Hair Loss

Today, hair loss problem becomes solvable. Best known abroad as a remedy for hair loss products purchased by minoxidil.

Handsome man, with hair growing back, was not only a logo of some forms of packaging minoxidil, but also a symbol of its effectiveness. In the treatment of hair loss products with minoxidil give excellent results, are relatively inexpensive and do not have any serious side effects or contraindications. These drugs are given to both men and women. In many countries, there is a pharmacy boom associated with minoxidil.

Enjoyed great success in Japan, the sensational "Viagra for bald", which, as we are assured, grows hair thinning, even at very top. In June, for the first twenty days of sales almost clean sweep shattered all first party is a miracle drug in the amount of 650 000 vials. Its manufacturer, pharmaceutical company, "Tice seyyaku" already decided on a very atypical for the normalization of Japan - no more than 24 packs at a drugstore. Impact on the work seven days a week transferred production plant in Saitama Prefecture, where the spill "Viagra for bald" - drug "Reap", developed in collaboration with the American pharmaceutical corporation "Pharmacia Upjohn End."

The basis of the drug - a substance minoxidil, which was originally created to combat high blood pressure. However, in the process of experimenting with wonder doctors have found that the use of minoxidil as a side effect is noticeable hair growth in patients. As a result, at its base, a number of drugs, including "Reap", which at the beginning of June 3 appeared in pharmacies across Japan.

Other drugs used in the treatment of alopecia, which caused a loud response to the international market, the drug was released under the brand name Propecia. Previously it was the active principle known in scientific circles as Finasteride. This is currently number 2 bestseller of tablets sold in the international market after Viagra. The drug is rapidly gaining popularity and heavily advertised on the pharmaceutical market. In the scientific press hard debate about the place after a while it may take Propecia market tools to combat hair loss.

The most common form of baldness is a so-called hereditary hair loss (androgenic alopecia). This form is observed in the majority of men and a large part of women. We'll see what causes this form of hair loss and what preparations and methods are used to treat it.

How is the hair loss:

Androgenic alopecia - hair loss is caused by one of the following reasons:

• excessive content of the male sex hormone dihydrotestosterone (DHT);
• increased sensitivity of hair follicles to DHT;
• increased activity of the enzyme 5-alpha-reductase, which converts testosterone into DHT.

Hippocrates noted that eunuchs do not go bald. Later the same circumstance mentioned by Aristotle. In the 40-ies of XX century, Dr. James Hamilton wrote that the cause of hair loss may be an excess of male hormones, combined with a genetic predisposition.

Strictly speaking, it is impossible to say that the sex hormones inhibit or enhance the growth of hair in general. Result of the action of androgens or estrogens on hair will be determined by the presence of a special receptor on the cell surface of the follicle. Receptor resembles the button, and the hormone - the finger that pushes the button. The result of pressing predetermined mechanisms that are present in the follicle. You can press the same finger on the same button, and the result in one case will have a blast in Chicago, and in another - launching of a space ship.

The question is what leads to these buttons are connected. Thus, estrogen stimulates the growth of hair and inhibit the growth of hair on the face and body. Androgens stimulate the growth of facial hair, hair growth in some parts of the body and can inhibit the growth of hair on the head. Of course, it's not so much the androgens, as in what the follicles in which areas are located. If the head will follicles that are DHT-sensitive "buttons" stop growth in response to androgen excess hair loss happens. If we transplanted follicles on the head with a mustache or beard area, the excess androgens, however, will cause the growth of hair on the head. By the way, one of the ways to combat hair loss in androgenic alopecia is just transplant DHT-activated follicles to areas of hair loss.

Women with androgenetic alopecia usually have other signs of hyperandrogenism syndrome - excessive hair growth on the face, as well as acne and oily seborrhea. However, virilization, ie, the appearance of masculine traits body structure is rare. Almost always, both men and women with androgenetic alopecia have normal or slightly elevated levels of androgens in the blood. It is believed that the main cause of hair loss in androgenic alopecia is either increased activity of 5-alpha-reductase inhibitor, or an increase in receptor sensitivity to DHT.

The enzyme 5-alpha-reductase is present in the body in two forms: type 1 is contained in the prostate gland in men, type 2 - in the sebaceous glands and hair follicles. The task of the enzyme - to transfer testosterone circulating in the blood, in the active form - dihydrotestosterone (DHT). One would think, why the hair follicles converts testosterone to DHT, if the hair from falling out? But this has profound biological significance. Hair is an important gender and they need to know whether they should grow in this area of the body. And it depends on who owns this body - man or woman. For example, the follicles are located in the chin area will respond to the DHT positive, since beard - male characteristics. But an excess of estrogen cause the same hair follicles to stop producing. Since long hair are the adornment of women, not men, the hair follicles are located on the head, are stimulated by estrogen and suppressed (suppressed) androgens. If a follicle becomes too sensitive to androgens, this suppressive effect may be too much for him.

DHT exerts its suppressive effect by acting on the growth phase of the hair, so hair prematurely enters the resting phase. In general, each follicle is in three different phases of the life cycle - the anagen, catagen and telogen (Fig. 3). Anagen - is the time when the hair follicle produces hair. In the anagen phase, which lasts for several years, is usually 85% of the hair follicles. Catagen - time degradation follicle. Hair growth stops and the hair root becomes a characteristic shape bulb. This phase lasts for several weeks. In the telogen phase, the hair is removed from the root and moving slowly to the surface of the skin. In the telogen phase is about 15% of hair. It is these hair falls out when combing and shampooing. Normal hair loss is 70-80 units per day.

DHT causes the follicles in some reduction in the growth phase. These follicles do not reach the maximum value, and therefore begin to produce thin and weak hair. A microscopic examination of visible miniaturized, atrophic follicles, which are a characteristic feature of androgenetic alopecia (Fig. 4). Since the ratio between the follicles in the anagen phase and telogen phase shifts to the resting follicles on the head, there are many follicles, which are simultaneously cast a hair fiber. As a result of the thinning and weakening of the hair completed their progressive shedding. In the hair bulb contains another enzyme - aromatase, which converts testosterone into DHT back and estrogens. It lowers the level of DHT in the hair follicles and is an antagonist of the 5-alpha-reductase. The women in the front area of the scalp follicles aromatase content is several times greater than that of men. This, apparently, due to the diffuse and less pronounced androgenic alopecia in women. In addition, women in the neck are DHT-resistant follicles that do not shorten the growth phase when exposed to DHT. Therefore, thinning hair in women usually do not affect the lower part of the neck. Men also the lower part of the neck is the most resistant to baldness. It is from this area take follicles for transplant surgery.

The Diagnosis of Androgenetic Alopecia

The diagnosis of androgenetic alopecia in women can be delivered if:

• observed visible signs of androgenic alopecia - a progressive thinning and diffuse hair loss, signs of hirsutism and acne;
• microscopic examination of the data show the presence of miniaturized follicles;
• counting the number of hairs that are in different stages of growth reveals the imbalance between hair follicles in the growth phase and in the resting stage;
• by microscopic examination revealed that the miniaturization and thinning of hair follicles does not affect the lower occipital region.

If there is good reason to talk about androgenic alopecia, and the diagnosis can be considered to be delivered, then raises the second problem - the problem of the treatment.

Treatment of Alopecia

Treatment of androgenic alopecia includes:

• specific treatment of androgenic alopecia;
• non-specific methods that are common for all types of hair loss.

Specific treatments for androgenetic alopecia is ADT, which is held as a drug, and folk (alternative) means. ADT helps stop hair loss, but does not lead to a regression of density of hair. Stimulation of hair growth by the methods that are common to all types of hair loss.

The most effective drug used to stimulate hair growth in androgenetic alopecia was minoxidil, which is available under the trade names Regaine, Rogaine, Headway. More about minoxidil will be discussed in a separate section of the site, and now we can only say that it is the only drug that acts directly on the hair follicles, prolonging the growth phase of hair. Other methods to stimulate hair follicles include electrical stimulation, massage, hypnotherapy, and electrophoresis of biologically active substances.

As for the specific anti-androgen therapy, the most promising method here is the impact on the activity of the enzyme 5-alpha-reductase, which converts testosterone into DHT. This method is attractive in that the effects of testosterone are responsible (spermatogenesis, sexual behavior, the distribution of muscle mass), are unaffected. This is particularly important for men who are horrified of the word "anti-androgen therapy." As in the human body has two types of 5-alpha-reductase, one of which is localized in the skin and hair follicles, and the other - in the prostate, it becomes theoretically possible to work on one type of enzyme without affecting the other. However, in practice it turns out that even selective inhibitors to some extent affect the two enzymes.

Besides inhibitors of 5-alpha-reductase, inhibitors for the treatment of androgenetic alopecia in men and women use the androgen receptor blockers. If the blocker is strong enough, it can affect libido, breast size (in males, this results in gynecomastia), spermatogenesis, and potency. Last most frustrating patients, so along with antiandrogen recommended medications such as yohimbe, the amino acid arginine, and other stimulants of potency.

There are a lot of anti-androgen drugs that should not be taken without consulting a doctor. Moreover, one of the most potent inhibitors of 5-alpha-reductase - Finasteride (Propecia, Proscar) is not suitable for the treatment of female androgenic alopecia, as it has a strong embryotoxic action. More acceptable for women is a drug Diane-35, which is used as an oral contraceptive. We'll talk more about Diane-35 and other anti-androgenic action of drugs in the general section on treatments for alopecia, and now focus on the tools that are more mild antiandrogenic action called "natural" for the treatment of androgenetic alopecia.

Recently, the ability to inhibit 5-alpha-reductase was found in many substances. Unexpected finding was the anti-androgenic effect of some polyunsaturated fatty acids, especially gamma-linolenic acid. The first link of polyunsaturated fatty acids to the metabolism of androgens was shown in 1992. Later, in 1994, it was shown that gamma-linolenic acid and other fatty acids are potent inhibitors of 5-alpha-reductase. In this case, the highest inhibitory activity was observed in gamma-linolenic acid, followed by DHA, arachidonic acid, alpha-linolenic acid, linoleic acid, and palmitoleic acid in descending order. Other unsaturated fatty acids and methyl esters and alcohols of these fatty acids, carotenoids, retinoids, and saturated fatty acids showed no inhibition of 5-alpha-reductase, even in high concentrations.

Gamma-linolenic acid is found in large quantities in black currant oil (16% gamma-linolenic, 17% alpha-linolenic, 48% linoleic acid), borage oil (20-25% gamma-linolenic, 40% linoleic acid), and evening primrose oil (14% gamma-linolenic, 65-80% linoleic acid). Good synergy exists with avocado oil (30% linoleic acid, 5% alpha-linolenic, 13% palmitoleic acid). Despite the absence of gamma-linolenic acid, avocado oil is one of the best remedies for hair treatment, as due to a higher content of oleic acid (80%), it has good penetration and a high coefficient of distribution. Avocado oil can be added to the complex oil compositions to improve their absorbency and spreadability. Docosahexaenoic acid, which also has the ability to inhibit 5-alpha-reductase, is found in jojoba oil (20%). Jojoba oil is the richest source of DHA among natural oils. Oil compositions having anti-androgenic effect have the advantage that they well cross the lipid barrier of the skin and the hair cuticle. They can be used as an additional tool to all kinds of hair treatment. In their application, there is a restoration of the normal structure of damaged hair and the normalization of the sebaceous glands. Oil-based anti-androgenic activity can be prepared in emulsion and microemulsion systems in which the scalp will be administered other biologically active substances.

A powerful anti-androgenic effect has palmetto extract from Saw Palmetto (Serenoa repens), which is used to treat prostate enlargement. Palmetto extract is effective immediately in two directions. First, it inhibits the enzyme 5-alpha-reductase, and secondly, blocks specific receptors for DHT. Special studies on the effect of the extract on hair have not been extensively conducted, but it is widely used for the treatment of androgenetic alopecia. Unlike finasteride, palmetto extract is safe and can be used for the treatment of female androgenic alopecia. Saw Palmetto is taken orally as a dietary supplement, with limited information available about external use.

Two more substances that inhibit the action of 5-alpha-reductase have been identified recently - vitamin B6 and zinc. Vitamin B6 alters tissue response to steroid hormones, including blocking the action of androgens. Zinc, when applied topically, reduces the activity of the sebaceous glands and diminishes the appearance of acne, reflecting its undoubted anti-androgenic action. Studies in animals have shown the ability of zinc to stimulate hair growth. Vitamin B6 is rich in yeast, so beneficial effects in androgenetic alopecia will come from nutritional compositions and shampoos containing beer yeast. Zinc is part of a supplement taken by mouth, and ointments are applied to the skin surface.

If androgens cause hair loss, the estrogens, on the contrary, stimulate the growth of hair. However, synthetic estrogens are not necessary for patients, as they have side effects (phlebitis and induction of tumors, including breast cancer). Nevertheless, there are substances that exhibit estrogen-like effects but show no side effects. These are phytoestrogens, which are similar in chemical structure to human estrogen, allowing them to bind to the same receptors and activate them. However, their estrogenic activity is much weaker than the effect of estrogen itself, but they have anticancer activity and beneficial effects on the skin. Estrogenic effects have been noted in hops, seeds, grape skin (Pycnogenol), verbena, wild yam, damiana leaves, St. John's wort, red clover, sarsaparilla, soybeans, alfalfa, and sage. Extracts of sage, among other things, contain a high amount of zinc, which also has anti-androgenic effects. Phytosterols, exhibiting estrogenic activity, are found in wheat germ oil, olive oil, sesame oil, palm oil, and coconut oil. Phytoestrogen extracts can be used internally or in hair rinse compositions, or used for electrophoresis and other hair treatment procedures.

We must be prepared for the treatment of androgenic alopecia to be long. The first results from the use of minoxidil and anti-androgens appear after a few months. Initially, there will be a slowing of hair loss, followed by a gradual recovery of hair thickness. It is important that the patient believes that the ongoing procedures will be effective; much depends on the ability of the doctor-cosmetologist to explain their meaning and achieve the understanding and trust of the patient. Patients should be informed that ADT will not only help stop hair loss but also quickly cleanse the skin from acne, reduce its fat content, and decrease hirsutism. If the improvement of the skin begins soon after starting to use anti-androgens, the hair treatment process remains lengthy and may need to be repeated at times.

Of great importance are any supportive methods that help the patient have faith in the treatment, including massage (manual and vacuum technology), hypnotherapy, psychotherapy, and the use of compounds that improve the structure and appearance of hair. All of these contribute to patients feeling better and more confident. The cosmetologist must do everything possible to encourage the patient to continue treatment and avoid losing heart if visible results do not appear after a couple of sessions.

However, it also occurs that, despite persistent treatment, hair growth and restoration do not occur and hair loss progresses. Most often, this happens in cases of androgenetic alopecia in men. In these instances, it may be necessary to resort to surgical hair restoration. Surgical treatment is conducted in special clinics, but before deciding on this, the patient should be counseled about the available equipment and whether it makes sense to pursue this option.

There are several non-surgical techniques for those desperate to restore hair thickness. Donor hair can be attached to existing hair to create the illusion of fullness, or small scraps may be glued onto the scalp.