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What ages hair?
Assaf Monselise, MD
a,d,
⁎
, David E. Cohen, MD, MPH
b
, Rita Wanser
c
, Jerry Shapiro, MD
a,b
a
Department of Dermatology and Skin Science, University of British Columbia, BC, Canada
b
The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, NY, USA
c
Cicatricial Alopecia Research Foundation, Chairman of the Board, IL, USA
d
Private practice, Tel Aviv, Israel
Background
Hair has always played an important role in the history of mankind.
Egyptian hieroglyphics are testimony of the paramount importance of
hair for this ancient civilization, not only because of the visual effect,
but also because of the erotic symbolism connected with hair. For the
ancient Romans hair was not only a question of fashion but was used
as a symbol of beauty, virility, class and intellect. In modern western
culture having a full head of hair is of ten associated with desirable
qualities such as youthfulness and vitality. Most pe ople experience
changes in hair and scalp health as they age. Subsequent hair loss may
cause significant distress that deeply affects people’s life causing social
anxiety and interfering with their well being. Genetic and hormonal
changes are important factors in hair loss, but weathering and grooming
habits take a toll on our hair as well.
A recent advisory board comprising twelve experts in hair fibers
and hair loss was formed to review hair loss in relation to heredity,
agin g and environmental factors emphasizing measures that m ay
slow alopecia. The following information is a summary of their discus-
sions on these topics.
Definition of a healthy scalp and hair
Although healthy scalp and hair are of prime importance, the general
public is no t kno wledgeable about these issues. Most people have little
awareness about how to appropriately care for their hair and scalp. Healthy
hair and healthy scalp typically complement each other, so a healthy scalp
is needed to give the appearance of healthy hair and vice versa. A healthy
scalp is generally defined by a lack of disease or abnormalities; however a
person could be bald and perceived as having a healthy scalp.
Experts in the field of dermatology (Rogaine®ScientificRoundtable,
2009) agree that the characteristics of healthy hair include thickness,
volume, lus ter and resilience of the fiber. The majority have agreed
that a healthy scalp would have normal follicular densi ty with no
scaling, itching, burning or erythema.
Many patients experiencing hair loss assume the problem is related
to the scalp if inflammation or flaking is present at the time of hair loss.
They believe that treatment of the scalp would promote future hair
growth, although th is is frequently not the case.
Chronic scalp inflammation likely dim inishes hair health via a variety
of mechanisms that are not fully understood. Although research on the
effects of chronic scalp inflammation on hair health is limited, a plausible
mechanism involves cytokine-driven decrease in the anagen phase hair
lengthening as well as miniaturization of the hair follicle. The ideal envi-
ronment required for a healthy growth of hair still has to be identified,
yet changes in the environment surrounding the follicle like sebum
excretion, debris, and chronic inflammation could significantly impact
the growth and health of hair. On the other hand, treatments targeted
at reducing inflammatory scalp conditions, such as dandruff and infec-
tion are harsh on the hair shaft and decrease shine and manageability.
Pattern Hair Loss or Age-related thinning
Pattern hair loss (PHL) has a multi-genetic background with half the
male population affected by the age of 50 years. Different patterns for hair
loss have been identified, including the Norwood-Hamilton pattern
(Figure 1), the Ludwig pattern (Figure 2) and the Christmas tree or frontal
accentuation pattern (Figure 3) Although the Norwood-Hamilton is tradi-
tionally used to describe PHL in men and th e Ludwig and Christmas tree
pattern for women, the different patterns are not gender restricted and
can be used interchangeably. According to available data 38% of women
over the age of 50 experience significant hair thinning (Rogaine®Scientific
Roundtable, 2009). Women often regard hair loss a problem related to
men exclusively and do not recognize this problem until significant hair
loss has occurred, thus delaying treatment with minoxidil.
In men, hormonal factors, namely dihydrotestosterone (DHT) levels,
play an important factor in the pathophysiology of PHL, with increased
5-alpha-reductase an d androgen receptors in the frontal scalp com-
pared to the occiput (Pri ce, 2003). High scalp DHT levels are associated
with follicu lar mi niaturization which is characteristic for PHL (Whiting,
2001), however follicular downsizing has been described for senescent
alopecia as well (Table 1)(Hordinsky et al., 2002). The pathophysiology
of follicular downsizing is not fully understood. It is described as an
alteration of the anagen (growth) and telogen (resting) phases of hair
growth with a diminished scalp vasculature as an adjustment for the
needs of the decrease in size follicles. In fact, the telogen phase during
which hair is shed changes as a person ages. In a child, the number of
hairs that are shed during this phase is much less compared with an
average adult, who typically loses 100 hairs each day. As a person
continues to age, the number of hairs that are shed increases, resulting
in thinning, which is common in the senior population. Conversely,
the anagen phase of hair growth is likely influenced by age and race
and appears to shorten as a person ages, however it is unclear when
International Journal of Women's Dermatology 1 (2015) 161–166
⁎ Corresponding Author.
E-mail address: a.mons@yahoo.com (A. Monselise).
http://dx.doi.org/10.1016/j.ijwd.2015.07.004
2352-6475/© 2015 The Authors. Published by Elsevier Inc. on behalf of Women's Dermatologic Society. This is an open access article under th e CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Contents lists available at ScienceDirect
International Journal of Women's Dermatology
or what triggers a shortening of this phase. Additionally, people from
some ethnic backgrounds, such as African American women, appear to be
more susceptible to shortening of the anagen phase, as they often experi-
ence difficulty in growing and maintaining long hair as they get older.
A direct relationship appears to exist between the degree of scalp
inflammation and pattern hair loss especially in men (Jaworsky et al.,
1992), and treating this inflammation can reduce the loss of hair. In this
regard, minoxidil may exert anti-inflammatory/immunomodulatory
effects in the follicle environment (Fiedler and Buys, 1987, 1988). In
contrast, research in the area of female PHL suggests that sebum excre-
tion is unchanged in these patients (Birch et al., 2006). Most women
with PHL have normal serum androgen levels, suggesting genetic and
environmental factors are likely playing a role in alopecia.
Some people experience widespread thinning of their hair as they
get older. This condition is defined as senescent alopecia or age-
related thinning, and is characterized by a scalp-wide reduction in the
number of hairs rather than classic pattern hair loss. Senescent alopecia
typically occurs between the ages of 50 and 80 years in a person without
a prior history of hair thinning and any underlying scalp diseases, and
can be superimposed on PHL. Indeed the distinction between age-
related thinning and PHL is confusing since the presence of follicular
miniaturization in age-related hair loss is an inconsistent finding. The
relation between senescent hair loss and androgens has yet to be deter-
mined. A drop in estrogen levels that occur during menopause could
contribute to hair thinning, which is commonly seen in older women.
Some areas of the scalp could be dependent on androgens for either
hair growth and/or hair loss, and this may explain, for example, the
association of Hamilton PHL, which is typical for men, in some women
with age-related hair loss. If low androgen plays a major role in
senescent alopecia, Estratest® (esterified estrogens combined with
methyltestosterone) would be the hormone replacement of choice in
women. This drug could also be combined with finasteride in women
with low dihydrotestosterone (DHT) levels. However, administration
of Estratest and dehydroepiandrosterone (DHEA) supplements has
been associated with hair loss in clinical practice, so determining the
appropriate dose and product for androgen replacement could be
challenging. The ideal androgen level for hair growth must be balanced
with the negative effects of androgen administration, such as hirsutism,
acne, and osteoporosis. Since minoxidil’s stimulatory effect impacts
many areas of the scalp, it would indeed help manage senescence and
hair loss related to aging alopecia.
Weathering & Grooming
Weathering is defined as the cumulative effect of environmental fac-
tors on the physicochemical structure of the hair. Hair damage induced
by environmental factors including UV, humidity, wind and chemicals
in hair products and procedures, has a negative impact on the growth
and texture of the hair fiber. Grooming habits and weathering interplay
in the process of hair wearing and both can compound the natural
Fig. 1. Androgenetic Alopecia in Males. Hamilton-Norwood Classification. (Reprinted with permission from Hair Loss and Hair Restoration. Authors: Shapiro J and Otberg N. CRC Press
Taylor and Francis 2015 Chapter 2 page 32.)
Fig. 2. Androgenetic Alopecia in Women. Ludwig Classification.
162 A. Monselise et al. / International Journal of Women's Dermatology 1 (2015) 161–166
decrease in hair density related to age-related thinning/PHL. Typically in
Caucasians and Asians, when the inciting factor is weathering, the dam-
age occurs distally on the hair shaft. However, damage to the shaft fre-
quently occurs proximally in African Americans, caused by the harsh
chemicals applied on the scalp to relax the hair. The resilience of the
hair shaft to weathering is determined by its unique structure. Much
of the fiber’s strength is given by the cortex and overlying cuticle that
serves as a mechanical protective barrier. The latter constitutes about
10% of the fiber’s weight and is made of tiny scales that overlap one an-
other like shingles on a roof, with their exposed edges towards the tip of
the fiber. The cortex provides strength thanks to keratin which is rich in
disulfide bonds. Additionally, melanin which resides in the cortex
provides protection to the fiber against UV radiation. The pathogenesis
of photo damage involves interaction between iron, wa ter, and UV
light with the formation of free radicals. The latter are partially absorbed
by melanin which acts as a scavenger of free radicals. However, when an
overwhelming amount of free radicals is formed, melanin is degraded
and UV light then generates crosslinks between proteins, melting the
cortex and making the hair very brittle. Red headed and blond people
are more prone to photo-damage since their hair is rich in pheomelanin
which is less resistant than eumelanin. Likewise white or graying hair is
less protected from UV radiation.
The frictional properties of the cuticle determine how the hair feels
to touch, how it combs and styles. When the cuticular scales are smooth
light is reflected and the hair appears shiny and healthy. Typically, the
macroscopic appearance of a damaged fiber is characterized by splitting
of the ends, so called trichoptilosis. This happens mostly for longer fibers
that have been exposed for lo nger periods to environmental fa ctors.
Observation of the hair by scanning electron microscopy reveals pro-
gressive damage to the fiber from root to tip, with slight scale lifting
proximally and gradual chipping and denudation of the cuticle, with
longitudinal fissures and transverse breakage or trichoschisis near
trichorrhexis nodosa like nodes.
Grooming habits have an important impact on the wearing of the
hair fiber. Shampooing daily cleanses off the protective layer of sebum
that covers the hair, causing the shaft to dry out so it easily gets statically
charged and consequentially more prone to friction. Shampoos are am-
phiphilic molecules that have both a lipophilic side that binds sebum
and a hydrophilic part that binds water. They are divided into groups
based on their chemical structure. Those belonging to the anionic
group contain negatively charged molecules with stronger and deeper
cleansing properties, such as sodium laureth sulfate and sodium lauryl
sulfate. Sodium lauryl sulfate was used almost exclusively in shampoos
several years ago and is more irritating and damaging to the follicle com-
pared to sodium laureth sulfate. Currently, the majority of shampoos
contain sodium laureth sulfate due to its moisturizing properties
(Rogaine®Scientific Roundtab le, 2009 ). Shampoos categorized in other
chemical groups (cationic, non ionic and amphoteric) include products
that have milder cleansing properties, are less irritating and leave the
hair more manageable. Shampoos are often marketed based on the
type of hair that they are meant for. Those for oily hair have stronger
detergent properties while those for permed, permanently dyed,
bleached or dry hair, are milder in order to reduce sebum removal.
Baby shampoos are usually mild, less irritating and are suitable for
daily use.
Permanent waving or relaxing of hair involves chemicals like ammo-
nium thioglycollate, sodium hydroxide and guanidine hydroxide, which
are extremely alkaline and cause breakage of disulphide cross-links
within the keratin, inducing swelling and softening of the fiber.
Reduced cysteine levels in relaxed hair is consistent with hair fragility
in comparison to normal unrelaxed hair Khumalo et al., nd.The
dama ged fiber characteristically breaks along the shaft, leaving the
root unaffected and is more often seen on the nape area which is
first
treated by the stylist and is thereby exposed to the product for longer
time. Bleaching products contain hydrogen peroxide or hydrogen
persulfate. These chemicals must traverse the cuticle in order to bleach
the melanin which lays in the cortex, causing irreversible oxidation of
keratin disulfide bonds with weakening the fiber.
Combing and brushing, especially when done tip to root on wet hair
can be harsh on the fiber with the development of trichoschisis. Wet
combing applies force on the hair close to the scalp, making it more
damaging than dry combing in which the force is pla ced on the en d
of the hair shaft (Rogaine®Scientific Roundtable, 2009). Using wide-
Fig. 3. Androgenetic Alopecia (AGA) in Women-Frontal Accentuation (Christmas Tree Pattern).
Table 1
Defining the characteristics of Senescent Alopecia
Scalp-wide reduction in the number of hairs
Occurs between the ages of 50 and 80 years
No prior history of hair thinning or underlying scalp disease
Presence of follicular miniaturization is inconsistent
Shortening of anagen
Decreased anagen/telogen ratio
Relation to androgens has yet to be determined.(low androgen levels could be a factor)
163A. Monselise et al. / International Journal of Women's Dermatology 1 (2015) 161–166
toothed combs and brushes with rounded tips is a good pro tective
measure when styling the hair. (Table 2)
In African Americans, straightened hair behaves similar to Caucasian
hair, so it is less difficult to comb when it is dry compared with non-
straightened hair. The application of oil to African American hair prior
to shampooing would lubricate the hair shaft, making hair more
manageable, easier to comb, and less susceptible to damage by the
shampooing and drying process. Oils may also have antifungal proper-
ties, which could ward off scalp infe ctions. However, triglycerides in
these oils could be cleaved to free fatty acids that produce inflammation
in the hair follicle (Rogaine®Scientific Roundtable, 2009).
Using hair dryers and curling irons can “cook” the ha ir fiber. Obser-
vation with a magnifier reveals the classic picture of Bubble Hair
(Mirmirani, 2008)(Figure 4) that is given by micro cavities within the
shaft, which are formed by the expansion of moisture induced by the
high temperatures of these devices. Japanese or ionic hair straightening
with ceramic irons that reach temperatures as high as 210°C has been
related to widespread breakage of the hair shaft as a result of acquired
trichorrhexis nodosa (Mirmirani, 2010). Temp orary disruption of
hydrogen bonds in the cortex involved in this procedure, imparts the
desirable softness to the hair. Interestingly, trichorrhexis nodosa is
observed where the cuticle is lost and the cortex has been damaged.
Current Treatment Concepts
Minoxidil
Minoxidil was the first FDA approved medication for male-pattern
baldness and has been on the market for more than 20 years. Increased
scalp blood flow resulting from local vasodilation has been proposed
as a possible mechanism of minoxidil's effect on hair growth however,
this mechanism has not been substantiated consi stently and not all
vasodilators produce hypertrichosis. Because minoxidil has stimulated
hair regrowth in several forms of alopecia, different speculations
regarding its mechanism of action have been forwarded. These include
immunomodulation (Fiedler and Buys, 1987, 1988), targeting specific
follicular p otassium channels (Davies et al., 2005 ) or induction of
PGE2 synthesis in the dermal papilla fibroblasts (Michelet et al., 1997).
Traditionally, topical minoxidil has shown to be efficacious for male
pattern hair loss (MPHL) involving the vertex, with an increase of 30% in
hair weight at 96 weeks of treatment compared to placebo (Price et al.,
1999). However, significant clinical data has demonstrated minoxidil’s
efficacy for frontal hair loss as well, which is consistent with histologic
(Whiting et al., 1999) and photographic evidence suggesting that folli-
cles in the vertex and frontal scalp have the same morphology. Indeed
it may take up to one year of treatment before significant changes in
hair growth are detectable by consumers. Minoxidil solution has a
high safety profile (Shapiro, 2003) with scalp irritation occurring in 7%
of patients which has been related to the vehicle (propylene glycol) or
minoxidil (Friedman et al., 2002). Minoxidil 5% foam is propylene glycol
free and is therefore recommended for patients who are suspected to be
sensitive to the vehicle. In the clinical trial of Minoxidil 5% foam (MTF) a
decrease in the incidence of irritation was observed on both the foam
vehicle a nd 5% MTF. Furthermore, the incidence of pruritus with 5%
MTF was 1.1% vs 6% seen in a separate trial of 5% Minoxidil topical solu-
tion (Olsen et al., 2007).
Many dermatologists recommend Minoxidil for age-related thinning
as this process inv olves a decrease in both hair density and the diameter
of the hair follicle (Ebling, 1988), which are successfully treated by
minoxidilinPHL.
Non approved hair regrowth treatments
A plethora of products for hair loss is available on the market, some of
which are easily accessible through different web sites and others are
sold in salons (Table 3). Slogans and claims are provided to the public
of healthy hair seekers indicating the beneficial effects of these products
as solid evidence for promoting hair growth. Hence people may be
provided with questionable information regarding their hair problem
and treatment options. Products for hair loss are sold as shampoos,
solutions, cle ansers, foams conditioners, and leave – in agents. An
array of natural and non-natural occurring ingredients is mixed into
these products (i.e. vitamins, adenosine, retinoic acid, herbal extracts,
minoxidil, ketoconazole, copper peptide, amino acids) as remedies for
hair loss. It is unknown whe ther some of these hair products may
indeed have beneficial effects on the follicl es. Only Rogaine®
(containing minoxidi l) has established evide nce base d sc ience to
substantiate proven efficacy.
Table 2
Good grooming habits
Shampoo daily with mild shampoo which is less irritating to the shaft
Apply shampoo to soaked hair with fingertips and rub gently
Avoid frequent perming
Avoid frequent application of permanent dyes
Avoid frequent bleaching
Comb hair root to tip when dry
Use wide-toothed combs and brushes with rounded tips
Avoid frequent use of hair dryers
Fig. 4. Bubble Hair-Deformed hair shafts due to heat exposure cau sed by dryers and
curling irons.
Table 3
Treatments
Efficacy proven by clinical trials:
Minoxidil 5% solution (or minoxidil 5% foam if allergy occurs with the solution)
Finasteride (Propecia®) 1mg Tab Once daily (for MPHL)Price et al., 2006
Dutasteride (Avodart®) 2.5mg Tab Once daily (for FPHL)
Dutasteride (Avodart®) 0.5mg Tab Once daily (for MPHL) Stough, 2007; Eun et al.,
nd; Olsen et al., 2006
Non approved products with limited clinical data :
Finasteride 2.5mg Tab Once daily (for FPHL) Iorizzo et al., 2006
Hair products with Ketoconazole
Hair products with copper peptide
Hair products combining minoxidil and retinoic acid
Hair products with various vitamins, adenosine and herbal extracts
Estratest +/- finasteride (for senescent hair loss)
164 A. Monselise et al. / International Journal of Women's Dermatology 1 (2015) 161–166
Combinations of minoxidil and retinoic acid probably enhance
the penetration of the former but are unlikely beneficial due to the
neutralizing effect of the latter on m inoxidil. Products that co ntain
both of these components are definitely not recommended by most
hair experts due to potential irritation and unproven efficacy. Further-
more, application of enhancing products in combination with minoxidil
should be separated by at least 2 hours to permit the abso rption of
minoxidil in to the epidermis and prevent its potential deactivation.
The concept of “opening hair follicles” was developed as a marketing
strategy for so me hair care products with allegedly enha nced hair
growth capabilities. However hair follicles are not necessarily closed
therefore it is unclear what are the benefits of such products. Nanosome
technology has been used to enhance th e penetration of some hair
products into the epidermis, but whether it is of benefit for growing
hair is questionable (Rogaine®Scientific Roundtable, 2009). Claims
regarding acceleration of metabolism in the follicle or surrounding
circulation by topically applied vitamins and herbal extracts, as well as
their nourishing effects on the hair follicle and scalp by direct applica-
tion are unknown. Many patients take mega doses of vitamins, which
could cause more harm than benefit. Indeed, consumption of Vitamin
A at doses higher than 5000IU per day may be a risk factor for hair loss.
Hair Fiber Protection
Limited data s upports that replaceme nt of amino acids via a
shampoo increases the tensile of the hair fiber, however this benefitre-
mains unproven (Rogaine®Sci entificRoundtable,2009). Hair products
with sun-screeners are useful as they provide protection to the scalp
and hair form UV ra diation and slow the weathering process. When
sun-screens are compounded as leave-in conditioners this can provide
moisture to the fiber and improve the manageability of the hair. DHT
likely exists on the scalp surface as a component of sebum. It has been
suggested that removal of DHT with clea nsing products containing
ketaconazole can improve hair growth. Literature suggests that ketoco-
nazole has anti-DHT properties, and not only improves seborrhea but
also androgenetic thinning (Pierard-Franchimont et al., 1998; Inui and
Itami, 2007). While the anti-DHT properties has not been proven to
help pattern hair loss, nevertheless the a ssociation of ketoconazole
may contribute to a healthier scalp. Copper peptide is compounded in
some hair products and scientific evidence suggests its beneficial effects
on hair grow th th rough stimulation of human dermal papilla cells
(Pyo et al., 2007), and as a potent activator of both telogen and anagen
follicles in mice (Trachy et al., 1991).
Discussion
Overcoming the denial of hair loss and encouraging people to seek
medical attention earlier rather than later would be valuable in the
overall management of hair thinning/hair loss. When evident alopecia
has ensued, at least 50% of the scalp hair has already been lost. Certain
patient populations are more prone to aging and thinning of their hair,
particularly those who practice certain grooming procedures, whose
hair is grayi ng or fair colored and are inadvertent ly exposed to
weathering factors. Most peo ple do not realize that UV exposure has
negative effects not only on the skin but on the hair as well, especially
when it is devoid of melanin.
Confusion exists around the definition of senescent alopecia
(Kligman, 1988; Ebling, 1988). In-office measurement of age-related
changes in hair density is problematic since an effi
cient instrument or
rating scale has not been identified to measure and monitor diffuse
thinning of th e hair. The scales used for alopecia, such as the SALT
(severity of alopecia tool) score, are not highly applicable to the situa-
tion of senescent thinning. Establishing a “norm” volume of hair for a
patient would be important, as the differences of hair shafts prevents
comparisons between patients. Furthermore, normal hair density
should be defin ed for each age bracket, so the severity of h air loss
could be determine d. Scalp biopsies with horizontal follicular counts
are the gold standard for confirming a reduction in hair number
(Whiting, 1993) but are problematic in everyday practice. Weathering
and grooming habits pose a significant problem in aging patients. Dif-
ferences between declines in hair quality due to weathering v ersus
aging should be clearly characterized to help guide treatment in these
two situations. Grey or chemically/physically treated hair is drier and
more easily weathered, so conditioning is n ecessary to reinforce the
cuticular sheath and protect it from damage. A distinction should be
made between scalp care and care of the hair shaft and proper educa-
tion of the pu blic should be instituted. The former requires regular
cleaning to remove debris and build-up that can negatively impact
hair growth. Before shampooing, untangling the hair is important and
emphasis should be directed at lathering the scalp rather than the hair
shaft in order to remove debris and build-up that can negatively impact
hair growth. The hair fiber is adequately cleaned as the shampoo is
rinsed off the scalp and out of the hair (Rogaine®ScientificRoundtable,
2009). The frequency of shampooing should be tailored according to the
oiliness of the scalp, as very oily scalps require daily shampooing. Some
experts a dvocate applying oil to the hair prior to sham pooing as a
protective measure. The oil would lubricate the hair, making it more
manageable and e asier to comb. In addition, the oil contains tri-
glycerides that are converted in the scalp epidermis to monoglycerides
and diglycerides, which have antifungal properties. However, some of
the triglycerides could be clea ved to free fatty acids that have a pro-
inflammatory effect on the hair follicle (Rogaine®ScientificRoundtable,
2009). Drying the hair should be done gently by patting with a towel,
rather than wrapping the hair. Comb ing done slowly when the hair
has dried out using a wide-tooth comb with rounded tips will eliminate
unnecessary tension and breakage of the hair. African American
patients compared to Caucasians and Asians, pose a particular challenge
for treatment of hair loss having unique hair density, texture, scalp
conditions, and styling techniques that could influence treatment
response. Additionally, African American women are more susceptible
to age-related thinning. This patient population, infrequently shampoo
their hair hence promoting the buildup of products on the scalp which
may negatively affect hair growth. Shampooing th e scalp more
frequently could help eliminate unwanted debris but would also wash
out the sebum and enhance dryness and irritation. Layering of condi-
tioning products may reduce hair breakage and dryness but on the
other hand impair the absorption of hair growth promoting agents
like minoxidil. Additiona lly, Minoxidil may aggravate sc alp and hair
dryness in these patients making compliance and adherence with treat-
ment difficult. Application of Minoxidil foam over several days could
produce a slight scalp residue, which does not affect its efficacy there-
fore avoiding the need of shampooing daily. Furthermore, this residue
could actually have a moisturizing effect since the Minoxidil foam con-
tains long-chain fatty acids found in conditioners. Rogaine®Scientific
Roundtable, 2009 Other measures t hat could improve ut ilization of
minoxidil and compliance of these patients would b e an over-the-
counter shampoo cont aining a low-l evel steroid that targets the
mild inflammation and i rritation of the scalp associated with mi-
noxidil. A combination of a mild shampoo and conditioner that is
rinsed out followed by a leave-in conditioner that is applied while
the hair is still wet could help as well. Indeed daily application of
conditioners to dry hair between shampoos would not interfere
with minoxidil (Rogaine®ScientificRoundtable,2009). The prevalence
and pathophysiology behind follicula r miniaturiz ation in senescent
alopecia merits further investigation to better understand the potential
benefits of minoxidil for this type of hair loss. Identifying the threshold
of hair thinning at which minoxidil would be beneficial for senescent
alopecia is important. Minoxidil has proven efficacy for AGA in men
165A. Monselise et al. / International Journal of Women's Dermatology 1 (2015) 161–166
with frontal (Olsen, 1999). The public should be educated about
grooming habits and weathering factors tha t may aggravate AGA or
senescent hair loss. Recommendations for UV protection with a hat or
by application of a sunscreen pr oduct specific for the hair should
be reinforced.
Conclusions
The advisors agreed that aging of hair is an inevitable process that is
determined by an interplay of many f actors including weathering,
grooming habi ts, UV exposure, hair color, androgenetic alopecia and
other age-related thining. Choice of hair care products is important to
the overall health of scalp and hair. Currently, there is no evidence
based data to suggest that hair care products are efficacious for more
than healthier hair fibers. Further study should be done to determine
if use of these products can provide healthier scalp con ditions, slow
the PHL process, due to androgenetic alopecia and/or age-related
thinning. Minoxidil foam and solution has proven efficacy for AGA and
advisors agreed that their clinical evidence suggests this is a useful
treatment option for age-related thinning as well.
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