Researchers at Columbia University have developed a hair restoration method that can create new human hair, rather than simply grafting hair from one part of the head to another. The approach could vastly expand opportunities for hair transplantation in both man and women. The method was described in a study published in the Proceedings of the National Academy of Sciences.

New hair follicle regeneration has been observed in several lower organisms, including rodents; demonstrating these regenerative properties in human cells and tissues has been challenging. In the study, researchers showed that by manipulating cell culture conditions to establish three-dimensional papilla spheroids, they were able to more successfully grow new hair that could readily graft to the human head.

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hair loss sex drive

Boston University researchers, working with colleagues at Lahey Clinic, have found that finasteride (also known as Propecia) may produce significant adverse effects in some individuals including loss of libido and erectile dysfunction.

The researchers suggest that caution should be used when prescribing finasteride to patients looking to slow hair loss – finasteride, say the Study’s authors, may produce persistent side effects in a number of young patients.

“Honest and open discussion with patients to educate them on these serious issues must be pursued prior to commencing therapy because, in some patients, these adverse effects are persistent and may be prolonged and patients do not recover well after discontinuation from drug use,” said Abdulmaged M. Traish, the Study’s lead author.

While some form of sexual dysfunction was thought to affect a small minority of patients, the magnitude of adverse effects on sexual function remains ill-defined. The Study’s authors have suggested that additional clinical and preclinical studies are needed.

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Researchers may have discovered an underlying cause of male baldness pattern and their findings suggest that the condition may be reversible.

In the study, scientists at the University of Pennsylvania examined hair follicles from 54 men seeking hair transplantation surgery. When they compared follicles from still-hairy samples to bald samples, they found that adult stem cells were still present, but progenitor stem cells were depleted.

progenitor cells

In a healthy hair follicle, the region known as “the bulge” contains a packet of adult stem cells from which the hair is replenished. Scientists believe that adult stem cells may rely on progenitor cells, also found in the hair follicle, to spur hair growth. A loss of progenitor cells appears to cause a decline in the size of the hair shaft (follicles in the bald scalp never disappear completely, they only shrink in size).

Like stem cells, progenitor cells differentiate into specific type of cells. Unlike stem cells, which can replicate indefinitely, progenitor cells will only divide a limited number of times. The new finding has the potential to help experts develop new cures for baldness in both men and women, by creating a novel treatment to restore progenitor cell function.

The findings are published in The Journal of Clinical Investigation.

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Angela ChristianoIn a recent interview in the New York Times, Angela Christiano, an associate professor of dermatology and genetics at Columbia University, discusses her hair loss research. Christiano became interested in the alopecia areata after noticing her first bald spots at thirty.

In the Summer of 2009, Christiano announced the discovery of the 139 markers for alopecia found across the human genome. Her team compared the DNA of 1,000 alopecia patients against a control group of 1,000 without it.

Interestingly, alopecia shares virtually no genes with autoimmune skin diseases like psoriasis or vitiligo; instead it has much in common with type 1 diabetes, celiac disease and arthritis. Because there are many drugs on the market to treat these diseases, there is a good chance that existing and approved drugs could have benefits for hair loss sufferers.

“We have a chance of pushing forward with clinical trials for potentially effective drugs much sooner than we’d thought,” says Christiano.

Read the full article at NYTimes.com.

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Dr. David Alpeter is a hair restoration physician working with Bosley out of New York. Alpeter joined us in the Hair Science Studios to discuss rogaine, propecia, and the current state of hair restoration science.

Alpeter also discusses Bosley’s Aderans Research Institute (“Aderans”), which is pioneering cell-based solutions for hair loss. Aderans technology, currently in development, may make it possible to multiply or clone hair, providing a potentially unlimited supply.

In 3 – 5 years, candidates for hair regeneration may no longer be limited by the number of hairs on their head. Aderans envisions a time when anyone, regardless of the degree of hair loss, can have a full head of hair.

During the Aderans process (which it calls “Ji Gami”), a small piece of tissue is removed from the neckline. Cells are cultivated in controlled conditions where they are encouraged to multiply by the addition of proprietary growth media. When enough new cells are formed, they are returned to the scalp, where they are injected and elicit new hair growth and thickness, ultimately producing more hair than the client had before.

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nizoral-shampooSome research suggests that ketoconazole shampoo (sold in the U.S. under the brand name Nizoral) may be beneficial in men suffering from male pattern baldness. Anecdotal reports indicate that both the one-percent (available over-the-counter) and two-percent (available by prescription) dosages have hair loss benefits. The more potent 2% formulation may produce superior results.

Nizoral Shampoo is only FDA approved for the treatment of dandruff and seborrheic dermatitis of the scalp, so although Nizoral may be useful as a hair loss remedy, it cannot be endorsed or marketed as one to the general public.

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Clinical Data

One study, completed in 1998, compared ketoconazole shampoo (two-percent solution) to minoxidil two-percent in men with male pattern baldness.

The study concluded that “hair density and size and proportion of anagen follicles were improved almost similarly by both ketoconazole and minoxidil regimens”. Ketoconazole shampoo used two to four times a week was nearly as effective as the proven hair loss treatment minoxidil two-percent.

One other study, completed in 2005, corroborated the existence of a stimulatory effect on hair growth in mice. More rigorous studies on larger groups of men should be done to confirm the findings.

Mechanism of Action

While ketoconazole’s mechanism of action in hair loss is still unclear, it has been posited that ketoconazole effectively treats a fungus that commonly inhabits the scalp; researchers hypothesize that it may prevent hair loss by reducing inflammation from this fungus.

Excessive usage of either formulation has not been shown to produce better results. The results produced in the one study in men are based on ketoconazole 2% shampoo, used once every 2-4 days, and leaving the shampoo on the scalp for 3–5 minutes before rinsing (as with the treatment of dandruff).

rogaineMinoxidil was developed as a drug to lower blood. Minoxidil was also found to stimulate hair growth. No one is certain how minoxidil works, but it is suspected to be caused by the vasodilation (the widening of blood vessels resulting from relaxation of smooth muscle cells) in the scalp. Minoxidil’s effects vary widely from person to person and results are difficult to predict.

The topical hair restoration agent minoxidil has been approved for use in treating male-pattern hair loss for over twenty years. Available first as a two-percent solution in 1998 (marketed under the brand name Rogaine), it has more recently been approved for use in five-percent solution; the five-percent solution has been found to be most effective.

What to Expect

The process of losing hair takes time, so it is logical to understand that reversing the process will time as well. As with any regimen, persistence and patience are two requisite factors. The timeline for minoxidil hair growth is similar to that of finasteride.

Month 1 – 2: You may see an increase in shedding during this time. This most likely means minoxidil is working. You will have stimulated a new growth cycle to begin, and this is going to push out some of the deteriorating follicles to make way for the newer, stronger hair.

Month 3 – 9: You may start to see some results. Your first hairs may be small, thin, and light in color. Over time these hairs will cycle through their growth phases and each time come in thicker, healthier and darker. This response time may take up to a year to occur.

After 12 Months: You will have gotten a hold on your hair loss. You may experience new hair growth or see a significant slowing or stoppage of hair loss and thinning.

Clinical Data

In 2003, dermatologists conducted a one-year study in 984 men with male-pattern hair loss. The study evaluated the effectiveness of a 5% minoxidil topical solution applied twice daily. Patients were evaluated every three months.

At the end of one year:

– Hair loss areas of the scalp had become smaller in 62% of the patients, unchanged in 35.1% and larger in 2.9%
– Patients lost an average of 69.7 hairs during washing at the beginning of the study and an average of 33.8 at the end of the study
– Side effects, mostly dermatologic, were reported by 3.9% of patients in the study

Downside and Possible Side Effects

Since it is a topical solution, you must apply it daily once or twice a day. This can be an inconvenience.
Possible side effects include mild scalp irritation. Occasionally, people have experienced low blood pressure or an increase in heart rate at the time of application.

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Finasteride (marketed by Merck under the trademark name Propecia) is a synthetic antiandrogen that acts by inhibiting the enzyme that converts testosterone to dihydrotestosterone (DHT). Finasteride significantly reduces DHT, a key cause of hair loss, by inhibiting the formation of DHT in your scalp. Lowering DHT appears to inhibit the continued shrinking of affected hair follicles.

DHT’s Roll in Hair Loss

propecia before and afterBoth men and women tend to lose hair due to some hormonal changes in the body. It is mainly the alterations in the metabolism of androgen in the body that brings about hair loss.

The most important structure of a hair follicle is the dermal papilla, which is responsible for hair growth. The dermal papilla lies in direct contact with capillaries in the skin and is responsible for deriving nutrients needed for hair follicle growth.

When DHT reaches the hair follicles and dermal papilla, it tends to prevent vitamins, minerals and proteins from nourishing the hair follicles. When this occurs, hair follicles will 1) reproduce at a slower rate, 2) will also shrink (or thin).

Men and women who are genetically pre-disposed to hair loss produce more DHT than others.

Clinical Data

Finasteride was initially approved by the FDA in 1992 under the brand name Proscar, a treatment for benign prostatic hyperplasia (BPH). In 1997, the FDA approved finasteride to treat male pattern baldness (MPB) under the brand name Propecia.

In a 5-year study of men with mild to moderate hair loss, two-thirds of the men who took Propecia daily regrew hair (as measured by hair counts). In contrast, all of the men in the study who were not taking Propecia lost hair. In the same study, 48% of those treated with Propecia experienced visible hair growth, and a further 42% had no additional hair loss.

Propecia is effective only for as long as it is taken. Any gains in hair count will be lost six to twelve months of stopping therapy. Propecia, like Rogaine, is effective on the crown area and the hairline, but is most successful in the crown area.

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Researchers may have uncovered the genetic basis for one of the most commons causes of hair loss. Alopecia areata, a common autoimmune skin disease that results in hair loss on the scalp and elsewhere, is to blame for 5.3 million cases of hair loss in America.

Now, a team from Columbia University Medical Center has uncovered eight genes that underpin the condition, several of which are implicated in other autoimmune disease such as rheumatoid arthritis and type 1 diabetes. The discovery, reported in a paper in the July 1, 2010 issue of Nature, means new, effective hair loss treatments could soon hit the market.

“Finding the initial genes underlying alopecia areata is a big step forward, but the nature of the genes is even more exciting,” said Angela M. Christiano, Ph.D., professor of dermatology and genetics & development at Columbia University Medical Center, and lead author of the study.

One gene, ULBP3, was identified for its role in the onset of alopecia areata. ULBP3 attracts cytotoxic cells that can invade and quickly destroy an organ. Normally, ULBP3 is not present in hair follicles, but the ULBP3 proteins are abundant in hair follicles affected by alopecia areata. The proteins attract cells marked by a killer cell receptor, known as NKG2D.

“There seems to be a shared mechanism among organs that express NKG2D danger signals as part of the initiating process,” said Dr. Christiano. “Since drugs are already in development that target these pathways — because they are being tested to treat rheumatoid arthritis, type 1 diabetes and other diseases where the NKG2D receptor is involved—we may soon be able to test these drugs in clinical trials for alopecia areata.”

Prior to the Columbia team’s findings, alopecia areata, because of its inflammatory quality, was considered similar to psoriasis. But psoriasis drugs used to treat alopecia areata have proved unsuccessful. It turns out, alopecia areata may have more genetic similarities to disease like rheumatoid arthritis, celiac, and type 1 diabetes.

Understanding the genetic makeup of alopecia areata could result in not only effective treatments but also diagnostic tests to predict the severity of the disease. The Columbia researchers found that alopecia areata in people who carried 13-14 of the identified genes did not progress, while people with 16+ genes usually developed alopecia universalis, or total baldness.

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Women experiencing hair loss often suffer in silence. Rather than altering their hairstyles or experimenting with hats, a visit to the dermatologist may be in order.

“Sometimes women experiencing hair loss think they should stop washing, coloring or perming their hair, but these things won’t impact the course of hair loss or speed up the process,” said dermatologist Mary Gail Mercurio, MD, FAAD, associate professor of dermatology at the University of Rochester, speaking at the 68th Annual Meeting of the American Academy of Dermatology.

The most common form of hair loss in women is androgenetic alopecia, usually inherited from either the mother or father. This condition, also known as pattern hair loss, affects both men and women, but in the female version, the frontal hairline is usually maintained; instead, there is visible thinning over the crown. In addition, hairs are miniaturized due to a shortened growth cycle where the hair stays on the head for a shorter period of time.

Minoxidil 2% is the only FDA-approved topical medication for female-pattern hair loss. Minoxidil 5%, for male-pattern hair loss, has been shown to be effective in women as well, but women should consult a dermatologist before starting the treatment since it can increase facial hair growth.

In some cases, a hormonal abnormality may be responsible for hair loss in women. Hyperandrogenism, a medical condition characterized by excessive production of male hormones (androgens), is one example. One clue that hormones are involved is if the hair loss pattern resembles that of a man’s. While female-pattern hair loss caused by a hormonal imbalance can be treated with prescription medications such as spironolactone or oral contraceptives, it is important that women see a dermatologist for proper diagnosis and treatment.

Also known as scarring alopecia, cicatricial alopecia is a form of hair loss in women and men marked by scarring of the scalp where the source of the hair follicle is destroyed. Unlike other forms of hair loss, cicatricial alopecia results in scattered patches of hair loss and is usually associated with redness and irritation on the scalp. Inflammation can be reduced with topical, injectable or oral medications, such as corticosteroids or anti-malarial drugs; minoxidil is not used for cicatricial alopecia. Patients with this form of hair loss should be closely monitored by a dermatologist.

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