Management of hair loss: Difference between revisions
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{{cleanup-date|November 2005}} |
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[[Image:Yul_brynner.jpg|thumb|Actor [[Yul Brynner]]]] |
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{{Use mdy dates|date=September 2012}} |
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[[Image:PatrickStewart2004-08-03.jpg|thumb|Actor [[Patrick Stewart]]'s bald head is considered part of his distinctive attractiveness.]] |
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{{Infobox medical intervention |
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Since the [[1980]]s, drug therapy has increasingly become a realistic management option for '''[[baldness]]''' for men and women, as increased understanding of the mechanisms of normal and pathologic hair growth has pointed the way to improved treatments. Scientifically proven baldness treatments continue to be an area of research that receives a large amount of funding. More than half of men are affected by male pattern baldness by age 50, and baldness treatment is estimated to be a US $1 billion per year industry.{{ref|1billion}} |
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| name = Management of hair loss |
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The '''management of hair loss''', includes prevention and treatment of [[alopecia]], [[baldness]], and [[Telogen effluvium|hair thinning]], and regrowth of hair. |
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==Prevention== |
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==General concerns== |
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Scratching of itchy scalp may contribute to hair loss.<ref>{{cite journal |last1=Bin Saif |first1=GA |last2=Ericson |first2=ME |last3=Yosipovitch |first3=G |title=The itchy scalp—scratching for an explanation. |journal=Experimental Dermatology |date=December 2011 |volume=20 |issue=12 |pages=959–68 |doi=10.1111/j.1600-0625.2011.01389.x |pmid=22092575|pmc=3233984 }}</ref> |
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It is easier to prevent the aging and falling out of healthy hairs than to regrow hair in [[Hair_follicle|follicles]] that are already dormant. [[Propecia]] is the only treatment that has been demonstrated as an effective maintainer. There are products that have good success rates with regrowth, including the scientifically proven [[finasteride]] (marketed in the U.S. as Propecia) and [[minoxidil]] (marketed in the U.S. as [[Rogaine (drug)|Rogaine]], and some places as Regaine). Without preventive treatment, in three double-blind, placebo-controlled, randomized studies, 72% of the balding men on placebo had lost hair compared to baseline by 24 months. This is compared to 83% of participants on [[Propecia]] experiencing either no more hair loss or regrowth. ''See [http://www.hairlosstalk.com/newsletter/article127.htm Prevent Hair loss, don't Regrow?]'' <!--article by Marcia Ramos-e-Silva, MD, PhD International Journal of Dermatology, written for hairlosstalk.com--> |
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===Health=== |
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The prospective treatment of '''hair multiplication''''/hair cloning, which extracts self-replenishing follicle stem cells, multiplies them many times over in the lab, and microinjects them into the scalp, has been shown to work in mice, and is currently under development, expected by some scientists to be available to the public in 2009-2015. Subsequent versions of the treatment are expected by some scientists to be able to cause these follicle stem cells to simply signal the surrounding hair follicles to rejuvenate. |
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====Body weight==== |
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The below treatments are some of the most prominent. Generic brands, often with identical chemical structure or the same active ingredients, may be equally effective and are cheaper. |
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Prevention of [[obesity]] helps. Obesity is linked to [[Telogen effluvium|hair thinning]].<ref>{{cite journal |last1=Morinaga |first1=H |last2=Mohri |first2=Y |last3=Grachtchouk |first3=M |last4=Asakawa |first4=K |last5=Matsumura |first5=H |last6=Oshima |first6=M |last7=Takayama |first7=N |last8=Kato |first8=T |last9=Nishimori |first9=Y |last10=Sorimachi |first10=Y |last11=Takubo |first11=K |last12=Suganami |first12=T |last13=Iwama |first13=A |last14=Iwakura |first14=Y |last15=Dlugosz |first15=AA |last16=Nishimura |first16=EK |title=Obesity accelerates hair thinning by stem cell-centric converging mechanisms. |journal=Nature |date=July 2021 |volume=595 |issue=7866 |pages=266–271 |doi=10.1038/s41586-021-03624-x |pmid=34163066|pmc=9600322 |bibcode=2021Natur.595..266M |s2cid=235625692 }}</ref> |
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====Healthy diet==== |
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Interestingly, '''[[placebo]] treatments''' in studies often have reasonable success rates, though not as high as the products being tested, and even similar side-effects as the products. For example, in [[Finasteride]] (propecia) studies, the percent of patients with any drug-related sexual adverse experience was 3.8% compared with 2.0% in the placebo group.[http://www.hairlosstalk.com/download/finfront.pdf] Proponents of alternative therapies believe that the majority of cases of hair loss that progress despite treatments do so because the people believe no such cure can occur. In this view, this belief, which is prevailing in the modern civilised world and continuously reinforced by medical science, is the main obstacle for effectively finding and applying a cure. |
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{{see also|Healthy diet}} |
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Oils with fatty acids that has been studied to prevent dermatitis includes:<ref>{{cite journal |last1=Søyland |first1=E |last2=Funk |first2=J |last3=Rajka |first3=G |last4=Sandberg |first4=M |last5=Thune |first5=P |last6=Rustad |first6=L |last7=Helland |first7=S |last8=Middelfart |first8=K |last9=Odu |first9=S |last10=Falk |first10=ES |title=Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study. |journal=The British Journal of Dermatology |date=June 1994 |volume=130 |issue=6 |pages=757–64 |doi=10.1111/j.1365-2133.1994.tb03414.x |pmid=8011502|s2cid=25066444 }}</ref><ref>{{cite journal |last1=Callaway |first1=J |last2=Schwab |first2=U |last3=Harvima |first3=I |last4=Halonen |first4=P |last5=Mykkänen |first5=O |last6=Hyvönen |first6=P |last7=Järvinen |first7=T |title=Efficacy of dietary hempseed oil in patients with atopic dermatitis. |journal=The Journal of Dermatological Treatment |date=April 2005 |volume=16 |issue=2 |pages=87–94 |doi=10.1080/09546630510035832 |pmid=16019622|s2cid=18445488 }}</ref> |
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While treating hair loss most successfully is a multi-faceted, ongoing experiment for the individual, there are three principles, sometimes called '''The Three P's''' that are considered important to help produce success and avoid the somewhat common mistakes that can sabotage treatments.[http://www.hairlosstalk.com/discussions/viewtopic.php?t=12638] <!--article written by the site administrator of the consumer information site hairlosstalk.com, one of the more respected hair loss consumer information sites--> The Three P's are: '''p'''roven treatments first, take '''p'''ictures, and be '''p'''atient. The most recommended treatments, in order of proven effectiveness, greatest to least, is as follows: (1) Propecia (2) Rogaine (3) Tricomin (4) Topical Spiro 5% (5) Revivogen (6) Crinagen (7) Folligen (8) Everything else. |
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* [[Corn oil]]: [[Linoleic acid]] (LA) |
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* [[Fish oil]]: [[Eicosapentaenoic acid]] (EPA) and [[docosahexaenoic acid]] (DHA) |
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* [[Hemp seed oil]]: [[Linoleic acid]] (LA), and [[alpha-Linolenic acid]] (ALA) |
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====Alternative medicine==== |
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The average hair loss treatment takes a minimum of 6 months to begin working, and sometimes up to 24 months to truly see optimal results. Treating hair loss takes time because of '''hair cycles'''. The process of hair loss is the process of "miniaturization," which takes many years. Hairs grow in, cycle into dormancy, and then grow in again several months later. Each time they re-emerge, they do so thinner, shorter, and less pigmented. In time, they become so small that they are no longer noticeable. This can take many years. New hairs only grow in 2 or 3 a year, which is why it can take a year or more to be able to detect the success of a treatment. |
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The scalp must be cleaned from [[sebum]], sweat, and dirt, prior to topical application, for agents to penetrate it. |
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A 2020 [[systemic review]] on agents used to treat androgenic alopecia found that:<ref name="PMID33011954">{{cite journal | vauthors = Ashique S, Sandhu NK, Haque SN, Koley K | title = A Systemic Review on Topical Marketed Formulations, Natural Products, and Oral Supplements to Prevent Androgenic Alopecia: A Review | journal = Natural Products and Bioprospecting | volume = 10 | issue = 6 | pages = 345–365 | date = December 2020 | pmid = 33011954 | pmc = 7648777 | doi = 10.1007/s13659-020-00267-9 }}</ref> |
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This difficulty can be increased because many (scientifically proven) treatments often cause initial periods of shedding, as some resting hair follicles are ejected and a new cycle of growth begins, hopefully with a thicker follicle. Discontinuing treatments can also cause periods of shedding, though this hair loss is generally considered to be temporary, not affecting the baseline. |
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* Oral supplementation of [[vitamin A]], [[vitamin B|B]], [[vitamin|C]], [[vitamin D|D]], [[vitamin E|E]], and trace element [[iron]], [[selenium]], and [[zinc]], will prevent androgenic alopecia caused by [[malnutrition]]. [[Multivitamin]]s can be used. |
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* Topical application of [[onion]] juice, [[rosemary]] oil, [[saw palmetto]], [[pumpkin seed]] oil, [[procyanidin]], [[garlic]] gel, [[capsaicin]], [[caffeine]], amino acids, and [[curcumin]] helped prevent hair loss. |
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===Heating, ventilation, and air conditioning (HVAC)=== |
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==Propecia== |
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[[Propecia]], also called by its non-brand name [[Finasteride]], is a "[[dihydrotestosterone|DHT]] [[inhibitor]]" pill that is FDA approved to inhibit production of DHT through the entire body (called ''systemic''). It does this through inhibiting the conversion of testosterone to DHT. Finasteride is taken orally and has a reported 29-68% success rate (''vs'' 17-45% in patients receiving a [[placebo]]). It is effective only for as long as it is taken; the hair gained or maintained is lost within 6-12 months of ceasing therapy (Rossi, 2004). In clinical studies, Propecia, like Minoxodil, was shown to work on both the crown area and the hairline,[http://www.hairlosstalk.com/download/finfront.pdf] but is most successful in the crown area. For those in the early stages of hair loss, it is generally recommended to start slow, using propecia alone for at least a year, as it has very good maintenance rates, then adding other products, such as minoxidil, if regrowth is desired. |
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====Humidifier==== |
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Propecia is the same as the oral prescription drug, '''[[Proscar]]''', used in higher doses to treat an enlarged prostate. Some users save money by buying Proscar instead of Propecia , and split the pills in quarters using a pill-splitter to ensure the same amount as is present in Propecia is taken. |
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A [[humidifier]] can be used to prevent low indoor humidity during [[winter]] (especially with indoor heating), and [[dry season]].<ref>{{cite web |title=Seasonal Shedding Hair in Summer or Winter! |url=https://mdm-communications.com/seasonal-shedding-hair-summer-winter/2/ |website=MDM Health |date=28 October 2015 |access-date=December 9, 2021 |archive-date=December 9, 2021 |archive-url=https://web.archive.org/web/20211209232940/https://mdm-communications.com/seasonal-shedding-hair-summer-winter/2/ |url-status=live }}</ref> |
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Commonly, patients with [[seborrhoeic dermatitis]] experience mild redness, scaly skin lesions and in some cases [[hair loss]].<ref>{{cite web|url=http://www.mamashealth.com/skin/seb.asp|title=What is Seborrheic Dermatitis?|access-date=June 11, 2010|url-status=live|archive-url=https://web.archive.org/web/20100420023503/http://www.mamashealth.com/skin/seb.asp|archive-date=April 20, 2010}}</ref> |
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Propecia has been shown to be ineffective for treating hair loss in women, and shouldn't even be touched by pregnant or potentially pregnant women, as it causes severe birth defects in male fetuses. |
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===Possible health concerns=== |
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The [[UC Berkeley Wellness Letter]] in March 2003 states they don’t recommend Propecia "because its long-term safety is unknown. This is disquieting, since young men are the prime candidates, and the drug has to be taken for a lifetime. If you do decide to take it, you should know that although the standard dose is one milligram, there is some evidence that one-fifth that amount also works. If you cut the pill into quarters, you will save money."[http://www.berkeleywellness.com/html/ds/dsAvacor.php] |
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Low humidity can cause adverse health effects and may cause [[atopic dermatitis]],<ref>{{cite journal | vauthors = Engebretsen KA, Johansen JD, Kezic S, Linneberg A, Thyssen JP | title = The effect of environmental humidity and temperature on skin barrier function and dermatitis | journal = Journal of the European Academy of Dermatology and Venereology | volume = 30 | issue = 2 | pages = 223–249 | date = February 2016 | pmid = 26449379 | doi = 10.1111/jdv.13301 | s2cid = 12378072 | doi-access = free }}</ref> and [[seborrhoeic dermatitis]].<ref>{{cite journal | vauthors = Araya M, Kulthanan K, Jiamton S | title = Clinical Characteristics and Quality of Life of Seborrheic Dermatitis Patients in a Tropical Country | journal = Indian Journal of Dermatology | volume = 60 | issue = 5 | pages = 519 | date = September 2015 | pmid = 26538714 | pmc = 4601435 | doi = 10.4103/0019-5154.164410 | doi-access = free }}</ref> |
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While they point out Propecia must be taken for a lifetime to avoid losing hair, it should be counterpointed that future treatments are widely expected by baldness specialists to replace Propecia, which would end the need for continued use. Additionally, Propecia is widely considered safe enough to prescribe by health professionals, and is one of the only two FDA-approved baldness treatment products on the market. |
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==Treatments== |
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===Propecia's effects in detail=== |
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''Summarized from: [http://www.hairloss-reversible.com/Hair%20News%20Index/hair_news10.htm DHT: the full story]'' |
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===Combination therapy=== |
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DHT is a derivative hormone (metabolite) of testosterone that is considered to be the main cause of miniaturization and eventual destruction of hair follicles in male pattern baldness. DHT is a steroid hormone just like testosterone but more powerful. |
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Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use.<ref>{{cite journal | vauthors = Khandpur S, Suman M, Reddy BS | title = Comparative efficacy of various treatment regimens for androgenetic alopecia in men | journal = The Journal of Dermatology | volume = 29 | issue = 8 | pages = 489–498 | date = August 2002 | pmid = 12227482 | doi = 10.1111/j.1346-8138.2002.tb00314.x | s2cid = 20886812 }}</ref> |
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Combination therapy of LLLT or microneedling with finasteride<ref name="Darwin Heyes Hirt Wikramanayake 2017 pp. 425–434"/> or minoxidil demonstrated substantive increases in hair count.<ref name="Zhou Chen Qu Zhang 2020 p.">{{cite journal | last1=Zhou | first1=Yi | last2=Chen | first2=Chenglong | last3=Qu | first3=Qian | last4=Zhang | first4=Chunhua | last5=Wang | first5=Jin | last6=Fan | first6=Zhexiang | last7=Miao | first7=Yong | last8=Hu | first8=Zhiqi | title=The effectiveness of combination therapies for androgenetic alopecia: A systematic review and meta-analysis | journal=Dermatologic Therapy | publisher=Hindawi Limited | volume=33 | issue=4 | year=2020 | pages=e13741 | issn=1396-0296 | doi=10.1111/dth.13741 | pmid=32478968 | doi-access=free }}</ref> |
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Many dermatologists and research scientists specializing in hair loss believe DHT molecules may diffuse into the interior of hair follicle cells (the cytoplasm or cytosol) and bind with androgen receptors. This complex, both the receptor and the DHT molecule, then enters the nucleus of the cell. In the nucleus of the hair follicle cell this complex could then alter the rate of protein synthesis in men who are genetically predisposed to baldness. |
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===Medication=== |
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However, DHT also plays an important role in the functioning of the central nervous system (the brain), the testicles and prostate, and almost everything but muscle tissue. In muscle tissue testosterone is the dominant hormone. (Some bodybuilders inject testosterone derivatives to gain muscle fast.) |
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====Add-hocs==== |
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*Propecia and Avodart cause a rise in testosterone levels because testosterone that would normally be converted into DHT remains testosterone. Continual high levels of testosterone in the body could possibly have negative side effects. |
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The topical [[bioavailability]] of synthetic medicines such as [[antiandrogen]]s, as well as phytochemicals such as [[quercetin]], has been improved with incorporation of drugs in [[nanoparticles]], or [[microneedling]].<ref>{{cite journal | vauthors = Cardoso CO, Tolentino S, Gratieri T, Cunha-Filho M, Lopez RF, Gelfuso GM | title = Topical Treatment for Scarring and Non-Scarring Alopecia: An Overview of the Current Evidence | journal = Clinical, Cosmetic and Investigational Dermatology | volume = 14 | pages = 485–499 | date = 2021 | pmid = 34012282 | pmc = 8126704 | doi = 10.2147/CCID.S284435 | doi-access = free }}</ref> |
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====Synthetic medicine==== |
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*Artificially low levels of DHT in the body could cause some unwanted conditions. DHT is an antagonist of estrogen. Men’s bodies also produce the female hormone estrogen in the adrenal glands although this is just one-tenth of the estrogen that premenopausal women produce in their ovaries. By reducing DHT with drugs a man’s protection from the effects of estrogen may also be reduced. Gynecomastia could be one result of this. Gynecomastia is abnormally large breasts in a male. |
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Treatments for the various forms of hair loss have only moderate success.<ref name=Levy2013>{{cite journal | vauthors = Levy LL, Emer JJ | title = Female pattern alopecia: current perspectives | journal = International Journal of Women's Health | volume = 5 | pages = 541–556 | date = August 2013 | pmid = 24039457 | pmc = 3769411 | doi = 10.2147/IJWH.S49337 | doi-access = free }}</ref> Three medications have evidence to support their use in male pattern hair loss: [[finasteride]], [[dutasteride]] and [[minoxidil]].<ref name=Ban2013/> They typically work better to prevent further hair loss than to regrow lost hair.<ref name=Ban2013/> |
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They may be used together when hair loss is progressive or further regrowth is desired after 12 months.<ref name="webmd_treatments">{{cite web |url=http://www.webmd.com/skin-beauty/guide/hair-loss-treatments |title=Propecia & Rogaine for Treating Male Pattern Baldness |publisher=Webmd.com |access-date=May 19, 2010 |archive-date=July 9, 2008 |archive-url=https://web.archive.org/web/20080709023925/http://www.webmd.com/skin-beauty/guide/hair-loss-treatments |url-status=live }}</ref> Other medications include [[ketoconazole]], and in female androgenic alopecia [[spironolactone]] and [[flutamide]].<ref name="pmid22735503">{{cite journal | vauthors = McElwee KJ, Shapiro JS | title = Promising therapies for treating and/or preventing androgenic alopecia | journal = Skin Therapy Letter | volume = 17 | issue = 6 | pages = 1–4 | date = June 2012 | pmid = 22735503 }}</ref> |
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*Even though both finasteride and dutasteride were developed to combat benign prostatic hyperplasic by reducing DHT in prostate tissue, some scientists question the wisdom of using these 5-alpha reductase inhibitors in younger men who have no problem with their prostates. A research chemist, Pat Arnold - “Evidence is mounting that the existence of a high estrogen/androgen ratio - a condition common in older men - is highly correlated with the development of benign prostatic hyperplastic.” |
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===== Baricitinib ===== |
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==Revivogen== |
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In June 2022, the FDA authorized [[baricitinib]] for the treatment of severe alopecia areata.<ref name="FDA PR 20220613">{{cite press release | title=FDA Approves First Systemic Treatment for Alopecia Areata | website=U.S. [[Food and Drug Administration]] (FDA) | date=13 June 2022 | url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-systemic-treatment-alopecia-areata | access-date=13 June 2022 | archive-date=14 June 2022 | archive-url=https://web.archive.org/web/20220614051142/https://www.fda.gov/news-events/press-announcements/fda-approves-first-systemic-treatment-alopecia-areata | url-status=live }} {{PD-notice}}</ref><ref name="Lilly PR 20220613">{{cite press release | title=FDA Approves Lilly and Incyte's Olumiant (baricitinib) As First and Only Systemic Medicine for Adults with Severe Alopecia Areata | publisher=Eli Lilly | via=PR Newswire | date=13 June 2022 | url=https://www.prnewswire.com/news-releases/fda-approves-lilly-and-incytes-olumiant-baricitinib-as-first-and-only-systemic-medicine-for-adults-with-severe-alopecia-areata-301567120.html | access-date=13 June 2022 | archive-date=14 June 2022 | archive-url=https://web.archive.org/web/20220614034511/https://www.prnewswire.com/news-releases/fda-approves-lilly-and-incytes-olumiant-baricitinib-as-first-and-only-systemic-medicine-for-adults-with-severe-alopecia-areata-301567120.html | url-status=live }}</ref> |
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Revivogen is a non-FDA approved topical '''DHT inhibitor''' treatment applied to the scalp, with many ingredients, such as types of fatty acids, that are thought, though not proven, to inhibit DHT levels in the scalp and have a positive influence in combatting hair loss. Revivogen also contains ingredients that are thought, though not proven, to function as an '''antiandrogen''' (see below) that has a positive influence in combatting hair loss. Clinical trials are reportedly underway. |
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===== Minoxidil ===== |
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Revivogen uses simple mixtures of fatty acids (gamma Linolenic acid, alpha Linolenic acid, Linolenic acid, and a few others, which are thought to be potent inhibitors of 5AR, both type I and type II[http://www.hairlosstalk.com/download/study1.pdf][http://www.hairlosstalk.com/download/study4.pdf][http://www.hairlosstalk.com/download/study6.pdf][http://www.hairlosstalk.com/newsletter/article233.htm]), in their free form, that come from the bulk de-esterification of natural oils like borage and flaxseed. This methodology is considered just as effective as using purified fatty acids, but saves considerable expense. There are other products that contain fatty acids from natural oils, such as black currant oil and emu oil, but virtually all natural oils, including these two, contain only insignificant amounts of ''free'' fatty acids. |
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[[Minoxidil]], applied topically, is widely used for the treatment of hair loss. It may be effective in helping promote hair growth in both men and women with [[androgenic alopecia]].<ref name="2014AArev"/><ref>{{cite journal | vauthors = van Zuuren EJ, Fedorowicz Z, Schoones J | title = Interventions for female pattern hair loss | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 5 | pages = CD007628 | date = May 2016 | pmid = 27225981 | pmc = 6457957 | doi = 10.1002/14651858.CD007628.pub4 }}</ref> About 40% of men experience hair regrowth after 3–6 months.<ref>{{cite journal | vauthors = Goren A, Shapiro J, Roberts J, McCoy J, Desai N, Zarrab Z, Pietrzak A, Lotti T | display-authors = 6 | title = Clinical utility and validity of minoxidil response testing in androgenetic alopecia | journal = Dermatologic Therapy | volume = 28 | issue = 1 | pages = 13–16 | year = 2015 | pmid = 25112173 | doi = 10.1111/dth.12164 | s2cid = 205082682 | doi-access = free }}</ref> It is the only topical product that is FDA approved in America for androgenic hair loss.<ref name="2014AArev">{{cite journal | vauthors = Varothai S, Bergfeld WF | title = Androgenetic alopecia: an evidence-based treatment update | journal = American Journal of Clinical Dermatology | volume = 15 | issue = 3 | pages = 217–230 | date = July 2014 | pmid = 24848508 | doi = 10.1007/s40257-014-0077-5 | s2cid = 31245042 }}</ref> However, increased hair loss has been reported.<ref>{{cite web|url=https://www.drugs.com/sfx/rogaine-side-effects.html|title=Rogaine Side Effects in Detail - Drugs.com|website=drugs.com|access-date=January 28, 2018|archive-date=September 22, 2017|archive-url=https://web.archive.org/web/20170922052041/https://www.drugs.com/sfx/rogaine-side-effects.html|url-status=live}}</ref><ref name="Drugs.com">{{cite web|url = https://www.drugs.com/pro/minoxidil.html|title = Minoxidil Official FDA information, side effects and uses|publisher = Drugs.com|access-date = January 28, 2018|archive-date = September 22, 2017|archive-url = https://web.archive.org/web/20170922051930/https://www.drugs.com/pro/minoxidil.html|url-status = live}}</ref> |
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==Antiandrogens== |
=====Antiandrogens===== |
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<!-- Finasteride --> |
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[[Antiandrogens]] block DHT already produced and present in the blood stream from ''binding'' with hair follicles. |
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[[Finasteride]] is used to treat [[male pattern hair loss]].<ref name=PropeciaLabel>{{Cite web|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020788s024lbl.pdf|title=Propecia label|access-date=June 3, 2015|archive-date=February 10, 2017|archive-url=https://web.archive.org/web/20170210151045/http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020788s024lbl.pdf|url-status=live}}</ref> Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken.<ref name=2014AArev/> There is no good evidence for its use in women.<ref name=Levy2013/> It may cause [[gynecomastia]], [[erectile dysfunction]] and [[Depression (mood)|depression]].<ref>{{cite journal | vauthors = Andersson S | title = Steroidogenic enzymes in skin | journal = European Journal of Dermatology | volume = 11 | issue = 4 | pages = 293–295 | year = 2001 | pmid = 11399532 }}</ref> |
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[[Nizoral Shampoo]] and Neutrogena [[T-Gel]] have been clincally shown to have antiandrogen properties and are prescribed by medical professionals. |
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<!-- Dutasteride --> |
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EDIT |
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[[Dutasteride]] is also used in the treatment of male pattern hair loss and appears to have better effectiveness than finasteride for the condition.<ref>{{cite web|url=http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=11618|title=Avodart 0.5mg soft capsules – Summary of Product Characteristics (SmPC) – (eMC)|website=emc.medicines.org.uk|access-date=August 7, 2010|archive-date=April 26, 2006|archive-url=https://web.archive.org/web/20060426212556/http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=11618|url-status=dead}}</ref><ref name="pmid30863034">{{cite journal | vauthors = Zhou Z, Song S, Gao Z, Wu J, Ma J, Cui Y | title = The efficacy and safety of dutasteride compared with finasteride in treating men with androgenetic alopecia: a systematic review and meta-analysis | journal = Clinical Interventions in Aging | volume = 14 | pages = 399–406 | date = 2019 | pmid = 30863034 | pmc = 6388756 | doi = 10.2147/CIA.S192435 | doi-access = free }}</ref><ref name="pmid17110217">{{cite journal | vauthors = Olsen EA, Hordinsky M, Whiting D, Stough D, Hobbs S, Ellis ML, Wilson T, Rittmaster RS | display-authors = 6 | title = The importance of dual 5alpha-reductase inhibition in the treatment of male pattern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride | journal = Journal of the American Academy of Dermatology | volume = 55 | issue = 6 | pages = 1014–1023 | date = December 2006 | pmid = 17110217 | doi = 10.1016/j.jaad.2006.05.007 }}</ref> While used off-label for male pattern hair loss in most of the world, dutasteride is specifically approved for this indication in [[South Korea]] and [[Japan]].<ref name="pmid27489426">{{cite journal | vauthors = Choi GS, Kim JH, Oh SY, Park JM, Hong JS, Lee YS, Lee WS | title = Safety and Tolerability of the Dual 5-Alpha Reductase Inhibitor Dutasteride in the Treatment of Androgenetic Alopecia | journal = Annals of Dermatology | volume = 28 | issue = 4 | pages = 444–450 | date = August 2016 | pmid = 27489426 | pmc = 4969473 | doi = 10.5021/ad.2016.28.4.444 }}</ref><ref name="ShapiroOtberg2015">{{cite book|vauthors=Shapiro J, Otberg N|title=Hair Loss and Restoration, Second Edition|url=https://books.google.com/books?id=bJG9BwAAQBAJ&pg=PA39|date=17 April 2015|publisher=CRC Press|isbn=978-1-4822-3199-1|pages=39–|access-date=December 9, 2021|archive-date=January 12, 2023|archive-url=https://web.archive.org/web/20230112145741/https://books.google.com/books?id=bJG9BwAAQBAJ&pg=PA39|url-status=live}}</ref> |
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<!-- Spironolactone --> |
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==Minoxidil== |
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There is tentative support for [[spironolactone]] in women.<ref name=Levy2013/> Due to its feminising side effects and risk of infertility it is not often used by men.<ref>{{cite journal | vauthors = Buchanan JF, Davis LJ | title = Drug-induced infertility | journal = Drug Intelligence & Clinical Pharmacy | volume = 18 | issue = 2 | pages = 122–132 | date = February 1984 | pmid = 6141923 | doi = 10.1177/106002808401800205 | s2cid = 24807929 }}</ref><ref>{{cite journal | vauthors = Sinclair R, Patel M, Dawson TL, Yazdabadi A, Yip L, Perez A, Rufaut NW | title = Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness | journal = The British Journal of Dermatology | volume = 165 | issue = Suppl 3 | pages = 12–18 | date = December 2011 | pmid = 22171680 | doi = 10.1111/j.1365-2133.2011.10630.x | s2cid = 39734527 | doi-access = free }}</ref> It can also cause [[hypotension|low blood pressure]], [[hyperkalemia|high blood potassium]], and [[cardiac dysrhythmia|abnormal heart rhythms]]. Also, women who are pregnant or trying to become pregnant generally cannot use the medication as it is a [[teratogen]], and can cause ambiguous genitalia in newborn children.<ref name="Spirono">{{cite journal | vauthors = Rathnayake D, Sinclair R | title = Use of spironolactone in dermatology | journal = Skinmed | volume = 8 | issue = 6 | pages = 328–32; quiz 333 | year = 2010 | pmid = 21413648 }}</ref> |
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[[Minoxidil]] dilates blood vessels, and is sometimes called a "potassium channel opener." In the brand name [[Rogaine (drug)|Rogaine]], it is FDA approved to stimulate regrowth and thicken hairs. Minoxidil is applied topically to the scalp, and has been shown to promote hair growth in about 25% of men and women, though it may take several months to work. New hair is usually thinner and lighter, like baby hair, and grows mostly on the top of the head, not at the hairline. Its effects may fade with time. Skin irritation is the most commonly reported side effect. Dizziness and increased heart rate have also been reported, but rarely. |
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<!-- Flutamide --> |
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==Copper peptides== |
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There is tentative evidence for [[flutamide]] in women; however, it is associated with relatively high rates of liver problems and strong recommendations have been made against its use.<ref name=Levy2013/><ref name="pmid28379593">{{cite journal | vauthors = Giorgetti R, di Muzio M, Giorgetti A, Girolami D, Borgia L, Tagliabracci A | title = Flutamide-induced hepatotoxicity: ethical and scientific issues | journal = European Review for Medical and Pharmacological Sciences | volume = 21 | issue = 1 Suppl | pages = 69–77 | date = March 2017 | pmid = 28379593 | doi = }}</ref> Like spironolactone, flutamide is typically only used by women.<ref>{{cite journal | vauthors = Yazdabadi A, Sinclair R | title = Treatment of female pattern hair loss with the androgen receptor antagonist flutamide | journal = The Australasian Journal of Dermatology | volume = 52 | issue = 2 | pages = 132–134 | date = May 2011 | pmid = 21605098 | doi = 10.1111/j.1440-0960.2010.00735.x | s2cid = 30128397 }}</ref> [[Bicalutamide]] is another option for the treatment of female pattern hair loss.<ref name="pmid35032336">{{cite journal | vauthors = Carvalho RM, Santos LD, Ramos PM, Machado CJ, Acioly P, Frattini SC, Barcaui CB, Donda AL, Melo DF | display-authors = 6 | title = Bicalutamide and the new perspectives for female pattern hair loss treatment: What dermatologists should know | journal = Journal of Cosmetic Dermatology | volume = 21| issue = 10| date = January 2022 | pages = 4171–4175 | pmid = 35032336 | doi = 10.1111/jocd.14773 | s2cid = 253239337 }}</ref><ref name="pmid34668238">{{cite journal | vauthors = Meyer-Gonzalez T, Bacqueville D, Grimalt R, Mengeaud V, Piraccini BM, Rudnicka L, Saceda-Corralo D, Vogt A, Vano-Galvan S | display-authors = 6 | title = Current controversies in trichology: a European expert consensus statement | journal = Journal of the European Academy of Dermatology and Venereology | volume = 35 | issue = Suppl 2 | pages = 3–11 | date = November 2021 | pmid = 34668238 | doi = 10.1111/jdv.17601 | hdl = 11585/863826 | s2cid = 239029062 | hdl-access = free }}</ref><ref name="pmid34741573">{{cite journal | vauthors = Nestor MS, Ablon G, Gade A, Han H, Fischer DL | title = Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics | journal = Journal of Cosmetic Dermatology | volume = 20 | issue = 12 | pages = 3759–3781 | date = December 2021 | pmid = 34741573 | doi = 10.1111/jocd.14537 | pmc = 9298335 | s2cid = 243801494 }}</ref> It has a far lower risk of liver toxicity than flutamide and is said to have an excellent safety profile.<ref name="pmid34668238" /><ref name="pmid34741573" /><ref name="pmid33334002">{{cite journal | vauthors = Cignarella A, Mioni R, Sabbadin C, Dassie F, Parolin M, Vettor R, Barbot M, Scaroni C | display-authors = 6 | title = Pharmacological Approaches to Controlling Cardiometabolic Risk in Women with PCOS | journal = International Journal of Molecular Sciences | volume = 21 | issue = 24 | page = 9554 | date = December 2020 | pmid = 33334002 | pmc = 7765466 | doi = 10.3390/ijms21249554 | doi-access = free }}</ref> However, bicalutamide retains a small risk of liver toxicity and for this reason periodic liver monitoring is recommended during treatment.<ref name="pmid34668238" /><ref name="pmid33334002" /> |
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Copper peptides are topical, and shorten the resting phase of hairs, resulting in more hair follicles on the scalp being in the growing phase (as opposed to the resting or falling out phase) at one time. Copper Peptides generally have superoxide dismutate activity. They likely work by destroying superoxide, the antagonist to Nitric Oxide (NO), the natural miNOxidil. |
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==Ketoconazole== |
=====Ketoconazole===== |
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[[Ketoconazole]] may help in women.<ref>{{cite journal | vauthors = Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE | title = Ketoconazole shampoo: effect of long-term use in androgenic alopecia | journal = Dermatology | volume = 196 | issue = 4 | pages = 474–477 | date = 1998 | pmid = 9669136 | doi = 10.1159/000017954 | s2cid = 30635892 }}</ref><ref>{{cite journal | vauthors = Fields JR, Vonu PM, Monir RL, Schoch JJ | title = Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review | journal = Dermatologic Therapy | volume = 33 | issue = 1 | pages = e13202 | date = January 2020 | pmid = 31858672 | doi = 10.1111/dth.13202 | s2cid = 209427721 | doi-access = free }}</ref> |
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Because [[Ketoconazole]] is both an anti-fungal and also a [[5-alpha reductase]] inhibitor, it can help to slow the balding process. |
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14729013&query_hl=5&itool=pubmed_docsum] |
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16358489&query_hl=12&itool=pubmed_docsum] |
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9669136&query_hl=14&itool=pubmed_docsum] |
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===Technological treatments=== |
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==Herbal Medicine== |
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====Low-level laser therapy (LLLT)==== |
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===Saw Palmetto=== |
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[[Low-level laser therapy]] or photobiomodulation is also referred to as red light therapy and cold laser therapy. It is a non-invasive treatment option. |
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[[Saw Palmetto]] ([[Serenoa repens]]) is an herbal DHT inhibitor often claimed to be cheaper and have fewer side effects than finesteride and dutasteride. Unlike other 5alpha-reductase inhibitors, Saw Palmetto extract works without interfering with the cellular capacity to secrete PSA. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15543614&query_hl=16&itool=pubmed_docsum] |
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Saw palmetto extract has been demonstrated to inhibit both isoforms of alpha-5-reductase unlike finesteride which only inhibits the (predominant) type 2 isoenzyme of alpha-5-reductase. |
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12006122&query_hl=16&itool=pubmed_docsum] |
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11337315&query_hl=16&itool=pubmed_docsum] |
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7577710&query_hl=16&itool=pubmed_docsum] |
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LLLT is shown to increase hair density and growth in both genders. The types of devices (hat, comb, helmet) and duration did not alter the effectiveness,<ref name="Liu Liu Chen Chin 2019 pp. 1063–1069">{{cite journal | last1=Liu | first1=Kao-Hui | last2=Liu | first2=Donald | last3=Chen | first3=Yu-Tsung | last4=Chin | first4=Szu-Ying | title=Comparative effectiveness of low-level laser therapy for adult androgenic alopecia: a system review and meta-analysis of randomized controlled trials | journal=Lasers in Medical Science | publisher=Springer Science and Business Media LLC | volume=34 | issue=6 | date=2019-01-31 | issn=0268-8921 | doi=10.1007/s10103-019-02723-6 | pages=1063–1069| pmid=30706177 | s2cid=59524423 }}</ref> with more emphasis to be placed on lasers compared to LEDs.<ref name="Gupta Carviel 2019 pp. 643–647">{{cite journal | last1=Gupta | first1=A. K. | last2=Carviel | first2=J. L. | title=Meta-analysis of photobiomodulation for the treatment of androgenetic alopecia | journal=Journal of Dermatological Treatment | publisher=Informa UK Limited | volume=32 | issue=6 | date=2019-11-20 | issn=0954-6634 | doi=10.1080/09546634.2019.1688755 | pages=643–647| pmid=31746251 | s2cid=208185306 }}</ref> Ultraviolet and infrared light are more effective for alopecia areata, while red light and infrared light is more effective for androgenetic alopecia.<ref name="Zhang Su Ma Fu 2022 pp. 737–740">{{cite journal | last1=Zhang | first1=Yuehou | last2=Su | first2=Jianlong | last3=Ma | first3=Kui | last4=Fu | first4=Xiaobing | last5=Zhang | first5=Cuiping | title=Photobiomodulation Therapy With Different Wavebands for Hair Loss: A Systematic Review and Meta-Analysis | journal=Dermatologic Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=48 | issue=7 | date=2022-04-25 | issn=1076-0512 | doi=10.1097/dss.0000000000003472 | pages=737–740| pmid=35510860 | s2cid=248526019 }}</ref> |
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===Nettle Root=== |
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Nettle root is a DHT inhibitor and is often used in conjunction with Saw Palmetto. The leaves of the plant should be generally be avoided as they contain formic acid, which is metabolized by the body to formadehyde. |
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Medical reviews suggest that LLLT is as effective or potentially more than other non invasive and traditional therapies like minoxidil and finasteride but further studies such as RCTs, long term follow up studies, and larger double blinded trials need to be conducted to confirm the initial findings.<ref name="Gupta Bamimore Foley 2020 pp. 62–72">{{cite journal | last1=Gupta | first1=Aditya K. | last2=Bamimore | first2=Mary A. | last3=Foley | first3=Kelly A. | title=Efficacy of non-surgical treatments for androgenetic alopecia in men and women: a systematic review with network meta-analyses, and an assessment of evidence quality | journal=Journal of Dermatological Treatment | publisher=Informa UK Limited | volume=33 | issue=1 | date=2020-04-13 | issn=0954-6634 | doi=10.1080/09546634.2020.1749547 | pages=62–72 | pmid=32250713 | s2cid=215405183 | url=https://figshare.com/articles/journal_contribution/12087042 | access-date=August 31, 2023 | archive-date=February 24, 2024 | archive-url=https://web.archive.org/web/20240224185232/https://figshare.com/articles/journal_contribution/Efficacy_of_non-surgical_treatments_for_androgenetic_alopecia_in_men_and_women_a_systematic_review_with_network_meta-analyses_and_an_assessment_of_evidence_quality/12087042 | url-status=live }}</ref><ref name="Darwin Heyes Hirt Wikramanayake 2017 pp. 425–434">{{cite journal | last1=Darwin | first1=Evan | last2=Heyes | first2=Alexandra | last3=Hirt | first3=Penelope A. | last4=Wikramanayake | first4=Tongyu Cao | last5=Jimenez | first5=Joaquin J. | title=Low-level laser therapy for the treatment of androgenic alopecia: a review | journal=Lasers in Medical Science | publisher=Springer Science and Business Media LLC | volume=33 | issue=2 | date=2017-12-21 | issn=0268-8921 | doi=10.1007/s10103-017-2385-5 | pages=425–434| pmid=29270707 | s2cid=23783876 }}</ref><ref name="S P Y P p.">{{cite journal | last1=S | first1=Lueangarun | last2=P | first2=Visutjindaporn | last3=Y | first3=Parcharoen | last4=P | first4=Jamparuang | last5=T | first5=Tempark |title=A Systematic Review and Meta-analysis of Randomized Controlled Trials of United States Food and Drug Administration-Approved, Home-use, Low-Level Light/Laser Therapy Devices for Pattern Hair Loss: Device Design and Technology | journal=The Journal of Clinical and Aesthetic Dermatology | date=2021 | volume=14 | issue=11 | pages=E64–E75 | issn=1941-2789 | pmid=34980962 | pmc=8675345 }}</ref> |
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===Pumpkin Seed=== |
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Used to aid in the breakdown of DHT by the liver. An extract is often used, as unprocessed pumpkin seeds are high in fat which can exacerbate hair loss in susceptible patients. |
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===Platelet-rich plasma (PRP)=== |
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==Diet and Lifestyle== |
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Using ones own cells and tissues and without harsh side effects, PRP is beneficial for alopecia areata<ref name="Tejapira Yongpisarn Sakpuwadol Suchonwanit 2022 p. ">{{cite journal | last1=Tejapira | first1=Kasama | last2=Yongpisarn | first2=Tanat | last3=Sakpuwadol | first3=Nawara | last4=Suchonwanit | first4=Poonkiat | title=Platelet-rich plasma in alopecia areata and primary cicatricial alopecias: A systematic review | journal=Frontiers in Medicine | publisher=Frontiers Media SA | volume=9 | date=2022-11-24 | issn=2296-858X | doi=10.3389/fmed.2022.1058431 | page=| pmid=36507528 | pmc=9731377 | doi-access=free }}</ref> and androgenetic alopecia and can be used as an alternative to minoxidil or finasteride.<ref name="Gentile Garcovich 2020 p=2702">{{cite journal | last1=Gentile | first1=Pietro | last2=Garcovich | first2=Simone | title=Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil®, Finasteride®, and Adult Stem Cell-Based Therapy | journal=International Journal of Molecular Sciences | publisher=MDPI AG | volume=21 | issue=8 | date=2020-04-13 | issn=1422-0067 | doi=10.3390/ijms21082702 | page=2702| pmid=32295047 | pmc=7216252 | doi-access=free }}</ref> It has been documented to improve hair density and thickness in both genders.<ref name="Evans Mwangi Pope Ivanic 2020 pp. 498–511">{{cite journal | last1=Evans | first1=Adam G. | last2=Mwangi | first2=James M. | last3=Pope | first3=Rand W. | last4=Ivanic | first4=Mirjana G. | last5=Botros | first5=Mina A. | last6=Glassman | first6=Gabriella E. | last7=Pearce | first7=F. Bennett | last8=Kassis | first8=Salam | title=Platelet-rich plasma as a therapy for androgenic alopecia: a systematic review and meta-analysis | journal=Journal of Dermatological Treatment | publisher=Informa UK Limited | volume=33 | issue=1 | date=2020-05-26 | issn=0954-6634 | doi=10.1080/09546634.2020.1770171 | pages=498–511 | pmid=32410524 | s2cid=218648227 | url=https://figshare.com/articles/journal_contribution/12376727 | access-date=August 31, 2023 | archive-date=February 24, 2024 | archive-url=https://web.archive.org/web/20240224185101/https://figshare.com/articles/journal_contribution/Platelet-rich_plasma_as_a_therapy_for_androgenic_alopecia_a_systematic_review_and_meta-analysis/12376727 | url-status=live }}</ref> A minimum of 3 treatments, once a month for 3 months are recommended, and afterwards a 3-6 month period of continual appointments for maintenance.<ref name="Gupta Cole Deutsch Everts 2019 pp. 1262–1273">{{cite journal | last1=Gupta | first1=Aditya K. | last2=Cole | first2=John | last3=Deutsch | first3=David P. | last4=Everts | first4=Peter A. | last5=Niedbalski | first5=Robert P. | last6=Panchaprateep | first6=Ratchathorn | last7=Rinaldi | first7=Fabio | last8=Rose | first8=Paul T. | last9=Sinclair | first9=Rodney | last10=Vogel | first10=James E. | last11=Welter | first11=Ryan J. | last12=Zufelt | first12=Michael D. | last13=Puig | first13=Carlos J. | title=Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia | journal=Dermatologic Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=45 | issue=10 | year=2019 | issn=1076-0512 | doi=10.1097/dss.0000000000001894 | pages=1262–1273| pmid=30882509 | s2cid=81980415 }}</ref> Factors that determine efficacy include amount of sessions, double versus single centrifugation, age and gender, and where the PRP is inserted.<ref name="Gupta Bamimore 2022 pp. 943–952">{{cite journal | last1=Gupta | first1=Aditya | last2=Bamimore | first2=Mary | title=Platelet-Rich Plasma Monotherapies for Androgenetic Alopecia: A Network Meta-Analysis and Meta-Regression Study | journal=Journal of Drugs in Dermatology | publisher=SanovaWorks | volume=21 | issue=9 | date=2022-08-01 | issn=1545-9616 | doi=10.36849/jdd.6948 | pages=943–952| pmid=36074501 | s2cid=252120370 }}</ref> |
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While drugs rather than lifestyle changes are frequently reccomended to treat baldness in the United States, the dramatic increase in baldness in the population of Japan after World War II suggests that the prevalence of baldness can be influenced by diet and lifestyle. Increased fat intake, decrease in aerobic exercise and general 'westernization' was accompanied by a dramatic increase in incidence of male pattern baldness. |
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The results of an investigation by Jin-Rong Zhou et al., Harvard Medical School, suggest that components of traditional Japanese diet, soy products such as tofu and |
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green tea, work synergistically to dramatically inhibit the conversion of testosterone to dihydrotestosterone (DHT). Reducing or abandoning these major elements |
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of the traditional diet may have been the main reason for the increase of male pattern baldness in Japanese men after World War II - including a probable increase |
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in the rate of prostate cancer. (J. Nutr. 133:516-521, February 2003) |
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Future larger randomized controlled trials and other high quality studies are still recommended to be carried out and published for a stronger consensus.<ref name="Gupta Bamimore Foley 2020 pp. 62–72"/><ref name="Evans Mwangi Pope Ivanic 2020 pp. 498–511"/><ref name="Oth Stene Glineur Vujovic 2018 pp. 438–446">{{cite journal | last1=Oth | first1=O | last2=Stene | first2=JJ | last3=Glineur | first3=R | last4=Vujovic | first4=A | title=Injection of PRP (Platelet-rich plasma) as a treatment for androgenetic alopecia : a systematic review of the literature | journal=Revue Médicale de Bruxelles | publisher=AMUB/Revue Médicale de Bruxelles | volume=39 | issue=5 | year=2018 | issn=0035-3639 | doi=10.30637/2018.17-056 | pages=438–446| pmid=29869472 | doi-access=free }}</ref> Further development of a standardized practice for procedure is also recommended.<ref name="Tejapira Yongpisarn Sakpuwadol Suchonwanit 2022 p. "/> |
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===Surgical treatments=== |
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Aerobic exercise (as opposed to short workout periods designed to raise androgen levels and build muscle) and a diet which is more moderate in terms of fat intake may help alleviate the metabolic conditions which contribute to male pattern baldness. |
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====Hair transplantation==== |
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Stress reduction can restore healthy levels of SHBG. |
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{{main|Hair transplantation}} |
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Hair transplantation is a [[surgery|surgical]] technique that moves individual [[hair follicle]]s from a part of the body called the donor site to bald or balding part of the body known as the recipient site. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore [[eyelash]]es, [[eyebrow]]s, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from [[skin graft]]ing in that grafts contain almost all of the [[Epidermis (skin)|epidermis]] and [[dermis]] surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin. |
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Since hair naturally grows in follicles in groups of 1 to 4 hairs, [[Organ transplant|transplant]]ation takes advantage of these naturally occurring follicular units. This achieves a more natural appearance by matching hair for hair through [[Follicular unit transplantation]] (FUT). |
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One explanation for the relationship between lifestyle and male pattern baldness is that lower caloric intake along with more aerobic exercise can decrease insulin levels, preventing a host of metabolic problems which contribute, in part, to hair loss. Insulin downregulates [[sex hormone binding globulin]]. In individuals with moderate levels of SHBG, SHBG would bind to testosterone and helps prevent its conversion into DHT in the scalp via 5-alpha reductase. But in individuals with lower levels of SHBG, more testosterone is left to float free in the bloodstream and thus be converted into DHT in the scalp. Levels of DHT in the scalp are a key factor in male pattern baldness. This link between diet, insulin, SHBG, androgens and baldness helps to explain recent studies which have shown that early male pattern baldness is an indicator for various metabolic and cardiovascular problems. In other words, diabetes, hairloss and cardiovascualr disease may all be linked to high caloric intake and low exercise. |
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Donor hair can be harvested in two different ways. Small grafts of naturally-occurring units of one to four hairs, called [[Hair follicle|follicular units]], can be moved to balding areas of the [[hair restoration]]. These follicular units are surgically implanted in the scalp in very close proximity to one another and in large numbers. The grafts are obtained in one or both of the two primary methods of surgical extraction, follicular unit transplantation, colloquially referred to as "strip harvesting", or [[Follicular Unit Extraction]] (FUE), in which follicles are transplanted individually. |
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16295051&query_hl=1&itool=pubmed_docsum] |
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16235154&query_hl=1&itool=pubmed_docsum] |
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In FUT, a strip of skin containing many follicular units is extracted from the patient and dissected under a stereoscopic microscope. The site of the strip removal is stitched closed. Once divided into follicular unit grafts, each unit is individually inserted into small recipient sites made by an incision in the bald scalp. In the newer technique, roots are extracted from the donor area and divided into strips for transplantation. The strip, two to three millimeters thick, is isolated and transplanted to the bald scalp.<ref>{{cite journal | vauthors = Rashid RM, Morgan Bicknell LT | title = Follicular unit extraction hair transplant automation: options in overcoming challenges of the latest technology in hair restoration with the goal of avoiding the line scar | journal = Dermatology Online Journal | volume = 18 | issue = 9 | pages = 12 | date = September 2012 | pmid = 23031379 | doi = 10.5070/D30X57S71R }}</ref> After surgery, a bandage is worn for two days to protect the stitched strip during healing. A small strip scar remains after healing, which can be covered by scalp hair growing over the scar.<ref name="pmid22808618"/> |
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==Others== |
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* [[Azelaic acid]] - promoters claim it is "Proven to inhibit up to 100% of DHT where applied." The evidence for this claim is uncertain. A study titled "Inhibition of 5a-reductase activity in human skin by zinc and azelaic acid" found a 90% inhibition of 5a-reductase activity in vitro with an azelaic acid and zinc combination. There was an additive effect between the two compounds. |
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* [[Spironolactone]] |
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* [[Capilor]] |
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* Retin-A ([[Retin-A|Retinoic acid]]; chemical peel stimulation of scalp) |
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* [[Avacor]] - discredited[http://www.berkeleywellness.com/html/ds/dsAvacor.php] |
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* LLT or Low-level Laser Therapy; Not FDA approved for hair regrowth, but only as a cosmetic hair enhancer. Treaments are administered at either a clinic or salon (most of which are in Europe), or by the individual user via a home-based portable system. For example, "The Laser Comb". No official results have been proven or published in regards to hair regrowth. |
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* [[Stinging nettle]] – |
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== |
====Scalp reduction==== |
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{{main|Scalp reduction}} |
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[[Surgery]] is another method of reversing hair loss and baldness, although it may be considered an extreme measure. The surgical methods used include [[hair transplantation]], where patches of skin with hair are moved from one part of the head to another. Another method is [[scalp reduction]], where parts of the scalp are removed, the skin is stretched over the area that had been removed, and everything is stitched back together. Hair transplants generally cause scarring, sometimes severe, which may be especially visible if hair loss continues over the rest of the scalp. |
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Scalp reduction is a surgical procedure in which the hairless region of the scalp of a [[Pattern hair loss|bald man]] is reduced. This procedure can reduce the area of the scalp without hair.<ref>{{cite journal | vauthors = Bell ML | title = Role of scalp reduction in the treatment of male pattern baldness | journal = Plastic and Reconstructive Surgery | volume = 69 | issue = 2 | pages = 272–277 | date = February 1982 | pmid = 7054796 | doi = 10.1097/00006534-198202000-00016 | s2cid = 20731930 }}</ref><ref>{{cite book |last1=Unger |first1=Martin G. |last2=Toscani |first2=Marco |year=2016 |chapter=Scalp reduction |editor1-last=Scuderi |editor1-first=Nicolò |editor2-last=Toth |editor2-first=Bryant A. |title=International Textbook of Aesthetic Surgery |chapter-url=https://www.springer.com/gp/book/9783662465981 |publisher=[[Springer Nature|Springer]] |pages=555–556 |doi=10.1007/978-3-662-46599-8 |isbn=978-3-662-46598-1 |access-date=7 December 2016 |archive-date=August 3, 2017 |archive-url=https://web.archive.org/web/20170803211713/http://www.springer.com/gp/book/9783662465981 |url-status=live }}</ref> |
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==Regrowth of hair== |
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==Hair multiplication (future treatment)== |
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[[Stem cells]] have been discovered in hair follicles and some researchers predict research on these follicle stem cells may lead to successes in treating baldness through ''[[hair multiplication]]'', also called ''hair cloning'' within three or four years (as of November 2004). This treatment is expected to initially work through taking stem cells from existing follicles, multiplying them in cultures, and implanting the new follicles into the scalp. Later treatments may be able to simply signal follicle stem cells to transmit chemical signals to nearby follicle cells which have shrunk during the aging process, which respond to these signals by regenerating and once again making healthy hair. [http://my.webmd.com/content/article/96/103836.htm?z=3734_00000_1000_qd_01] |
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===Facial hair=== |
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*[http://cbs2chicago.com/health/health_story_075114234.html Stem Cell Research Update] (March 2004) - Covers a study by Dr. George Cotsarelis and his team of researchers at the University of Pennsylvania. |
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== |
====Eyebrows==== |
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[[Bimatoprost]] 0.03% has been used to grow [[eyebrow]]s.<ref>{{cite journal |last1=Riahi |first1=RR |last2=Cohen |first2=PR |title=Topical Treatment of Eyebrow Hypotrichosis with Bimatoprost 0.03% Solution: Case Report and Literature Review. |journal=Cureus |date=21 May 2018 |volume=10 |issue=5 |pages=e2666 |doi=10.7759/cureus.2666 |doi-access=free |pmid=30042917 |pmc=6054329}}</ref> |
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*[[baldness]] |
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*[[comb over]] |
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== |
====Eyelashes==== |
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The FP receptor agonist, [[bimatoprost]], in the form of an 0.03% ophthalmic solution termed [[Latisse]], is approved by the US [[Food and Drug Administration]] to treat [[hypotrichosis]] of the [[eyelash]]es, in particular to darken and lengthen eyelashes for cosmetic purposes.<ref>{{cite journal |last1=Choi |first1=YM |last2=Diehl |first2=J |last3=Levins |first3=PC |title=Promising alternative clinical uses of prostaglandin F2α analogs: beyond the eyelashes. |journal=Journal of the American Academy of Dermatology |date=April 2015 |volume=72 |issue=4 |pages=712–6 |doi=10.1016/j.jaad.2014.10.012 |pmid=25601618}}</ref> Also, bimatoprost may be used to treat small or underdeveloped [[eyelash]]es.<ref name="Bimatoprost label">{{cite web | title=Bimatoprost solution/ drops | website=DailyMed | date=18 September 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=27bef7e1-750a-4ac1-ab5f-e4c0121ffcbc | access-date=4 January 2020 | archive-date=September 21, 2020 | archive-url=https://web.archive.org/web/20200921171858/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=27bef7e1-750a-4ac1-ab5f-e4c0121ffcbc | url-status=live }}</ref><ref name="Lumigan label">{{cite web | title=Lumigan- bimatoprost solution/ drops | website=DailyMed | date=31 July 2017 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5e67c75-db88-4372-bb07-c8dd15c97631 | access-date=4 January 2020 | archive-date=September 21, 2020 | archive-url=https://web.archive.org/web/20200921171612/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5e67c75-db88-4372-bb07-c8dd15c97631 | url-status=live }}</ref> |
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*[http://www.aafp.org/afp/990415ap/2189.html "Medical Treatments for Balding in Men,"] April 1999, ''American Family Physician'' (medical journal) |
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*[http://nahrs.org/faqs/mphl.aspx North American Hair Research Society] Frequently asked questions |
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=== |
===Scalp hair=== |
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*[http://www.hairlosstalk.com Hairlosstalk.com] |
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*[http://www.hairlosshelp.com/ Hairlosshelp forums ] |
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*[http://www.hairsite.com/ Hairsite forums] |
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*[http://www.doctorproctor.com/baldfaq1.htm FAQ] |
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*[http://www.hair-transplant-helpdesk.com Hair Transplant Research] |
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====Alternative medication==== |
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===Hair loss specialist directories=== |
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* [http://www.ahlc.org/MembersDir.htm Directory of Specialists by Region] from the American Hair Loss Council |
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**[http://www.hairlossdocshop.com/ (Smaller) Directory of Specialists by Region] (U.S.) from hairlossdocshop.com |
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=== |
=====Topical===== |
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Some popular plant juices sold as hair serum may instead of growing human hair actually inhibit the growth, including [[6-gingerol]] found in [[ginger]].<ref>{{cite journal | vauthors = Miao Y, Sun Y, Wang W, Du B, Xiao SE, Hu Y, Hu Z | title = 6-Gingerol inhibits hair shaft growth in cultured human hair follicles and modulates hair growth in mice | journal = PLOS ONE | volume = 8 | issue = 2 | pages = e57226 | date = 2013 | pmid = 23437345 | pmc = 3578824 | doi = 10.1371/journal.pone.0057226 | doi-access = free | bibcode = 2013PLoSO...857226M }}</ref> |
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*[http://www.timesonline.co.uk/article/0,,8125-1584988,00.html Health Alternatives:] zinc, silica, methylsulphonylmethane (MSM) and cod-liver oil, to slow down the process. |
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=====Topical crude onion juice===== |
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==References== |
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[[File:CSIRO ScienceImage 2782 Brown Onions.jpg|thumb|Topical crude onion juice from Australian brown onion was used in a 2002 study to regrow hair in bald people.<ref name="Crude onion juice from Australian brown onion" />]] |
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*{{note|1billion}}[http://nl.newsbank.com/nl-search/we/Archives?s_site=ozarksnow&f_site=ozarksnow&f_sitename=Springfield+News-Leader+%28MO%29&p_theme=gannett&p_product=SNLB&p_action=search&p_field_base-0=&p_text_base-0=baldness&Search=Search&p_perpage=10&p_maxdocs=200&p_queryname=700&s_search_type=keyword&p_sort=_rank_%3AD&p_field_date-0=YMD_date&p_params_date-0=date%3AB%2CE&p_text_date-0= "Uncovering the bald truth about hair loss."] ''Springfield News-leader'', May 10, 2005. "Half of men" estimate is made by the American Academy of Dermatology and specifically estimates prevalence in the U.S. population, though this should reflect prevalence in other populations. |
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A small 2002 study demonstrated that treatment twice daily for six weeks with crude onion juice from Australian brown onion, re-growth hair on [[alopecia areata]] (spot baldness) in 86.9% of the 23 participants.<ref name="Crude onion juice from Australian brown onion">{{cite journal | vauthors = Sharquie KE, Al-Obaidi HK | title = Onion juice (Allium cepa L.), a new topical treatment for alopecia areata | journal = The Journal of Dermatology | volume = 29 | issue = 6 | pages = 343–346 | date = June 2002 | pmid = 12126069 | doi = 10.1111/j.1346-8138.2002.tb00277.x | s2cid = 24116769 }}</ref> Twice as many [[flavonols]] are found in [[red onion]] than in [[yellow onion]].<ref name="Onions: a source of unique dietary">{{cite journal | vauthors = Slimestad R, Fossen T, Vågen IM | title = Onions: a source of unique dietary flavonoids | journal = Journal of Agricultural and Food Chemistry | volume = 55 | issue = 25 | pages = 10067–10080 | date = December 2007 | pmid = 17997520 | doi = 10.1021/jf0712503 }}</ref> Also, non-organic onions might contain pesticides on the peel and in the first scaly leaf. Compounds found in onion that stimulates hair growth: |
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[[Category:Dermatology]] |
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* [[Quercetin]]: |
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**[[Quercetin]] (a flavanoid found in vegan food) supplements, has been suggested to treat baldness.<ref name="Quercetin" /> A 2012 study demonstrated that alopecia areata could be used to prevent ant treated with quercetin in mice.<ref name="Quercetin">{{cite journal | vauthors = Wikramanayake TC, Villasante AC, Mauro LM, Perez CI, Schachner LA, Jimenez JJ | title = Prevention and treatment of alopecia areata with quercetin in the C3H/HeJ mouse model | journal = Cell Stress & Chaperones | volume = 17 | issue = 2 | pages = 267–274 | date = March 2012 | pmid = 22042611 | pmc = 3273564 | doi = 10.1007/s12192-011-0305-3 }}</ref> Quercetin is found in onions primarily in the peel and the first scaly leaf but not in the flesh.<ref>{{cite journal | vauthors = Kwak JH, Seo JM, Kim NH, Arasu MV, Kim S, Yoon MK, Kim SJ | title = Variation of quercetin glycoside derivatives in three onion (''Allium cepa'' L.) varieties | journal = Saudi Journal of Biological Sciences | volume = 24 | issue = 6 | pages = 1387–1391 | date = September 2017 | pmid = 28855836 | pmc = 5562462 | doi = 10.1016/j.sjbs.2016.05.014 }}</ref> Onion [[surface area|bulb size]] or weight does not appear to be affected by quercetin concentration.<ref name="Onions: a source of unique dietary"/> |
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** A 2020 study demonstrated that quercitrin stimulated hair shaft growth in cultured human hair follicles.<ref>{{cite journal | vauthors = Kim J, Kim SR, Choi YH, Shin JY, Kim CD, Kang NG, Park BC, Lee S | display-authors = 6 | title = Quercitrin Stimulates Hair Growth with Enhanced Expression of Growth Factors via Activation of MAPK/CREB Signaling Pathway | journal = Molecules | volume = 25 | issue = 17 | page = 4004 | date = September 2020 | pmid = 32887384 | pmc = 7504764 | doi = 10.3390/molecules25174004 | doi-access = free }}</ref> |
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* Volatile compounds responsible for pungency and tearing in onions when they are cut (e.g. [[syn-Propanethial-S-oxide|''syn''-propanethial ''S''-oxide]] gas). However, no formal studies have conducted to evaluate if these compounds promote hair growth or if they help other compounds to penetrate the skin to form hair follicles. |
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** To use the volatile compounds: Onions must be extracted and applied topically quickly before the volatile compounds evaporates. The extract will cause tearing eyes, but it can be prevented with a [[shower cap]], or a pair of swimming goggles. |
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** To discard the volatile compounds: The onion juice is extracted and stored for a short while to evaporate the volatile compounds. The extract will not cause tearing eyes. Also, both [[genetically modified food|genetically modified]], and [[plant breed]] onions have been produced with significantly reduced levels of tear-inducing lachrymatory factor.<ref>{{cite journal | vauthors = Eady CC, Kamoi T, Kato M, Porter NG, Davis S, Shaw M, Kamoi A, Imai S | display-authors = 6 | title = Silencing onion lachrymatory factor synthase causes a significant change in the sulfur secondary metabolite profile | journal = Plant Physiology | volume = 147 | issue = 4 | pages = 2096–2106 | date = August 2008 | pmid = 18583530 | pmc = 2492635 | doi = 10.1104/pp.108.123273 }}</ref><ref>{{cite news |title=Cutting this new type of onion won't make you cry |url=https://www.independent.co.uk/life-style/onion-no-crying-cut-up-tears-sting-juice-a8149821.html |work=The Independent |date=9 January 2018 |language=en |access-date=September 7, 2021 |archive-date=September 7, 2021 |archive-url=https://web.archive.org/web/20210907223821/https://www.independent.co.uk/life-style/onion-no-crying-cut-up-tears-sting-juice-a8149821.html |url-status=live }}</ref> |
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=====Dietary supplements===== |
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Dietary supplements are not typically recommended.<ref name=Roger2008>{{cite journal | vauthors = Rogers NE, Avram MR | title = Medical treatments for male and female pattern hair loss | journal = Journal of the American Academy of Dermatology | volume = 59 | issue = 4 | pages = 547–66; quiz 567–8 | date = October 2008 | pmid = 18793935 | doi = 10.1016/j.jaad.2008.07.001 }}</ref> Many people use unproven treatments,<ref name=Ban2013>{{cite journal | vauthors = Banka N, Bunagan MJ, Shapiro J | title = Pattern hair loss in men: diagnosis and medical treatment | journal = Dermatologic Clinics | volume = 31 | issue = 1 | pages = 129–140 | date = January 2013 | pmid = 23159182 | doi = 10.1016/j.det.2012.08.003 }}</ref> but there is little evidence of the effectiveness of [[vitamin]]s, minerals, or other dietary supplements regrowing hair or retaining hair.<ref name=Levy2013/> There is no evidence for [[biotin]] (vitamin B7).<ref name=Roger2008/> While lacking both evidence and expert recommendation, there is a large market for hair growth supplements, especially for products that contain biotin. |
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However, one small trial of [[saw palmetto]] which shows tentative benefit in those with mild to moderate androgenetic alopecia.<ref name=Roger2008/> There was no good evidence for [[gingko]], [[aloe vera]], [[ginseng]], [[bergamot essential oil|bergamot]], or [[hibiscus]] as of 2011.<ref name=Blu2011>{{cite journal | vauthors = Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, Trakatelli M, Finner A, Kiesewetter F, Trüeb R, Rzany B, Blume-Peytavi U | display-authors = 6 | title = Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men | journal = Journal der Deutschen Dermatologischen Gesellschaft | volume = 9 | issue = Suppl 6 | pages = S1-57 | date = October 2011 | pmid = 21980982 | doi = 10.1111/j.1610-0379.2011.07802.x | s2cid = 29821046 }}</ref> |
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==Radiation-induced hair loss== |
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Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression.<ref>{{cite journal | vauthors = Nanashima N, Ito K, Ishikawa T, Nakano M, Nakamura T | title = Damage of hair follicle stem cells and alteration of keratin expression in external radiation-induced acute alopecia | journal = International Journal of Molecular Medicine | volume = 30 | issue = 3 | pages = 579–584 | date = September 2012 | pmid = 22692500 | doi = 10.3892/ijmm.2012.1018 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Kamiya K, Sasatani M | title = [Effects of radiation exposure on human body] | journal = Nihon Rinsho. Japanese Journal of Clinical Medicine | volume = 70 | issue = 3 | pages = 367–374 | date = March 2012 | pmid = 22514910 }}</ref> Radiation therapy has been associated with increased [[mucin]] production in hair follicles.<ref>{{cite journal | vauthors = Takeda H, Nakajima K, Kaneko T, Harada K, Matsuzaki Y, Sawamura D | title = Follicular mucinosis associated with radiation therapy | journal = The Journal of Dermatology | volume = 38 | issue = 11 | pages = 1116–1118 | date = November 2011 | pmid = 22034994 | doi = 10.1111/j.1346-8138.2010.01187.x | s2cid = 31876890 }}</ref> |
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Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia.<ref>{{cite journal | vauthors = Kalia S, Lui H | title = Utilizing electromagnetic radiation for hair growth: a critical review of phototrichogenesis | journal = Dermatologic Clinics | volume = 31 | issue = 1 | pages = 193–200 | date = January 2013 | pmid = 23159188 | doi = 10.1016/j.det.2012.08.018 }}</ref> |
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==Cosmeses== |
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[[File:Wigs on display.jpg|thumb|There have been advances in the [[fashion industry]] in [[wig]] design.]] Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle.<ref>{{cite journal | vauthors = Davis MG, Thomas JH, van de Velde S, Boissy Y, Dawson TL, Iveson R, Sutton K | title = A novel cosmetic approach to treat thinning hair | journal = The British Journal of Dermatology | volume = 165 | issue = Suppl 3 | pages = 24–30 | date = December 2011 | pmid = 22171682 | doi = 10.1111/j.1365-2133.2011.10633.x | s2cid = 21918537 }}</ref> There have also been developments in the fashion industry with [[wig]] design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a "constant companion".<ref>{{cite journal | vauthors = Zannini L, Verderame F, Cucchiara G, Zinna B, Alba A, Ferrara M | title = 'My wig has been my journey's companion': perceived effects of an aesthetic care programme for Italian women suffering from chemotherapy-induced alopecia | journal = European Journal of Cancer Care | volume = 21 | issue = 5 | pages = 650–660 | date = September 2012 | pmid = 22339814 | doi = 10.1111/j.1365-2354.2012.01337.x | doi-access = free }}</ref> Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use.<ref>{{cite journal | vauthors = Inui S, Inoue T, Itami S | title = Psychosocial impact of wigs or hairpieces on perceived quality of life level in female patients with alopecia areata | journal = The Journal of Dermatology | volume = 40 | issue = 3 | pages = 225–226 | date = March 2013 | pmid = 23252418 | doi = 10.1111/1346-8138.12040 | s2cid = 43795003 }}</ref> |
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Specialized tattoos, commonly known as scalp micropigmentation, can mimic the appearance of a short buzzed haircut.<ref>{{cite news |title=Considering a hair tattoo? Pros and cons to consider before you commit |author=Elisabeth Leamy |url=https://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |newspaper=ABC News |date=May 31, 2012 |access-date=December 16, 2012 |archive-date=April 11, 2019 |archive-url=https://web.archive.org/web/20190411205715/https://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |url-status=live }}</ref> |
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==Human hair growth== |
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{{main|Human hair growth}} |
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[[File:Skin.png|thumb|[[Hair follicle]] with mesenchymal [[dermal papilla]], labelled at top, location of hair follicle [[stem cell]]s and thought to be site of action of [[Dihydrotestosterone|DHT]].]] |
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[[5-alpha reductase|Type 1 and 2 5α reductase enzymes]] are present at [[Sebaceous gland|pilosebaceous units]] in papillae of individual [[hair follicle]]s. They catalyse formation of the androgens testosterone and DHT, which in turn regulate hair growth. Androgens have different effects at different follicles: they stimulate [[Insulin-like growth factor 1|IGF-1]] at facial hair, causing hair regrowth, but stimulate [[TGF beta 1|TGF β1]], [[TGF beta 2|TGF β2]], [[DKK1|dickkopf1]] and [[Interleukin 6|IL-6]] at the scalp, causing hair follicle miniaturisation.<ref name=Inui2013>{{cite journal | vauthors = Inui S, Itami S | title = Androgen actions on the human hair follicle: perspectives | journal = Experimental Dermatology | volume = 22 | issue = 3 | pages = 168–171 | date = March 2013 | pmid = 23016593 | doi = 10.1111/exd.12024 | s2cid = 33521841 | doi-access = free }}</ref> |
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Female androgenic alopecia is characterized by diffuse crown thinning without hairline recession, and like its male counterpart rarely leads to [[Alopecia totalis|total hair loss]].<ref name="Female pattern baldness"/> [[Finasteride]] and [[minoxidil]] are usually first line therapy for its treatment. Other options include topical or systemic [[spironolactone]] or [[flutamide]], although they have a high incidence of [[Feminisation (biology)|feminising]] [[side effects]] and are better tolerated in female androgenic hair loss. |
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More advanced cases may be resistant or unresponsive to medical therapy, however, and require [[hair transplantation]]. Naturally-occurring units of one to four hairs, called [[Hair follicle|follicular units]], are excised and moved to areas of hair restoration. These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either [[Follicular unit transplantation|Follicular Unit Transplantation]] (FUT) – colloquially referred to as "strip harvesting" – or [[Follicular Unit Extraction]] (FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites.<ref name="pmid22808618">{{cite journal | vauthors = Caroli S, Pathomvanich D, Amonpattana K, Kumar A | title = Current status of hair restoration surgery | journal = International Surgery | volume = 96 | issue = 4 | pages = 345–351 | year = 2011 | pmid = 22808618 | doi = 10.9738/cc31.1 | doi-access = free }}</ref><ref name="pmid 21792780">{{cite journal | vauthors = Rose PT | title = The latest innovations in hair transplantation | journal = Facial Plastic Surgery | volume = 27 | issue = 4 | pages = 366–377 | date = August 2011 | pmid = 21792780 | doi = 10.1055/s-0031-1283055 | s2cid = 260138453 }}</ref> Specialized scalp tattoos can also mimic the appearance of a short buzzed haircut.<ref>{{cite news |title=Considering a hair tattoo? Pros and cons to consider before you commit |author=Elisabeth Leamy |url=https://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |newspaper=ABC News |date=May 31, 2012 |access-date=December 16, 2012 |author-link=Elisabeth Leamy |archive-date=April 11, 2019 |archive-url=https://web.archive.org/web/20190411205715/https://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |url-status=live }}</ref> Androgenic alopecia also occurs in women, and more often presents as diffuse thinning without hairline recession. Like its male counterpart, the condition rarely leads to [[Alopecia totalis|total hair loss]]. Treatment options are similar to those for men, although topical or systemic estrogen is used more often.<ref name="Female pattern baldness">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/001173.htm |title=Female pattern baldness |access-date=December 15, 2012 |date=December 15, 2012 |publisher=MedlinePlus |archive-date=December 1, 2012 |archive-url=https://web.archive.org/web/20121201014315/http://www.nlm.nih.gov/medlineplus/ency/article/001173.htm |url-status=live }}</ref><ref>{{cite journal | vauthors = Kovalevsky G, Ballagh SA, Stanczyk FZ, Lee J, Cooper J, Archer DF | title = Levonorgestrel effects on serum androgens, sex hormone-binding globulin levels, hair shaft diameter, and sexual function | journal = Fertility and Sterility | volume = 93 | issue = 6 | pages = 1997–2003 | date = April 2010 | pmid = 19394598 | doi = 10.1016/j.fertnstert.2008.12.095 | doi-access = free }}</ref> |
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==Research== |
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===Bimatoprost and latanoprost=== |
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[[Latanoprost]] and [[bimatoprost]] are specific PGF2a analogues applied topically, and have been found to lengthen eyelashes,<ref>{{cite journal | vauthors = Law SK | title = Bimatoprost in the treatment of eyelash hypotrichosis | journal = Clinical Ophthalmology | volume = 4 | pages = 349–358 | date = April 2010 | pmid = 20463804 | pmc = 2861943 | doi = 10.2147/opth.s6480 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Tosti A, Pazzaglia M, Voudouris S, Tosti G | title = Hypertrichosis of the eyelashes caused by bimatoprost | journal = Journal of the American Academy of Dermatology | volume = 51 | issue = 5 Suppl | pages = S149–S150 | date = November 2004 | pmid = 15577756 | doi = 10.1016/j.jaad.2004.05.002 }}</ref> darken hair pigmentation<ref>{{cite journal | vauthors = Wand M | title = Latanoprost and hyperpigmentation of eyelashes | journal = Archives of Ophthalmology | volume = 115 | issue = 9 | pages = 1206–1208 | date = September 1997 | pmid = 9298071 | doi = 10.1001/archopht.1997.01100160376025 }}</ref> and elongate hair.<ref name="pmid22735503"/> Bimatoprost is available as treatment for eyelash growth.<ref>{{cite journal | vauthors = Banaszek A | title = Company profits from side effects of glaucoma treatment | journal = CMAJ | volume = 183 | issue = 14 | pages = E1058 | date = October 2011 | pmid = 21876012 | pmc = 3185096 | doi = 10.1503/cmaj.109-3919 }}</ref> Latanoprost has shown ability to promote scalp hair density and pigmentation,<ref>{{cite journal | vauthors = Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N | title = A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia | journal = Journal of the American Academy of Dermatology | volume = 66 | issue = 5 | pages = 794–800 | date = May 2012 | pmid = 21875758 | doi = 10.1016/j.jaad.2011.05.026 }}</ref> and is theorized to function at the [[dermal papilla]].<ref>{{cite journal | vauthors = Johnstone MA, Albert DM | title = Prostaglandin-induced hair growth | journal = Survey of Ophthalmology | volume = 47 | issue = Suppl 1 | pages = S185–S202 | date = August 2002 | pmid = 12204716 | doi = 10.1016/s0039-6257(02)00307-7 }}</ref> A study found latanoprost ineffective on eyelashes in a patient with [[alopecia areata]].<ref>{{cite journal | vauthors = Roseborough I, Lee H, Chwalek J, Stamper RL, Price VH | title = Lack of efficacy of topical latanoprost and bimatoprost ophthalmic solutions in promoting eyelash growth in patients with alopecia areata | journal = Journal of the American Academy of Dermatology | volume = 60 | issue = 4 | pages = 705–706 | date = April 2009 | pmid = 19293023 | doi = 10.1016/j.jaad.2008.08.029 }}</ref> It has also been found ineffective in treatment of eyebrow hair loss.<ref>{{cite journal | vauthors = Ross EK, Bolduc C, Lui H, Shapiro J | title = Lack of efficacy of topical latanoprost in the treatment of eyebrow alopecia areata | journal = Journal of the American Academy of Dermatology | volume = 53 | issue = 6 | pages = 1095–1096 | date = December 2005 | pmid = 16310083 | doi = 10.1016/j.jaad.2005.06.031 | doi-access = free }}</ref> |
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===Hormones=== |
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Estrogens are indirect anti-androgens and can be used to treat androgenetic hair loss in women with [[oral contraceptives]]. Systemic estrogen increases SHBG, which binds androgens, including testosterone and DHT, in turn reducing their bioavailability. Topical formulations are available in [[Europe]].<ref name=Blu2011 /> Hair follicles have estrogen receptors and it is theorized that topical compounds act on them directly to promote hair growth and antagonize androgen action. Large clinical studies showing effectiveness are absent. Topical treatment is also usually unavailable in [[North America]].<ref name="pmid22735503"/> |
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There is tentative evidence for [[cyproterone acetate]] in women.<ref name=Levy2013/> |
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===IGF-1=== |
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In December 2012, topical application of [[Insulin-like growth factor 1|IGF-1]] in a liposomal vehicle led to thicker and more rapid hair growth in transgenic mice with androgenic alopecia. The study did not show measurable systemic levels or hematopoietic side effects, suggesting potential for use in humans.<ref>{{cite journal | vauthors = Castro RF, Azzalis LA, Feder D, Perazzo FF, Pereira EC, Junqueira VB, Rocha KC, Machado CD, Paschoal FC, Gnann LA, Fonseca FL | display-authors = 6 | title = Safety and efficacy analysis of liposomal insulin-like growth factor-1 in a fluid gel formulation for hair-loss treatment in a hamster model | journal = Clinical and Experimental Dermatology | volume = 37 | issue = 8 | pages = 909–912 | date = December 2012 | pmid = 22924775 | doi = 10.1111/j.1365-2230.2012.04441.x | s2cid = 21021986 }}</ref> Low energy radiofrequency irradiation induces IGF-1 in cultured human dermal papilla cells.<ref name="pmid22164296">{{cite journal | vauthors = Yoon SY, Kim KT, Jo SJ, Cho AR, Jeon SI, Choi HD, Kim KH, Park GS, Pack JK, Kwon OS, Park WY | display-authors = 6 | title = Induction of hair growth by insulin-like growth factor-1 in 1,763 MHz radiofrequency-irradiated hair follicle cells | journal = PLOS ONE | volume = 6 | issue = 12 | pages = e28474 | year = 2011 | pmid = 22164296 | pmc = 3229574 | doi = 10.1371/journal.pone.0028474 | editor1-last = Najbauer | doi-access = free | bibcode = 2011PLoSO...628474Y | editor1-first = Joseph }}</ref> Adenosine stimulates dermal papillae in vitro to induce IGF-1, along with fibroblast growth factors [[FGF7]], [[Basic fibroblast growth factor|FGF-2]] and [[Vascular endothelial growth factor|VEGF]]. [[Beta-catenin|β-catenin]] transcription increased, which promotes dermal papillae as well.<ref name="pmid22164296"/> Dietary [[isoflavones]] increase IGF production in scalp [[dermal papillae]] in transgenic mice.<ref>{{cite journal | vauthors = Zhao J, Harada N, Kurihara H, Nakagata N, Okajima K | title = Dietary isoflavone increases insulin-like growth factor-I production, thereby promoting hair growth in mice | journal = The Journal of Nutritional Biochemistry | volume = 22 | issue = 3 | pages = 227–233 | date = March 2011 | pmid = 20576422 | doi = 10.1016/j.jnutbio.2010.01.008 }}</ref> Topical capsaicin also stimulates IGF at hair follicles via release of vanilloid receptor-1, which in turn leads to more CGRP.<ref>{{cite journal | vauthors = Okajima K, Harada N | title = Promotion of insulin-like growth factor-I production by sensory neuron stimulation; molecular mechanism(s) and therapeutic implications | journal = Current Medicinal Chemistry | volume = 15 | issue = 29 | pages = 3095–3112 | year = 2008 | pmid = 19075656 | doi = 10.2174/092986708786848604 }}</ref> Ascorbic acid has led to increased IGF expression ''in vitro''.<ref>{{cite journal | vauthors = Kwack MH, Shin SH, Kim SR, Im SU, Han IS, Kim MK, Kim JC, Sung YK | display-authors = 6 | title = l-Ascorbic acid 2-phosphate promotes elongation of hair shafts via the secretion of insulin-like growth factor-1 from dermal papilla cells through phosphatidylinositol 3-kinase | journal = The British Journal of Dermatology | volume = 160 | issue = 6 | pages = 1157–1162 | date = June 2009 | pmid = 19416266 | doi = 10.1111/j.1365-2133.2009.09108.x | s2cid = 42210965 }}</ref> |
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===Stem cell therapy=== |
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{{Main|Hair cloning}} |
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Although follicles were previously thought gone in areas of complete baldness, they are more likely dormant, as recent studies have shown the scalp contains the [[stem cell]]s from which the follicles arose.<ref>{{cite journal | vauthors = Garza LA, Yang CC, Zhao T, Blatt HB, Lee M, He H, Stanton DC, Carrasco L, Spiegel JH, Tobias JW, Cotsarelis G | display-authors = 6 | title = Bald scalp in men with androgenetic alopecia retains hair follicle stem cells but lacks CD200-rich and CD34-positive hair follicle progenitor cells | journal = The Journal of Clinical Investigation | volume = 121 | issue = 2 | pages = 613–622 | date = February 2011 | pmid = 21206086 | pmc = 3026732 | doi = 10.1172/JCI44478 }}</ref> Research on these follicular stem cells may lead to successes in treating baldness through ''hair multiplication'' (HM), also known as ''[[hair cloning]]''. |
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Per a May 2015 review, no successful strategy to generate human hair follicles, for hair regrowth, from adult stem cells has yet been reported.<ref>{{cite journal | vauthors = Balañá ME, Charreau HE, Leirós GJ | title = Epidermal stem cells and skin tissue engineering in hair follicle regeneration | journal = World Journal of Stem Cells | volume = 7 | issue = 4 | pages = 711–727 | date = May 2015 | pmid = 26029343 | pmc = 4444612 | doi = 10.4252/wjsc.v7.i4.711 | doi-access = free }}</ref> However, in April 2016, scientists from Japan published results of their work in which they created human skin from [[induced pluripotent stem cell]]s; implanted into laboratory mice, the cells generated skin with hair and glands.<ref>{{cite journal | vauthors = Takagi R, Ishimaru J, Sugawara A, Toyoshima KE, Ishida K, Ogawa M, Sakakibara K, Asakawa K, Kashiwakura A, Oshima M, Minamide R, Sato A, Yoshitake T, Takeda A, Egusa H, Tsuji T | display-authors = 6 | title = Bioengineering a 3D integumentary organ system from iPS cells using an in vivo transplantation model | journal = Science Advances | volume = 2 | issue = 4 | pages = e1500887 | date = April 2016 | pmid = 27051874 | pmc = 4820374 | doi = 10.1126/sciadv.1500887 | bibcode = 2016SciA....2E0887T }}</ref> |
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===Genetics=== |
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From 2005 to 2007, Curis and [[Procter & Gamble]] collaborated on developing a topical [[Hedgehog signaling pathway|hedgehog]] [[agonist]] for hair loss; the agent did not meet safety standards, and the program was terminated.<ref>{{cite news|last1=Weintraub|first1=Arlene|title=Curis and Genentech Unleash the Hedgehog to Fight a Deadly Skin Cancer|url=http://www.xconomy.com/boston/2011/06/28/curis-and-genentech-unleash-the-hedgehog-to-fight-a-deadly-skin-cancer/?single_page=true|work=Xconomy|date=28 June 2011|access-date=November 9, 2016|archive-date=November 9, 2016|archive-url=https://web.archive.org/web/20161109221622/http://www.xconomy.com/boston/2011/06/28/curis-and-genentech-unleash-the-hedgehog-to-fight-a-deadly-skin-cancer/?single_page=true|url-status=live}}</ref><ref>{{cite web|title=Curis Form 8-K: Termination of a Material Definitive Agreement.|url=https://www.sec.gov/Archives/edgar/data/1108205/000119312507109693/d8k.htm|publisher=SEC EDGAR|date=May 10, 2007|access-date=November 9, 2016|archive-date=November 9, 2016|archive-url=https://web.archive.org/web/20161109222303/https://www.sec.gov/Archives/edgar/data/1108205/000119312507109693/d8k.htm|url-status=live}}</ref> In 2008, researchers at the [[University of Bonn]] announced they have found the genetic basis of two distinct forms of inherited hair loss. They found the gene [[P2RY5]] causes a rare, inherited form of hair loss called hypotrichosis simplex. It is the first [[Receptor (biochemistry)|receptor]] in humans known to play a role in hair growth.<ref>{{cite journal | vauthors = Pasternack SM, von Kügelgen I, Al Aboud K, Lee YA, Rüschendorf F, Voss K, Hillmer AM, Molderings GJ, Franz T, Ramirez A, Nürnberg P, Nöthen MM, Betz RC | display-authors = 6 | title = G protein-coupled receptor P2Y5 and its ligand LPA are involved in maintenance of human hair growth | journal = Nature Genetics | volume = 40 | issue = 3 | pages = 329–334 | date = March 2008 | pmid = 18297070 | doi = 10.1038/ng.84 | s2cid = 20241237 }}</ref><ref>{{cite journal | vauthors = Shimomura Y, Wajid M, Ishii Y, Shapiro L, Petukhova L, Gordon D, Christiano AM | title = Disruption of P2RY5, an orphan G protein-coupled receptor, underlies autosomal recessive woolly hair | journal = Nature Genetics | volume = 40 | issue = 3 | pages = 335–339 | date = March 2008 | pmid = 18297072 | doi = 10.1038/ng.100 | s2cid = 1635950 }}</ref><ref>{{cite journal | vauthors = Sprecher E | title = Disentangling the roots of inherited hair disorders | journal = Nature Genetics | volume = 40 | issue = 3 | pages = 265–266 | date = March 2008 | pmid = 18305473 | doi = 10.1038/ng0308-265 | s2cid = 2311629 }}</ref> Researchers found that disruption of the [[gene]] [[SOX21]] in mice caused cyclical hair loss. Research has suggested SOX21 as a master regulator of hair shaft cuticle differentiation, with its disruption causing cyclical alopecia in mice models.<ref>{{cite journal | vauthors = Kiso M, Tanaka S, Saba R, Matsuda S, Shimizu A, Ohyama M, Okano HJ, Shiroishi T, Okano H, Saga Y | display-authors = 6 | title = The disruption of Sox21-mediated hair shaft cuticle differentiation causes cyclic alopecia in mice | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 106 | issue = 23 | pages = 9292–9297 | date = June 2009 | pmid = 19470461 | pmc = 2695080 | doi = 10.1073/pnas.0808324106 | doi-access = free | bibcode = 2009PNAS..106.9292K }}</ref> Deletion of SOX21 dramatically affects hair lipids.<ref>{{cite journal | vauthors = Kawaminami S, Breakspear S, Saga Y, Noecker B, Masukawa Y, Tsuchiya M, Oguri M, Inoue Y, Ishikawa K, Okamoto M | display-authors = 6 | title = Deletion of the Sox21 gene drastically affects hair lipids | journal = Experimental Dermatology | volume = 21 | issue = 12 | pages = 974–976 | date = December 2012 | pmid = 23171466 | doi = 10.1111/exd.12050 | s2cid = 205126099 | doi-access = free }}</ref> |
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== References == |
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{{Reflist|30em}} |
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== External links == |
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* [http://www.aafp.org/afp/990415ap/2189.html "Medical Treatments for Balding in Men"], April 1999, ''American Family Physician'' (medical journal) |
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{{Human hair}} |
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{{Other dermatological preparations}} |
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<!--?: {{DEFAULTSORT:Baldness Treatments}}--> |
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[[Category:Dermatologic procedures]] |
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[[Category:Plastic surgical procedures]] |
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Latest revision as of 18:52, 24 February 2024
| Management of hair loss | |
|---|---|
| Specialty | Dermatology |
The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.
Prevention
Scratching of itchy scalp may contribute to hair loss.[1]
Health
Body weight
Prevention of obesity helps. Obesity is linked to hair thinning.[2]
Healthy diet
Oils with fatty acids that has been studied to prevent dermatitis includes:[3][4]
- Corn oil: Linoleic acid (LA)
- Fish oil: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
- Hemp seed oil: Linoleic acid (LA), and alpha-Linolenic acid (ALA)
Alternative medicine
The scalp must be cleaned from sebum, sweat, and dirt, prior to topical application, for agents to penetrate it.
A 2020 systemic review on agents used to treat androgenic alopecia found that:[5]
- Oral supplementation of vitamin A, B, C, D, E, and trace element iron, selenium, and zinc, will prevent androgenic alopecia caused by malnutrition. Multivitamins can be used.
- Topical application of onion juice, rosemary oil, saw palmetto, pumpkin seed oil, procyanidin, garlic gel, capsaicin, caffeine, amino acids, and curcumin helped prevent hair loss.
Heating, ventilation, and air conditioning (HVAC)
Humidifier
A humidifier can be used to prevent low indoor humidity during winter (especially with indoor heating), and dry season.[6]
Commonly, patients with seborrhoeic dermatitis experience mild redness, scaly skin lesions and in some cases hair loss.[7]
Low humidity can cause adverse health effects and may cause atopic dermatitis,[8] and seborrhoeic dermatitis.[9]
Treatments
Combination therapy
Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use.[10]
Combination therapy of LLLT or microneedling with finasteride[11] or minoxidil demonstrated substantive increases in hair count.[12]
Medication
Add-hocs
The topical bioavailability of synthetic medicines such as antiandrogens, as well as phytochemicals such as quercetin, has been improved with incorporation of drugs in nanoparticles, or microneedling.[13]
Synthetic medicine
Treatments for the various forms of hair loss have only moderate success.[14] Three medications have evidence to support their use in male pattern hair loss: finasteride, dutasteride and minoxidil.[15] They typically work better to prevent further hair loss than to regrow lost hair.[15]
They may be used together when hair loss is progressive or further regrowth is desired after 12 months.[16] Other medications include ketoconazole, and in female androgenic alopecia spironolactone and flutamide.[17]
Baricitinib
In June 2022, the FDA authorized baricitinib for the treatment of severe alopecia areata.[18][19]
Minoxidil
Minoxidil, applied topically, is widely used for the treatment of hair loss. It may be effective in helping promote hair growth in both men and women with androgenic alopecia.[20][21] About 40% of men experience hair regrowth after 3–6 months.[22] It is the only topical product that is FDA approved in America for androgenic hair loss.[20] However, increased hair loss has been reported.[23][24]
Antiandrogens
Finasteride is used to treat male pattern hair loss.[25] Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken.[20] There is no good evidence for its use in women.[14] It may cause gynecomastia, erectile dysfunction and depression.[26]
Dutasteride is also used in the treatment of male pattern hair loss and appears to have better effectiveness than finasteride for the condition.[27][28][29] While used off-label for male pattern hair loss in most of the world, dutasteride is specifically approved for this indication in South Korea and Japan.[30][31]
There is tentative support for spironolactone in women.[14] Due to its feminising side effects and risk of infertility it is not often used by men.[32][33] It can also cause low blood pressure, high blood potassium, and abnormal heart rhythms. Also, women who are pregnant or trying to become pregnant generally cannot use the medication as it is a teratogen, and can cause ambiguous genitalia in newborn children.[34]
There is tentative evidence for flutamide in women; however, it is associated with relatively high rates of liver problems and strong recommendations have been made against its use.[14][35] Like spironolactone, flutamide is typically only used by women.[36] Bicalutamide is another option for the treatment of female pattern hair loss.[37][38][39] It has a far lower risk of liver toxicity than flutamide and is said to have an excellent safety profile.[38][39][40] However, bicalutamide retains a small risk of liver toxicity and for this reason periodic liver monitoring is recommended during treatment.[38][40]
Ketoconazole
Ketoconazole may help in women.[41][42]
Technological treatments
Low-level laser therapy (LLLT)
Low-level laser therapy or photobiomodulation is also referred to as red light therapy and cold laser therapy. It is a non-invasive treatment option.
LLLT is shown to increase hair density and growth in both genders. The types of devices (hat, comb, helmet) and duration did not alter the effectiveness,[43] with more emphasis to be placed on lasers compared to LEDs.[44] Ultraviolet and infrared light are more effective for alopecia areata, while red light and infrared light is more effective for androgenetic alopecia.[45]
Medical reviews suggest that LLLT is as effective or potentially more than other non invasive and traditional therapies like minoxidil and finasteride but further studies such as RCTs, long term follow up studies, and larger double blinded trials need to be conducted to confirm the initial findings.[46][11][47]
Platelet-rich plasma (PRP)
Using ones own cells and tissues and without harsh side effects, PRP is beneficial for alopecia areata[48] and androgenetic alopecia and can be used as an alternative to minoxidil or finasteride.[49] It has been documented to improve hair density and thickness in both genders.[50] A minimum of 3 treatments, once a month for 3 months are recommended, and afterwards a 3-6 month period of continual appointments for maintenance.[51] Factors that determine efficacy include amount of sessions, double versus single centrifugation, age and gender, and where the PRP is inserted.[52]
Future larger randomized controlled trials and other high quality studies are still recommended to be carried out and published for a stronger consensus.[46][50][53] Further development of a standardized practice for procedure is also recommended.[48]
Surgical treatments
Hair transplantation
A man before and after a hair transplant.
Hair transplantation is a surgical technique that moves individual hair follicles from a part of the body called the donor site to bald or balding part of the body known as the recipient site. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.
Since hair naturally grows in follicles in groups of 1 to 4 hairs, transplantation takes advantage of these naturally occurring follicular units. This achieves a more natural appearance by matching hair for hair through Follicular unit transplantation (FUT).
Donor hair can be harvested in two different ways. Small grafts of naturally-occurring units of one to four hairs, called follicular units, can be moved to balding areas of the hair restoration. These follicular units are surgically implanted in the scalp in very close proximity to one another and in large numbers. The grafts are obtained in one or both of the two primary methods of surgical extraction, follicular unit transplantation, colloquially referred to as "strip harvesting", or Follicular Unit Extraction (FUE), in which follicles are transplanted individually.
In FUT, a strip of skin containing many follicular units is extracted from the patient and dissected under a stereoscopic microscope. The site of the strip removal is stitched closed. Once divided into follicular unit grafts, each unit is individually inserted into small recipient sites made by an incision in the bald scalp. In the newer technique, roots are extracted from the donor area and divided into strips for transplantation. The strip, two to three millimeters thick, is isolated and transplanted to the bald scalp.[54] After surgery, a bandage is worn for two days to protect the stitched strip during healing. A small strip scar remains after healing, which can be covered by scalp hair growing over the scar.[55]
Scalp reduction
Scalp reduction is a surgical procedure in which the hairless region of the scalp of a bald man is reduced. This procedure can reduce the area of the scalp without hair.[56][57]
Regrowth of hair
Facial hair
Eyebrows
Bimatoprost 0.03% has been used to grow eyebrows.[58]
Eyelashes
The FP receptor agonist, bimatoprost, in the form of an 0.03% ophthalmic solution termed Latisse, is approved by the US Food and Drug Administration to treat hypotrichosis of the eyelashes, in particular to darken and lengthen eyelashes for cosmetic purposes.[59] Also, bimatoprost may be used to treat small or underdeveloped eyelashes.[60][61]
Scalp hair
Alternative medication
Topical
Some popular plant juices sold as hair serum may instead of growing human hair actually inhibit the growth, including 6-gingerol found in ginger.[62]
Topical crude onion juice
A small 2002 study demonstrated that treatment twice daily for six weeks with crude onion juice from Australian brown onion, re-growth hair on alopecia areata (spot baldness) in 86.9% of the 23 participants.[63] Twice as many flavonols are found in red onion than in yellow onion.[64] Also, non-organic onions might contain pesticides on the peel and in the first scaly leaf. Compounds found in onion that stimulates hair growth:
- Quercetin:
- Quercetin (a flavanoid found in vegan food) supplements, has been suggested to treat baldness.[65] A 2012 study demonstrated that alopecia areata could be used to prevent ant treated with quercetin in mice.[65] Quercetin is found in onions primarily in the peel and the first scaly leaf but not in the flesh.[66] Onion bulb size or weight does not appear to be affected by quercetin concentration.[64]
- A 2020 study demonstrated that quercitrin stimulated hair shaft growth in cultured human hair follicles.[67]
- Volatile compounds responsible for pungency and tearing in onions when they are cut (e.g. syn-propanethial S-oxide gas). However, no formal studies have conducted to evaluate if these compounds promote hair growth or if they help other compounds to penetrate the skin to form hair follicles.
- To use the volatile compounds: Onions must be extracted and applied topically quickly before the volatile compounds evaporates. The extract will cause tearing eyes, but it can be prevented with a shower cap, or a pair of swimming goggles.
- To discard the volatile compounds: The onion juice is extracted and stored for a short while to evaporate the volatile compounds. The extract will not cause tearing eyes. Also, both genetically modified, and plant breed onions have been produced with significantly reduced levels of tear-inducing lachrymatory factor.[68][69]
Dietary supplements
Dietary supplements are not typically recommended.[70] Many people use unproven treatments,[15] but there is little evidence of the effectiveness of vitamins, minerals, or other dietary supplements regrowing hair or retaining hair.[14] There is no evidence for biotin (vitamin B7).[70] While lacking both evidence and expert recommendation, there is a large market for hair growth supplements, especially for products that contain biotin.
However, one small trial of saw palmetto which shows tentative benefit in those with mild to moderate androgenetic alopecia.[70] There was no good evidence for gingko, aloe vera, ginseng, bergamot, or hibiscus as of 2011.[71]
Radiation-induced hair loss
Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression.[72][73] Radiation therapy has been associated with increased mucin production in hair follicles.[74]
Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia.[75]
Cosmeses
Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle.[76] There have also been developments in the fashion industry with wig design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a "constant companion".[77] Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use.[78]
Specialized tattoos, commonly known as scalp micropigmentation, can mimic the appearance of a short buzzed haircut.[79]
Human hair growth
Type 1 and 2 5α reductase enzymes are present at pilosebaceous units in papillae of individual hair follicles. They catalyse formation of the androgens testosterone and DHT, which in turn regulate hair growth. Androgens have different effects at different follicles: they stimulate IGF-1 at facial hair, causing hair regrowth, but stimulate TGF β1, TGF β2, dickkopf1 and IL-6 at the scalp, causing hair follicle miniaturisation.[80]
Female androgenic alopecia is characterized by diffuse crown thinning without hairline recession, and like its male counterpart rarely leads to total hair loss.[81] Finasteride and minoxidil are usually first line therapy for its treatment. Other options include topical or systemic spironolactone or flutamide, although they have a high incidence of feminising side effects and are better tolerated in female androgenic hair loss.
More advanced cases may be resistant or unresponsive to medical therapy, however, and require hair transplantation. Naturally-occurring units of one to four hairs, called follicular units, are excised and moved to areas of hair restoration. These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either Follicular Unit Transplantation (FUT) – colloquially referred to as "strip harvesting" – or Follicular Unit Extraction (FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites.[55][82] Specialized scalp tattoos can also mimic the appearance of a short buzzed haircut.[83] Androgenic alopecia also occurs in women, and more often presents as diffuse thinning without hairline recession. Like its male counterpart, the condition rarely leads to total hair loss. Treatment options are similar to those for men, although topical or systemic estrogen is used more often.[81][84]
Research
Bimatoprost and latanoprost
Latanoprost and bimatoprost are specific PGF2a analogues applied topically, and have been found to lengthen eyelashes,[85][86] darken hair pigmentation[87] and elongate hair.[17] Bimatoprost is available as treatment for eyelash growth.[88] Latanoprost has shown ability to promote scalp hair density and pigmentation,[89] and is theorized to function at the dermal papilla.[90] A study found latanoprost ineffective on eyelashes in a patient with alopecia areata.[91] It has also been found ineffective in treatment of eyebrow hair loss.[92]
Hormones
Estrogens are indirect anti-androgens and can be used to treat androgenetic hair loss in women with oral contraceptives. Systemic estrogen increases SHBG, which binds androgens, including testosterone and DHT, in turn reducing their bioavailability. Topical formulations are available in Europe.[71] Hair follicles have estrogen receptors and it is theorized that topical compounds act on them directly to promote hair growth and antagonize androgen action. Large clinical studies showing effectiveness are absent. Topical treatment is also usually unavailable in North America.[17]
There is tentative evidence for cyproterone acetate in women.[14]
IGF-1
In December 2012, topical application of IGF-1 in a liposomal vehicle led to thicker and more rapid hair growth in transgenic mice with androgenic alopecia. The study did not show measurable systemic levels or hematopoietic side effects, suggesting potential for use in humans.[93] Low energy radiofrequency irradiation induces IGF-1 in cultured human dermal papilla cells.[94] Adenosine stimulates dermal papillae in vitro to induce IGF-1, along with fibroblast growth factors FGF7, FGF-2 and VEGF. β-catenin transcription increased, which promotes dermal papillae as well.[94] Dietary isoflavones increase IGF production in scalp dermal papillae in transgenic mice.[95] Topical capsaicin also stimulates IGF at hair follicles via release of vanilloid receptor-1, which in turn leads to more CGRP.[96] Ascorbic acid has led to increased IGF expression in vitro.[97]
Stem cell therapy
Although follicles were previously thought gone in areas of complete baldness, they are more likely dormant, as recent studies have shown the scalp contains the stem cells from which the follicles arose.[98] Research on these follicular stem cells may lead to successes in treating baldness through hair multiplication (HM), also known as hair cloning.
Per a May 2015 review, no successful strategy to generate human hair follicles, for hair regrowth, from adult stem cells has yet been reported.[99] However, in April 2016, scientists from Japan published results of their work in which they created human skin from induced pluripotent stem cells; implanted into laboratory mice, the cells generated skin with hair and glands.[100]
Genetics
From 2005 to 2007, Curis and Procter & Gamble collaborated on developing a topical hedgehog agonist for hair loss; the agent did not meet safety standards, and the program was terminated.[101][102] In 2008, researchers at the University of Bonn announced they have found the genetic basis of two distinct forms of inherited hair loss. They found the gene P2RY5 causes a rare, inherited form of hair loss called hypotrichosis simplex. It is the first receptor in humans known to play a role in hair growth.[103][104][105] Researchers found that disruption of the gene SOX21 in mice caused cyclical hair loss. Research has suggested SOX21 as a master regulator of hair shaft cuticle differentiation, with its disruption causing cyclical alopecia in mice models.[106] Deletion of SOX21 dramatically affects hair lipids.[107]
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External links
- "Medical Treatments for Balding in Men", April 1999, American Family Physician (medical journal)