Risk Factors for Developing Pattern Baldness

With a high prevalence of baldness in the population, it seems quite common, especially as we age, to be concerned over those stray hairs building up in your hair brush and shower drain. But how likely are these concerns to come to fruition?  It’s impossible to predict with 100% certainty but there are some contributing factors that can increase your odds of developing pattern baldness. Likewise there are some urban legends in current circulation which have turned out to have absolutely nothing to do with your hair growth potential.

Age

Age is probably one of the first things to come to mind when discussing hair loss and unsurprisingly, your risk of hair loss does in fact increase with age. By age 50 years, the likelihood of male pattern hair loss has increased by 20% from age 30 years (1).

Genetics

Male pattern baldness is heritable (3). It is triggered by hormones called androgens. Some people can be genetically pre-disposed to be sensitive to androgen levels in the scalp, leading to hair loss. A family history is not a guarantee however, as it is believed to be a complex disorder that involves multiple genes as well as environmental factors (4).

Race and Sex

Males are significantly more likely to be affected in comparison with females (5). Similarly there is a lower prevalence in both Asian and black populations (6–9).

Alcohol

Consumption of alcoholic beverages has been associated with male-pattern baldness (2).

Weight

A negative correlation with body weight and development of male pattern baldness has been reported(2). Specifically, less hair loss was observed in those with less weight gain in their younger years (2).

Occupational and Environmental Factors

Research following occupational groups has also revealed some contributing factors. Studies show that people involved with certain types of work were twice as likely to develop pattern hair loss. Investigators identified increased exposure to sunlight and obesity at a young age as the root cause (10).

Non-risk factors

According to current research, your acne or marital status will not affect your hairline. Additionally, although a host of other unrelated  issues with smoking have been suggested, it is not believed to lead to hair loss (2).

Remember, this list is composed of risk factors only.  Having any or all of them does not ensure hair loss. If you are concerned though, speak with a hair loss specialist to assess your individual situation.

Article by: Dr. J.L. Carviel  PhD, Mediprobe Research Inc.

References

1. HAMILTON JB. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. 1951 Mar;53(3):708–28.
2. Severi G, Sinclair R, Hopper JL, English DR, McCredie MRE, Boyle P, et al. Androgenetic alopecia in men aged 40-69 years: prevalence and risk factors. Br J Dermatol. 2003 Dec;149(6):1207–13.
3. Birch MP, Messenger AG. Genetic factors predispose to balding and non-balding in men. Eur J Dermatol EJD. 2001 Aug;11(4):309–14.
4. Levy-Nissenbaum E, Bar-Natan M, Frydman M, Pras E. Confirmation of the association between male pattern baldness and the androgen receptor gene. Eur J Dermatol EJD. 2005 Oct;15(5):339–40.
5. Norwood O. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg. 2001;27(1):53–4.
6. Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Hairdressing and the prevalence of scalp disease in African adults. Br J Dermatol. 2007 Nov;157(5):981–8.
7. Paik JH, Yoon JB, Sim WY, Kim BS, Kim NI. The prevalence and types of androgenetic alopecia in Korean men and women. Br J Dermatol. 2001 Jul;145(1):95–9.
8. Tang PH, Chia HP, Cheong LL, Koh D. A community study of male androgenetic alopecia in Bishan, Singapore. Singapore Med J. 2000 May;41(5):202–5.
9. Su L-H, Chen TH-H. Association of androgenetic alopecia with smoking and its prevalence among Asian men: a community-based survey. Arch Dermatol. 2007 Nov;143(11):1401–6.
10. Su L-H, Chen H-H. Androgenetic alopecia in policemen: higher prevalence and different risk factors relative to the general population (KCIS no. 23). Arch Dermatol Res. 2011 Dec;303(10):753–61.

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The Hair Growth Cycle

Hair growth occurs from within the hair follicle in the skin. The hair follicle goes through a cycle of growth containing four main stages:

• Anagen – active growth
• Catagen – regression
• Telogen – rest
• Exogen – shedding

Each individual strand of hair is at a different stage of development in any one moment in time, making changes in these phases generally unnoticeable.

Anagen

During each anagen phase a completely new hair forms. Growth of the new hair shaft lasts on average three years, but can last up to 7 years. Men and women with androgenetic alopecia have a shortened anagen phase and smaller hair follicles (1), whereas those with hirsutism have a longer anagen phase and more hair growth (2). During anagen, hair color is generated from specialized pigment-producing cells (3). Once color production stops, the hair shaft has entered the catagen phase (4).

Catagen

During this phase the hair follicle shrinks and further growth of the hair is prevented. Catagen phase lasts a few weeks.

Telogen

The hair does not grow or shrink at this point; it is in a resting phase which lasts approximately 3 months.

Exogen

The hair that was resting will now fall out and make room for new hair to grow. This process occurs independently of new hair formation in the underlying hair follicle (5), as a new hair has likely already started forming. It usually takes some time before a new anagen phase hair emerges, and this period is referred to as the kenogen phase (6). Men and women with androgenetic alopecia have a longer and more frequent kenogen phase (6), resulting in less hair on their head.

Article by: Dr. C.D. Studholme Ph.D. , Mediprobe Research Inc.

1. Sinclair RD, Dawber RP. Androgenetic alopecia in men and women. Clin Dermatol. 2001 Apr;19(2):167–78.
2. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003 May;101(5 Pt 1):995–1007.
3. Passeron T, Mantoux F, Ortonne J-P. Genetic disorders of pigmentation. Clin Dermatol. 2005 Feb;23(1):56–67.
4. Slominski A, Paus R, Plonka P, Chakraborty A, Maurer M, Pruski D, et al. Melanogenesis during the anagen-catagen-telogen transformation of the murine hair cycle. J Invest Dermatol. 1994 Jun;102(6):862–9.
5. Piérard-Franchimont C, Piérard GE. Teloptosis, a turning point in hair shedding biorhythms. Dermatol Basel Switz. 2001;203(2):115–7.
6. Rebora A, Guarrera M. Kenogen. A new phase of the hair cycle? Dermatol Basel Switz. 2002;205(2):108–10.

Photo taken from http://www.depilarsystem.com/_downloads/hair_growth_US.pdf

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Clinical trials demonstrate effectiveness of low level laser therapy (LLLT) helmet device

Low level laser therapy (LLLT) uses red light to stimulate hair growth. Two recent clinical trials investigated the use of a home-use LLLT helmet device (iGrow helmet, Apira Science) in men¹ and women² with androgenetic alopecia. The bicycle-like apparatus was used in the home for 25 minutes, every other day for 16 weeks, totaling 60 treatments. Patients in the control group used an identical helmet, but with incandescent red lights. These clinical trials were double-blinded, meaning that patients and the doctor evaluating treatments did not know which device (LLLT or control red light) a person had used.

Forty one men completed the clinical trial, 22 in the LLLT group and 19 in the control group. Pictures of the scalp were taken before treatment (baseline) and after treatment, with the area of interest being the vertex area of the head where hair loss was occurring. At the end of treatment (16 weeks), the percent increase in hair counts from baseline was calculated for each person. LLLT produced an increase in hair counts of 35% as compared to the control treatment. An average increase of 30.4 hairs/cm² was observed in the LLLT group, compared to an average decrease of -0.11 hairs/cm² in the control group.

Forty two women completed the clinical trial, 24 in the LLLT group and 18 in the control group. The procedure was similar as above, with pictures taken before and after treatment. The area of interest was again the vertex area of the head and the percent increase in hair counts from baseline was calculated for each person. LLLT produced an increase in hair counts of 37% as compared to the control treatment. An average increase of 35.2 hairs/cm² was observed in the LLLT group, compared to an average increase of 8.39 hairs/cm² in the control group.

In both clinical trials, there were no adverse side effects reported. The LLLT helmet device was safe and effective in increasing hair growth in men and women with androgenetic alopecia. In men, there was an average increase in hair of 35% and in women, an average increase of 37%. These clinical trials, at 4 months, were shorter than other clinical trials that have been conducted. Depending on the individual, it may take up to 6 months before one can determine whether LLLT is effective.

References:

1. Lanzafame RJ, Blanche RR, Bodian AB, Chiacchierini RP, Fernandez-Obregon A, Kazmirek ER. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers Surg Med 2013;45:487–95.
2. Lanzafame RJ, Blanche RR, Chiacchierini RP, Kazmirek ER, Sklar JA. The growth of human scalp hair in females using visible red light laser and LED sources. Lasers Surg Med 2014;46:601–7.

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Facial Hair Restoration

Over the last couple of years, facial hair transplants (particularly beard transplants) have grown in popularity. Various media outlets have noticed this growing trend.(1) Facial hair restoration can be used to create natural appearing facial hair where hair is sparse or completely absent. This can include restoring hair to the eyebrows, beards, goatees, mustaches, and sideburns.(2) Hair may be sparse or absent due to genetics, prior laser hair removal or plucking, trauma, or previous cosmetic surgery.(2)

The principle behind facial hair restoration is the same as scalp hair restoration.(3)  The donor hair comes from either the back or sides of the scalp, depending on which location matches the facial hair the best. If the patient is bald, donor hair from the body (e.g. chest) may be used. Hairs are transplanted using either strip-follicular unit grafting or follicular unit extraction (FUE).(2) The number of grafts required can vary depending on the area being restored. For example, a mustache restoration may require 350-500 grafts whereas a full goatee can require 600-700 grafts.(4) The hairs are carefully placed at the correct angle and in the right direction to create a natural look. Overall, facial hair restoration generally takes about 2-8 hours to complete and is performed under local anesthesia.(4) The transplanted hair is permanent and can be shaved just like regular facial hair. If you are considering a facial hair transplant, please contact one of our qualified hair transplant surgeons for more information.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Dalal M. Beard transplants a growing trend [Internet]. 2014 [cited 2015 Nov 18]. Available from: http://www.cbc.ca/news/health/beard-transplants-a-growing-trend-1.2592967
2. Epstein J. Facial hair restoration: hair transplantation to eyebrows, beard, sideburns, and eyelashes. Facial Plast Surg Clin N Am. 2013 Aug;21(3):457–67.
3. Gandelman M, Epstein JS. Hair transplantation to the eyebrow, eyelashes, and other parts of the body. Facial Plast Surg Clin N Am. 2004 May;12(2):253–61.

4.         Facial Hair Transplant [Internet]. Foundation For Hair Restoration. [cited 2015 Nov 17]. Available from: http://www.foundhair.com/pages/facial-hairtransplant.shtml

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Use of Body and Beard Hair in Hair Restoration

One of the limiting factors in hair transplantation is the amount of donor hair that an individual has on the scalp. For patients with extensive hair loss scalp donor hairs may not provide sufficient coverage for all affected areas. Body hair transplantation has emerged as a new option for selected patients with poor donor scalp hair and good body hair.¹

Follicular unit extraction (FUE) makes it possible to extract the individual follicular units from the body and beard donor areas without strip excision and suturing. It is important to keep in mind that the characteristics of body and beard donor hair differ from scalp donor hairs in length, growth cycles, shaft diameter (calibre), curl, and colour, which do not change when the hair is transplanted to the scalp. Thus, proper planning is critical when using the different types of donor hair for transplanting.

Beard hair is a good option for donor hair due to its thicker caliber and the length that may be achieved after transplantation compared to hair from other areas of the body. Chest hair is also a good candidate for body donor hair as it has been shown to have the lowest transection rate (the potential for damage that can occur to the hair follicles during transplantation). Donor hair from the back, arms, and abdomen have also been used in hair transplants; however this hair is thinner and has been shown to have a higher transection rate.²

However, the use of body hair in hair restoration is still a relatively new concept, for which limitations and concerns still need to be addressed:

• The procedure is possible only in patients who have a good amount of body/beard hair.
• The procedure is performed by an extraction method which may produce small scars to the body donor area.
• Follicular unit extraction can be a slow and painstaking method. As such, the procedure requires a high degree of motivation from the patient as multiple sessions may be required to achieve desired results.
• Body hairs are usually found as 1 and 2 hair units, and hence the density and thereby results achieved may not be as impressive as with scalp hair.
• Body hairs are shorter in length and thinner, which means that transection rates will be higher than those of scalp donor hairs. While transection rates with scalp hairs are 5% or lower, the rate of transection with body hairs ranges from 13-32%.²

Article by: Dr. M. Cernea Ph.D., Mediprobe Research Inc.

References

1. Umar S. 2013. Use of body hair and beard hair in hair restoration. Facial Plast Surg Clin North Am.; 21(3):469-77.
2. Venkataram, M. 2013. Body Hair Transplantation: Case Report of Successful Outcome. J Cutan Aesthet Surg.; 6(2): 113–116.

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Treating Alopecia Areata with Platelet-Rich Plasma

Alopecia areata (AA) is an autoimmune condition which results in hair loss. It affects both women and men of all age groups and symptoms range from mild with only slight patches of hair loss typically of the scalp, to extreme, with loss of scalp and body hair including eyebrows and eyelashes.  Prognosis is also diverse with spontaneous remission observed in some cases and a completely unresponsive nature in others. Thus it is exciting to hear the recent report of an extreme case that resulted in successful treatment.

This past month the story of a 15-year-old boy who had lost 80% of his hair (including body hair) due to AA was reported. After five years with AA and undergoing multiple traditional treatments, platelet-rich plasma (PRP) therapy was finally able to restore the lost hair (1). With the post-treatment photographs featuring a full head of long hair, the results were impressive (1). PRP therapy is a relatively new treatment employed for multiple types of hair loss. Growth factors obtained from a small sample of the boy’s own blood were used to stimulate the new hair growth.

Two scientific studies lend some credibility to this case. A randomized, controlled trial concluded that PRP therapy led to significant growth and recommends further investigation into PRP as a safe and effective treatment option for AA (2). A second trial reported a lack of side-effects associated with the procedure and confirmed safety (3).

Overall, AA can be challenging to treat. This makes the introduction of innovative therapies such as PRP essential to improving upon the current options. Initial therapies are generally potent topical or intralesional corticosteroids. Please consult with your health care provider if you think that you may have this condition.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. Vekris A, Zefeiratou D, Andriopoulou A, Tsiatoura A. Total Regrowth in Chronic Severe Alopecia Areata Treated with Platelet Rick Plasma: A Case Report and Literature Review. Hair Transpl Forum Int. 2015;(September/October):190–1.
2. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013 Sep;169(3):690–4.
3. Singh S. Role of platelet-rich plasma in chronic alopecia areata: Our centre experience. Indian J Plast Surg Off Publ Assoc Plast Surg India. 2015 Apr;48(1):57–9.

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What is low level laser (light) therapy (LLLT)?

Low level laser therapy, also known as low level light therapy (LLLT), uses red light to stimulate hair follicles to grow. Laser light therapy is used to treat many dermatological conditions, as well as wound healing and joint pain relief. Possible mechanisms of action include extension of the growth phase of hair follicles (anagen) or re-entry of resting hair follicles into the growth phase (telogen to anagen).^{1, 2} LLLT requires hair follicles to be present in the dermal (mid) and subcutis (deep) layers of the skin.

In office LLLT devices have more diodes/ LEDs and are more effective than the devices available for home use. When in-office treatment is not possible then there are devices that can be used at home or combined with in-office visits. Home use devices include laser helmets/ caps/ combs. The only devices cleared for home use by Health Canada are the iGrow Helmet (Apira Science) and the HairMax Laser Comb (Lexington).

Clinical research has demonstrated that the efficacy of LLLT therapy may be similar to that of the use of 5% minoxidil (Rogaine) and oral finasteride. However, individual results may vary. For optimal results the source of the light has to be close to the scalp. The effectiveness of LLLT likely depends on consistent use (3 times/week) for at least 6 months,^3–5 and as long as 12 months, depending on the individual’s response.

References:

1. Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers Surg Med 2014;46:144–51.
2. Keene SA. Part 2: LLLT Devices, Medical Device Regulation, and Impact on Development. Hair Transpl Forum Int 2015;25:10–2.
3. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky M, Hickman JG, Hamblin MR, et al. Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study. Am J Clin Dermatol 2014;15:115–27.
4. Lanzafame RJ, Blanche RR, Chiacchierini RP, Kazmirek ER, Sklar JA. The growth of human scalp hair in females using visible red light laser and LED sources. Lasers Surg Med 2014;46:601–7.
5. Lanzafame RJ, Blanche RR, Bodian AB, Chiacchierini RP, Fernandez-Obregon A, Kazmirek ER. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers Surg Med 2013;45:487–95.

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Are You a Hair Transplant Candidate?

There are a few things you should take into consideration to determine if you are a good candidate for a hair transplant.^1,2

One of the most important factors to consider is expectations. If you are expecting to regain your adolescent hairline or a full head of hair, you are setting yourself up for unrealistic expectations and disappointment. The goal of hair transplantation is multifaceted. Density is without a doubt, one of the top priorities for most patients; however, other factors should also be considered.

Naturalness should be the most important factor to consider in a hair transplant. A good hair transplant clinic will give you the appearance of a natural adult hairline and naturalness throughout the mid-scalp and crown (including recreating the crown whirl).

Symmetry would be the second most important consideration – a patient with a high density frontal 1/3 and thinning mid-scalp and crown is less visually appealing than a patient with a moderately dense frontal 1/3 and good coverage in the mid-scalp and crown.

Coverage is also an important consideration and is linked with symmetry. There are limitations to how much hair can be transplanted from your donor area to the area of hair loss and the expectations should be managed both from a patient’s perspective and the hair transplant clinic. Almost any top clinic can transplant 70 FU/Cm2. Just because one can, does not mean one should. You should discuss your expectations with your hair transplant surgeon so that realistic goals are established, not only to satisfy your expectation today, but to ensure that your future goals are met as you age. Establishing reasonable expectations is very important prior to the transplantation through pre-operative consultations.

Although there is no specific minimum age requirement for a hair transplant, it is easier to determine the progression and severity of hair loss with increasing age. Typically, the younger you start to lose your hair, the worse it gets with time. For instance, if you experience significant hair loss during your 20’s, you may be able to get a hair transplant, but eventually the hair loss may become so drastic that there may not be enough hair follicles in the donor area left to finish the job as you age. This is why a younger patient should strictly adhere to the FUE procedure – as the head can be shaved in cases of more severe hair loss in the future.  As such, the ideal age for an FUT/STRIP hair transplant is the mid 30’s to late 40’s. If you want to determine how your hair loss will progress, take a look at your father and uncles and/or grandfathers on both paternal and maternal sides – assume that their most severe hair loss will resemble yours at their age. It is better to be conservative rather than too optimistic, and to wait if you are unsure about how your hair loss will progress.

Ideal candidates for hair transplant surgery are:

• Men and women in their mid-30’s to late 40’s, who have been experiencing hair loss for many years and who’s hair loss pattern has stabilized. If you are in your 20s and are severely impacted by the hair loss from a quality of life point of view, then this should be discussed with the doctor.
• Men who have been losing their hair due to male pattern baldness for several years or who have progressed to a late stage 2 or above in the Norwood scale. Patients with Norwood 1 hair loss should initially consider non-surgical treatments such as 5% minoxidil (Rogaine) or low level laser therapy. Oral Finesteride may not be recommended in men of child bearing age due to potential negative side effects such as impotence.
• Men and women with realistic expectations who understand that their hair loss might continue to progress even after a hair transplant.
• Men and women who have lost hair due to traction, other trauma, or burns, or due to other cosmetic procedures such as face-lifts.

 

Other factors to consider:

• Is your hair straight or curly? When transplanted, curly or wavy hair usually looks denser and gives the impression of more hair.
• What colour is your hair? Based on the colour of your hair and how it contrasts with your skin colour, it may give the appearance of a fuller, more natural hairline (e.g. the hairline of a Caucasian individual with light hair may look fuller than the hairline of a Caucasian individual with dark hair).
• How much hair do you have in your donor area? The amount of hair that can be transplanted depends on the amount you have available at the back of your scalp, in your donor area.

Individuals with certain types of scarring alopecia, autoimmune disease, telogen effluvium, trichotillomania, or body dysmorphic disorder, are generally not considered good candidates for hair transplantation.

In order to determine if a hair transplant is right for you, please consult a hair transplant surgeon for an in-depth consultation and evaluation.

 

References

1. Avram, MR. 2012. Hair Transplantation. Cutis; 90(6):317-20.

2. Rose, PT. 2012. Hair restoration surgery: challenges and solutions. Clin Cosmet Investig Dermatol; 8: 361–370.

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Oral tofacitinib for combined treatment of psoriasis and hair loss caused by alopecia universalis

Alopecia areata is a special form of hair loss with an autoimmune basis, with alopecia universalis being a more severe presentation of this condition. Most of the clients seen at Sure Hair have male- or female- pattern hair loss known as androgenetic alopecia.

A recent case study by Craiglow and King demonstrate the use of tofacitinib to reverse hair loss in a patient suffering from plaque psoriasis and alopecia universalis (1). Tofacitinib (Xeljanz®) was United States Food and Drug Administration (US FDA) approved in 2012 for the treatment of rheumatoid arthritis (2). However, several studies have demonstrated the safety and efficacy of tofacitinib oral and topical formulations for the treatment of plaque psoriasis (3–5). Tofacitinib works by inhibiting the activation of inflammatory signaling pathways that are seen in autoimmune diseases such as psoriasis and alopecia (6).

The patient in this case study had a history of patchy hair loss on the scalp known as alopecia areata, which began during childhood. This hair loss slowly progressed from hair loss on the scalp to hair loss on the entire body by age 18. Full body hair loss is known as alopecia universalis and includes hair loss of eyebrows and eyelashes. A few years after the loss of all hair, the patient began to exhibit symptoms of psoriasis, which progressed to cover a significant portion of his body. Treatment with adalimumab was able to clear the psoriasis for a period of time, however the psoriasis persisted. The patient wanted to try something new to combat his autoimmune diseases since adalimumab was not enough. Therefore, he looked at off-label treatment with a drug approved for arthritis; tofacitinib. Before treatment with tofacitinib the patient had no hair on his scalp, face (including eyebrows and eyelashes), arms, legs, torso, armpits, or groin. He also had several large psoriatic scaly plaques that were pink-red in coloration on his scalp, torso and elbows.

The patient took tofacitinib 5 mg twice a day to treat symptoms of both psoriasis and alopecia universalis. Partial regrowth of hair on the scalp was seen as early as 2 months after treatment began. His dosage was then increased to 15 mg daily, which led to complete regrowth of the scalp hair after 3 months. Furthermore, hair began to grow back on the face, groin region and armpits as well. After 8 months of treatment the patient had full regrowth of all body hair. Although some symptoms of psoriasis remained, the patient was so pleased with the regrowth of hair that he remains on tofacitinib. The dosage level of 15 mg of tofacitinib daily was well tolerated, however further clinical trial testing would need to be done to test the safety and efficacy of tofacitinib for treatment of combined psoriasis with alopecia. There are currently 3 clinical trials underway to study the efficacy of tofacitinib in moderate to severe alopecia areata and its variants (NCT02299297, NCT02197455, NCT02312882).

If you are experiencing patchy hair loss or hair loss on several body parts consult your doctor to determine the best treatment regimen for you.

Article by: Dr. C.D. Studholme, Mediprobe Research Inc.

1. Craiglow BG, King BA. Killing two birds with one stone: oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis. J Invest Dermatol. 2014 Dec;134(12):2988–90.
2. Xeljanz (package insert). New York: Pfizer, 2012. Available from: http://labeling.pfizer.com/ShowLabeling.aspx?id=959.
3. Boy MG, Wang C, Wilkinson BE, Chow VF-S, Clucas AT, Krueger JG, et al. Double-blind, placebo-controlled, dose-escalation study to evaluate the pharmacologic effect of CP-690,550 in patients with psoriasis. J Invest Dermatol. 2009 Sep;129(9):2299–302.
4. Papp KA, Menter A, Strober B, Langley RG, Buonanno M, Wolk R, et al. Efficacy and safety of tofacitinib, an oral Janus kinase inhibitor, in the treatment of psoriasis: a Phase 2b randomized placebo-controlled dose-ranging study. Br J Dermatol. 2012 Sep;167(3):668–77.
5. Ports WC, Khan S, Lan S, Lamba M, Bolduc C, Bissonnette R, et al. A randomized phase 2a efficacy and safety trial of the topical Janus kinase inhibitor tofacitinib in the treatment of chronic plaque psoriasis. Br J Dermatol. 2013 Jul;169(1):137–45.
6. O’shea JJ. Targeting the Jak/STAT pathway for immunosuppression. Ann Rheum Dis. 2004 Nov;63 Suppl 2:ii67–71.

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Hirsutism: Strategies for unwanted female hair growth

At Sure Hair International we are involved in helping clients regrow their hair. In this blog we will look at the opposite situation: how to deal with unwanted female hair growth.

Hirsutism is the appearance of male-patterned hair growth such as beards as well as chest and back hair in females. It affects between 5 – 15% of women, and in most cases is believed to be the result of higher-than-normal levels of male hormones referred to as androgens (1–4). This is why it is important for hirsuate women to seek professional consultation, as there may be additional underlying issues. Nonetheless there are a variety of treatment options available and a recent article has analyzed both the efficacy and potential for side-effects of each. Use of drugs to suppress or block the excess androgens as well as very low calorie diets were among the therapies investigated.

Oral Contraceptive Pills

As a method of hormone suppression, oral contraceptives are used in mild cases as a first-line treatment, and may be combined with  androgen blockers after 6 months if required (5,6). Multiple types of oral contraceptives were evaluated and were found to be equally effective (7).  Combining oral contraceptives with additional therapies such as cyproterone acetate was believed to boost results versus oral contraceptives alone (7).

Flutamide and Spironolactone

Flutamide and spironolactone are examples of androgen blockers and are generally used in more severe cases. Flutamide and spironolactone treatment were shown to produce similar results (7). Use of flutamide led to reports of breast tenderness and dry skin while some spironolactone-users  reported irregular bleeding (7).

Finasteride and Gonadotropin-Releasing Analogues   

Finasteride and gonadotropin-releasing analogues are more examples of drugs designed to block or suppress the actions of the unwanted androgens. They were both shown to have some success for this purpose but results were inconsistent (7). Finasteride use resulted in reports of breast tenderness and dry skin while hot flushes and headaches were related to gonadotropin-releasing analogue use (7).

Very Low Calorie Diets

As weight and insulin sensitivity can be linked to hirsutism, very low calorie diets were investigated but did not improve the condition (7). They did however lower body mass index (BMI)(7).

Cosmetic Procedures

Cosmetic procedures such as waxing, shaving, bleaching and chemical depilation can be useful for removing previously established hair until treatment has taken effect.  More permanent options such as electrology (electrolysis) or laser hair removal are sometimes recommended for any growth still present after 6-12 months of hormone therapy (8).

Overall, multiple methods for treatment are available. Depending on the severity of the disease, a specialist can help determine the best option for each individual case, or even combine several strategies for faster, more effective results.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961 Nov;21:1440–7.
2. Mcknight E. THE PREVALENCE OF “HIRSUTISM” IN YOUNG WOMEN. Lancet Lond Engl. 1964 Feb 22;1(7330):410–3.
3. Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA. The association of obesity with infertility and related menstural abnormalities in women. Int J Obes. 1979;3(1):57–73.
4. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998 Sep;83(9):3078–82.
5. Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008 Apr;93(4):1105–20.
6. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al., Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565–92.
7. Van Zuuren EJ, Fedorowicz Z. Interventions for Hirsutism. JAMA. 2015 Nov 3;314(17):1863–4.
8. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003 May;101(5 Pt 1):995–1007.

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More hair, nice skin: ketoconazole for skin infections

This is part two of “More hair, less dandruff: ketoconazole and hair loss.” Tinea versicolor and seborrheic dermatitis are common infections of the skin caused by yeast normally found on skin. Patients with tinea versicolor exhibit round scaly lesions which may be lighter or darker than natural skin tone on their face, neck, upper arms or torso (1,2). Patients with seborrheic dermatitis have inflamed skin resulting in red patches or greasy scales on the scalp, face, torso, or groin (3). Malassezia are the species of yeast that cause these skin conditions and are present naturally on everyone’s skin. Overgrowth of Malassezia can be caused by oily skin, and warm and humid climates, it does not mean you have poor hygiene. Although these conditions are not usually life threatening, they are highly visible, prompting patients to seek medical treatment.

Topical ketoconazole is currently United States (US) Food and Drug Administration (FDA) approved for treatment of tinea versicolor, dandruff and seborrheic dermatitis of the scalp (4). Nizoral ® is a shampoo containing 2% ketoconazole and is available over the counter for effective treatment against tinea versicolor, dandruff, and seborrheic dermatitis. Ketoconazole’s antifungal properties work by disrupting the production of ergosterol, which is required by the fungal cells to make cell membranes. Without a functioning cell membrane, the cell will die, and the infection will clear up.

Ketoconazole 2% shampoo solution is also effective at decreasing scalp irritation, itching, and discomfort when used two-three times weekly for at least a month (4). To maintain the effects, ketoconazole solutions should continue to be used, however you can decrease the number of times used per week. Always discuss treatment with your doctor to ensure a change in frequency of ketoconazole use is appropriate.

For the areas of affected skin other than the scalp, ketoconazole can be purchased as a cream or foam solution. Just like the topical shampoo, these solutions do not enter the tissue underlying the skin easily, and therefore are more safe for treating superficial mycoses (5) when compared to oral drugs. Follow the directions on the label and avoid exposure to moist areas of the skin like the nostrils, mouth, and eyelids. Keep in mind this does not mean they are risk free, there are still side effects associated with topical ketoconazole. Some of these side effects are: allergic reactions, stinging, itching, and dry skin. Remember to always consult your physician before making any changes to medication, including medicated creams, foams, and shampoos. Your physician will know what will work best for you.

Article by: Dr. C.D. Studholme, Mediprobe Research Inc.

1. Gupta AK, Bluhm R, Summerbell R. Pityriasis versicolor. J Eur Acad Dermatol Venereol JEADV. 2002 Jan;16(1):19–33.
2. Gaitanis G, Velegraki A, Mayser P, Bassukas ID. Skin diseases associated with Malassezia yeasts: facts and controversies. Clin Dermatol. 2013 Aug;31(4):455–63.
3. Shi VY, Leo M, Hassoun L, Chahal DS, Maibach HI, Sivamani RK. Role of sebaceous glands in inflammatory dermatoses. J Am Acad Dermatol. 2015 Nov;73(5):856–63.
4. Rafi AW, Katz RM. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatol. 2011;2011:241953.
5. Janssen Pharmaceutica. Nizoral (Ketoconazole) 2% shampoo [Internet]. [cited 2014 Nov 11]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019927s032lbl.pdf

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Top 4 Concealing Products for Hair Loss

1. Toupees or wigs

Toupees or wigs (as seen in the picture) are custom made, fitted hair pieces that cover up hair loss or thinning hair.¹ They consist of natural or synthetic hair, attached to a customized membrane. They can be fixed to the wearer’s scalp either semi-permanently, using medical grade adhesives, or can be removable using special hairpiece tape or clips. A semi-permanent toupee can stay in place for weeks at a time, although the hair must be partially or completely shaved to ensure a good fit and periodic refitting must occur as the hair grows underneath.

2. Thickening fibres

These are tiny electro-statically charged microfibers that attach themselves to the hair shaft, giving the impression of thicker, fuller hair. Because the electrostatic charge on the fibres is strong, they are virtually water resistant, but can be removed by shampooing. Attaining the right “look” by using thickening fibres may take some practice; some individuals report that applying too much product does not look natural. The fibres adhere to existing hair; therefore this product is not recommended for use by those who are completely bald or have large bald patches.

3. Scalp micropigmentation

This procedure involves creating several micro-tattooed dots over the scalp to give the impression of stubble. Although the process is tedious and may need to be done in two visits, the results are often dramatic. Micropigmentation is a great option for people who have minimal hair for transplantation or cannot afford a hair transplant. This procedure can also be used to cover up a previous hair transplant scar.² It is important to remember that tattoos fade slightly with time, so touch-ups may be required every few years.

4. Masking lotion

Masking lotion can be used to tint the scalp so that it matches your individual hair colour, giving the impression of a full head of hair. Although the technology of masking lotions has improved and most lotions are waterproof, they can sometimes rub off on pillows or soft furnishings, and their masking ability can also be affected by water. As with thickening fibres, masking lotions adhere to existing hairs to give the impression of volume. As such, these lotions rely on the individual having a good amount of hair to which they can adhere.

 

Article by: Dr. M. Cernea, Mediprobe Research Inc.

 

References

1. Banka N,Bunagan MJ, Dubrule Y, and Shapiro J. 2012. Wigs and hairpieces: evaluating dermatologic issues. Dermatol Ther., 25(3):260-6.
2. Rassman WR, Pak JP, and Kim J. 2013. Scalp micropigmentation: a useful treatment for hair loss. Facial Plast Surg Clin North Am., 23(3): 497.503.

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The Vampire Treatment

The vampire treatment is not a post-Halloween inspired story, but the endearing nickname for an innovative new hair growth therapy also known as PRP (platelet-rich plasma). The fast gain in popularity of this treatment comes from its well-diversified benefits including efficacy, safety and cost.

As the name suggests, PRP is plasma, (a component of the blood,) that has been enriched for platelets. Simply, a small amount of blood (only a fraction of what would be drawn for a blood donation for example) is collected from the patient. That sample is then concentrated for its platelets which contain healing properties and an abundance of growth factors (1). Lastly, the platelets are activated and injected at the site of desired hair growth.

PRP therapy has diverse applications in hair treatment with an improvement in hair growth and thickness observed in those diagnosed with the immune condition alopecia areata (2,3), the more prevalent pattern baldness (4–8) and to increase the success of hair transplant surgery (9).

One of the main advantages of PRP is that the patient’s own blood is drawn for treatment. Therefore when executed properly by your haircare professional, opportunities for transmission of infectious disease and reported side-effects are minimal (10).  Likewise without the use of specialized drugs, the costs remain low comparatively.

Currently the technology is still new but does have FDA approval for specific uses. Use of PRP for haircare would be considered “off label,” however with all of its advantages and some further investigations into methods, PRP may soon become a popular option in haircare. Talk with your hair loss specialist for more information.

Article by: Dr. J.L. Carviel, Mediprobe Research Inc.

References

1. Okuda K, Kawase T, Momose M, Murata M, Saito Y, Suzuki H, et al. Platelet-rich plasma contains high levels of platelet-derived growth factor and transforming growth factor-beta and modulates the proliferation of periodontally related cells in vitro. J Periodontol. 2003 Jun;74(6):849–57.
2. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013 Sep;169(3):690–4.
3. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2004 Apr;62(4):489–96.
4. Li ZJ, Choi H-I, Choi D-K, Sohn K-C, Im M, Seo Y-J, et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2012 Jul;38(7 Pt 1):1040–6.
5. Sorbellini E, Coscera T with F Rinaldi. The role of platelet rich plasma to control anagen phase: Evaluation in vitro and in vivo in hair transplant and hair treatment. Int J Trichol. 2011;3:S14–5.
6. Kang J-S, Zheng Z, Choi MJ, Lee S-H, Kim D-Y, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol JEADV. 2014 Jan;28(1):72–9.
7. Park KY, Kim HK, Kim BJ, Kim MN. Letter: Platelet-rich plasma for treating male pattern baldness. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2012 Dec;38(12):2042–4.
8. Takikawa M, Nakamura S, Nakamura S, Ishirara M, Kishimoto S, Sasaki K, et al. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2011 Dec;37(12):1721–9.
9. Uebel CO, da Silva JB, Cantarelli D, Martins P. The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg. 2006 Nov;118(6):1458–66; discussion 1467.
10. Kumaran MS with Arshdeep. Platelet-rich plasma in dermatology: boon or a bane? Indian J Dermatol Venereol Leprol. 2014 Feb;80(1):5–14.

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