not been previously reported. Objectives. To assess the efficacy and safety of finasteride in men with MPHL compared to treatment with placebo over five years. METHODS: In two 1-year, Phase III trials, 1,553 men with MPHL were randomized to receive finasteride 1 mg/day or placebo, and 1,215 men continued in up to four 1-year, placebo-controlled extension studies. Efficacy was evaluated by hair counts, patient and investigator assessments, and panel review of clinical photographs. RESULTS: Treatment with finasteride led to durable improvements in scalp hair over five years (p 3/4 0.001 versus placebo, all endpoints), while treatment with placebo led to progressive hair loss. Finasteride was generally well tolerated and no new safety concerns were identified during long-term use. CONCLUSIONS: In men with MPHL, long-term treatment with finasteride 1 mg/day over five years was well tolerated, led to durable improvements in scalp hair growth, and slowed the further progression of hair loss that occurred without treatment.

Aust Fam Physician. 1999 Mar;28(3):248-50, 252-3.

Understanding and managing common baldness.
Tran D, Sinclair RD.

BACKGROUND: Society places importance on physical attributes especially the appearance of our hair. Common baldness, male patterh hair loss, or androgenetic alopecia is a normal physiological process of hair loss in genetically predisposed individuals. Premature or accelerated hair loss can engender considerable negative thoughts and anxiety associated with feelings of diminished attractiveness. OBJECTIVE: To enable general practitioners to recognise the various treatment options available, therefore offering patients reasonable hope and informed choices. DISCUSSION: Common baldness can be prevented by currently available mediums and regrowth may be achieved in a significant percentage of cases. Correct use of these agents requires an understanding of the pathogenesis of androgenetic alopecia, its natural history and the time course of response to treatment.

The Journal of Clinical Endocrinology & Metabolism Vol. 86, No. 6 2875-2880
Copyright © 2001 by The Endocrine Society

5-Reductase Type 2 Is Constitutively Expressed in the Dermal Papilla and Connective Tissue Sheath of the Hair Follicle in Vivo But Not during Culture in Vitro1

Yuji Asada, Tadashige Sonoda, Mayumi Ojiro, Sotaro Kurata, Toshihiro Sato, Tetsuo Ezaki and Susumu Takayasu
Department of Dermatology (Y.A., T.So., M.O., S.K., T.Sa., S.T.), Oita Medical University; and Ezaki Clinic (T.E.), Oita 879-5593 , Japan

Address all correspondence and requests for reprints to: Yuji Asada, M.D., Oita Medical University, Department of Dermatology, 1-1 Daigaoka, Hasama-Machi, Oita 879-5593, Japan.

Abstract

Recent studies suggest that 5-reductase type 2 (5R2) rather than 5R1 plays a key role in the pathogenesis of male-pattern baldness. To clarify the localization of the androgen receptor (AR), 5R1, and 5R2 in the hair follicle, we investigated the expression of the corresponding genes by RT-PCR using microdissected hair follicles. AR and 5R1 mRNAs were expressed in all portions of the hair follicle. By contrast, 5R2 mRNA was expressed only in mesenchymal portions that included the dermal papilla and connective tissue sheath, and hardly any was expressed in epithelial portions. The intensity of expression of these genes in each portion of the hair follicles did not differ between follicles from balding and nonbalding scalp. We also examined the expression of these genes in cultured fibroblasts derived from the dermal papilla and connective tissue sheath. Although expression of AR and 5R1 mRNAs was easily detected, there was no obvious expression of 5R2 mRNA in either type of cell. Type-specific inhibition of 5R activity by MK386 and MK906 confirmed these patterns of expression of 5R mRNA. Thus, the expression of 5R2 mRNA seems to be characteristic of freshly microdissected mesenchymal portions of the hair follicle, but such expression might not be maintained in culture.

Australas J Dermatol. 1990;31(1):17-25.

Australian trial of topical minoxidil and placebo in early male pattern baldness.
Connors TJ, Cooke DE, De Launey WE, Downie M, Knudsen RG, Shumack S, Eggleston AS.

One hundred and sixty nine men with early male pattern baldness (androgenic alopecia) were treated in a random, double-blind fashion with either 2% minoxidil solution or placebo vehicle for 24 weeks, one ml applied twice daily. After 24 weeks all patients received the active solution until week 48. After 24 weeks the minoxidil treated patients had increased their non-vellus hair counts significantly more than the placebo treated group; means were 37.6 and 8.8 hairs per reference area, 95% C.I. for difference = 10.85 to 60.75. The rate of non-vellus hair regrowth was also greater among minoxidil treated patients than placebo treated patients. Nine (12.5%) evaluable minoxidil treated patients compared with 2 (2.7%) evaluable placebo treated patients reported moderate or dense hair regrowth at week 24. Minimal regrowth was reported by 18 (25%) active group and 15 (20%) placebo group patients. The investigators considered that 3 (2%) of the minoxidil group and none of the placebo group had moderate hair regrowth and that none had dense hair regrowth. After 48 weeks treatment 28 (23%) patients considered that they had moderate hair regrowth and the investigators considered that 14 (12%) patients had moderate regrowth. None had dense growth. No serious adverse reactions or deaths were reported. Minoxidil solution appeared to be an efficacious and safe treatment for early androgenic alopecia.

Hiar loss and hair loss treatment blog

Gynecol Endocrinol. 2002 Dec;16(6):431-41.

Current concepts in aesthetic endocrinology.
Gruber CJ, Wieser F, Gruber IM, Ferlitsch K, Gruber DM, Huber JC.

The extragenital effects of ovarian steroids are relevant to the metabolism of skin and hair, the changes in body composition and the alterations of the subcutaneous fat distribution throughout life. When ovarian steroids become deficient or are produced in excess, different problems may arise in these tissues and some of these problems, i.e., obesity and cellulite, display gender-specific components. Therefore, a new field in endocrine research known as aesthetic endocrinology is gaining more interest. Because sex steroids are small molecules they can be transported into the skin by topical application when properly formulated. This possibility is used in aesthetic endocrinology in order to achieve local effects but to avoid systemic reactions. After reviewing the current data it collectively seems legitimate to recommend estrogens, either orally or topically, in order to counteract the aging of the skin after menopause. Although a reconstitution of juvenile skin cannot be achieved through this method, a slowing in the skin aging process seems a reasonable expectation. In contrast, the successful treatment of hair loss in women is only confirmed for the application of the non-hormonal compound minoxidil. Apart from the difficult problem of hirsutism, acne and changes in body composition offer promising therapeutical options for endocrinological methods.

Hair loss blog

Jpn Heart J. 2000 Jul;41(4):519-23.

A case of acute myocardial infarction associated with topical use of minoxidil (RiUP) for treatment of baldness.
Satoh H, Morikaw S, Fujiwara C, Terada H, Uehara A, Ohno R.

Third Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.

A 45-year-old Japanese man with paroxysmal atrial fibrillation (AF) developed acute anteroseptal myocardial infarction (MI). He had used 1% topical minoxidil (RiUP) once a day for 4 months before the onset of MI for treatment of baldness. Coronary angiography demonstrated severe stenosis at the proximal portion of the left anterior descending coronary artery with a tilling defect. Electrocardiographic monitoring revealed paroxysmal AF and sinus bradycardia with sinus arrests, suggestive of sick sinus syndrome. Topical minoxidil is now widely used for the treatment of male pattern baldness. Although it may be difficult to relate topical use of minoxidil to myocardial ischemia, a greater awareness of its toxicity will be necessary, and patients with cardiovascular disorders should be excluded from the therapy.

hair Loss blog

hair Loss blog

hair Loss blog

hair Loss blog

Dermatology. 1996;193(3):177-84.  Links

Trüeb RM.

Int J Dermatol. 1991 Jan;30(1):22-8. 

Psychologic characteristics of men with alopecia androgenetica and their modification.

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