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Fenugreek+micronutrients: Efficacy of a food supplement against hair loss

  • BioTeSys GmbH, Esslingen, Germany

Abstract and Figures

Hair loss, hair thinning, poorly growing hair and powerless or dull hair are common complaints in clinical dermatology. There is a need for products, which support the hair growing process and control some of the disturbances in the hair cycle dynamics. In context of a randomised, placebo-controlled clinical trial efficacy of a fenugreek seeds containing food supplement against hair loss is evaluated. The results indicate a successful treatment of low to moderate hair loss in women and men. Additionally, positive effects on hair growth were demonstrated.
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Cosmetic Medicine
ORGANSCHAFTEN: Vereinigung für ästhetische Dermatologie und Lasermedizin e.V.
Deutsche Gesellschaft für Ästhetische Dermatologie
Österreichische Gesellschaft für Ärztliche Kosmetologie und Altersforschung der Haut
27. Jahrgang
Bockshornsamen + Mikronährstoffe:
Wirksamkeit eines Nahrungsergänzungsmittels gegen Haarausfall
Fenugreek+micronutrients: Efficacy
of a food supplement against hair loss
Christiane Schulz, Stephan Bielfeldt, Dr. Jürgen Reimann
Haarausfall, Haarwachstum, Bockshornklee, Bockshorn+Mikro-
nährstoff Haarkapseln Arcon-Tisane
plus, Phototrichogramm, kli-
nische Studie, Nagelgesundheit
Haarverlust, dünner werdendes Haar, schlecht wachsende Haare
und kraftlose oder stumpfe Haare sind bekannte Beschwerden in
der klinischen Dermatologie. Daher gibt es einen Bedarf an Produk-
ten zur Unterstützung des Haarwachstums oder die regulierend in
den Haarzyklus eingreifen. Im Rahmen einer randomisierten, Pla-
cebo-kontrollierten klinischen Studie wurde die Wirksamkeit eines,
auf Bockshornkleesamen basierenden Nahrungsergänzungsmittels
gegen Haarausfall überprüft. Die Ergebnisse zeigen eine erfolgrei-
che Behandlung bei leichtem bis mäßigem Haarausfall bei Frauen
und Männern. Weiterhin zeigt das Präparat positive Effekte auf das
Hair growth depends on a com-
plex and precisely controlled
process, which is not fully under-
stood. It is a cyclical process,
involving synthesis, elongation
and finally shedding of the hair
shaft. Three phases are recog-
nized in this cycle, namely the
anagen (growth), catagen (regres-
sion) and telogen (rest) phases.
Shedding of the hair shaft occurs
at a time called telogenesis.
After telogenesis, a latency
period may be present before a
new hair shaft emerges at the skin surface. In normal states it is esti-
mated that 85–90 % of scalp hairs are in anagen, with the majority
of the remainder in telogen state [4, 6, 11]. If this balance in hair
growth cycle is impaired effluvium occurs [5]. This can be caused
due to complex interactions which may involve molecular mecha-
nisms, angiogenesis, micro-inflammation, neuroendocrine influences
as well as environmental impact, microorganisms and nutritional
supply [11].
Hair loss, hair thinning, poorly growing hair and powerless or dull
hair are common complaints in clinical dermatology. Therefore it is
desirable to have products, which support the hair growing process
and control some of the disturbances in the hair cycle dynamics. The
aim of the study was to investigate the efficacy of a fenugreek seeds
extract containing food supplement* against hair loss. The efficacy
was evaluated over time and in comparison to placebo.
Key Words
hair loss, hair growth, fenugreek, Bockshorn+Mikronährstoff
Haarkapseln Arcon-Tisane
plus, phototrichogram, clinical study,
nail health
Hair loss, hair thinning, poorly growing hair and powerless or dull
hair are common complaints in clinical dermatology. There is a
need for products, which support the hair growing process and con-
trol some of the disturbances in the hair cycle dynamics. In context
of a randomised, placebo-controlled clinical trial efficacy of a fenu-
greek seeds containing food supplement against hair loss is evalu-
ated. The results indicate a successful treatment of low to moder-
ate hair loss in women and men. Additionally, positive effects on
hair growth were demonstrated.
Fig. 1: Fenugreek
(Trigonella foenum-graceum L.).
Fenugreek extract
he verum preparation used in this study is a fenugreek seeds
extract containing food supplement, which additionally contains
micronutrients like hair active B-vitamins, antioxidants and trace
elements. Fenugreek (Trigonella foenum-graceum L.) (fig. 1) is an
annual herb of leguminosea. Fenugreek is native to Southern
Europe, the Mediterranean region and Western Asia. Seeds of fenu-
greek contain a wide range of active ingredients like saponins, espe-
cially derivatives of diosgenin, yamogenin and gitogenin, alkaloids
trigonelline), flavonoids, vitamins and fiber galactomannan etc
10]. Its seeds have a strong aroma and somewhat bitter in taste. It
has a long history as both a culinary and medicinal herb in the
ancient world. Beneficial properties of fenugreek seeds have
attracted wide attention in the recent past due to their therapeutic
potential, including its use as hypoglycemic, antiulcerogenic, hypo-
cholesterolemic and antihypertensive agent [1, 3, 13]. Beyond, it is
used in Ayurvedic medicine [18]. Up to now, all active ingredients
responsible for the possible observed effects are not identified yet.
In monography of fenugreek a dosage of 6 g / day is quoted for oral
use and 50 g powdered drug in 1/4 l water for external use.
Positive effects of fenugreek on hair growth are known, however, the
mechanism is not characterized. It is discussed that fenugreek inter-
acts in a physiologic way by stimulating blood circulation to hair fol-
licles and steroid saponins are expected to interact with DHT (dihy-
drotestosterone) metabolism. One reason for male and female
pattern hair loss is thought to be due to the effects of DHT on geneti-
cally predisposed hair follicles. Binding of DHT to the hair follicle
results in gradual miniaturization of the hair and eventual hair loss.
A fenugreek containing product is already successfully on the market
since 1987. Now the formulation shall be further improved with addi-
tional micronutrients: vitamins and trace element compounds. In the
following clinical study its efficacy against hair loss shall be scientif-
ically proven.
Study design
The study was conducted as a mono-centric, randomised, double-
blind, placebo controlled clinical study. Prior study start, the study
design was approved by an independent ethics committee. Volun-
teers were screened for there eligibility to take part in the clinical
trial according to in- and exclusion criteria and enrolled after
informed consent. 60 volunteers (30 men and 30 women) with mild
to moderate hair loss ingested the test preparations (2 capsules
daily) over a period of 6 months. Additionally 6 volunteers were
enrolled two months after start of clinical trial because of drop outs
due to private reasons. In total, 53 volunteers successfully finished
the clinical trial. Every two months there was a dermatological
assessment of hair loss, a questionnaire and the assessment of hair
parameters via phototrichogram picture analysis (fig. 2). Addition-
ally after 6 months of treatment a retrospective questionnaire was
performed. Methods used enclose both subjective and objective
parameters, reliable methods to assess hair loss and hair growth
parameters to monitor response of therapy [4, 8, 11, 16].
Study group
Volunteers were randomly assigned to placebo (1/3 of volunteers of
each sex) or verum* group (2/3 of volunteers of each sex). Demo-
graphic data were assessed with a questionnaire. Regarding age,
volunteers between 30 and 67 years participated in the trial. Women
were significantly younger compared to men (p=0,0389) with 48,5 ±
11,0 years and 54,4 ± 11,0 years, respectively. However, the sub-
groups regarding gender and preparation showed no significant dif-
ference in age (p = 0,1304). BMI was distributed quite homoge-
neously between study groups. Noticeable is the high fraction (31,5
%) of subjects with BMI > 30 kg/m
, termed as overweight. However,
looking at outcome parameters, these volunteers did not show out-
standing differences to other volunteers. In total, volunteers build a
representative group for examination of intended objectives.
Compliance and compatibility
Compliance visits took place every month. Compliance of intake of
test preparations was very good. Tolerance was very high. Only a few
volunteers disliked the strong smell of fenugreek which reminds to
lovage. To mimic the smell in placebo capsules a fenugreek aroma
was added. In both groups only a very few volunteers reported an
unpleasant smell / belch / feeling after intake of study preparations.
This especially occurred, if preparations were taken after over night
fast without breakfast. Volunteers in the trial were asked to take the
preparations in the morning together with breakfast. No other side
effects were reported in relation to the intake of study preparations.
Satisfaction of preparations was quite high, 72 % and 86 % of volun-
teers in placebo and verum group, respectively, would recommend
product to others and most of them (85 % and 90 %, respectively)
would take the product further on.
Hair loss / hair growth parameters
Volunteers with slight to moderate hair loss were enclosed to the
trial. Hair loss was assessed according to a scale of 0–4 (0: none,
1: very slight, 2: slight, 3: moderate, 4: strong); placebo: 2,06;
verum: 2,31 (baseline values). After 6 months of intake of test prepa-
rations, hair loss was significantly improved p < 0,0001 in both
groups; placebo: 0,39; verum: 0,37 (dermatologist assessment).
Data are confirmed by volunteer assessment. With both study prepa-
rations improvement in hair loss was observed over treatment phase.
The trial was performed as double-blind study design to control for
psychological influence. However, the placebo effect is high and
intensively developed for some parameters. Anyhow, clear conclu-
sions can be stated from the clinical trial. The placebo effect is
reflected in other placebo controlled trials [2]. To mimic the intense
smell of fenugreek in placebo capsules, a fenugreek aroma was
added. However, it was not possible to get an aroma completely free
of saponins. Therefore it cannot ruled out, whether small amounts of
saponins could have contributed to the positive effects.
Sex specific differences in baseline values were obvious especially
for the ratio counts anagen/telogen counts. Men: 1,63 (placebo
ig. 2: Picture analysis prior (left) and post treatment (right) with Bockshorn
Mikronährstoff Haarkapseln Arcon-Tisane
lus over a period of 6 months.
equivalent to 62 % anagen hairs) and 2,03 (verum equivalent to 67 %
nagen hairs); women 4,69 (placebo equivalent to 82 % anagen
airs) and 5,43 (verum equivalent to 84 % anagen hairs). However,
changes over time depending on treatment were comparable
between gender groups. For evaluation of statistical significance,
parameters of picture analysis and dermatologist/volunteer assess-
ment were evaluated for preparations but not in gender subgroup,
because of small falling number. Hair density parameter from image
analysis (fig. 2) was significantly improved (p < 0,045; baseline ver-
sus all treated assessment times) over time in comparison to base-
ine data after intake of verum preparation. Maximum hair density
as observed after intake of capsules for four months. Both, hair
density and thickness anagen hair showed diminishing values after 6
months compared to 4 months. Here the seasonal shedding of hairs
could have interfered with the study design.
The parameter hair density was also evaluated via subjective volun-
teer assessment which confirmed the results of picture analysis. The
results clearly show superiority of the verum preparation over the
placebo preparation for the parameter hair density. With the placebo
preparation no significant improvement could be documented over
total treatment phase. Verum preparation showed significant influ-
ence (p < 0,001) on the growth rate of anagen hairs with lowest lev-
els prior treatment. The ratio of anagen/telogen hair counts resulted
in improvement for the benefit of anagen hairs after intake of verum
preparation. However, differences over time were not statistically
Final questionnaire
After intake of study preparations over a period of 6 months, volun-
teers were asked to evaluate retrospective subjective changes of
parameters according to a scale of –4 up to +4 (1: slight, 2: moder-
ate, 3: medium, 4: strong). Negative numbers referred to worsening,
positive numbers to improvement of parameters. Besides hair
growth parameters, nail parameters were evaluated with this retro-
spective subjective questionnaire. Statistical evaluation was per-
formed gender specifically as the subjective assessment of parame-
ters showed that between genders different problem areas are
defined and evaluated differently between gender groups.
Hair growth
After intake of verum preparation, 82,9 % of volunteers reported an
improvement for the parameter hair volume and hair thickness. 74,3 %
reported an improvement of resistance of hairs. Significant prepara-
tion differences (placebo versus verum) were found for hair dressing
in women (fig. 3) and hair thickness, hair density at parting region
(fig. 4) and hair growth at receding brow in men for the benefit of
verum preparation. Evaluating all observed hair parameters with
clustering in worsening and no change (scale: –4 to 0) versus
improvement (scale: 1 to 4) resulted in significant (p < 0,05) differ-
ences between placebo and verum preparation.
Nail health
In respect of nail health, volunteers mentioned changes especially in
nail growth and robustness of nails (fig. 5). The parameter robust-
ness was significantly improved after intake of verum preparation
compared to placebo (p < 0,003 for total group). The results indi-
cate, that intake of a supplement containing fenugreek and micronu-
trients could come along with positive changes with related tissues
like nails and skin.
Context of literature
Commercially different therapeutics on the field of medical and sup-
plemental area are available. These preparations are used as topical
or oral applications. In the field of pharmaceutical products, Finas-
terid and Minoxidil are the best known preparations [7, 9, 15, 17].
Finasterid, a competitive inhibitor of type 2 5-alpha reductase
inhibits the transformation of testosterone to dihydrotestosterone
Fig. 3: Retrospective assessment of changes in hair dressing of women on a
scale of –4 to +4; depicted are relative frequencies. p < 0,017.
Fig. 4: Retrospective assessment of hair density at parting region of men on a
scale of –4 to +4; depicted are relative frequencies. p < 0,047.
Fig. 5: Retrospective assessment of robustness of nails in women on a scale of
–4 to +4; depicted are relative frequencies. p < 0,022.
Hair dressing
Hair density at parting region
obustness of nails
relative frequency (%)
relative frequency (%)
relative frequency (%)
Kosmetische Medizin –
Cosmetic Medicine
Organ der Vereinigung für Ästhetische
Dermatologie und Lasermedizin e.V.
Organ der Deutschen Gesellschaft für
Ästhetische Dermatologie
Organ der Österreichischen Gesellschaft
für Ärztliche Kosmetologie und
Altersforschung der Haut
27. Jahrgang, Heft 4, 2006
ISSN 1430-4031
Grosse Verlag
Brandenburgische Straße 18
10707 Berlin
Douglas Grosse
Vorsitzender des Verlagsbeirats
Dr. Eduard Grosse
Prof. Dr. med. Uwe Wollina
Hautklinik des Krankenhauses
Friedrichstraße 41
01067 Dresden
Telefon: 03 51/4 801210
Douglas Grosse
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(DHT). Androgen-dependent process in hair loss are predominantly due to the binding of DHT to
he androgen receptor. The hormone-receptor complex activates the genes responsible for the
radual change of large terminal follicles to miniaturized follicles [12, 14]. Minoxidil an adeno-
sine triphosphate sensitive potassium channel opener has been reported to stimulate the pro-
duction of vascular endothelial growth factor in cultured dermal papilla cells.
Since the clinical success rate of treatment of hair loss with modulators of androgen metabolism
or hair growth promoters is limited, further possible cofactors are discussed. One approach is a
sustained microscopic follicular inflammation considered as a possible cofactor in the complex
aetiology of androgenetic alopecia [14]. The approach of dietary supplements with focus to sup-
ort hair growth with different plant extracts, vitamins, trace elements, have shown comparable
ositive effects compared to drugs with the advantage of no side effects. This outlines good
alternatives for persons with slight to moderate hair loss.
The data support, that treatment with fenugreek containing food supplement* results in
favourable effects on hair loss that contribute to improvements in hair growth observed in
treated volunteers. Fenugreek is used in a physiologic dosage of 300 mg extract, equivalent to
1200 mg fenugreek seeds. Therewith, efficacy of Bocks-horn+Mikronährstoff Haarkapseln Arcon-
plus, a fenugreek seeds extract containing food supplement, could be documented in
women and men with low to moderate hair loss.
Address of Correspondence
Christiane Schulz
BioTeSys GmbH
Schelztorstr. 54-56
D-73728 Esslingen
* Bockshorn + Mikronährstoff Haarkapseln Arcon-Tisane
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14 Trueb RM (2002) Molecular mechanisms of androgenetic alopecia. Exp Gerontol 37: 981-990.
Van Neste D, Fuh V, Sanchez-Pedreno P, Lopez-Bran E, Wolff H, Whiting D, Roberts J, Kopera D, Stene JJ, Calvieri S,
Tosti A, Prens E, Guarrera M, Kanojia P, He W, Kaufman KD (2000) Finasteride increases anagen hair in men with
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Yelne MB, Sharma PC, Dennis TJ (2002) Database on Medicinal Plants used in Ayurveda. Central Council for Research in
Ayurveda & Siddha, New Delhi Volume 4
... Minerals are essential for healthy hair growth. Perhaps, the presence of these minerals in T. foenum-graecum is one of the effective factors in strengthening the hair [30, 32,33]. Zinc helps to secrete the scalp. ...
Full-text available
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The growth of scalp hair is a cyclical process of successive phases of growth (anagen) and rest (telogen). In previous clinical trials in men with androgenetic alopecia, treatment with finasteride increased scalp hair counts in a defined area (i.e. increased hair density). The current study used a phototrichogram methodology to assess the effect of finasteride on the phases of the hair growth cycle. Two hundred and twelve men, age 18-40 years, with androgenetic alopecia were randomized to receive finasteride 1 mg daily or placebo for 48 weeks. At baseline and at 24 and 48 weeks, macrophotographs were taken to measure total and anagen hair count in a 1-cm(2) target area of the scalp. At baseline, mean total and anagen hair counts in the finasteride group were 200 and 124 hairs, respectively (% anagen = 62%) and the anagen to telogen ratio was 1.74 (geometric mean). In the placebo group, the respective values were 196 and 119 hairs (% anagen = 60%) and 1.57. At week 48, the finasteride group had a net improvement (mean +/- SE) compared with placebo in total and anagen hair counts of 17.3 +/- 2.5 hairs (8.3% +/- 1.4%) and 27.0 +/- 2.9 hairs (26% +/- 3.1%), respectively (P < 0.001). Furthermore, treatment with finasteride resulted in a net improvement in the anagen to telogen ratio of 47% (P < 0.001). In this study, treatment with finasteride 1 mg day(-1) for 48 weeks increased both total and anagen hair counts, and improved the anagen to telogen ratio. These data provide direct evidence that finasteride 1 mg daily promotes the conversion of hairs into the anagen phase. These data support that finasteride treatment results in favourable effects on hair quality that contribute to the visible improvements in hair growth observed in treated patients.
The safety and efficacy of minoxidil 2% for the treatment of female androgenetic alopecia was assessed in a 32-week double-blind placebo-controlled trial. Thirty-three women aged 22 to 44 years with hair loss classified as Ludwig's grade I or II were enrolled, and 28 completed the trial. Before the administration of treatment, mean nonvellus hair counts were taken within a 1-cm2 target area of the scalp. For the 15 patients in the minoxidil group, the mean count was 169 hairs compared with 161 hairs for the 13 patients in the placebo group. At the completion of the trial, the patients treated with minoxidil 2% had a mean nonvellus hair count of 195 hairs versus a mean hair count of 177 for patients in the placebo group; 60% (9) of the patients in the minoxidil group showed minimal to moderate hair growth compared with 46% (6) of the patients in the placebo group. No serious side effects were encountered during this study, nor any significant changes in safety parameters. There were no dropouts due to medical events related to minoxidil 2%.
The effect of fenugreek seeds (Trigonella foenum graecum) on blood glucose and the serum lipid profile was evaluated in insulin-dependent (Type I) diabetic patients. Isocaloric diets with and without fenugreek were each given randomly for 10 d. Defatted fenugreek seed powder (100 g), divided into two equal doses, was incorporated into the diet and served during lunch and dinner. The fenugreek diet significantly reduced fasting blood sugar and improved the glucose tolerance test. There was a 54 per cent reduction in 24-h urinary glucose excretion. Serum total cholesterol, LDL and VLDL cholesterol and triglycerides were also significantly reduced. The HDL cholesterol fraction, however, remained unchanged. These results indicate the usefulness of fenugreek seeds in the management of diabetes.
Male pattern alopecia is the outcome of profound modifications in the duration, succession and frequency of hair cycles. These phenomena were studied by phototrichogram in 10 male subjects, with or without alopecia, over a period of 15 years. Almost 10,000 hair cycles were accounted for, yielding a detailed picture of the alopecia condition: (1) A decrease in the duration of anagen for a certain proportion of hairs, a proportion which increases in size, the more advanced the alopecia; the result of this premature transformation from anagen to telogen is an increase in the rate of hair loss. (2) A parallel decline in hair diameter. (3) Longer latency periods between the fall of a hair and the onset of regrowth, leading to a reduction in the number of hairs present on the scalp surface. The shorter finer hairs are absent more frequently and absent for longer periods and this contributes to the effect of alopecia.
Women generally regard their hair loss as socially unacceptable and go to great measures to conceal their problem. In some cases, the negative self-image brought about by hair loss may be the basis of psychiatric illness. The purpose of this study was to evaluate a 2% topical minoxidil solution (Rogaine/Regaine, The Upjohn Co, Kalamazoo, Mich) for the treatment of female androgenetic alopecia. A 32-week, double-blind, placebo-controlled trial was conducted in 11 US centers. Three hundred eight women with androgenetic alopecia were enrolled. Two hundred fifty-six of these women completed the trial. A refined photographic technique was used to objectively determine the number of nonvellus hairs regrown. After 32 weeks of treatment, the number of nonvellus hairs in a 1-cm2 evaluation site was increased by an average of 23 hairs in the 2% minoxidil group and by an average of 11 hairs in the placebo group. The 95% confidence interval for the difference in mean hair count change between the treatment groups was 5.9 to 17.5 hairs. The investigators determined that 13% in the minoxidil-treated group had moderate growth and 50% had minimal growth. This compared with 6% and 33%, respectively, in the placebo-treated group. Similarly, 60% of the patients in the 2% minoxidil group reported that they had new hair growth (20% moderate, 40% minimal) compared with 40% (7% moderate, 33% minimal) of the patients in the placebo group. No evaluations of dense hair growth were reported for either treatment group. No clinically significant changes in vital signs were observed and no serious or unexpected medical events were reported. Topical minoxidil was significantly more effective than placebo in the treatment of female androgenetic alopecia.
Androgenetic alopecia is the most common cause of hair loss in men and women. Androgenetic alopecia in women begins as a diffuse and progressive thinning of the frontoparietal area of the scalp. In women, hair loss at any age is socially unacceptable and may be the basis of psychiatric illness. A 32-week, double-blind, placebo-controlled trial was conducted in 10 European centers to assess the efficacy and safety of 2% topical minoxidil solution for the treatment of androgenetic alopecia in women. Two hundred ninety-four of the 346 women enrolled (85%) completed the 32-week trial. Photographic and computer imaging techniques were used at each visit to determine objectively the number of nonvellus hairs present in a 1-cm2 area selected as the target evaluation site. In the 2% minoxidil group, the mean increase in nonvellus hair count was 33 hairs, which was significantly greater than that of 19 hairs in the placebo group (P = 0.0001). The investigators observed that 44% of the patients in the 2% minoxidil group achieved new hair growth compared with 29% in the placebo group. When asked to evaluate their own hair growth, 55% of the women in the 2% minoxidil group compared to 41% of the women in the placebo group believed that they had achieved new hair growth. No clinically significant changes in vital signs were observed during the study and no serious or unexpected medical events were reported. Topical minoxidil solution was significantly more effective than placebo in the treatment of androgenetic alopecia in women.
Anti-inflammatory and antipyretic effects of the Trigonella foenum-graecum (TFG) leaves extract, an Iranian medicinal plant, were examined. For anti-inflammatory activity, the formalin-induced edema model was used. Hyperthermia was induced by intraperitoneal injection of 20% (w/v) aqueous suspension of brewer's yeast. Sodium salicylate (SS) was used as a positive control. Both TFG and SS significantly reduced formalin-induced edema in single dose (TFG 1000 and 2000 mg/kg, SS 300 mg/kg) and chronic administration (TFG 1000 mg/kg and SS 300 mg/kg). TFG and SS also significantly reduced hyperthermia induced by brewer's yeast in 1 and 2 h after their administration. The results indicate that the TFG leaves extract possess anti-inflammatory as well as antipyretic properties in both i.p. and p.o. administration. Phytochemical studies indicate that alkaloids, cardiac glycosides, and phenols are the major component in the extract. Although existence of three anti-inflammatory, analgesic and antipyretic effects in this extract suggest a NSAID-like mechanism for it, but the presence of alkaloids, the absence of other effective compounds such as flavonoids, saponins, steroids, etc., and also its analgesic effect on tail-flick test that usually is not produced by NSAIDs, suggest another mechanism for the extract. So the possibility of alkaloids as effective compounds, in this extract, increases.
This review on hair growth measurement methods focuses on human scalp hair in the context of clinically relevant assessment of hair loss. This phenomenon is the end result of a complex combination of events closely associated with hair cycling followed by defective hair replacement. The methodological spectrum ranges from the most to the least invasive approach. All of the measurement methods referred to are critically reviewed, with their stronger and weaker aspects, in view of their potential application in the skin and hair clinic. The existence of recently developed highly resolutive noninvasive analytical methods capable of exploring almost every aspect of the dynamics of this growth and loss phenomenon allowed calibration of more global scoring method. From this review, the author concludes that a combination of a highly resolutive analytical approach with a global calibrated method seems advisable in the context of the monitoring of hair growth changes for better or worse, i.e. scalp hair growth or hair loss in the hair clinic.
Androgenetic alopecia (AGA) is hereditary and androgen-dependent, progressive thinning of the scalp hair that follows a defined pattern. While the genetic involvement is pronounced but poorly understood, major advances have been achieved in understanding principal elements of the androgen metabolism involved: androgen-dependent processes are predominantly due to the binding of dihydrotestosterone (DHT) to the androgen receptor (AR). DHT-dependent cell functions depend on the availability of weak androgens, their conversion to more potent androgens via the action of 5 alpha-reductase, low enzymatic activity of androgen inactivating enzymes, and functionally active AR present in high numbers. The predisposed scalp exhibits high levels of DHT, and increased expression of the AR. Conversion of testosterone to DHT within the dermal papilla plays a central role, while androgen-regulated factors deriving from dermal papilla cells are believed to influence growth of other components of the hair follicle. Current available treatment modalities with proven efficacy are oral finasteride, a competitive inhibitor of type 2 5 alpha-reductase, and topical minoxidil, an adenosine-triphosphate-sensitive potassium channel opener which has been reported to stimulate the production of vascular endothelial growth factor in cultured dermal papilla cells. Since the clinical success rate of treatment of AGA with modulators of androgen metabolism or hair growth promoters is limited, sustained microscopic follicular inflammation with connective tissue remodeling, eventually resulting in permanent hair loss, is considered a possible cofactor in the complex etiology of AGA.