Hairloss PI

Archive for July, 2010

Seeing recent pictures of Naomi Campbell's bald patches, probably caused by hair extensions, brought back bad memories for me.

I know how she feels because a similar thing happened to me a few years ago. I wanted the front of my hair to look thicker and longer so I went to a hair-extension stylist who'd been highly recommended.

At first it looked fantastic but about a month later the join between my own hair and the extension had become noticeable so I decided to have them removed.

That's when it went wrong. It took several attempts to dissolve the glue that was holding them on but the chemical used to do this pulled out my own hair.

As I looked down I saw huge clumps, roots and all, in my lap. When I looked up in the mirror, I had no hair at the front.

Once the shock had worn off, I was devastated. But I also felt incredibly stupid. I hadn't really looked into what could go wrong - after all, it was a just a hair treatment, not a medical procedure.

What a mistake - although my hair has partially recovered it never regained its original thickness.

Hair today..

Over the past few years, a number of celebrities, including Victoria Beckham, are said to have had the odd temporary bald patch after having extensions. Meanwhile, Jennifer Aniston has complained that having it done ruined the condition of her locks.

Stylists maintain that, if your own hair is in good nick and the extensions are properly fitted and maintained, they should be fine.

However, last year research
in the British Journal of Dermatology claimed that some women lose their hair within a week of having extensions and that even women with no obvious signs of hair loss had considerable underlying damage to the scalp when examined more closely.

The dermatologists - from the University of Miami in Florida and Bologna University in Italy - suggested that the problems are probably far more common than reported.

Danger areas

Traction alopecia tends to happen at the front of the head and around the temples, where the hair is weakest.

The extensions, which are attached by glue, weaving or braiding, put tension on the hair follicles, which become inflamed, causing hair to fall out. This is more likely if the extensions are heavy, left in a long time or fitted badly. Some glues can damage hair, too.

But any tight hairstyles like braids can have the same effect while harsh chemicals such as dyes, bleaches and straightening solutions further weaken hair.

If it's caught early, it'll grow back but the hair loss can be permanent.

1. Joe Biden: The new Vice President's hair transplant surgery was a hot topic of discussion during the final months of the 2008 presidential election.
2. Nicholas Cage: This star's newly plentiful hairline speaks of a very well-done hair transplant surgery.
3. Matt Lauer: Longtime host of the Today Show, Matt Lauer's hairline has been under the spotlight for years; giving the public witness to his bald-to-beautiful hair makeover.
4. Matthew McConaughey: This female-friendly actor and his new-and-improved hairline have made him an inspiration to the hair loss community.
5. Wade Boggs: Baseball-Hall-of-Famer Wade Boggs has received attention lately for his successful hair transplant surgery, rather than for his former batting skills.
6. Dennis Miller: This comedian made sure his hairline was no longer a punchline, after transforming it with hair transplant surgery.
7. Mel Gibson: Heartthrob actor Mel Gibson probably chose hair transplant surgery to help maintain his A-list status as well as his formerly plentiful mane.
8. Burt Reynolds: Idolized since the 70s for being the epitome of swaggering, hairy masculinity, Burt Reynolds turned to hair transplant surgery in his later years to keep his thick locks up to par.
9. Mickey Rourke: This star and comeback artist has been under scrutiny in the past for the plastic surgery work he's had done. But now, a welcome addition to that list is hair transplant surgery, likely evidenced in recent pics of his subtly re-emerging hairline.
10. Kevin Costner: Actor Kevin Costner, now in his 50s, is reported to have used hair transplant surgery to supplement his previously thinning mane.

CLINICAL PRESENTATION OF ANDROGENETIC ALOPECIA

Alopecia is a general term for hair loss and requires further description. Androgenetic alopecia (AGA) is the most common cause of hair loss, presenting as loss of hair over the top (vertex) and the anterior mid-scalp area (receding hairline) in affected men. The term androgenetic alopecia denotes that both a genetic predisposition and the presence of androgens are necessary to cause expression. AGA is also referred to as male pattern hair loss and typically begins gradually in men in there 20s with incidence increasing 10% per decade.

Presence of Androgens must be present for baldness to occur

For centuries, it has been observed that the presence of androgens was necessary for Androgenetic Alopecia to express itself. In 400 BC Hippocrates observed that eunuchs (castrated males) did not become bald. Aristotle noticed this also.(1) Through out history it was also observed that the Italian Castrati (boys that castrated in order to train them as adult soprano singers, a practice which was ended by Pope Leo XIII in 1878) never became bald. Researchers knew that AGA had to be associated with the male hormone testosterone. It comes as no surprise that current research shows that the balding scalp contains miniaturized hair follicles and increased amounts of DHT compared to a hairy scalp. This suggests that it is the excess presence of dihydrotestosterone in the scalp tissue that causes AGA in those patients genetically predisposed.

Pathophysiology of Androgenetic Alopecia

In the body testosterone is broken down by an enzyme call 5 alpha reductase to dihydrotestosterone. (DHT). DHT, a potent metabolite of testosterone causes a gradual, progressive shrinkage in the length and caliber of genetically programmed hair follicles. This process is called miniaturization. Miniaturization results from shortening of the anagen phase and a decrease in the sit of the dermal papilla and volume of matrix cells. Consequently, each succeeding hair cycle results in production of smaller, finer hairs which contribute less to the overall appearance and density of the hair. These biochemical events occur at the cellular level of the hair follicle. Because the dermal papilla is highly vascular, it is continuously bathed in circulating androgens. It has been demonstrated that the dermal papilla is rich in androgen receptors and is the primary target of androgen action. (Choudhry et al., 1996) Cells in genetically programmed hair follicles contain the enzyme 5 alpha reductase. 5 alpha reductase converts testosterone into the more potent DHT (Chen, Zouboulis & Orfanos, 1996). 5 alpha reductase is found in higher quantities in the scalp follicles of affected men. (Sawaya & Price 1997) Androgen receptors in the cells of the dermal papilla bind with circulating DHT, forming androgen receptor complexes. This results in the androgen effects of miniaturization on the hair follicle. (Randall et al., 1992)

In conclusion, by inhibiting the breakdown of testosterone to DHT, hair loss can be prevented or at least kept to a minimum.

Treatments for Androgenetic Alopecia

5 Alpha Reductase inhibitors

Drugs in this class work by inhibiting the enzyme 5 alpha reductase, which limits the conversion of testosterone to DHT (Chen et al., 1996) Finasteride (propecia) is the first drug in this class to undergo extensive clinical trials in men. Finasteride has selective activity against 5 alpha reductase. As a result, serum and follicular DHT levels are significantly reduced (Dallob et al., 1994).

Saw Palmetto extract

Studies have shown that saw palmetto is an effective anti-androgen. It acts in a similar way that propecia does. Firstly it lowers levels of DHT in the body by blocking 5 alpa-reductase. Secondly Saw Palmetto blocks receptors sites on cell membranes required for cells to absorb DHT. Although no studies have been carried out on saw palmetto and its relation to hair growth, studies have been performed on the use of Saw Palmetto in the treatment of benign prostatic disease, which is similar to androgenetic alopecia in that it also depends on the production of dihydrotestosterone. All of the studies that have been performed to date show that Saw Palmetto is an effective anti-androgen and has shown conclusively to be effective in the treatment of benign prostatic disease.

One may assume from this that since Saw Palmetto is an effective anti-androgen and is used in the treatment of prostatic disease then it may also be effective in the treatment of androgenetic alopecia.

Vitamins

Some vitamins have been show to inhibit the activity of 5 alpha reductase and subsequent production of DHT. These vitamins therefore may be of great benefit in the treatment of androgenetic alopecia or preventing baldness. There has been studies in which zinc is shown to inhibit 5 alpha reductase activity and it has therefore been concluded that zinc is beneficial in disease and disorders related to an excess in DHT. There has also been studies which have show that vitamin B6, Zinc and azelaic combined together even in low concentrations resulted in a 90% inhibition of 5 alpha reductase activity.

Recommendations

Propecia has been tested and found to be effective in the treatment of AGA. However, its list of possible side effects include sexual adverse experiences. It also affects PSA levels, which is the screening indicator for prostrate cancer.

Saw Palmetto has been proven safe to use. It has no known drug interactions and is well tolerated by most people. The only noted side effect in a very small percent of people is upset stomach. Saw Palmetto can be taken with zinc, vitamin b6, and azelaic acid for a synergistic effect.

Conclusion

Normal healthy hair grows about ½ inch per month. It may take several months before any effects are noticed. Where the area is completely bald, hair may not grow, if the follicles are dead. It takes years for the hair to thin, so one must assume that it will take time to also reverse the process. Keeping the hair from further thinning is success in itself.

References

Chen, W., Zouboulis, Ch.C., & Orfanos, E.E. 1996) the 5-reductase system and its inhibitors. Dermatology, 193, 177-184

Choudry, R., Hodgins, M.B., Van der Kwast, T.H., Brinkmann, A.O., & Boersma, W.J.A. (1992) localization of androgen receptors in human skin by immunohistochemistry: implications for the hormonal regulation of hair growth, sebaceous glands and sweat glens. Journal of Endocrinology, 133 467-475

Dallob, A.L., Sadick, N.S., Unger, W., Lipert, S., Geissler, L.A., Gregoire, S.L., Nguyen, H.H., Moore, E.C., & Tanaka, W.K. (1994) The effect of finasteride, a 5-reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness. Journal of Clinical Endocrinology and Metabolism, 79(3), 703-706.

Sawaya, M.E., & Price, V.H. (1997). Different levels of 5 alpha reductase type I & II, aromatase, and androgen receptors in hair follicles of women and men with androgenetic alopecia. The Journal of Investigative Dermatology, 10(3), 296-300.

Usually, micropigmentation is tattooing and should be thought of as permanent.

Micropigmentation tends to look better from further away than from close up as the distinct smoothness of the texture tends to indicate something is just not right when viewed close up.

Common problems with micropigmented center on the hairlines, which are often too straight and look unnatural, but this may be a sign of the poor quality of the workmanship, rather than the procedure itself.

As with hair transplantation, creating a low, full, permanent “hairline” on a young man could look terrible after he ages and/or experiences further balding. Remember that your hairline at 20 will naturally be significantly lower down than your hairline at 50, so plan ahead otherwise you could be defeating the purpose.

Apart from the safety aspects of the procedure that apply to the general practice of tattooing, micropigmentation is not for everyone, andits effectiveness as a masking of a balking head depends on:

• the shape of your head,
• the colour of your natural hair,
• your age
• the skill of the practitioner

The choice is yours but you should think of micropigmentation as a permanent procedure that will force you to keep your hair buzzed forever and should plan accordingly. The same rules and guidelines used when designing a hairline for hair transplantation should apply for micropigmentation.

Myth #1: A new hair loss treatment called Caproxen has just been approved by the FDA to treat Male Patern Balding (MPB)  -

NOT TRUE: Caproxen is marketing hype unfortunately. It was not tested by the FDA nor has it been found to grow hair back to any greater extent than Minoxidil. This is because Caproxen IS Minoxidil, under a different brand name.

If it is sold at the same strength as Rogaine but at a cheaper price, then buy it, otherwise ignore the product and the hype.

Myth #2: Natural hair loss treatments are safer and better for hair regrowth  -

NOT TRUE: Treat all 'natural' hair loss treatment claims as suspicious, most likely useless, and potentially unsafe. Any claims should always be double-checked for verifiable, peer-reviewed clinical trials or other credible substantiation, and without such compelling evidence, avoid at all costs.

Myth #3: Male Pattern Baldness has now been cured with the likes of the FDA approved Minoxidil and Finasteride -
NOT TRUE: Unfortunately, these treatments work partially, and only on some men. There is currently NO SILVER bullet treatment for MPB, only partly effective treatments that may slow down or partially reverse hair loss in some men.

Myth #4: MPB can be reversed by increasing the blood flow to the scalp -

NOT TRUE: Blood flow to the scalp is completely unrelated to MPB, and increased blood flow to the scalp DOES NOT halt or reverse MPB.

Myth #5: A healthy diet and regular exercise reduces or reverses hair loss -

NOT TRUE: MPB is genetically programmed to occur It is unrelated to the general physical health of the sufferer. Regular exercise and healthy living may make you feel better physically, but it will have zero impact on your hair loss.

Myth #6: Removing stress from your lifestyle will reduce or reverse hair loss -

NOT TRUE: As per above, MPB is unrelated to environment factors such as physical or emotional well-being. The disease progression will continue unabated regardless of your general health and well-being.

Myth #7: Hair loss is caused by blocked or clogged hair follicles Removing stress from your lifestyle will reduce or reverse hair loss -

NOT TRUE: As per above, MPB is unrelated to environmental factors such as physical or emotional well-being. The disease progression will continue unabated regardless of your general health and well-being.

Blocked or clogged hair follicles do not affect the growth of your hair. Your hair will still grow from the root so no matter how blocked your scalp is it will continue to grow.

Myth #8: FDA approved hair loss medications only work on the crown -

NOT TRUE: Drugs like minoxidil and finasteride are better at slowing down or halting hair loss, rather than in re-growing hair. Likewise, these drugs are more effective on the crown, however they still do have some effect on other parts of the scalp as well. In fact, these drugs can work wherever there is thinning and baldness.

Myth #9: Drinking coffee can cause or exacerbate MPB -

NOT TRUE: No reliable studies have ever shown a connection between the consumption of coffee and an increase in hair loss. In fact, recent studies have shown some efficacy in the application of a coffee lotion directly on the scalp. In other words, some men who have been regularly applying a lotion made of coffee beans directly on their scalp, have suffered less hair loss and in some regrowth as a result. This suggests a potential positive affect of coffee, not negative.

Myth #10: Hair loss is merely a cosmetic change, so accept it and forget it  -

NOT TRUE: Unfortunately, MPB is strongly associated will cardio-vascular events like heart attack, and a form of cancer known a prostate cancer, later on in life.  Some studies have suggested that treatment for hair loss with finasteride made also have later benefits as a protective measure against prostate cancer.