Medical Therapies For Hair Loss

Introduction
Hair loss is impacting job opportunities, relationships, mental wellbeing and self-confidence. It is common that, as people age, hair growth slows down. However, the phenomenon of hair loss can be due to many other causes also. Some of them are pathological or external or diet related, with effects on hair growth that vary depending on the evolution of the related disease or external event.

What are the causes of alopecia?
Alopecia (hair loss) can be classified as being one of two types: non-scarring alopecia and scarring alopecia. Non-scarring alopecia has been attributed to:

• Genetics and advanced age (i.e. androgenetic alopecia, female pattern hair loss)
• High fevers, severe infections, thyroid disease
• Childbirth, taking birth control pills
• Inadequate proteins or iron in diet
• Patients on drugs like blood thinners, treatments for gout, arthritis, depression, hypertension, chemotherapy
• Alopecia areata (localized patches of hair loss which can coalesce to give huge areas of hair loss or hair loss throughout the body in rare cases to cause alopecia universalis)
• Physical or emotional stress
• Topical use of chemical treatments, such as hair dyes, permanent wave solutions, etc.
• Diseases, such as leprosy or syphilis
• Allergy

Scarring alopecia may be a consequence of burns (accidental or post-surgical from cryosurgery or laser surgery) or trauma, which often causes destruction of hair follicles.
The most common cause of baldness or hair loss (95%) is however, the so called Androgenetic alopecia, that is the well-known tendency to baldness or thinning, developing in the twenty, thirty or forty aged persons.

Androgens (steroid hormones such as estrogen and testosterone) are the most obvious regulators of human hair growth in both sexes. Interestingly, androgens have contrasting effects on hair follicles depending on the hair follicle’s location in the body. Androgens stimulate hair growth in many locations (i.e., beard, axilla) while inhibiting scalp hair growth in genetically predisposed individuals. Androgens are converted into various active molecules (metabolites) like DHT (di hydro testrosterone) which act on the hair roots, presumably by altering the production of regulatory factors (growth factors, peptides etc.). If one of the metabolites of the androgen is in excess, or the hair roots become oversensitive to it, it can lead to destruction of the hair root.

What are the changes which lead to baldness in men?
Generally there are one million hair on the scalp. At any given time 80% hair grows (anagen phase), 15% sleeps and 5% falls (telogen phase). Thus one hair grows for 3 years continuously, sleeps for 3 months and then falls. This 5% of falling hair constitutes 50-75 hair/day. This 5% of hair which is shed starts growing in the course of time. If this hair fall is not there, we will look like a bear, as they do not have cyclic hair growth and it just goes on lifelong for them. Inspite of this shedding hair, the growing hair compensates for the loss. If this ratio is affected, it manifests as alopecia. With the onset of male pattern baldness, a successively greater proportion of hairs are in the Telogen phase with correspondingly fewer in the active growth Anagen phase.

Various types of hair on the body include terminal hair, vellus hair, and modified terminal hair such as in the eyebrows and eyelashes. Terminal hairs are coarse, pigmented, long hairs in which the bulb of the hair follicle is situated deep in the dermis (deep layer of the skin). Vellus hairs, on the other hand, are fine, thin, non-pigmented short hairs in which the hair bulb is located superficially in the dermis. As alopecia progresses, a transition takes place in the area of approaching baldness wherein the hairs themselves are changing from the terminal to the vellus type. The size of the hair follicles is known to decrease.

One-third reduction in hair follicles which, when added to the increased proportion of vellus hair follicles and the increased number of hair follicles in the Telogen phase, is both significant and noticeable. Approximately, 50% of hair follicles must be shed to produce visible thinning of scalp hair. It is thus a combination of these factors: transition of hairs from terminal to vellus, increased number of Telogen hairs- some of which have been shed, and loss of hair follicles that produce ‘baldness’.

What is the grading of male pattern baldness?
The Norwood Hamilton grading of hair loss in males is shown below:

Hair Loss Pattern in Males

Ludwig’s grading of female pattern hair loss (Female Androgenetic alopecia):

Hair Loss in Females

What is the grading of female pattern baldness?

Females never go completely bald due to female pattern hair loss.

What are the treatments available for hair loss?
So far, various approaches have been conceived to limit or remedy hair loss.
Hair loss due to stress, infections, childbirth etc. generally is self resolving and improves after 6 months to a year after onset.

Despite the widespread occurrence of androgenetic alopecia, the need for prevention and therapy still exists. There is a lot of ongoing research world over to develop a wonderdrug to treat this problem, though treatments from medications to surgery are currently available to control this problem.

1. Daily hair wash, specially in patients with dandruff, and use of antifungal (eg. Ketoconazole shampoo) twice a week. If the problem persists,
   you must consult a dermatologist.
2. Healthy food habits – eggs, dates, curry leaves, pulses, protein powder, and iron tablets. Hair supplements containing amino acids may be helpful
   in cases of deficiency.
3. Thyroid hormone supplementation in case of hypothyroidism
4. Medicinal treatments for Androgenetic alopecia:
   Medicinal treatments include topical application of vasodilators like minoxidil, diazoxide etc. which cause the reactivation of cutaneous blood flow, thus producing the influx of oxygen and nutrients necessary for regeneration of tissues. One of the medications uses minoxidil as its active ingredient and is sold under the trade name Rogaine (a trademark of Pharmacia and Upjohn Company).Rogaine has shown to reduce hair loss and stimulate hair growth in upto 10% of men with male pattern baldness. Minoxidil is available in 2, 5, 10 % formulations in lotion, foam and gel forms. It is also available in combinations with aminexil, tretinoin etc. It is relatively safe to use long term. However, it must be avoided in pregnant and lactating females.Certain antiandrogens like Spironolactone, Aldactone, Cimetidine, or 5-alpha reductase inhibitors like oral Finasteride are known to avoid the transformation of testosterone to DHT which is responsible for hair loss. Finasteride is an active ingredient in Propecia (a trademark of Merck and Co.inc.) in pill form and has to be taken regularly. Rarely, undesired effects (decreased libido, impotence, gynaecomastia, etc.) can occur in men. A analog is dutasteride, though the results with either of these do not differ much. A natural alternative to finasrteride is available called Saw palmetto, which supposedly does not have the side effects of finasteride.

5. Generally, Finasteride given in combination with minoxidil has been found to give the best results.Finasteride in the doses of 5mg daily is used by some specialists in cases of hair loss in post menopausal women, however, studies to support this are lacking.

6. Newer treatments: QR 678: the latest invention in hair growth which comprises of a patented composition of specific growth factors, and peptides to stimulate hair growth.
   Alopecia is a deficiency of terminal hair. In the bald person, there is a noticeable absence of terminal hair; though the skin does contain vellus
   hair which is the fine colorless hair which may require microscopic examination to determine its presence. This vellus hair is the precursor to terminal hair.
   Many growth factors have been implicated in controlling different signals in the cycle of hair growth, with some playing major and some playing minor
   roles Growth factors from the hair root act as inducting signals for the normal cyclic growth of the hair. There are stem cells in an area of the hair
   follicle which pick up these signals and form a down growth into the dermis to form the hair shaft. These growth factors have been identified and are
   components of the invention. Thus, the QR678 relates to a method of treating the scalp to reduce hair loss and stimulate hair regrowth on the scalp.
   It is a new therapy and results are encouraging.
7. Examination of hormone levels and hair microscopic study in resistant cases. This is generally required in women with prolonged and severe hair loss.
   In women, flutamide is given in cases with hair loss due to high Dihydrotestosterone levels. Some females with abnormal insulin levels are treated
   with Metformin, and some with hair loss due to imbalance of ovarian hormones may be put on cyclical oral contraceptives to manage the hair loss.
   Such cases are usually cases with polycystic ovarian disease which can cause hair loss from the scalp on one hand and hirsutism (excess hair growth) on the
   rest of the body.
8. Genetic modification: Identification of the genes responsible for male pattern baldness is being
   currently studied. Replacement or modification of these may finally provide the answer to the suffering of millions of men. However, it is currently in
   the nascent stages of research and has a long time to be available.

For more information, contact doctor@myglobalhospital.com.