Drug that Causes Hair Loss and Promotes Hair Growth-A Review

Abstract

Hair is a major esthetic display feature of the human body, especially in social and sexual interactions. Diagnosis of hair diseases occurred as early as ancient Egyptian times and is one of the oldest medical disciplines. Today, hair loss or thinning, and hypertrichosis or hirsutism are common complaints in clinical dermatology, but patients seeking advice for their hair problem are not necessarily completely bald or overall haired. The difficult task in diagnosing hair and hair disorders is to distinguish between a true disorder and a subjective complaint and to analyze the underlying pathogenesis. Patients consult for focal or diffuse effluvium, non-scarring or scarring alopecia, changes in hair structure or color and hair graying. Establishing the correct diagnosis is the key feature of successfully managing a hair patient.

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____________________________________________Review Article
Drug that Causes Hair Loss and Promotes Hair Growth - A Review
PK. Jain1, Himanshu Joshi1 and DJ. Dass2
1Faculty of Pharmacy, Naraina Vidya Peeth Group of Institution, Kanpur, Uttar Pradhesh, India.
2School of Pharmaceutical Sciences, SOA University, Bhubaneswar, Odessa, India.
_____________________________________________________________________________________
ABSTRACT
Hair is a major esthetic display feature of the human body, especially in social and sexual interactions. Diagnosis of
hair diseases occurred as early as ancient Egyptian times and is one of the oldest medical disciplines. Today, hair
loss or thinning, and hypertrichosis or hirsutism are common complaints in clinical dermatology, but patients
seeking advice for their hair problem are not necessarily completely bald or overall haired. The difficult task in
diagnosing hair and hair disorders is to distinguish between a true disorder and a subjective complaint and to
analyze the underlying pathogenesis. Patients consult for focal or diffuse effluvium, non-scarring or scarring
alopecia, changes in hair structure or color and hair graying. Establishing the correct diagnosis is the key feature of
successfully managing a hair patient.
Keywords: Hair, hair diseases, scarring alopecia, hair graying, hypertrichosis.
INTRODUCTION
Hair is a protein filament that grows through the
epidermis from follicles deep within the dermis. The
fine, soft hair found on many nonhuman mammals is
typically called fur; wool is the characteristically
curly hair found on sheep and goats. Found
exclusively in mammals, hair is one of the defining
characteristics of the mammalian class [Al-Reza et al.
2009]. Hair is an epidermal appendage that lies
within the dermis. Each hair emerges from a tubular
invagination called a follicle. The follicle resembles a
narrow pocket within the skin, as if a tiny finger had
pushed the epidermis down into the Dermis and the
underlying subcutaneous tissue. The lower extreme is
penetrated by the Dermal Papilla an upward
protrusion of connective tissue which produces
microscopic cells of several kinds from which the
hair is formed and developed by cellular elongation
and keratinisation. Hair is closely associated with
sweat gland and sebaceous gland activity [Al-Reza et
al. 2010]. Each hair-producing follicle with its
sebaceous gland is known as a pilo-sebaceous unit.
The arrector pili muscle joins the wall of the follicle
to the epidermis and is responsible for the erection of
hairs and goose flesh during cold weather or
emotional stresses [Ambasta et al. 2004]. The hair
shaft is currently believed to be a dead structure
composed of cells which die after leaving the dermal
papilla. As all follicles are established before birth no
new ones are created thereafter. All characteristics
are genetically determined. Their hairshaft - a
keratinised structure composed of an outer cuticle
(tile-like protective layer of keratinised cells) the
cortex where cells are held firmly together, and an
inner medulla where the cells are larger more loosely
connected and partially separated by air spaces
[Arase et al. 1991]. The hair is approximately
cylindrical.
The hair can be divided into three parts length-wise-
1. The bulb, a swelling at the base which
originates from the dermis
2. The root, which is the hair lying beneath the
skin surface
3. The shaft, which is the hair above the skin
surface.
In cross-section, there are also three parts-
1. The medulla, an area in the core which
contains loose cells and airspaces
2. The cortex, which contains densely, packed
keratin
3. The cuticle, which is a single layer of cells
arranged like roof shingles [Bandaranayke et
al. 2004].

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Fig. 1: The epilated and embedded hair roots under magnification
Hair Cycle
Normal hair follicles undergo periods of growth
(Anagen) followed by regression (Catagen), resting
(Telogen), regenesis ('new' Anagen) with hair
shedding. No hair therefore grows continuously. This
hair cycle, which dictates the ultimate hair length
attainable by an individual, is explained under the
following headings:-
Anagen
The period of follicle regeneration (folliculo-genesis)
with active hair growth. (scalp hairs grow for 2-7
years).Hair in the anagen phase may grow faster
during the early years. Average growth rate is 1-2 cm
per month.
Catagen
The preliminary stage of the retrogressive catagen
phase. During this changes may occasionally be seen
above the skin surface with the naked eye: e.g. loss of
pigment and the narrowing of the hairshaft
accompanied by a narrowing and eventual loss of the
medulla. During this short period of change
(approximately 2 weeks) the follicle rests the dermal
papilla stops production of new cells, the dentrites
and melanocytes contract and melanin production
ceases. The follicle and epithelial sheath contract and
the hairshaft is ejected.
Telogen
The resting phase of the follicle which lasts for
approximately four months. The follicle remains
quiescent in its shortened state and awakens to
regenerate with the onset of the new Anagen phase.
Exogen
The process of hair shedding. Whereas hairs may be
shed at any stage of the cycle, the majority of
shedding occurs during the 'new' Anagen phase
[Bhaumik et al. 2002, Cash 2001].
Fig. 2a: Anagen hair; b. Telogen hair; c. Catagen hair; d. Anagen dysplastic hair; e. (#) Dystrophic and (*)
broken hair

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Hair Density, Numbers of Hairs, Rate of growth
The average human scalp measures approximately
120 sq. inches (770 sq.cm).
The hair covering varies numerically according to
hair colour and ethnicity [Ebling 1987].
Rate of growth
Normal Caucasian hair growth rate is 1-2 cm per
month. Researchers have shown that this rate of
growth may reduce beyond the length of approx.
27cm. Afro-Caribbean hair growth rate is
approximately half that of Caucasian, and due to the
fragility of their multi-helixal structure, rarely attain
great length. Asian hair-shafts grow rapidly
exceeding the average for Caucasians and may attain
great length [Erenmemisoglu et al. 1995, Fujie et al.
1993].
Fig. 3: Modified Ferriman-Gallwey score (mF6): Nine body regions are evaluated for their degree of hair
growth from 0–4. A total score >8 is a sign for hirsutism.
Causes of Hair Loss
Hair loss is a dermatological disorder that has been
recognised for more than 2000 years. It is common
throughout the world and has been estimated to effect
nearly 2% of the world's population [Hattori et al.
1983, Jahoda et al. 1992].
 Apart from metabolic and hereditary causes
alopecia has been observed as a major side
effect of anticancer, immunosuppressant and
many others drug treatments.
 Low thyroid function (hypothyroidism) can
cause a thick oily scalp, with coarse sparse
hair, or actual baldness. Over active thyroid
function (hyperthyroidism) results in sparse
fine hairs.
 Damage of pituitary gland that stimulates
the thyroid gland, sex glands and adrenal
cortex also result in hair loss.
 Excess formation of male hormones due to
any of the disorders can be a cause of hair
fall.
 Heredity may also play an important role.
Sushruta stated that romkoop (hair follicles)
never increase, they remains constant, since
birth [Jain et al. 2006].
 Most popular theory of alopecia areata states
it as an autoimmune disease where the
immune system of the body attacks the hair
follicles.
 Inadequate calories and insufficient protein
intake will affect your hair, if you are on a
crash diet to loose your extra weight. Hair
loss can occur [Kim et al. 2002].
 In anorexia nervosa, a psychosomatic
problem associated with refusal to eat an
adequate amount of food may also affect
hair.
 Severe psychic stress results in sudden loss
of hair. Biological stress is a more common
cause of sudden hair loss. Any number of
surgical operations, haemorrhage or shock
associated with an accident can cause it.

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 There are number of mechanical stresses on
the scalp and hair that can cause hair loss
[Liang et al. 1997].
 Post partum alopecia - About two to five
months after having a baby, women may
suddenly start loosing hair. The hair loss
may continue for several months, but
eventually there is a complete restoration of
normal hair. The cause is not clear.
 Severe fever or any illness associated with
prolonged fever may result in a subsequent
loss of hair [Oliver 1970].
 Diseases, particularly those associated with
weight loss, which usually means mal
nutrition as well, may also cause alopecia.
This includes cancer of lymphoma group
[Paus 1998].
 Tuberculosis and syphilis may rarely cause
alopecia.
 Some patients have autoimmune diseases
such as systemic lupus erythematosus.
Alolpecia is a useful diagnostic pointer for
that and is seen in more than 50% of
patients.
 Tinea capitis, which is a fungal infection of
the scalp, may cause a localized loss of a
patch of hair that resembles alopecia areata,
but that spot usually has scales and other
changes by which doctor can identify it
[Paus et al. 1991].
 Certain beauty practices can lead you to hair
loss. Hair styles that cause pulling on the
hair providing constant traction cause
traction alopecia, when the hair is pulled
back from the frontal hairline, as in a
ponytail, top knot etc. You can see the
stretched hair contributing to a receding
hairline. Alopecia may occur in those who
straighten their hair with a hot comb and use
hot petrolatum with iron e.g., crimping or
hot water bath etc. This causes thermal
damage to the hair follicle and may
eventually lead to irreversible destruction of
hair follies [Price 1999].
 Certain techniques can damage the hair
shaft, but it won’t affect the hair growth.
You can regard the hair shaft as a piece of
dead wood. It can become dry and cracked
or broken if not properly cared for, or if
subjected to harsh chemicals e.g., hair
bleaching and colouring [Rathi et al. 1998].
 Many medicines may cause hair loss. The
most common are those, which are used for
chemotherapy, in the treatment of cancer,
particularly doxorubicin and
cyclophosphamide. If such drugs are
prescribed, physicians warn the patients in
advance [Roh et al. 2002].
 Medicines used to treat arthritis
(Penicillamine, Indomethacin, Naprosyn and
Methotrexate), parkinson’s disease
(levodopa); any other medication which has
an androgenic (male) hormone action, such
as - anabolic steroids, often used by athletes
and bodybuilders or danocrine used for
treating endometriosis in women causes hair
loss.
 Oral contraceptives may sometimes causes
loss of hair.( Progestins & Estrogens)
[Souleles et al. 1998].
 High blood pressure beta-blocker
medications that have been noted to
occasionally cause hair loss include:
Atenolol (Tenormin), Metoprolol
(Lopressor), Nadolol (Corgard), Propranolol
(Inderal), and Timolol (Blocadren).
 Prescription NSAIDs that may also cause
hair loss include: Celecoxib (Celebrex),
Diclofenac (Voveren), Etodolac (Lodine),
Fenoprofen (Nalfon), Indomethacin
(Indocin), Ketoprofen (Orudis, Oruvail),
Oxaprozin (Daypro), Nabumetone
(Relafen), and Sulindac (Clinoril) [Stenn et
al. 1998].
These medicaments do not always have this side
effect as many patients use these without hair loss,
still one should keep this in mind that thinning or fall
of hair could occurs.
Method for preventing hair loss
a. Fruit and vegetables should be taken in
abundance to facilitate the supply of
essential vitamins and minerals.
b. Endocrine abnormalities like
hyperthyroidism, disorders that result in an
excess formation of male hormones, an
autoimmune disease like SLE etc., should be
properly managed by treatment.
c. Don’t go for a crash diet to lose your weight
as it causes damage to your health and will
affect your hairs also. Return to proper
nutrition that provides you sufficient protein
and required calories, to recover normal hair
growth.
d. Avoid tension, stress, worries, anger, etc., as
far as possible.
e. Avoid inflicting mechanical tension to the
hair by pulling, crimping etc. Certain beauty
practices like trimming, using strong hair
colour etc., impart sufficient damage to the
hair.

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f. Avoid such hairstyles, which pull back hairs
from frontal hairline.
g. Don’t use hot combs or hot water bath for
hairs.
h. Take care of hair shafts also by proper oiling
etc., to avoid dryness or cracking of it.
i. Don’t use harsh chemicals (certain
shampoos) over scalp.
j. If dandruff is there take proper treatment. A
high fat intake including whole milk, butter,
cream, cheese chocolates etc., often worsens
the dandruff condition; better avoid it
[Stough et al. 2001].
Medication for your hair fall has to be taken in the
earlier stages because if all the hair has fallen out and
the follicles have closed, nothing much can be done.
Hair loss treatment Available
Specialists often biopsy hair to determine the
integrity of a given hair follicle. This evaluation is
used to establish the underlying cause of the hair
thinning / balding, and to decide what treatment
options are available.
Counseling of Patient
An explanation of alopecia areata, including
discussion of the nature and course of the disease and
the available treatments, is essential. Some patients
are profoundly upset by their alopecia and may
require psychological support. Contact with other
sufferers and patient support groups may help
patients adjust to their disability. The decision to treat
alopecia areata actively should not be taken lightly.
Treatment can be uncomfortable for the patient, time
consuming and potentially toxic. It may also alter the
patient’s attitude to their hair loss. Some patients find
it difficult to cope with relapse following or during
initially successful treatment and they should be
forewarned of this possibility. These considerations
are particularly important in children where the social
disruption and focusing of the child’s attention on
their hair loss, which may result from active
treatment, have to be weighed carefully against the
potential benefits. On the other hand, some patients
are appreciative that something has been tried, even if
it does not work.
Traditional / Herbs used as medicines for hair
growth include
i. Aromttherapy and include scalp blood
circulation- Ginkgo biloba( ginkgoaceae),
thyme vulganis (lamiaceae), cedrus
atlantica( Pinaceae)
ii. Few herbal preparation and method of
application for the treatment of alopecia as-
Phyllanthus embelica( Euphorbeaceae),
Rosmarinus officinalis ( labiatae) Allium
cepa (liliaceae) glycyrrhiza glabra(
leguminosae)
iii. Bacopa monniera include alkaloids,
saponins and sterols [Kulshreshtha et
al.1973].
iv. Spore of Lygodime jubonicum- inhibit
testosterone 5-α-reductase activity. It
contain oleic acid, linolic acid and palmiitc
acid
v. Eclipta alba extract with potential for hair
growth activity.
vi. Semecarpus anacardium, Trigonella
Foenumgracum. Trigonella conniculata,
Zizyphus jujube essential oil, Hibiscus rosa
sinensis [Adhirajan et al.,2003].
vii. Tridax procumbens L. (Compositae) is a
weed found throughout India. The plant is
known to local people as “Ghamara” and is
dispensed for “Bhringraj” by some of the
practitioners of Ayurveda .
viii. Cuscuta reflexa Roxb.(Convolvulaceae) is a
leafless, twinning, parasitic dodder with
slender long yellow stems distributed in
tropical and temperate region and common
throughout India.
Synthetic drugs used as medicines for hair
growth include
 Minoxidil- used for hair regrowth and to
inhibit any additional loss of hair
 Tretinion- decreases dermal layers on scalp
to further the penetration of applied products
containing minoxidil
 Hair Transplantation
 Topical or Injectable Steroid Treatments
 Finasteride (Propecia)
 Radiation Therapy (PUVA) [Takahashi et al.
1998]

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Role of Nutritional Supplement for Prevention of Hair Loss: [Uno et al. 1993]
Supplement Application
Essential Fatty Acids (EFAs) Improves Hair Texture
Raw Thymus Glandular Improves Functioning Capacity of Hair Glands
B-complex Vitamins Extremely Important Nutrients for the Overall Health and Growth of Hair
Biotin Deficiencies of Biotin Have Been Linked to Hair Loss
Inositol Critical for Proper Hair Growth
Methylsulfonyl-methane (MSM) Assists With Production of Keratin, a Protein Component of Hair
Vitamin C with Bioflavonoids Provides Antioxidant Action in Hair Follicles/Increases Scalp Circulation
Vitamin E Also Increases Scalp Circulation, d-alpha tocopherol Improves Health and Growth of Hair
Zinc Stimulates Hair Growth via Immune System
Coenzymes Q10, A Increases Tissue Oxygenation in Scalp
Dimethylglycine (DMG) Circulation Properties
Kelp Dense Mineral Which Assists in Hair Growth
Copper Used in conjunction with Zinc, Chelated Copper Aids in Hair Growth
Grape Seed Extract Antioxidant Properties Protect Follicles from Free Radical Damage
L-Cysteine, L-methionine,
Glutathione Amino Acids which Prevent Hair Fallout/Promotes Blood Supply to Scalp
Silica Aids in the Health and Growth of Hair
L-Lysine Inhibits 5-alpha-reductase Conversion of Testosterone into Dihydrotestosterone
L-Arginine Enhances Nitric Oxide to Promote and Maintain Health and Growth of Hair
Saw Palmetto Block 5-alpha-reductase, Provides a Reduction in DHT Uptake by Follicles, Blocks Binding of DHT to
Specific Androgen Receptors
Green Tea Extract Adversely Affect type I 5-alpha-reductase
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