ArticleLiterature Review

Medical treatments for male and female hair loss

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Abstract

Unlabelled: Male and female pattern hair loss affects a large percentage of the population, and patients frequently present for treatment of this to their dermatologist. Here we review the many treatments available for hair loss. We review the evidence for each, and outline the most effective treatment strategies for both men and women. Learning objective: At the conclusion of this article, the reader should be able to describe the most effective treatments for hair loss, understand their mechanism(s) of action, and explain which treatments are the best in different settings.

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... Androgenetic alopecia (AGA) is genetic in nature and thus causes hair loss in 60-70% of males of Caucasian descent. It affects approximately 40% of women by age 50 (1). Its prevalence is seen to increase with age (2)(3)(4). ...
... Female androgenetic alopecia in comparison with Male androgenic alopecia is not always associated with elevated serum androgen levels, many women with female androgenetic alopecia have androgen levels within the normal range, indicating that the condition is not entirely dependent on systemic hormonal abnormalities. Instead, their hair follicles might have an increased local sensitivity to androgens due to genetic or molecular factors (1). Although considered only a cosmetic condition, it has a significant psychological impact on the self-esteem and confidence of an individual (9). ...
... Although considered only a cosmetic condition, it has a significant psychological impact on the self-esteem and confidence of an individual (9). Unlike male pattern baldness, women rarely experience complete baldness, but the psychosocial impact of hair thinning can be more significant (1). It is reported that the psychological impacts associated with conditions of hair loss are rather comparable to those emanating from various other more serious diseases or disorders (10). ...
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Objective This systematic review evaluates the efficacy of minoxidil alone versus minoxidil with low-level laser therapy (LLLT) for androgenic alopecia. Study design systematic review and meta-analysis. Methods An online search of PubMed, Web of Science, and MEDLINE was conducted. Randomized clinical trials comparing minoxidil monotherapy with minoxidil and LLLT combination therapy were included based on predefined criteria. The Risk of Bias 2.0 (RoB 2.0) tool was used for quality assessment. Results From 38 identified studies, 34 remained after excluding 4 duplicates. Further exclusions left 4 eligible studies comparing minoxidil alone with minoxidil and LLLT. The meta-analysis found no statistically significant differences in hair counts between the two groups at baseline, 12 weeks, and 8 weeks post-treatment [mean difference = −0.04, 95% CI −1.22 to 1.14, p = .95, I² = 0%]. Similarly, hair diameter showed no significant differences at the same time points [mean difference = 0.00, 95% CI −0.00 to 0.00, p = .98, I² = 38%]. Conclusion The combination of minoxidil and LLLT does not significantly improve outcomes compared to minoxidil alone for treating androgenic alopecia.
... mg/day [4,73,74]. Although 5-ARIs are generally considered safe [75], they are category X drugs in pregnancy and may cause male fetus feminization. Therefore, finasteride is recommended in women due to its shorter half-life compared to dutasteride. ...
... Therefore, finasteride is recommended in women due to its shorter half-life compared to dutasteride. Effective contraception is also recommended [45,75]. Although 5-ARIs are considered the most effective drugs for FFA [4,17,45,56], further research is necessary to clarify their therapeutic mechanism. ...
Article
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Frontal fibrosing alopecia (FFA) is a type of cicatricial alopecia predominantly observed in postmenopausal women, with the incidence rising since its initial description in 1994. The exact etiopathogenesis of the disease has not been completely elucidated. FFA is characterized by an inflammatory process affecting the hair follicles of the fronto-temporal hairline, leading to its gradual recession. Eyebrows, particularly the lateral parts, may also be affected. Early diagnosis and an implementation of effective therapy to limit the inflammatory process are crucial in halting disease progression. Various treatment possibilities have been reported, including anti-inflammatory and immunosuppressive agents, as well as 5-alpha-reductase inhibitors, retinoids, and antimalarial agents. The use of phototherapy and surgical procedures has also been described. However, most available data have been obtained retrospectively, frequently consisting of descriptions of case reports or small case series, and not from randomized controlled trials. In addition, the etiopathogenesis of FFA remains unclear and its course unpredictable, occasionally being linked with spontaneous stabilization. Hence, no precise guidelines exist regarding treatment modalities. Therefore, the aims of this study were to provide a comprehensive review of the efficacy of existing therapeutic modalities for FFA and to highlight novel therapeutic options.
... The half-life of dutasteride is 5 weeks compared with 6 to 8 hours for finasteride. 40 For this reason, it has been thought that the potential adverse effects of sexual dysfunction with dutasteride could be longer lasting and more challenging to reverse. [40][41][42] Despite this hesitancy about dutasteride use, sexual adverse effects in patients treated with dutasteride have been observed to be comparable with those treated with finasteride. ...
... 40 For this reason, it has been thought that the potential adverse effects of sexual dysfunction with dutasteride could be longer lasting and more challenging to reverse. [40][41][42] Despite this hesitancy about dutasteride use, sexual adverse effects in patients treated with dutasteride have been observed to be comparable with those treated with finasteride. Similar rates of sexual adverse effects have been reported in multiple studies and like finasteride, some studies reported that those treated with dutasteride showed improvement in symptoms over time. ...
Article
Finasteride and dutasteride are 5-α-reductase inhibitors (5-ARIs) used to treat androgenetic alopecia (AGA). This review evaluates the efficacy of 5-ARIs for treatment of men with AGA and the potential adverse effects on reproduction including sexual dysfunction, infertility, and teratogenicity. A broad literature review was conducted to search for publications on 5-ARI treatment in men with AGA. Hair counts, hair growth assessments, sexual adverse effects (erectile dysfunction, ejaculatory dysfunction, and decreased libido), change in sperm parameters (decreased sperm count, semen volume, sperm motility), and teratogenic drug concentration levels in semen were the measured outcomes of studies included in this literature review. Both finasteride and dutasteride are effective at treating hair loss in male AGA, with studies finding dutasteride was more efficacious than finasteride. Many studies reported sexual adverse effects of 5-ARIs that are uncommon and resolve spontaneously, although there remains no consensus with respect to the presence, severity, and duration of sexual adverse effects. 5-ARIs may have a negative impact on spermatogenesis although the clinical significance of this is unclear and discontinuation of these medications results in improved sperm parameters for most patients. Teratogenicity after paternal exposure is unlikely due to the low concentration of 5-ARIs absorbed in semen. Further research is needed to evaluate the effects of 5-ARI use on reproduction.
... AGA is one of the most frequent hair loss causes, 1 affecting 50% of men by 50 years of age and nearly 50% of women. 2 This condition is characterized by hair follicular miniaturization. TE is a common cause of diffuse nonscarring hair loss that is usually correlated by a physiological stress. ...
... Hair loss is a common problem that affects up to 50 percent of men and women. 2 supplementation among patients with hair loss disorders is prevalent. ...
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Background Oral supplementation with some amino acids (like methionine, taurine, and cysteine) could be useful in subjects with hair loss conditions such as androgenic alopecia (AGA or FAGA) or telogen effluvium (TE). Hydrolysed collagen (HC) oral supplementation has demonstrated to have beneficial effects on nail and skin health and could improve hair growth. A food supplement in tablet formulation containing hydrolysed fish‐origin collagen (300 mg/dose), taurine, cysteine, methionine, iron, and selenium has been recently available. To date no controlled data are available regarding the clinical efficacy of this product as adjuvant to hair loss specific treatments in these clinical conditions. Study aims To evaluate and compare the efficacy and tolerability of an oral supplementation based on HC and amino acids in subjects with hair loss due to AGA/FAGA or chronic TE in combination with drug treatments in comparison with drug treatments alone. Methods and subjects In a prospective, 12‐week, randomized, assessor‐blinded controlled trial 83 subjects (mean age 41 ± 16 years; 26 men and 57 women) were enrolled in the study. Fifty‐nine subjects suffered from AGA/FAGA (Hamilton I‐VA, Ludwig I‐1, II‐2) and 24 from chronic TE. Subjects were randomized to oral supplementation (1 tablet day) in combination with the specify drug treatment decided by the investigator according to the type of hair loss (AGA/FAGA or TE) (Group A; N = 48) or to specific drugs treatment only (Group B; N = 35). The main outcome of the trial was the clinical efficacy evaluation using a 7‐point global assessment score (GAS) (from +3: Much Improved to ‐3 Much worsened; with score 0 representing no modification). The GAS score was evaluated using standardized photographs by an investigator unaware of the treatment groups at week 6 and at week 12. A secondary outcome was the evaluation of acceptability of the treatment regimen using a 10‐point evaluation score. Results Seventy‐six participants (91.6%) completed the 12‐week study period. The GAS score at week 6 was 0.5 ± 0.2 in group A and 0.0 ± 0.1 in Group B (p < 0.05; Mann‐Whitney). At week 12 the GAS score in Group A was statistically significant higher in comparison with Group B (1.67 ± 0.16 and 0.66 ± 0.20, p < 0.001; Mann–Whitney test). A higher percentage of Group A subjects achieved a GAS score of ≥2 in comparison with group B (50% vs. 23%). The oral supplement was generally well tolerated. Conclusion An oral supplement containing hydrolysed fish‐origin collagen, taurine, cysteine, methionine, iron, and selenium has demonstrated to improve the clinical efficacy of specific anti‐hair loss treatments in subjects with AGA/FAGA or chronic TE.
... The enzyme 5-alpha reductase converts testosterone to dihydrotestosterone and acts on androgen-dependent tissues by binding to dihydrotestosterone androgen receptors. 16 Androgens provides trophic support to lacrimal glands and increases lacrimal glands tissue growth and activity. 17 Testosterone positively affects the ocular surface and immune functions of the lacrimal glands. ...
Article
Clinical relevance: The prevalence of male androgenetic alopecia is increasing worldwide. Evaluation of dry eye parameters and meibomian glands of male androgenetic alopecia patients may help to better understand the effect of this disease on dry eye and to provide appropriate treatment for these patients. Background: To evaluate the relationship between male androgenetic alopecia, dry eye, and meibomian gland function. Method: A total of 80 eyes of 80 patients, 40 eyes of 40 patients diagnosed with male androgenetic alopecia, and 40 eyes of 40 healthy men were included. The presence of dry eye was evaluated with the Schirmer I test, invasive tear film breakup time (TBUT), Oxford scale scoring (cornea and conjunctiva staining), and the Ocular Surface Disease Index score. Evaluation of the eyelid meibomian glands was performed using the LipiScan System, and the descending meibomian glands for each eyelid were scored proportionally. Results: The average age of patients with androgenetic alopecia and the control group is 41.93±6.65 and 40.75±7.32 years, respectively (p = 0.413). The mean Schirmer I test score was statistically significantly lower in the androgenetic alopecia group (p = 0.001), and the mean Ocular Surface Disease Index score was significantly higher in the androgenetic alopecia group compared to the control group (p = 0.001). In the androgenetic alopecia group, mean TBUT was lower (p = 0.001) and mean Oxford scale score was higher (p = 0.009). Total, upper, and lower meibomian gland scores were statistically significantly higher in the androgenetic alopecia group (p = 0.001, p = 0.001, and p = 0.001, respectively). Conclusion: There may be an association between male androgenetic alopecia and dry eye, meibomian gland dysfunction. Male individuals with androgenetic alopecia should be closely followed for dry eye and meibomian gland dysfunction. Key Words: Androgenetic alopecia, Dry eye, Meibomian gland dysfunction, LipiScan system
... NLCs, composed of a blend of solid and liquid lipids, offer significant advantages over other lipid-based nanocarriers in enhanced topical drug delivery due to their improved stability, higher drug loading capacity, and the ability to penetrate deeper into the skin, ensuring sustained release and better bioavailability at the target site (Nasr and Nawaz 2008). Studies have explored the use of NLCs for delivering minoxidil, finasteride and herbal extracts, showing promising results in terms of enhanced drug delivery and therapeutic outcomes (Rogers and Avram 2008;Kaufman et al. 1998;Ufomadu 2024). ...
Article
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Alopecia, a common dermatological condition, poses significant psychological and social challenges. Despite the availability of various treatments, their efficacy is often limited by poor bioavailability and delivery challenges. Nanostructured lipid carriers have emerged as promising advanced drug delivery systems for alopecia treatment due to their ability to encapsulate both hydrophilic and lipophilic compounds, enhancing their stability, solubility, and controlled release. This manuscript explores the potential of Nanostructured lipid carriers as innovative delivery platforms for alopecia therapeutics, focusing on their formulation, characterization, and application in topical treatments. The unique properties of Nanostructured lipid carriers, including their small size, biocompatibility, and ability to target specific skin layers, are discussed in relation to improving the penetration and therapeutic efficacy of active ingredients such as minoxidil, finasteride, and plant-derived compounds. Additionally, we highlight the role of Nanostructured lipid carriers in improving scalp penetration, reducing side effects, and offering a more efficient alternative to conventional treatments. The manuscript concludes with insights into future trends, challenges, and the clinical potential of Nanostructured lipid carriers-based formulations in revolutionizing alopecia treatment.
... Contudo, a diferença principal para com a finasterida se dá pois a primeira atua na isoenzima 5 alfa-redutase, enquanto que a dutasterida atua nos subtipos 1, assim como no 2. Dessa forma, acaba por ter uma atividade cerca de 3 vezes mais potente do que a finasterida ao inibir a isoenzima do tipo 2 e cerca de 100 vezes mais potente para inibir o tipo 1. Devido a isso, em comparação com outros tratamentos, a eficácia da dutasterida é considerada superior à da finasterida (5 mg/dia) e do minoxidil (5 mg/dia). 33 A farmacocinética de dutasterida é distinta, apresentando uma meia-vida plasmática média de cerca de cinco semanas, em contraste com a meia-vida de aproximadamente quatro horas do minoxidil e da finasterida. Assim, a dutasterida representa uma opção promissora e potencialmente mais eficaz para o tratamento da AAG, embora ainda seja utilizada off-label em muitas regiões. ...
Article
Introdução: A alopecia androgenética (AAG) masculina, ou calvície masculina, é a causa mais comum de perda capilar, afetando até 80% dos homens caucasianos, com início geralmente entre 17 e 23 anos e pico de incidência entre 40 e 50 anos. Essa condição é particularmente relevante em um contexto em que a aparência influencia a autoimagem e a identidade capilar, gerando impactos psicológicos significativos, como ansiedade e depressão. Além disso, a AAG está associada a riscos elevados de doenças cardiovasculares e síndrome metabólica. Os incluem desafios à resistência dos homens na busca por tratamento devido a estigmas sociais e falta de conhecimento sobre opções terapêuticas. Apesar de haver uma variedade de abordagens disponíveis, muitos pacientes não recebem o tratamento adequado, e a necessidade de estratégias personalizadas se torna evidente. Este trabalho visa contribuir para a prática médica baseada em evidências. Objetivo: Revisar as opções de tratamento disponíveis na literatura para a alopecia androgenética masculina. Métodos: Trata-se de uma revisão integrativa de literatura, realizada nas bases de dados: PubMed, Scientific Electronic Library Online (Scielo) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), no qual utilizou-se os descritores “alopecia”, “adrogenética”, “AAG” e “tratamento”. A busco limitou-se aos artigos em português, inglês e espanhol com data de publicação entre 2004 e 2024. Discussão: Foram analisados todos os métodos farmacológicos e não farmacológicos validados dentro de suas especificidades, além de análise complementar das perspectivas futuras quanto às novas opções terapêuticas. Conclusão: A análise das terapias para alopecia androgenética destaca a importância de abordagens personalizadas. Embora os tratamentos sejam mais focados nos homens, há uma necessidade de novas pesquisas, especialmente sobre alternativas como terapia com células-tronco e uso de exossomos. A comparação entre dutasterida e finasterida revela que a primeira é mais eficaz. O transplante capilar, aliado aos tratamentos descritos, também é uma opção viável. O campo está em evolução constante, e a atualização clínica é essencial para melhorar os resultados.
... 5 Insights into additional molecular pathways influenced by minoxidil suggest its involvement beyond potassium channel opening. Studies indicate that minoxidil may impact various pathways linked to hair growth including prostaglandin synthesis, endothelin-1 modulation and vascular endothelial growth factor expression. 7,8 These multifaceted interactions suggest that minoxidil's therapeutic actions might extend beyond its known vasodilatory effects, potentially involving complex signalling cascades influencing hair follicle growth and regeneration. 8 ...
Article
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Minoxidil, originally developed as an antihypertensive medication, has evolved into a versatile therapeutic agent within dermatology, notably for its effectiveness in promoting hair growth. Despite its widespread use, understanding its precise mechanism of action remains a challenge. This paper addresses this gap by providing a comprehensive review of pharmacological properties, action mechanisms, clinical effectiveness and side effects associated with topical minoxidil. Furthermore, it highlights emerging trends and applications, including its role in treating androgenetic alopecia, its potential for alopecia areata management and its utilization in combination therapies. Additionally, this paper explores novel applications in scar treatment and wound healing. By synthesizing current knowledge and insights, this review adds clarity to the diverse applications of minoxidil, providing valuable guidance for clinicians and researchers aiming to optimize its therapeutic use in dermatology.
... In men, AGA typically presents as a receding hairline and thinning of the hair on the crown. In women, it manifests as reduced hair density and finer hair diameter on the top of the head, whereas the hairline at the forehead usually remains unaffected [6]. ...
Article
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Background Androgenetic alopecia (AGA) is the most prevalent type of hair loss. Traditionally, treatment for AGA has primarily involved the topical application of minoxidil in conjunction with oral finasteride or spironolactone. Recently, platelet‐rich plasma (PRP) has emerged as a significant focus of research in hair loss treatment. However, many studies on PRP‐assisted hair transplantation have encountered various limitations. Objective This study aims to conduct a prospective, comparative clinical investigation to evaluate the therapeutic effects of combining PRP with minoxidil and finasteride/spironolactone as adjuncts to hair transplantation. Method From August 2019 to December 2022, we enrolled 30 patients with AGA in the study, randomly assigning them to an experimental group and a control group. The experimental group received drug therapy alongside hair transplantation and underwent PRP injections, whereas the control group received only drug therapy to assist with hair transplantation. Results Prior to surgery, no significant differences in baseline data were observed between the two groups. Following treatment, the experimental group demonstrated significantly improved follicle survival rates, follicle growth rates, and hair strength compared with the control group. Conclusion This prospective, comparative clinical study demonstrated that the application of PRP in conjunction with pharmacological support during FUE treatment for AGA resulted in improved follicle survival rates, hair growth rates, and hair strength.
... • when Applying the serum on the scalp, can lead to inflammation. • Scalp application should be avoided because it may cause oiliness or irritation [11]. ...
Article
By Hair is an epidermal by-product that plays an important role in enhancing the overall beauty of the body. Dandruff, Hair fall, grey hair are few problems committed hair faced by people.
... There have been reports of pulmonary hypertension caused by elevated pulmonary artery pressure along with increased cardiac output resulting from utilizing minoxidil [13] . Additional adverse consequences could involve sporadic throbbing headache, irritated eyes, skin rashes including bullous eruptions, as well as excessive postmenstrual bleeding [14] . ...
... However, finasteride-induced adverse effects are observed in clinics, including gynecomastia and sexual dysfunction (Mysore and Shashikumar, 2016;Dhurat et al., 2020). MIN may lead to local irritation, itching, dryness, and erythema (Diani et al., 1992;Rogers and Avram, 2008). Thus, developing effective therapeutic strategies for AGA therapies is urgently needed. ...
Article
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Background: Angrogenetic alopecia (AGA) is one of the most prevalent hair loss disorders worldwide. The hair follicle stem cell (HFSC) is closely related to the formation of hair follicle (HF) structure and HF self-renewal. The activation of HFSC in AGA is critical for hair growth. Pilose antler has been reported to have hair growth-promoting activity, but the mechanism of action on AGA and HFSC has not been reported. Methods: We previously extracted an active component from the pilose antler known as PAEs. In this study, we conducted experiments using AGA mice and HFSC. The effects of PAEs on hair growth in AGA mice were firstly detected, and then the mechanisms of PAEs for AGA were predicted by integrating network pharmacology and de novo transcriptomics data of pilose antler. Finally, biological experiments were used to validate the molecular mechanism of PAEs in treating AGA both in vivo and in vitro. Results: It was found that PAEs promoted hair regrowth by accelerating the activation of anagen, delaying the anagen-catagen transition. It also alleviated the morphological changes, such as hair shortening, thinning, miniaturization, and HF number reduction, and regulated the hair regeneration process of four subtypes of hair. We further found that PAEs could promote the proliferation of HFSC, outer root sheath (ORS) cells, and hair bulb cells in AGA mice. We then integrated network pharmacology and pilose antler transcriptomics data to predict that the mechanism of PAEs treatment in AGA mice is closely related to the PI3K-AKT/Wnt-β-Catenin pathways. Subsequently, it was also verified that PAEs could activate both pathways in the skin of AGA mice. In addition, we found that PAEs perhaps increased the number of blood vessels around dermal papilla (DP) in experiments in vivo. Meanwhile, the PAEs stimulated the HFSC proliferation in vitro and activated the AKT and Wnt pathways. However, the proliferative activity of HFSC was inhibited after blocking the Wnt pathway and AKT activity. Conclusion: This study suggests that the hair growth-promoting effect of PAEs in AGA mice may be closely related to the stimulation of the AKT and Wnt pathways, which in turn activates the proliferation of HFSC.
... Minoxidil is associated with a number of adverse reactions, including pruritus, scalp irritation, irritant and allergic contact dermatitis, cardiovascular system symptoms/signs in a dose-dependent manner, and facial hypertrichosis [15][16][17]. Although primarily utilized in dermatologic applications, finasteride has been associated with hepatic dysfunction, unilateral breast enlargement and palpitations, libido reduction, head pain, fever, sexual dysfunction, and neuropsychiatric side effects [18][19][20]. ...
Article
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Background Androgenetic alopecia (AGA) is the most prevalent cause of hair loss around the world. Objective The purpose of this study was to evaluate the efficacy of laser stimulation with a 675-nm wavelength for the treatment of AGA in male and female Indian patients. Methods A total of 20 Indian healthy patients aged 23-57 years who presented a grade of alopecia stage I to stage V underwent one single pass with a 675-nm laser to the scalp area twice a week for a total of 8 sessions, followed by once a week for 4 sessions and once in 2 weeks for 2 sessions. There are 14 laser treatments in total. Macro- and dermatoscopic images have been acquired at T0 (baseline) and T1 (4 months). The vertex, frontal, and parietal areas of the scalp were evaluated. Many parameters were analyzed including hair count and hair density of terminal; mean thickness; vellus follicles; total follicular units; units with 1 hair, 2 hairs, 3 hairs, 4 hairs, and >4 hairs; unit density; and average hair/unit. Results The macroimages and dermatoscopic evaluations showed good improvement over the entire treated area, with a clear increase in the number of hairs and hair thickness. General parameters such as hair count and hair density showed a percentage increase of around 17%. The hair mean thickness parameters showed a significant (P<.001) percentage increase of 13.91%. Similar results were obtained for terminal and vellus hair: terminal hair count and hair density significantly (P=.04 and P=.01, respectively) increased by 17.45%, vellus hair count increased by 16.67% (P=.06), and the density of vellus hair increased by 16.61% (P=.06). Conclusions The study findings demonstrate that the 675-nm laser system improved AGA in Indian patients, facilitating the anagen phase and improving hair density and other positive hair parameters.
... This article aims to outline the different signs and symptoms of alopecia with specific reference to gender, as supported by reputable medical journals and books. [20,21] This is the most common form of hair loss in both men and women. ...
... AGA is the most common form of hair loss; it varies in prevalence by race and ethnicity, affecting over 50% of men and up to 50% of women with increasing incidence with age. 1,11 The underlying etiology is multifactorial and includes a combination of genetic susceptibility combined with a heightened sensitivity to circulating androgens. Specifically, dihydrotestosterone (DHT), a testosterone metabolite that is a more potent ligand of androgen receptors, plays a key role in AGA pathogenesis in both men and women. ...
Article
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Alopecia is traditionally classified into scarring and nonscarring subtypes, with etiopathologies ranging from androgen‐mediated to immuno‐inflammatory. Over 50% of men and almost 50% of women will experience some form of hair loss in their lifetime. Given this prevalence and the psychosocial significance of hair, understanding the pathophysiology and comorbidities of different types of hair loss is imperative. Other proinflammatory dermatologic disorders, such as psoriasis, are recognised to have systemic manifestations including an increased risk of cardiovascular (CV) disease, and are now considered CV risk‐enhancing conditions. With increased recognition of the importance of systemic inflammation in promoting atherosclerosis, high prevalence, and improved treatment strategies, there is increased interest in establishing whether a similar association between alopecia and cardiovascular disease (CVD) exists. In this manuscript, we aim to review the current literature regarding CV risk in androgenic alopecia (AGA) and alopecia areata (AA). Additionally, we review the literature for cicatricial alopecias and highlight the need for more research into their potential associations with CV risk. Evidence from the identified AGA publications suggests an association of AGA with CV risk factors including hypertension, dyslipidemia, and insulin resistance, as well as with coronary artery disease. For AA, most of the identified studies found an association between AA and CV risk, though the relationships were not always statistically significant. Research on cicatricial alopecias and CV risk is limited and often contradictory. There is great need for more studies regarding the association between various types of alopecia and the development of CVD, and potential mechanisms. Particularly needed are more studies of cicatricial alopecias and potential associated CV risk. While some literature suggests that patients with alopecia have an increased risk of CVD, the lack of concrete evidence represents a notable gap in our current understanding.
... After treatment had been stopped, a slight decrease of the hair density and weight of the treated groups was observed. This loss of treatment-stimulated hair growth is expected, as reported in previous studies on hair loss, since the treatment does not alter the genetic predisposition for alopecia (4,(37)(38)(39). The results obtained in this study demonstrate a good skin and gastro-intestinal tolerability of the product AT HAIR-FUL AA® food supplement, confirming a good compliance of use, and an efficacy in supporting the hair loss reduction and hair density increase; an improvement of all studied primary end-points after product use was observed. ...
Article
Androgenic alopecia is the most common form of hair loss, affecting men and women at different ages. The role of natural bioactive compounds has gained increasing recognition as a potential means to address hair loss. There is great interest in oligomeric procyanidins, particularly procyanidin B2, which have been shown to possess hair-growing activity. Annurca (Malus pumila Miller cv Annurca) apple fruits have one of the highest amounts of oligomeric procyanidins, specifically of procyanidin B2, compared to more common apple cultivars. In this study, randomized double-blind controlled parallel group trial was performed to compare the efficacy of the Annurca apple fruit extract as nutraceutical AT HAIR-FUL AA® food supplement with a placebo in hair growth. AT HAIR-FUL AA® procyanidin B2 whole fruit (peel and pulp) is characterized by a complex mixture of polyphenolic compounds, especially chlorogenic acid (400 - 600 μg/g) and procyanidin B2 (60-100 μg/g). The products were assigned to 80 enrolled subjects with alopecia, divided into 2 groups: 40 subjects took AT HAIR-FUL AA® food supplement and 40 subjects took the alternative treatment (PLACEBO). Each group of volunteers underwent 180 days of treatment, with the intake of 2 capsules per day. After that, volunteers took nothing for 30 consecutive days (follow up). The AT HAIR-FUL AA® food supplement significantly affected hair loss: hair density and weight significantly increased and hair loss significantly decreased over time (p<0.001). Moreover, we observed a fairly good pleasantness and a good skin and gastro-intestinal tolerability of the product, confirming its compliance of use: the product did not have a significant effect on gastrointestinal disorder and stomach ache onset (p=0.41 and p=0.25, respectively). AT HAIR-FUL AA® food supplement could be used as potential agent to induce hair growth.
... [6] Minoxidil is traditionally a topical treatment for AGA, and opens adenosine triphosphate gated potassium channels in cell membranes leading to vasodilation, facilitating the progression to the G1 stage of the cell cycle of dermal papilla cells (DPCs), and ultimately improving hair growth through increased DPC proliferation and reduced dihydroxytestosterone (DHT) due to vasodilation. [7,8] Both treatments require long-term compliance and are associated with adverse effects that render longterm compliance difficult for many patients. Given the limitations of current food and drug administration approved treatments, other experimental treatments have been evaluated yielding promising results. ...
Article
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Androgenetic alopecia (AGA) is the most common cause of alopecia in males and females. Minoxidil and finasteride are the only FDA-approved treatments for AGA. New treatments including Platelet Rich Plasma (PRP) and microneedling have shown promising results. The purpose of this literature review was to highlight recent studies examining the effects of topical minoxidil combined with PRP to minoxidil or PRP monotherapy. The method used for this paper includes a systematic review of the literature from 2010 to 2022 using the PubMed, EMBASE, and MEDLINE databases examining studies evaluating combination therapies for AGA. Three randomized control trials compared combination PRP + topical 5% minoxidil to either no treatment, 5% minoxidil, or PRP only. Two studies found increased hair growth at five months and at six months following combined therapy. Another study found an increase in hair density and improved patient satisfaction with combination therapy compared to monotherapy. A prospective study revealed that patients treated with combined 5% minoxidil, PRP, and microneedling reported the highest patient and physician satisfaction compared to minoxidil monotherapy. An observational study evaluating topical 5% minoxidil with PRP reported an increase in hair diameter after one year of combination treatment compared to minoxidil monotherapy. PRP therapy combined with minoxidil and microneedling in a retrospective study was shown to increase hair growth compared to PRP with minoxidil as well as PRP or minoxidil monotherapy. In conclusion, a variety of studies demonstrated superior treatment response with a combination of PRP and minoxidil therapy in patients with AGA. Limitations to this study include different PRP preparation protocols, few randomized control studies, and small sample sizes.
... One mechanism that inhibits the telogen phase is the inhibition of DHT, which is generated from testosterone by 5α-reductase [29]. Finasteride and dutasteride are widely used medications that have been reported to act through this mechanism [30]. Spironolactone inhibits the telogen phase by operating as an antagonist of the androgen receptor, the biological target of DHT [31]. ...
Article
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Proso millet (Panicum miliaceum L.) and common wheat (Triticum aestivum L.) have been used as major crops in multiple regions since ancient times, and they contain various nutrients that can affect human hair health. This study investigated the various biological effects of a complex of millet extract and wheat extract (MWC) on hair health. Human immortalized dermal papilla cells (iDPCs) for an in vitro study and an anagen-synchronized mouse model for an in vivo study were employed. These findings revealed that the application of the MWC in vitro led to an increase in the mRNA levels of antioxidant enzymes (catalase and SOD1), growth factors (IGF-1, VEGF, and FGF7), and factors related to hair growth (wnt10b, β-catenin) while decreasing inflammatory cytokine mRNA levels (IL-6 and TNFα). The mRNA levels of hair follicles (HFs) in the dorsal skin of the mouse model in the early and late telogen phases were also measured. The mRNA levels in the in vivo study showed a similar alteration tendency as in the in vitro study in the early and late telogen phases. In this model, MWC treatment elongated the anagen phase of the hair cycle. These findings indicate that the MWC can suppress oxidative stress and inflammation and may elongate the anagen phase by enhancing the growth factors involved in the wnt10b/β-catenin signaling pathway. This study suggests that the MWC might have significant potential as a functional food for maintaining hair health.
... On the other hand, topical minoxidil is generally considered to be a safer option. However, Rogers and Avram recommended a cautious approach by advising against its use during pregnancy and breastfeeding [15,52]. ...
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Low-dose oral minoxidil (LDOM) has demonstrated a promising safety and efficacy profile in the treatment of various hair disorders, including male androgenetic alopecia (AGA) and female-pattern hair loss (FPHL); however, it lacks FDA approval. The usual LDOM starting dose for male AGA is 1–5 mg/day, depending on physician preference and the patient’s condition. For FPHL, it is 0.5–1 mg/day. The maximum dose is generally 5 mg/day. If patients respond well without major side effects, the dose may be gradually increased since the LDOM’s efficacy appears to be dose-dependent. Patients may use LDOM long term if the treatment outcome is satisfactory. The common side effects of LDOM are hypertrichosis and cardiovascular symptoms. Females are more prone to hypertrichosis than males. The side effects of LDOM can be categorized as (a) dose-dependent type A side effects (hypertrichosis and cardiovascular symptoms) and (b) idiosyncratic type B side effects (pericardial effusion). Minoxidil acts via multiple pathways. Although minoxidil has a relatively short half-life of around 4 h, its hypotensive effect may last approximately 72 h. Effective treatments for alopecia are limited. Therefore, LDOM could be an important addition to the available therapies for managing some hair disorders, including AGA.
... As minoxidil shortens the telogen phase, this will result in more hairs transitioning into the exogen phase. 4 Patient should be informed that hair shedding may be observed in the first few weeks of starting the medication but will resolve, even if the medication is continued to manage the hypertension. However, female patients should also be counselled on the expected body hypertrichosis as it may be an undesirable side-effect. ...
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This Athena details the case of a 53-year-old woman with ongoing hair loss who was taking several medications.
... Among the most common treatments that are prescribed is the use of vitamins (such as vitamin D) and other medicinal supplements such as zinc and biotin [19]. One of the most effective and well-known drugs for reducing hair loss is minoxidil [20]. Taking low-dose minoxidil along with spironolactone is a suitable treatment option for hair loss [21]. ...
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Hair loss has a great impact on the self-esteem, attractiveness, and appearance of people in society. Genetics and stress are important factors in hair loss. Vitamin D has many receptors on the stem cells of a hair follicle. Also, vitamin B7 helps in the growth of hair follicles and prevents hair loss. Several diseases play a role in hair loss, including thyroid disorders. According to the type of hair loss pattern of the patient, special treatment can be prescribed for it. We were conducting a questionnaire-based survey on 309 people regarding the assessment of the common reasons and treatments they had for their hair loss. Statistical analyses were carried out using SPSS V-23.0. Descriptive statistics were applied to determine the frequencies and percentages. And results were written by interpreting the descriptive statistics. Out of 309 people who were examined, 189 people had hair loss. Losing hair in the female population was a little more. 82% of the participants who had hair loss reported that their first-degree relatives experienced hair loss like them. It appeared that people with (RH+) had a higher incidence of hair loss. Hair loss among the participants was associated with thyroid dysfunctions. Participants with moderate stress levels had a higher incidence of hair loss. The majority of participants reported the positive impact of biotin, Vitamin D, and zinc on reducing hair loss. Hair loss has a profound negative impact on the mental health and social life of a person which can be a challenge for some people.
... Therefore, many studies on treating of AGA and its mechanisms have been conducted. Currently, medication and hair transplantation are the most common treatments (de Sousa & Tosti, 2015;Rogers & Avram, 2008;Shen et al., 2018). However, the only Food and Drug Administration (FDA)-approved drugs for the former are minoxidil and finasteride, and the long-term use of these drugs can have major side effects, such as drug dependence and sexual dysfunction (Goren et al., 2018;Gupta et al., 2022;Miyata et al., 2014;Shin et al., 2019). ...
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Androgenetic alopecia (AGA) is one of the most common chronic skin diseases caused by the destruction of androgens in the body. It is caused by the excessive deposition of dihydrotestosterone around the hair follicle, resulting in hair follicle atrophy and hair cell apoptosis. It causes great anxiety and psychological distress to patients and affects sexual function in severe cases. As traditional Chinese herbs, ginsenosides have been proven to possess various pharmacological activities. Ginsenoside CK is one of the main ginsenosides, but its role and molecular mechanism in treating AGA remain unclear. Here, we found that ginsenoside CK intervention significantly reduced back hair loss in AGA mice, improved sexual organ damage and hair follicle cell apoptosis, and promoted hair growth in AGA mice. Ginsenoside CK treatment inhibited p53 expression, reduced the apoptosis of hair follicle cells induced by hormone deposition, activated the Wnt/β‐catenin cell proliferation signaling pathway, increased the level of vascular endothelial growth factor, promoted cell proliferation, and improved the atrophy of hair follicle tissue. Ginsenoside CK treatment also reduced testosterone levels in AGA mice, improved testicular tissue inflammation, and restored normal hormone metabolism in AGA mice. Our results indicated that ginsenoside CK reduced hair follicle cell apoptosis, promoted proliferation and development, and prolonged the hair growth cycle by regulating the Wnt and p53 signaling pathways, indicating the potential value of ginsenoside CK as a natural therapeutic agent for AGA.
... In bald scalp, genetically programmed miniaturization of hair follicles is controlled by increased uptake, metabolism, and conversion of testosterone to dihydrotestosterone (DHT) with the help of the enzyme 5-α-reductase type II. Steroid 5-α-reductase type II is responsible for 2/3 of circulating DHT causing alopecia [20,21]. The androgen receptor is a protein of the nuclear receptor type whose activity can be activated by formation bond interactions with androgens. ...
Article
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Alopecia is a condition in which hair on the scalp or other areas of the body is lost or falls out excessively. Nutritional deficiency causes blood flow to the head to decrease causing the hormone testosterone to be changed by the enzyme 5-α-reductase to dihydrotestosterone, which inhibits the growth phase and accelerates the death phase. One of the methods developed to treat alopecia is through inhibition of the 5-α-reductase enzyme, which converts testosterone to its more potent metabolite, dihydrotestosterone (DHT). Ethnomedicinally, Merremia peltata leaf is used by the people of Sulawesi as a remedy for baldness. Therefore, in this research, an in vivo study was conducted on rabbits to determine the anti-alopecia activity of M. peltata leaf compounds. The structure of the compounds isolated from the M. peltata leaf ethyl acetate fraction was determined by analysis of NMR and LC-MS data. An in silico study was then carried out using minoxidil as a comparison ligand; scopolin (1) and scopoletin (2) isolated from M. peltata leaf were identified as anti-alopecia compounds by predicting docking, simulating molecular dynamics and predicting absorption, distribution, metabolism, excretion, and toxicology (ADME-Tox). Compounds 1 and 2 had a better effect on hair growth compared to positive controls, and NMR and LC-MS analysis showed that they had comparable binding energies to receptors in the molecular docking interaction study: −4.51 and −4.65 kcal/mol, respectively, compared to −4.8 kcal/mol for minoxidil. Molecular dynamics simulation analysis with the parameters binding free energy calculated using the MM-PBSA method and complex stability based on SASA, PCA, RMSD, and RMSF showed that scopolin (1) has a good affinity for androgens receptors. The ADME-Tox prediction for scopolin (1) showed good results for the parameters of skin permeability, absorption and distribution. Therefore, scopolin (1) is a potential antagonist to androgen receptors and could be useful in the treatment of alopecia.
... All these treatments have been associated with several adverse events. As such, pruritus, scalp irritation, irritant and allergic contact dermatitis, and facial hypertrichosis are observed with minoxidil [3][4][5]. Finasteride (1 mg) is mainly used in dermatological practice and has been found to be associated with erectile dysfunction and decreased libido [6], hepatic functional disorder, unilateral mammary hypertrophy and palpitations, febricula, and headache [6][7]. Moreover, low-level laser therapy is linked to acne, mild paresthesia such as burning sensation, dry skin, headache, pruritus, the temporary onset of telogen effluvium, and the presence of dysplastic or malignant lesions on the scalp [8]. ...
Article
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Background Androgenetic alopecia (AGA) is frequently encountered in dermatological practice; however, there is a lack of approved treatment. At present, only three therapies have been approved for on-label use in androgenetic alopecia: minoxidil, finasteride, and lower-level laser therapy. Micronutrients are primary elements in the normal hair follicle cycle, and their role in androgenetic alopecia is a growing matter of research nowadays. This study aims to investigate the clinical efficacy and safety of Dr. SKS Hair Booster Serum, a cocktail of micronutrients and multivitamins (copper, niacinamide, hyaluronic acid, thiamine, riboflavin, and biotin), in male and female patients with androgenetic alopecia. Methods We did an open-label, non-randomized, multicenter, prospective study across five hair clinic chains in India (Mumbai, Hyderabad, Jabalpur, Balaghat, and Nagpur). Eligible participants were patients with a confirmed diagnosis of androgenetic alopecia based on clinical examination and trichoscopic findings, age of 18 years or older, and any gender. Each patient received Dr. SKS Hair Booster Serum, 1 ml in volume, once a month by mesotherapy or derma roller/derma pen for up to six months. All patients were subjected to a 60-second hair count test (comb test), hair pull test, global photographic assessment (GPA), trichoscopy assessment, patient self-assessment questionnaire, and safety assessment at baseline and six months after the treatment. Results One thousand patients (500 males and females each) with androgenetic alopecia were analyzed. There was a significant reduction in hair fall with bulb (<0.0001) and without bulb (<0.0001) six months after the treatment versus baseline. There was a significant improvement in the number of hairs removed per pull (<0.0001), global photographic assessment score (<0.0001), hair growth rate (<0.0001), follicular hair density (<0.0001), vellus hair density (<0.0001), and terminal hair density (<0.0001) six months after the treatment versus baseline. The majority of patients (95%) were satisfied with six-month treatment of Dr. SKS Hair Booster Serum. No major adverse events were reported during the study. Conclusion Dr. SKS Hair Booster Serum was found to be a safe and effective treatment for androgenetic alopecia, with 95% patient self-assessment score.
... In less than 50% of women who reach the age of 65, their normal volume of hair remains unchanged, and the rest of women experience this form of hair loss. 7,8 Androgenetic alopecia causes regional baldness in men and a decrease in the overall density and thickness of the hair in women. ...
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Female pattern hair loss (FPHL) is a hereditary form of hair loss in women and the most common patterned progressive hair loss in female patients with androgenetic alopecia (AGA). One of the best methods for treating hair loss in women is the finasteride treatment. This systematic review includes a summary of the pharmacology of finasteride and the effect of the drug on women, especially those in the menopausal age group, and is aimed at elucidating methods of preventing systematic side effects. A search of all published literature from 1999 to 2020 has been conducted with the use of PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, as well as Cochrane Skin databases. A total of 380 articles were found, of which 260 articles were removed and 87 review studies were excluded. Lastly, full texts of 33 original articles were reviewed and 14 articles that met the inclusion criteria were selected. Ten out of the 14 articles reported a high rate of alopecia recovery in women taking finasteride. Based on the results, it can be stated that 5 mg of oral finasteride per day could be an effective and safe treatment in normoandrogenic women with FPHL, especially when used in combination with other drugs, such as topical estradiol and minoxidil. We also found that topical finasteride is more effective than other topical formulas for treating hair loss.
... Minoxidil was the first drug approved by the FDA to treat hair loss. Minoxidil might prolong the anagen phase, stimulate and elongate hair follicles, and have antiapoptotic effects [15,16]. Studies showed that topical minoxidil (2-5%) treatment increases hair count, hair weight, hair shaft diameter, and anagen: telogen ratio [78]. ...
Article
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Hair health is associated with personal distress and psychological well-being. Even though hair loss (alopecia) does not affect humans' biological health, it affects an individual's social well-being. So, treatment for hair problems and improving hair health are obligatory. Several pharmacological and cosmeceutical treatment procedures are available to manage hair loss and promote growth. Several factors associated with hair health include genetics, disease or disorder, drugs, lifestyle, chemical exposure, and unhealthy habits such as smoking, diet, and stress. Synthetic and chemical formulations have side effects, so people are moving towards natural compounds-based remedies for their hair problems. The history of using phytochemicals for hair health has been documented anciently. However, scientific studies on hair loss have accelerated in recent decades. The current review summarizes the type of alopecia, the factor affecting hair health, alopecia treatments, phytochemicals' role in managing hair loss, and the mechanisms of hair growth-stimulating properties of phytochemicals. The literature survey suggested that phytochemicals are potent candidates for developing treatment procedures for different hair problems. Further detailed studies are needed to bring the scientific evidence to market.
... [4] This explains why hair was initially used as trace evidence and a possible way of identification by the legal and medical communities. [5] Virchow is credited with one of the first forensic hair analysis reports, which he wrote in 1861 for a murder case, in which he employed examination variables that are still part of the macro and microscope processes used in hair analysis today. [6] Hair analysis can be classified into three types: microscopic, gross, and molecular. ...
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The outer cuticle, middle cortex, and inner medulla make up hair, which is an epidermal outgrowth. Hair is resilient under harsh natural conditions, thus it is frequently collected at crime scenes, making human hair analysis important in the forensic sciences field. It aids in the formation of a triangle connecting a crime scene, a victim, and a culprit. The aim of this study is to observe the microscopic structure of male and female human hair. Samples of hair specimens from males and females were collected. The materials used were ethanol to degrease and a stereomicroscope to observe the structural differences between the male and female hair samples. The comparison between male and female hair is done on the grounds of color, shaft profiles, the proximal and distal ends of the hair, cuticle, and surface texture, and the other found characters. This study of comparison between male and female hair specimens revealed that the hair color at the distal end is found to be brown for females while it is completely black in that of males, and the surface texture of males is found to have some irregularities while there are no irregularities in female. This study can be concluded that the structural comparison between male and female hair specimens can be used as evidence for forensic analysis at crime scenes.
... Dutasteride, which inhibits both types I and II 5a-reductase, is also effective but has not yet undergone FDA approval [2]. Minoxidil is a topical and oral treatment for AGA, and its exact mechanism is postulated to be centered around its ability to open ATP-gated potassium channels in cell membranes leading to vasodilation, progression to the G1 stage of the cell cycle, cellular prolif-Skin Appendage Disord 2023;9:104-110 DOI: 10.1159/000527782 eration, and ultimately hair growth [3][4][5]. Minoxidil is converted to its active component minoxidil sulfate through a sulfotransferase located within hair follicles. Topical minoxidil has been shown to reduce the length of the anagen phase and extend the length of the telogen phase [6]. ...
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Introduction: We analyzed randomized clinical trials (RCTs) evaluating the efficacy of combined therapy with low-level light therapy (LLLT) and topical minoxidil for treatment of androgenetic alopecia (AGA). Methods: A literature search within PubMed identified RCTs evaluating hair regrowth following LLLT and minoxidil. Selection criteria were 600-1,100 nm wavelengths, treatment time ≥16 weeks, and objective evaluation for hair regrowth. Results: Five RCTs compared LLLT with minoxidil (2% or 5%) to 5% minoxidil treatment or LLLT treatment. One study showed combination therapy of LLLT, and 5% minoxidil improved hair density more than monotherapy. Another found combination LLLT with 2% minoxidil induced hair regrowth equivalent to 5% minoxidil. Similarly, another study described LLLT with 5% minoxidil versus minoxidil monotherapy to increase the number of hairs with no statistical difference between groups. One trial found that combination group increased hair regrowth in the first 2 months. The last study found a statistically significant increase in hair density with combined therapy compared to monotherapy. Conclusion: The studies describe either superiority or equivalence of combination therapy to minoxidil monotherapy for AGA. Early outcomes appear to support the superiority of combination therapy, but this advantage wanes at the end of the study periods.
... Hair loss is a problem faced by more than half of the global population. First-line drugs, such as minoxidil and finasteride, have significant side effects, and hair transplantation has certain drawbacks [235,236]. There are problems of low survival rate of the transplanted hairs and damage to the donor site. ...
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Extracellular vesicles (EVs) are a collective term for nanoscale or microscale vesicles secreted by cells that play important biological roles. Mesenchymal stem cells are a class of cells with the potential for self-healing and multidirectional differentiation. In recent years, numerous studies have shown that EVs, especially those secreted by mesenchymal stem cells, can promote the repair and regeneration of various tissues and, thus, have significant potential in regenerative medicine. However, due to the rapid clearance capacity of the circulatory system, EVs are barely able to act persistently at specific sites for repair of target tissues. Hydrogels have good biocompatibility and loose and porous structural properties that allow them to serve as EV carriers, thereby prolonging the retention in certain specific areas and slowing the release of EVs. When EVs are needed to function at specific sites, the EV-loaded hydrogels can stand as an excellent approach. In this review, we first introduce the sources, roles, and extraction and characterization methods of EVs and describe their current application status. We then review the different types of hydrogels and discuss factors influencing their abilities to carry and release EVs. We summarize several strategies for loading EVs into hydrogels and characterizing EV-loaded hydrogels. Furthermore, we discuss application strategies for EV-loaded hydrogels and review their specific applications in tissue regeneration and repair. This article concludes with a summary of the current state of research on EV-loaded hydrogels and an outlook on future research directions, which we hope will provide promising ideas for researchers.
Article
Alopecia is a common dermatological disorder of patchy hair loss with substantial patient burden. Phytotherapeutic compounds are increasingly used as a source of new therapeutic options. This review aimed to synthesize the evidence on plant species in hair growth and the methodological aspects of in vivo experimental models. The systematic scoping review was conducted following the PRISMA checklist, Joanna Briggs Institute and in accordance with Cochrane. A systematic search was carried out in the Pubmed, Scopus, Web of Science, and SciELO databases. In vivo experiments that evaluated hair growth activity using natural substances of plant origin were included. Data collection and analysis: A total of 1,250 studies were identified, of which 175 were included for qualitative synthesis. Of these, 128 used mice, 37 rats, 10 rabbits, 1 guinea pig, and 1 sheep as animal models. The methodologies mapped were: hair growth analysis, histological analysis, immunohistochemistry, gene expression analysis, Western blot, enzyme-linked immunosorbent assay, and biochemical analysis. Minoxidil and finasteride were the most commonly used positive controls. The studies evaluated plant species (166), algae (11) or isolated substances (31). Overall 152 plant species and 37 isolated substances were identified. This is the first systematic scoping review on methodological aspects of in vivo hair growth activity. We created a checklist to be completed by authors to allow data comparison and reproducibility, facilitate data interpretation by readers and ensure better quality of evidence. This work may become a valuable tool for future research and contribute to significant advances in hair growth studies.
Article
Background Low dose oral minoxidil (LDOM) is a preferred treatment for alopecia due to ease of use and efficacy. While LDOM is typically well tolerated, patients may experience a temporary increase in hair shedding starting treatment, colloquially regarded as “dread shed”. One proposed method to combat this is to overlap therapies by maintaining use of topical minoxidil when initiating LDOM. Objective To evaluate the impact of maintaining topical minoxidil when initiating LDOM on “dread shed”. Methods We performed a retrospective chart review of patients seen at New York University Langone Health Dermatology from January 1, 2008 to August 1, 2023 prescribed LDOM. Results A total of 115 patients met inclusion criteria, of whom 37 maintained use of topical minoxidil when initiating LDOM. Six patients experienced “dread shed” when initiating LDOM, 2 of whom overlapped therapies. We did not find that overlapping therapies had a significant impact on decreasing rates of “dread shed”. Limitations Limitations include retrospective design, sample size, and subjective patient-reported assessment of hair shedding. Conclusions A total of 5.2% of patients experienced dread shed, which is lower than previously reported in literature. Maintaining topical minoxidil during LDOM initiation does not significantly impact “dread shed”. This remains a significant side effect deserving of further research.
Article
Introduction: Treating alopecia can be challenging. The available treatments are topical minoxidil, low-dose oral minoxidil (LDOM), and 5-α reductase inhibitors like finasteride and dutasteride. Only topical minoxidil and finasteride 1 mg daily are FDA-approved, while the rest are used off-label. Recent research has suggested that oral minoxidil may be a safe and effective treatment for both female androgenetic alopecia (female AGA) and male androgenetic alopecia (male AGA). Areas covered: In this review, we explore the pharmacokinetics, mechanism of action, safety, and efficacy of oral minoxidil. Additionally, we discuss its effectiveness compared to other treatments available for female AGA and male AGA. Expert opinion: LDOM has demonstrated a favorable efficacy and safety profile in several trials. Subsequently, its use for the treatment of male AGA and female AGA is increasing. However, its use remains off-label, and through increased usage, we will get a better idea of the best dosage and monitoring guidelines. LDOM has also been used with some effectiveness in other forms of hair loss.
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The scar repair inevitably causes damage of skin function and loss of skin appendages such as hair follicles (HF). It is of great challenge in wound repair that how to intervene in scar formation while simultaneously remodeling HF niche and inducing in situ HF regeneration. Here, chemical reprogramming techniques are used to identify a clinically chemical cocktail (Tideglusib and Tamibarotene) that can drive fibroblasts toward dermal papilla cell (DPC) fate. Considering the advantage of biomaterials in tissue repair and their regulation in cell behavior that may contributes to cellular reprogramming, the artificial HF seeding (AHFS) hydrogel microspheres, inspired by the natural processes of “seeding and harvest”, are constructed via using a combination of liposome nanoparticle drug delivery system, photoresponsive hydrogel shell, positively charged polyamide modification, microfluidic and photocrosslinking techniques. The identified chemical cocktail is as the core nucleus of AHFS. In vitro and in vivo studies show that AHFS can regulate fibroblast fate, induce fibroblast‐to‐DPC reprogramming by activating the PI3K/AKT pathway, finally promoting wound healing and in situ HF regeneration while inhibiting scar formation in a two‐pronged translational approach. In conclusion, AHFS provides a new and effective strategy for functional repair of skin wounds.
Article
Different types of alopecia have negative impacts on patients. Recently, some kinds of laser or light therapies have been reported to effectively alleviate hair loss. Carbon dioxide fractional laser (CO2FL) treatment is one of the most effective laser treatments, but its beneficial effects and exact mechanism in hair regrowth have not been reported in detail. The purpose of this study was to investigate the effect and molecular mechanism further. C57 and Lgr5-Cre: Rosa-mTmG mouse models of hair regrowth were established by CO2FL treatment, and the parameters that induced the best effect were determined. Tissues were harvested on the day prior to the treatment day and on days 3, 5, 7, 10 and 14 after CO2FL. H&E and immunofluorescence staining, RNA sequencing (RNA-seq), quantitative real‐time polymerase chain reaction (qPCR), Western blotting (WB) and related inhibitor were used to determine the molecular mechanism underlying the effect of CO2FL treatment on the hair cycle and hair regrowth. In clinical trial, five participants were treated three sessions at 1-month intervals to obverse the effects. Hair regrew and covered the treatment area on the tenth day after CO2FL treatment with the best parameters, while the control group showed signs of hair growth on the 14th day. H&E and immunofluorescence staining showed that the transition of hair follicles (HFs) from telogen to anagen was accelerated, and the rapid activation and proliferation of Lgr5+ hair follicle stem cells (HFSCs) were observed in the treatment group. The RNA-seq, qPCR and WB results indicated that the Wnt pathway was significantly activated after CO2FL treatment. Improvement achieved with CO2FL treatment in clinical trial. The results of this study suggest that CO2FL treatment can promote hair regrowth by activating Lgr5+ HFSCs and upregulating the Wnt/β-catenin pathway. Clinical trial results demonstrated that CO2FL treatment will be a promising therapeutic regimen for alopecia. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Article
Hair restoration is an essential topic in the current management of facial plastic surgery concerns and queries. Advances in hair restoration include oral and topical medications and compounded preparations, injections including platelet-rich plasma, light therapy, and follicular unit extraction methods. This article provides a review of current techniques.
Chapter
In cases of idiopathic alopecia, nutritional and laboratory-proven micronutrient deficiencies should be clinically suspected. Even with factors strongly associated with its onset, such as systemic conditions and emotional stress, a large majority of clinical cases of alopecia remain without a clear etiologic source. Nutrient deficiencies are often multifactorial and may arise due to genetic disorders, medical conditions, or comorbidities such as endocrine diseases (i.e. hypothyroidism), adverse effects of medications, or limited dietary practices. Micronutrient deficiency may represent a modifiable risk factor associated with the development, prevention, and treatment of alopecia. In addition, nutritional deficiencies may impact not only hair loss but promote unwanted structural changes and premature pigmentary alterations. While there is not a definitive first-line therapy for alopecia as a result of nutritional deficiency, studies indicate that diets rich in protein, vegetables, and soy promote hair growth and may be protective against androgenetic alopecia (AGA), alopecia areata (AA), and chronic telogen effluvium (TE). In addition, detecting low serum iron, vitamin D, or zinc levels could provide therapeutic insight, especially in high-risk groups. Although commonplace, the efficacy of biotin supplementation is widely debated. In a recent clinical comparative study evaluation amongst patients with TE, supplementation with combination oral nutritional components was shown to improve alopecia through both symptomatic resolution and stimulation of hair regrowth. Alopecia secondary to nutritional deficiency is rising as a differential clinical diagnosis as recognition of the vital roles micronutrients contribute in maintaining the physical elements of hair growth and structural integrity steadily increases. Physicians can improve rates of diagnosis and therefore treatment of chronic alopecia by heightening awareness in regards to the interplay between a patient’s medical history, active medications, and overall dietary lifestyle practices. Patients should also be counseled on the potential worsening of hair loss from excessive over-supplementation.KeywordsNutritional deficiencyHair lossAlopeciaIron deficiencyBiotin
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The use of low levels of visible or near infrared light for reducing pain, inflammation and edema, promoting healing of wounds, deeper tissues and nerves, and preventing tissue damage has been known for almost forty years since the invention of lasers. Originally thought to be a peculiar property of laser light (soft or cold lasers), the subject has now broadened to include photobiomodulation and photobiostimulation using non-coherent light. Despite many reports of positive findings from experiments conducted in vitro, in animal models and in randomized controlled clinical trials, LLLT remains controversial. This likely is due to two main reasons; firstly the biochemical mechanisms underlying the positive effects are incompletely understood, and secondly the complexity of rationally choosing amongst a large number of illumination parameters such as wavelength, fluence, power density, pulse structure and treatment timing has led to the publication of a number of negative studies as well as many positive ones. In particular a biphasic dose response has been frequently observed where low levels of light have a much better effect than higher levels. This introductory review will cover some of the proposed cellular chromophores responsible for the effect of visible light on mammalian cells, including cytochrome c oxidase (with absorption peaks in the near infrared) and photoactive porphyrins. Mitochondria are thought to be a likely site for the initial effects of light, leading to increased ATP production, modulation of reactive oxygen species and induction of transcription factors. These effects in turn lead to increased cell proliferation and migration (particularly by fibroblasts), modulation in levels of cytokines, growth factors and inflammatory mediators, and increased tissue oxygenation. The results of these biochemical and cellular changes in animals and patients include such benefits as increased healing in chronic wounds, improvements in sports injuries and carpal tunnel syndrome, pain reduction in arthritis and neuropathies, and amelioration of damage after heart attacks, stroke, nerve injury and retinal toxicity.
Article
A double-blind clinicopathologic study was designed to assess the efficacy and safety of topical minoxidil in the treatment of male-pattern baldness. Twenty-one bald but otherwise healthy male volunteers were randomly assigned (7 per group) to receive a 1% or 5% minoxidil solution in a vehicle of ethanol-water-propylene glycol or the vehicle alone applied twice daily to the bald scalp. The 15 white and 6 black subjects were aged 24 to 46 years. Scalp biopsies were done pretreatment and at weeks 12 and 24 after treatment began. Ten normal subjects from the same population, matched for age, served as controls for histopathologic studies. Increased hair growth was seen in both minoxidil-treated and placebo-treated groups, and there was no statistically significant difference between groups at 15.7 weeks when treatment was discontinued. Hair growth appeared to be limited to hypertrophy of pre-existent follicles; there was no good evidence for follicular neogenesis. It was concluded that topical application of up to 5% minoxidil solution was safe within the limits of this study.
Article
Synopsis: Minoxidil1is an orally effective vasodilator which is more potent than hydralazine. The drug induces reflex stimulation of the sympathetic nervous system and of plasma renin activity and produces fluid retention. For these reasons, minoxidil must usually be administered in combination with an antiadrenergic agent and with a diuretic. Its acceptability for use in females is limited by the frequent appearance of hypertrichosis. Minoxidil is particularly useful in the treatment of patients with severe refractory hypertension. However, its suitability in the management of male patients with moderate hypertension remains to be determined. As with many other antihypertensive agents, the administration of minoxidil in patients with malignant hypertension may be accompanied by a transitory continuing deterioration of renal function to a point where haemodialysis may be required. However, subsequent improvement of renal function may be observed in many patients, sometimes to a degree where haemodialysis is no longer needed. In patients with so-called ‘benign’ hypertension not responding well to ‘traditional’ therapy, better control of blood pressure with minoxidil may prevent the deterioration of renal function which occurs in the majority of such patients. Reversible hypertrichosis is a common side effect which appears to some degree in nearly all patients treated with minoxidil for longer than 1 month, and constitutes a serious limitation to the use of this drug in females.
Article
The 5α-reductase inhibitor finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT), the androgen responsible for male pattern hair loss (androgenetic alopecia) in genetically predisposed men. Results of phase III clinical studies in 1879 men have shown that oral finasteride 1 mg/day promotes hair growth and prevents further hair loss in a significant proportion of men with male pattern hair loss. Evidence suggests that the improvement in hair count reported after 1 year is maintained during 2 years’ treatment. In men with vertex hair loss, global photographs showed improvement in hair growth in 48% of finasteride recipients at 1 year and in 66% at 2 years compared with 7% of placebo recipients at each time point. Furthermore, hair counts in these men showed that 83% of finasteride versus 28% of placebo recipients had no further hair loss compared with baseline after 2 years. The clinical efficacy of oral finasteride has not yet been compared with that of topical minoxidil, the only other drug used clinically in patients with male pattern hair loss. Therapeutic dosages of finasteride are generally well tolerated. In phase III studies, 7.7% of patients receiving finasteride 1 mg/day compared with 7.0% of those receiving placebo reported treatment-related adverse events. The overall incidence of sexual function disorders, comprising decreased libido, ejaculation disorder and erectile dysfunction, was significantly greater in finasteride than placebo recipients (3.8 vs 2.1%). All sexual adverse events were reversed on discontinuation of therapy and many resolved in patients who continued therapy. No other drug-related events were reported with an incidence ≥1% in patients receiving finasteride. Most events were of mild to moderate severity. Oral finasteride is contraindicated in pregnant women because of the risk of hypospadias in male fetuses. Conclusions:Oral finasteride promotes scalp hair growth and prevents further hair loss in a significant proportion of men with male pattern hair loss. With its generally good tolerability profile, finasteride is a new approach to the management of this condition, for which treatment options are few. Its role relative to topical minoxidil has yet to be determined. Pharmacodynamic Properties Finasteride specifically inhibits the type II 5α-reductase enzyme which converts testosterone to dihydrotestosterone (DHT), the androgen responsible for the development of male pattern hair loss in genetically predisposed men. Oral finasteride 1 mg/day significantly reduced serum DHT levels by a median 68.4% in men with male pattern hair loss treated for 1 year. A corresponding 9.1% (median) increase in testosterone levels from baseline was reported, but these levels remained within the normal physiological range. Oral finasteride 0.2 to 5 mg/day for 4 to 6 weeks reduced DHT levels by up to 65% in the scalp, the desired site of action of finasteride in men with male pattern hair loss. Finasteride did not affect serum luteinising hormone or follicle-stimulating hormone responses to gonadotropin-releasing hormone stimulation in healthy volunteers, and therefore does not appear to influence the hypothalamic-pituitary-testicular axis. In addition, the drug did not alter serum prolactin, sex hormone-binding globulin, aldosterone or cortisol levels in healthy volunteers. Slight increases in serum estradiol levels were seen but, like testosterone levels, these remained within the normal physiological range and the ratio of testosterone to estradiol was unaltered. Finasteride 1 mg/day does not appear to significantly affect ejaculate volume or other measures of testosterone-mediated semen production such as sperm motility, morphology and number. In addition, this dosage of finasteride had no clinically significant effects on prostate volume in healthy men aged ≤41 years, but caused a slight reduction in serum prostate-specific antigen levels. Evidence suggests that finasteride has no adverse effects on lipid or bone metabolism. Pharmacokinetic Properties Peak plasma concentrations of finasteride (9.2 µg/L) were reached 1 to 2 hours after drug administration in healthy volunteers who received a 1 mg/day dosage of finasteride for 17 days. Modest accumulation of finasteride in plasma was reported with repeated administration, but trough concentrations appeared to reach steady state within 3 days. The oral bioavailability of finasteride (80%) is not affected by the presence of food. Finasteride undergoes wide tissue distribution (volume of distribution = 76L), with ≈90% of circulating finasteride being protein bound. The drug has been detected in nanogram quantities in seminal fluid but these low levels have no clinical significance. After oral administration, finasteride is extensively metabolised in the liver to compounds which are then eliminated in the bile (56.8%) and the urine (39.1%). Virtually no unchanged drug is recovered after an oral dose of finasteride. The mean terminal elimination half-life of finasteride 1 mg/day after repeated administration is 4.8 hours. The elimination of finasteride is slower in elderly (≥70 years) than in younger (45 to 60 years) volunteers, but no dosage adjustment is warranted in the former age group, nor in patients with renal impairment. Reduced renal excretion of finasteride is compensated for by an increase in faecal elimination. There are currently no data on the pharmacokinetic properties of finasteride in patients with hepatic impairment. Although finasteride is principally metabolised by cytochrome P450 3A4 enzymes within the liver, no clinically significant interactions have been reported between finasteride and digoxin, propranolol, aminophylline, warfarin, glibenclamide (glyburide) or antipyrine. Therapeutic Efficacy Oral finasteride 1 mg/day has shown efficacy in men with male pattern hair loss. The clinical use of this dosage of finasteride has been assessed in 3 phase III studies involving 1879 men with vertex or frontal hair loss who were treated for up to 2 years. Finasteride produced statistically significant increases in scalp hair growth from baseline within several months of starting treatment, a finding documented by hair count, patient self-assessment, investigator assessment and pre- and post-treatment clinical assessment based on standardised photos. Importantly, finasteride prevented the further hair loss seen in placebo recipients. In men with vertex hair loss, the mean improvement in hair count reported after 1 year with finasteride was maintained during a further 12 months’ treatment. Global photographs of the vertex area showed improvement in hair growth in 48% of finasteride recipients at 1 year (versus 7% with placebo) and in 66% at 2 years (versus 7% with placebo). Furthermore, vertex hair counts showed that 83% of finasteride versus 28% of placebo recipients had no further hair loss compared with baseline after 2 years. Hair growth was enhanced in patients who switched from placebo to finasteride after 12 months but declined progressively in those switched from finasteride to placebo. Tolerability Available data from 1879 patients with male pattern hair loss who received either finasteride 1 mg/day or placebo for 1 year in phase III studies show that finasteride is generally well tolerated. Overall, 7.7% of finasteride and 7.0% of placebo recipients reported mild to moderate treatment-related adverse events (1.4 and 1.6% withdrew). The only events reported more frequently in finasteride than placebo recipients were sexual disorders (3.8 vs 2.1%; p = 0.041), which comprised decreased libido (1.8 vs 1.3%), ejaculation disorders (1.2 vs 0.7%) and erectile dysfunction (1.3 vs 0.7%). These resolved in many men who reported them but remained on therapy and in all men who discontinued therapy because of these adverse events. No other drug-related events were reported with an incidence ≥1% in finasteride recipients. The incidence of drug-related laboratory events was similar in finasteride and placebo groups (2.6 vs 2.4%). Finasteride had no significant effects on non-scalp body hair. Dosage and Administration Finasteride is indicated for the treatment of men with male pattern hair loss. The recommended dosage of finasteride in male pattern hair loss is 1 mg/day, taken with or without food. Daily treatment for 3 months or more is necessary before results are seen, and continued treatment is essential to sustain benefit. Furthermore, the effects of the drug are reversed within 12 months after treatment cessation. There are no current data to support the use of finasteride in women with androgenetic alopecia. Moreover, pregnant women should not be directly exposed to finasteride by using or handling crushed tablets because of the risk of hypospadias developing in a male fetus.
Article
• Little is known about the mechanism of action of minoxidil-induced hair growth in male pattern baldness. We studied the potential antiandrogenic effect of topical minoxidil administered at the same dose and in the same vehicle that has been used successfully clinically in human subjects on the androgen-dependent cutaneous structures of the flank organ of the golden Syrian hamster. Minoxidil applied topically to one flank organ had no androgenic effect. Neither 1% nor 5% minoxidil topically applied for three weeks prevented the androgen-dependent growth of the pigmented spot, the sebaceous gland, or the hair follicle diameter induced by subcutaneous Silastic capsules filled with crystalline testosterone. As a positive control in the same experiments, 5% progesterone did significantly inhibit pigment and sebaceous gland enlargement. We conclude that there is no antiandrogenic component to the mechanism of action of topical minoxidil in the hamster flank organ, and thus there is probably no antiandrogenic role in man either. (Arch Dermatol 1987;123:59-61)
Article
• Topical 5% minoxidil solution was used to treat 47 patients with severe alopecia areata. Forty patients (85%) had terminal hair regrowth after 48 to 60 weeks of treatment. In the majority of patients, hair regrowth was not cosmetically acceptable. Data were compared with those from a previous study with topical 1% minoxidil solution. Both the percentage of responders and the quality of their hair regrowth were significantly greater with 5% than with 1% topical minoxidil solution. One patient developed an allergic contact dermatitis to minoxidil, but no systemic side effects were detected. The results strongly suggest a dose-response effect for topical minoxidil treatment of alopecia areata and the importance of exploring modifications in dosing and delivery systems to enhance therapeutic efficacy. (Arch Dermatol 1986;122:180-182)
Article
Press reports of preliminary minoxidil research have generated a great deal of public enthusiasm to establish it as a method of treatment for hair loss well before research has been completed and data analyzed for safety and efficacy. It is imperative that we critically assess the status of minoxidil research, the current relevance of minoxidil as a therapeutic modality for hair loss, and the future directions for research in this area. Minoxidil, a potent direct peripheral vasodilator that is used to control severe hypertension, causes a reversible hypertrichosis in most patients who receive systemic therapeutic doses for one month or longer.1,2 In 1980, Zappacosta3 reported the reversal of male pattern alopecia in a patient receiving oral minoxidil therapy for hypertension. In 1981, preliminary observations were reported in which two of three patients treated with a 1% topical minoxidil solution had hair regrowth at sites of severe, treatment-resistant alopecia
Article
To the Editor.— Since the original report by Weiss et al1 there have been several enthusiastic reports on the efficacy of topical minoxidil in the treatment of alopecia areata.2-4 This trend was continued in the follow-up study by Weiss et al5 on their preliminary report. We have studied the effects of 3% minoxidil solution on 15 patients with alopecia totalis in a double-blind cross-over trial. The duration of alopecia ranged from 1.5 to 40 years (median, 17.7 years); all patients had previously been treated unsuccessfully with topical or injected steroids, some had had treatment with oral steroids, and others sensitization with dinitrochlorobenzene and psoralens and UV-A treatment. There were ten women and five men, and their ages ranged from 18 to 67 years (median, 39.9 years).The patients were randomly allocated to receive active treatment or placebo. The scalp was treated twice daily for 16 weeks, after
Article
Synopsis When minoxidil is administered orally for periods in excess of 1 month, hypertrichosis occurs as a side effect in a majority of patients. Consequently, topical minoxidil¹ has been developed to try to improve hair growth in patients with alopecia areata and alopecia androgenetica. Preliminary studies have shown that topical minoxidil promotes cosmetically acceptable hair regrowth in a variable proportion of patients with alopecia areata. Data from a large multicentre trial indicate that cosmetically worthwhile results are achieved in about one-third of subjects with alopecia androgenetica after 1 year of treatment A much higher proportion (about 80%) of patients with alopecia androgenetica exhibited some non-vellus hair regrowth after 1 year, and whether more of these patients would develop a cosmetically acceptable result with a longer treatment period is an important area of future investigation. Initial indications suggest that less severe disease is a predictor of likely response. Thus, topical minoxidil would seem to be a useful treatment modality for patients with alopecia androgenetica — a disease for which no other safe and effective drug therapy exists. Results from treating patients with alopecia areata with topical minoxidil, although encouraging, have been more variable and require further evaluation. Even though a number of questions remain to be answered about topical minoxidil (as would be expected at this stage in its development), it would seem to be the first available drug with the potential to promote substantial hair regrowth in these divergent diseases.
Article
In the 20 yr since it was established that impairment of dihydrotestosterone formation is the cause of a rare form of human intersex, a wealth of information has accumulated about the genetics, endocrinology, and variable phenotypic manifestations, culminating in the cloning of cDNAs encoding two 5 alpha-reductase genes and documentation that mutations in the steroid 5 alpha-reductase 2 gene are the cause of 5 alpha-reductase deficiency. Perplexing and difficult problems remain unresolved, e.g. whether the variability in manifestations is due to variable expressions of steroid 5 alpha-reductase 1 or to effects of testosterone itself. It is also imperative to establish whether defects in steroid 5 alpha-reductase 2, perhaps in the heterozygous state, are responsible for a portion of cases of sporadic hypospadias, to determine whether 5 alpha-reductase plays a role in progesterone action in women, and to elucidate the relation between androgen action and gender role behavior.
Article
The expression of 5α-reductase type 1 and type 2 isoenzymes in hyperplastic human prostate tissue and several human prostate cell lines was investigated by Northern blot analyses, reverse transcription-polymerase chain reaction (RT-PCR), and enzyme activity. Separation of stroma and epithelium was confirmed histologically and only preparations with no apparent contamination were employed in the subsequent studies. Poly(A)+ RNA was isolated from stromal and epithelial fractions and analysed by Northern blot and RT-PCR. Inhibition of epithelial and stromal 5α-reductase activities by 17β-N,N-diethylcarbamoyl-4-methyl-4-aza-5α-androstan-3-one (4MA) was assessed using a range of concentrations between 10−13 and 10−5 M. Results from Northern blot analyses and RT-PCR showed that the prostate stroma expressed 5α-reductase type 1 and type 2 isoenzymes, whereas the prostate epithelium only expressed 5α-reductase type 1. This was consistent with biphasic inhibition of 5α-reductase activity by 4MA in stroma and monophasic inhibition in epithelium. Cultured epithelial cells derived from human prostate only expressed 5α-reductase type 1 and had Vmax and Km values that approximated the lower end of the range reported for surgically removed prostate epithelium. The foregoing data explains the disparate activities of 5α-reductase, previously reported, in stroma and epithelium. The differential localization of these isoenzymes in the prostate suggests that future therapy of androgen-sensitive disease may be more successful through the use of selective inhibitors of the different 5α-reductase isoenzymes.
Article
Background: Androgenetic alopecia (male pattern hair loss) is caused by androgen-dependent miniaturization of scalp hair follicles, with scalp dihydrotestosterone (DHT) implicated as a contributing cause. Finasteride, an inhibitor of type II 5α-reductase, decreases serum and scalp DHT by inhibiting conversion of testosterone to DHT. Objective: Our purpose was to determine whether finasteride treatment leads to clinical improvement in men with male pattern hair loss. Methods: In two 1-year trials, 1553 men (18 to 41 years of age) with male pattern hair loss received oral finasteride 1 mg/d or placebo, and 1215 men continued in blinded extension studies for a second year. Efficacy was evaluated by scalp hair counts, patient and investigator assessments, and review of photographs by an expert panel. Results: Finasteride treatment improved scalp hair by all evaluation techniques at 1 and 2 years (P < .001 vs placebo, all comparisons). Clinically significant increases in hair count (baseline = 876 hairs), measured in a 1-inch diameter circular area (5.1 cm2 ) of balding vertex scalp, were observed with finasteride treatment (107 and 138 hairs vs placebo at 1 and 2 years, respectively; P < .001). Treatment with placebo resulted in progressive hair loss. Patients’ self-assessment demonstrated that finasteride treatment slowed hair loss, increased hair growth, and improved appearance of hair. These improvements were corroborated by investigator assessments and assessments of photographs. Adverse effects were minimal. Conclusion: In men with male pattern hair loss, finasteride 1 mg/d slowed the progression of hair loss and increased hair growth in clinical trials over 2 years. (J Am Acad Dermatol 1998;39:578-89.)
Article
Objective To examine the safety of finasteride as used in general medical practice to treat benign prostatic hypertrophy (BPH). Patients and methods Information was collected on 14 772 patients who were included in an observational cohort study conducted using Prescription-Event Monitoring. Results Finasteride was reported to have been effective in 60% of the patients in whom an opinion on efficacy was recorded. Impotence or ejaculatory failure was reported in 2.1% of the patients, decreased libido in 1% and gynaecomastia and related conditions in 0.4%. Impotence was the most frequent reason for stopping treatment with finasteride and was the most commonly reported adverse reaction to the drug. Of the patients included in the elderly cohort involved in this study, 819 (5.5%) died; none of these deaths was attributed to finasteride. Conclusion Impotence or ejaculatory failure, decreased libido and gynaecomastia in a small proportion of patients were associated with the use of finasteride. The results of this study strongly suggest that this drug is acceptably safe when used in accordance with the current prescribing information.
Article
The authors wished to confirm the efficacy of low level laser therapy (LLLT) using a Hair- Max LaserComb for the stimulation of hair growth and also to determine what effect LLLT with this device had on the tensile strength of hair. Thirty-five patients, 28 males and 7 fe- males, with androgenetic alopecia (AGA) underwent treatment for a six-month period. Both the hair counts and tensile strength of the hair were affected very beneficially in both sexes in the temporal and vertex regions, with the males and vertex areas showing the most im- provement.
Article
Prazosin hydrochloride is an orally administered vasodilator that recently became available for the treatment of hypertension. It causes less tachycardia than hydralazine but may produce orthostatic hypotension, particularly after the initial dose. The role of prazosin in therapy is limited because of the risk of a first-dose syncopal reaction, and it appears to be indicated primarily in patients who cannot tolerate hydralazine hydrochloride or sympathetic depressant drugs. Like other antihypertensive agents, prazosin should be given with a diuretic. (JAMA 238:157-159, 1977)
Article
Early reports of the success of topical minoxidil in alopecia areata have been followed by a mixture of enthusiasm and disappointment. Our double-blind trial was prompted by remaining doubts about its effectiveness and safety. Fifty adult patients (22 male, 28 females) with longstanding alopecia areata (mean age at onset 20 years, mean duration 16 years) took part in the trial. The severity of their disease was categorised as universalis (23 patients), totalis (10), ophiasiform (6) and severe patchy alopecia (11). Thirty-eight per cent had a personal history of atopy and 14% had circulating thyroid antibodies. For the first 2 months patients were randomly allocated to treatment wjth i % minoxidil in Unguentum Merck® or Unguentum Merck® alone. At the end of this period the same treatment was continued if hair growth was observed; if not, the alternative treatment was used. After 4 months, if no hair growth had occurred, 1% minoxidil was prescribed. Forty-eight patients were treated for at least 6 months, 46 for 10 months and 13 for longer periods. Equal proportions of the patients treated with minoxidil or with placebo experienced regrowth, but this was substantial only in seven patients and cosmetically acceptable in only two. No patient felt able to stop wearing a wig. Many patients disliked the greasy nature of the preparation. Patients with alopecia universalis had the highest prevalence of nail changes, and the worst response to treatment.
Article
We have known for over 30 years that minoxidil stimulates hair growth, yet our understanding of its mechanism of action on the hair follicle is very limited. In animal studies, topical minoxidil shortens telogen, causing premature entry of resting hair follicles into anagen, and it probably has a similar action in humans. Minoxidil may also cause prolongation of anagen and increases hair follicle size. Orally administered minoxidil lowers blood pressure by relaxing vascular smooth muscle through the action of its sulphated metabolite, minoxidil sulphate, as an opener of sarcolemmal KATP channels. There is some evidence that the stimulatory effect of minoxidil on hair growth is also due to the opening of potassium channels by minoxidil sulphate, but this idea has been difficult to prove and to date there has been no clear demonstration that KATP channels are expressed in the hair follicle. A number of in vitro effects of minoxidil have been described in monocultures of various skin and hair follicle cell types including stimulation of cell proliferation, inhibition of collagen synthesis, and stimulation of vascular endothelial growth factor and prostaglandin synthesis. Some or all of these effects may be relevant to hair growth, but the application of results obtained in cell culture studies to the complex biology of the hair follicle is uncertain. In this article we review the current state of knowledge on the mode of action of minoxidil on hair growth and indicate lines of future research.
Article
Synopsis Topical application of minoxidil in bald scalps of stumptailed macaques successfully induced regrowth of terminal hairs. The rate and degree of hair growth by minoxidil are much greater in the early stage of baldness in adolescent and young adults. Minoxidil also prevented the development of baldness when applied on non‐bald scalps of peri‐adolescent animals. Morphometric analysis of hair follicles (folliculograms) has brought a new aspect in observing cyclic dynamics and growth (transformation) of hair follicles. Using this analytic method and autoradiographic observation of DNA synthesis of hair follicles, the action of minoxidil appears to be a potent mitotic stimulator of the follicular as well as peri‐follicular germinal (or reserve) cells, thus inducing an enlargement of vellus follicles through the process of cyclic growth and maintaining anagen follicles in the growing phases. Most importantly, minoxidil has no influence in epidermal keratinocytes, sebaceous glands and other dermal components. During almost 3 years of consecutive treatment, the animals showed no detectable local or systemic side effects when examined by laboratory tests of blood cells, chemistry, steroid hormones, measurement of blood pressure and EKG test. Le macaque a queue courte: exemple de calvitie
Article
Background: Benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate, can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH is common. The extract of the berry of the American saw palmetto, or dwarf palm plant, Serenoa repens (also known by its botanical name of Sabal serrulatum), is one of several phytotherapeutic agents available for the treatment of BPH. Objectives: This systematic review aimed to assess the effects of Serenoa repens in the treatment of LUTS consistent with BPH. Search strategy: Trials were searched in computerized general and specialized databases (MEDLINE, EMBASE, and The Cochrane Library), by checking bibliographies, and by handsearching the relevant literature. Selection criteria: Trials were eligible if they (1) randomized men with symptomatic BPH to receive preparations of Serenoa repens (alone or in combination) for at least four weeks in comparison with placebo or other interventions, and (2) included clinical outcomes such as urologic symptom scales, symptoms, and urodynamic measurements. Eligibility was assessed by at least two independent observers. Data collection and analysis: Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The main outcome measure for comparing the effectiveness of Serenoa repens with placebo or other interventions was the change in urologic symptom-scale scores. Secondary outcomes included changes in nocturia and urodynamic measures. The main outcome measure for side effects or adverse events was the number of men reporting side effects. Main results: In this update 9 new trials involving 2053 additional men (a 64.8% increase) have been included. For the main comparison - Serenoa repens versus placebo - 3 trials were added with 419 subjects and 3 endpoints (IPSS, peak urine flow, prostate size). Overall, 5222 subjects from 30 randomized trials lasting from 4 to 60 weeks were assessed. Twenty-six trials were double blinded and treatment allocation concealment was adequate in eighteen studies.Serenoa repens was not superior to placebo in improving IPSS urinary symptom scores, (WMD (weighted mean difference) -0.77 points, 95% CI -2.88 to 1.34, P > 0.05; 2 trials), finasteride (MD (mean difference) 0.40 points, 95% CI -0.57 to 1.37, P > 0.05; 1 trial), or tamsulosin (WMD -0.52 points, 95% CI -1.91 to 0.88, P > 0.05; 2 trials).For nocturia, Serenoa repens was significantly better than placebo (WMD -0.78 nocturnal visits, 95% CI -1.34 to -0.22, P < 0.05; 9 trials), but with the caveat of significant heterogeneity (I(2) = 66%). A sensitivity analysis, utilizing higher quality, larger trials (>/= 40 subjects), demonstrated no significant difference (WMD -0.31 nocturnal visits, 95% CI -0.70 to 0.08, P > 0.05; 5 trials) (I(2) = 11%). Serenoa repens was not superior to finasteride (MD -0.05 nocturnal visits, 95% CI -0.49 to 0.39, P > 0.05; 1 trial), or to tamsulosin (per cent improvement) (RR) (risk ratio) 0.91, 95% CI 0.66 to 1.27, P > 0.05; 1 trial).Comparing peak urine flow, Serenoa repens was not superior to placebo at trial endpoint (WMD 1.02 mL/s, 95% CI -0.14 to 2.19, P > 0.05; 10 trials), or by comparing mean change (WMD 0.31 mL/s, 95% CI -0.56 to 1.17, P > 0.05; 2 trials).Comparing prostate size at endpoint, there was no significant difference between Serenoa repens and placebo (MD -1.05 cc, 95% CI -8.84 to 6.75, P > 0.05; 2 trials), or by comparing mean change (MD -1.22 cc, 95% CI -3.91 to 1.47, P > 0.05; 1 trial). Authors' conclusions: Serenoa repens was not more effective than placebo for treatment of urinary symptoms consistent with BPH.
Article
Minoxidil in combination with propranolol and diuretics controlled the blood-pressure in a group of hypertensive patients who were resistant to treatment with large doses of standard drugs. The main problem was fluid retention but subjective side-effects were fewer than in a comparable group on other drugs.
Article
Six children, from 1.3 to 18 years of age, with severe hypertension associated with the hemolytic uremic syndrome, periarteritis, and renal transplant rejection received minoxidil, an antihypertensive agent, for three to 36 weeks. All had severe hypertension resistant to oral antihypertensive medications; five required frequent intravenous diazoxide therapy prior to minoxidil therapy. The mean pretreatment systolic and diastolic blood pressures were 176 and 117 mm Hg, respectively. Following treatment, the mean systolic and diastolic blood pressures were 133 and 82 mm Hg, respectively. Concomitant antihypertensive medications were decreased in all six patients once optimal blood pressure control was obtained. The initial dosage of minoxidil was 0.1 to 0.2 mg/kg/day; maximal dosage for blood pressure was 0.3 to 1.4 mg/kh/day. Major complications of therapy were fluid retention and hirsutism. Transient asymptomatic pericardial effusions occurred in two patients. Three patients on prolonged minoxidil therapy had persistent increases in right ventricular end diastolic diameters. Minoxidil is an effective oral antihypertensive agent for treatment of severe hypertension in pediatric patients. Avoidance of fluid retention is mandatory to prevent congestive heart failure.
Article
A case of hypertrichosis due to the hypotensive drug minoxidil is described. A review of the literature suggests that this complication appears in nearly all patients treated with this drug. The mechanism is unknown, but the similarity to the cases of hypertrichosis due to diazoxide, another potent vasodilator, suggests that increased cutaneous blood flow may be a factor.
Article
Forty-four patients with severe hypertension who were resistant to treatment with more conventional hypotensive drugs or could not tolerate the side effects were treated with minoxidil, a potent peripheral vasodilator. A beta-blocking drug and a diuretic were used routinely to control, respectively, the tachycardia and fluid retention caused by minoxidil. During treatment the outpatient supine blood pressure fell from a mean of 221/134 mm Hg to 162/98 mm Hg. Eleven patients required additional or alternative hypotensive agents before blood pressure was adequately controlled. Side effects were minor, although the invariable hirsuties caused by minoxidil was unacceptable to three women. The possibility of cardiotoxic effects, raised by early studies in dogs, has not been excluded, and therefore this drug should be used only in patients with severe hypertension. In such patients minoxidil appears to be most effective.
Article
1. One hundred patients with severe essential hypertension have been treated with minoxidil for a mean period of 8·4 months in a study involving eleven European centres. Seventy-two males and twenty-eight females were included in the group; the mean age was 55 years and the initial supine systolic and diastolic pressures averaged 212 (range 150–270) and 125 (range 90–150) mmHg respectively. 2. Reduction of supine diastolic pressure to less than 100 mmHg occurred in 94% of patients within 4 weeks. After the average follow-up period of 8·4 months the mean pressures were 151/91 mmHg. Concomitant therapy with β-receptor-blocking agents and diuretics resulted in satisfactory control of heart rate and weight gain. 3. Side effects included increased hair growth, nausea, fatigue, rash and darkening of the skin. ECG showed mainly T-wave changes and echocardiographic examination indicated improved ventricular emptying.
Article
Seventeen patients who were partially or totally refractory to maximal doses of conventional antihypertensive agents were treated with minoxidil. Three patients were receiving long-term maintenance dialysis. Propranolol and diuretics were given to prevent reflex tachycardia and fluid retention. Initial control of blood pressure was excellent in 16 patients. In one patient, diastolic blood pressure remained unchanged (120 mm Hg) despite 60 mg of minoxidil and volume depletion. In three other patients, secondary resistance developed, and the addition of guanethidine was necessary. The main side-effects were fluid retention (in eight) and hypertrichosis (in ten), accompanied in some by a peculiar coarsening of the facial features. Renal function stabilized or improved in most, and urine output increased in the three hemodialysis patients. We conclude that minoxidil is a valuable drug in severe hypertension. (JAMA 233:249-252, 1975)
Article
Two cases of hypertrichosis due to diazoxide are described. The mechanism is unknown bu may be due either to increased cutaneous perfusion or to increased levels of cyclic AMP.
Article
A 5 alpha-reductase inhibitor, finasteride, was administered orally at 0.5 mg/day, alone or in combination with topical 2% minoxidil, for 20 weeks to determine the effects on scalp hair growth in balding adult male stumptail macaque monkeys. A 7-day dose-finding study showed that both 0.5- and 2.0-mg doses of the drug produced a similar diminution in serum dihydrotestosterone (DHT) in male stumptails. Hair growth was evaluated by shaving and weighing scalp hair at baseline and at 4-week intervals during treatment to obtain cumulative delta hair weight (sum of the 4-week changes in hair weight from baseline) for the 20-week study. The activity of the 5 alpha-reductase enzyme was assessed by RIA of serum testosterone (T) and DHT at 4-week intervals. The combination of finasteride and minoxidil generated significant augmentation of hair weight (additive effect) compared to either drug alone. Finasteride increased hair weight in four of five monkeys. When the data of the one nonresponsive monkey were excluded, finasteride elicited a significant elevation in hair weight compared to topical vehicle alone. Minoxidil also evoked a significant increase in hair weight compared to vehicle alone. Serum T was unchanged, whereas serum DHT was significantly depressed in monkeys that received either finasteride or the combination of finasteride and minoxidil. These data suggest that inhibition of the conversion of T to DHT by this 5 alpha-reductase inhibitor reverses the balding process and enhances hair regrowth by topical minoxidil in the male balding stumptail macaque.
Article
The opening of intracellular potassium channels has been suggested as a mechanism regulating hair growth. Enhancing the flux of potassium ions is a mechanism shared by several structurally diverse antihypertensive agents including minoxidil sulfate (the active metabolite of minoxidil), pinacidil, P-1075 (a potent pinacidil analog), RP-49,356, diazoxide, cromakalim, and nicorandil. Of these drugs, minoxidil, pinacidil, and diazoxide have been reported to elicit hypertrichosis in humans. This potassium channel hypothesis was examined by testing these drugs for effects on hair growth both in vitro and in vivo. For the in vitro studies, mouse vibrissae follicles were cultured for 3 d with drug and the effects on hair growth were measured by metabolic labeling. All drugs, except diazoxide, enhanced cysteine incorporation into the hair shafts of the cultured vibrissae. Diazoxide was poorly soluble and thus was tested only at low doses. Minoxidil, P-1075, cromakalim, and RP-49,356 were also evaluated in vivo by measuring hair growth effects in balding stumptail macaque monkeys. The drugs were administered topically to defined sites on balding scalps once per day for 4-5 months and the amount of hair grown was determined by monthly measurements of shaved hair weight. Three of the drugs produced significant increases in hair weight whereas, the RP-49,356 had no effect. These studies provide correlative evidence that the opening of potassium channels is an important regulatory mechanism for hair growth. This provides the impetus for further studies on this potentially important mechanism affecting hair biology.
Article
The therapeutic value of topical minoxidil in alopecia areata (AA) has been investigated in recent years, with variable results. Although the mechanism whereby minoxidil may stimulate hair regrowth in some cases of AA has not yet been elucidated, there have been reports of a decrease in the perifollicular infiltrates of mononuclear leukocytes (MNC)--particularly T lymphocytes--that characterize this condition, in patients "responding" to topical minoxidil. In a randomized and double-blind study, we have investigated the effect of 5% topical minoxidil versus placebo (vehicle alone) on the extent and composition of the perifollicular MNC infiltration in 20 patients having extensive AA (26-99% scalp hair loss). The proportions of hair follicles showing perifollicular infiltration by MNC and their main subsets were determined with histologic and immunohistochemical stainings of scalp biopsies obtained before treatment, after 12 weeks of randomized double-blind minoxidil versus placebo treatment, and after 12 additional weeks during which all patients received minoxidil. Six of the patients showed cosmetically acceptable hair regrowth (CAHR) at the end of the 24 weeks and this was associated with a significant decrease in the proportions of follicles infiltrated by total T and B lymphocytes, macrophages, and Langerhans cells at week 12, and by total T lymphocytes at week 24. However, no significant differences in the extent or composition of the perifollicular infiltrates were detected at week 12 between patients receiving minoxidil and placebo, or between the week-12 and week-24 biopsies of those patients who first received placebo and then minoxidil. These findings indicate that in AA the reduction in perifollicular T-cell infiltration associated with CAHR is not attributable to an effect of topical minoxidil.
Article
Several reports have demonstrated the efficacy of topical ketoconazole in dermatologic conditions that are not exclusively related to fungi. Some basic pharmacologic studies have indicated effects of ketoconazole on cholesterol production in keratinocytes, on the 5-lipoxygenase enzyme, and on the metabolism of all-trans-retinoic acid in the skin. These observations have led to the hypothesis that topically applied ketoconazole may possess antiinflammatory properties. This hypothesis was tested in an animal model in which living and killed Staphylococcus aureus applied to the backs of guinea pigs resulted in inflammation with erythema and hyperkeratosis. Ketoconazole 0.5% or 2% was applied topically once daily in an ointment base, either as monotherapy or in combination with hydrocortisone acetate 1%. In addition, untreated, excipient-treated, and hydrocortisone acetate-treated animals were included in the study design. All groups consisted of 10 animals that were observed and scored daily up to 3 days after the experimental therapy was stopped. In the animal model involving killed bacteria (i.e., no infection), topical ketoconazole had antiinflammatory activity comparable to that of hydrocortisone acetate. The activity of ketoconazole on the skin of animals infected with living bacteria (i.e., active bacterial infection) was superior to that of steroid therapy, which suggests some antibacterial effect of topically applied ketoconazole. The combination therapy was highly active under both conditions. These results suggest that, apart from the known antimycotic effects of ketoconazole, this molecule might also have effects against gram-positive bacteria at the high concentrations obtained after local application.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The precise biochemical mechanism and site(s) of action by which minoxidil stimulates hair growth are not yet clear. Minoxidil sulfate is the active metabolite of minoxidil, with regard to smooth muscle vasodilation and hair growth. Formation of minoxidil sulfate is catalyzed by specific PAPS-dependent sulfotransferase(s) and minoxidil-sulfating activities have been previously reported to be present in liver and hair follicles. One of these minoxidil-sulfating enzymes has been purified from rat liver (rat minoxidil sulfotransferase, MST) and a rabbit anti-MST antibody has been prepared. Using this anti-MST antibody, we have immunohistochemically localized minoxidil sulfotransferase in the liver and anagen hair follicles from rat. In rat pelage and vibrissa follicles, this enzyme is localized within the cytoplasm of epithelial cells in the lower outer root sheath. Although the immunolocalization of MST might not necessarily correlate with the MST activity known to be present in anagen follicles, the results of this study strongly suggest that the lower outer root sheath of the hair follicle may serve as a site for the sulfation of topically applied minoxidil.
Article
Minoxidil 2% topical solution applied twice a day is known to induce hair growth and prevent hair loss in normal male pattern baldness. Based on this potential, this pilot study tested the effect of Minoxidil on hair loss during chemotherapy for gynecologic cancers. Ten women about to start alopecia-inducing chemotherapy protocols were entered into this non-randomized prospective trial. By study design, each patient served as her own control, as only a portion of the scalp was treated with Minoxidil. Four of the ten patients were unevaluable for failing to comply with the twice-a-day Minoxidil application schedule. Of the six evaluable patients, five experienced complete or severe symmetrically diffuse hair loss, all of which occurred within four weeks of initiating chemotherapy. One patient had no hair loss in either the treatment or control area. Application of the topical Minoxidil in all ten patients had no untoward side effects, skin changes or hypotension. Thus, in this pilot study, 2% Minoxidil was non-toxic but showed no benefit in the prevention of chemotherapy-induced alopecia.
Article
Ketoconazole is an orally active antimycotic agent and a potent inhibitor of gonadal and adrenal steroidogenesis. As inhibitor of steroid production, it has been employed in Cushing's syndrome, prostatic cancer and precocious puberty due to autonomous Leydig-cell hyperfunction. By virtue of its selective action on androgen synthesis at low doses by inhibition of C17-20 lyase, this drug could be of potential therapeutic utility in hirsutism. We evaluated the hormonal and clinical effects of a low-dose regimen (400 mg/day) for 3 months in 16 women with a spectrum of disorders from idiopathic hirsutism to polycystic ovary syndrome. Four of them completed 6-month treatment. At 3 months, DHEA-S decreased from 9.9 +/- 1.0 (mean +/- SE) to 6.9 +/- 1.0 mumol/L (p less than 0.01), androstenedione from 13.3 +/- 1.5 to 8.3 +/- 1.3 nmol/L (p less than 0.005), and testosterone from 4.2 +/- 0.4 to 3.1 +/- 0.4 nmol/L (p less than 0.05). No significant changes were observed in LH, FSH, prolactin and estradiol levels. In patients treated for 6 months, androgens were within normal limits at the end of the study. Eleven out of 16 women (about 70%) reported some improvement in their hirsutism. There was a significant decrease in Ferriman-Gallwey's score (p less than 0.001) and mean hair-shaft diameter (p less than 0.001). The patients treated for 6 months showed a further improvement. Pelvic ultrasonography, when repeated (n = 8), was either unchanged or improved. Side effects (polymenorrhea, gastrointestinal reaction, somnolence) were generally mild and transient. Of 20 women who entered the study the dropout rate was 20% (n = 4).(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Thirty-one men with androgenetic alopecia completed 4 1/2 to 5 years of therapy with 2% and 3% topical minoxidil. Hair regrowth with topical minoxidil tended to peak at 1 year with a slow decline in regrowth over subsequent years. However, at 4 1/2 to 5 years, maintenance of nonvellus hairs beyond that seen at baseline was still evident. Topical minoxidil appears to be effective in helping to maintain nonvellus hair growth in men with androgenetic alopecia.
Article
An important step in understanding minoxidil's mechanism of action on hair follicles was to determine the drug's active form. We used organ-cultured vibrissa follicles to test whether it is minoxidil or its sulfated metabolite, minoxidil sulfate, that stimulates hair growth. Follicles from neonatal mice were cultured with or without drugs and effects were assessed by measuring incorporation of radiolabeled cysteine in hair shafts of the treated follicles. Assays of minoxidil sulfotransferase activity indicated that vibrissae follicles metabolize minoxidil to minoxidil sulfate. Dose-response studies showed that minoxidil sulfate is 14 times more potent than minoxidil in stimulating cysteine incorporation in cultured follicles. Three drugs that block production of intrafollicular minoxidil sulfate were tested for their effects on drug-induced hair growth. Diethylcarbamazine proved to be a noncompetitive inhibitor of sulfotransferase and prevented hair growth stimulation by minoxidil but not by minoxidil sulfate. Inhibiting the formation of intracellular PAPS with chlorate also blocked the action of minoxidil but not of minoxidil sulfate. Acetaminophen, a potent sulfate scavenger blocked cysteine incorporation by minoxidil. It also blocked follicular stimulation by minoxidil sulfate apparently by directly removing the sulfate from the drug. Experiments with U-51,607, a potent minoxidil analog that also forms a sulfated metabolite, showed that its activity was inhibited by both chlorate and diethylcarbamazine. These studies show that sulfation is a critical step for hair-growth effects of minoxidil and that it is the sulfated metabolite that directly affects hair follicles.
Article
Quantitative growth of hair over a 40-week period is reported for eight women with androgenetic alopecia. Using a random, double-blind protocol, the women were given either a 2% minoxidil solution or a placebo of vehicle only. Hair in a permanently marked site on the fronto-parietal scalp was pulled through a 1-cm-square clear plastic template, and the outline of the template was drawn on the scalp. The hair was carefully hand clipped and collected at five eight-week intervals (one untreated and four treated), using great care to collect only hairs within the marked area. Subsequent measurements included the total weight of hair grown in the marked area, the total number of hairs, and, on a randomized 50-hair subsample, the weight, lengths, and optical diameters. Calculated quantities included average weight per hair, average length, and average optical width. The average total hair weight of minoxidil-treated subjects increased over the 32-week test period by 42.5%, compared to 1.9% for the placebo-treated subjects (average p = 0.018). Changes for the average number count were 29.9% and -2.6%, respectively (average p = 0.022). These increases, observed using an unusually small number of subjects, clearly distinguished the treated subjects from the untreated. During the same test period, the averaged quantities of weight, diameter, and length from the 50-hair subsample showed insignificant change (p usually greater than 0.5). In addition to showing a larger percentage increase than did the total number, the total weight is not only easier to obtain, but less prone to error during sampling and measurement. Therefore, we recommend that total weight from a defined area be considered as the primary quantitative estimator for hair growth.
Article
Pathologic hoof changes in horses and swine can be normalized by administration of biotin. This vitamin has been given orally to women with brittle fingernails or onychoschizia. The aim of the study was to test whether the favorable clinical results could be corroborated by scanning electron microscopy. We investigated the distal ends of the fingernails from 32 persons. They were placed into three groups: group A consisted of 10 control subjects with normal nails, group B comprised eight patients with brittle nails studied before and after biotin treatment, and group C was 14 patients with brittle nails in whom the administration of biotin did not coincide exactly with the initial and terminal clipping of the nails. The thickness of the nails in group B increased significantly by 25%. In group C, the increase was 7%. Splitting of the nails were reduced in groups B and C and the irregular cellular arrangement of the dorsal surface of brittle nails became more regular in all nails of group B and in 8 of 11 nails of group C.