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Turmeric for Scalp Psoriasis: New Research Highlights Potential Role

New Research Highlights Potential Role

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Psoriasis is an autoimmune condition that affects 3-5 % of the world. For many patients, the scalp is the very first site of involvement. Current treatments include topical steroids, vitamin D analogues, calcineurin inhibitors and a variety of biologic agents.

Turmeric (Curcuma longa L.), a spice commonly used throughout many parts of the world. Turmeric has been shown to exhibit anti-inflammatory, antioxidant, antimicrobial, and even anti-cancer properties.

T lymphocytes are a type of white blood cell that have a key role in psoriasis. Interestingly, Turmeric has been reported to exhibit inhibitory activity on potassium channels
A new study examined the effects of turmeric compared to placebo in 40 patients with mild-to-moderate scalp psoriasis. The study group received turmeric tonic twice daily for 9 weeks, whereas the other group received a placebo applied in the same manner. Patients were evaluated at baseline, as well as weeks 3, 6, and 9.

Compared to the placebo group, topical turmeric tonic significantly reduced the redness, scaling and induration of lesions (PASI score), and also improved the patients' quality of life.

This is interesting and adds to the body of research supporting a role for turmeric in psoriasis.
 

Reference

Bahraini P, et al. Turmeric tonic as a treatment in scalp psoriasis: A randomized placebo-control clinical trial. J Cosmet Dermatol. 2018.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Classic studies from the Past: A Look at the Early Dutasteride Studies

Dutasteride vs Finasteride: Suppression of DHT

In the world of hair loss, we often quote numbers and statistics. We frequently throw around information without a good idea of where that information actually came from. An important study is a 2004 study by Dr. Clark and colleagues. It is one of the the classic studies examining how DHT changes with use of finasteride and dutasateride. 

The researchers studied 399 men with prostate enlargement (BPH) and randomized them to once-daily dosing for dutasteride (0.01, 0.05, 0.5, 2.5, or 5.0 mg), or 5 mg finasteride, or placebo for a total of 24 weeks. The percent decrease in DHT was 98% with 5.0 mg dutasteride and 95% with 0.5 mg dutasteride. This was found to be significantly lower than the 71% suppression observed with 5 mg finasteride.  Moreover there was less variability in DHT changes with dutasteride than finasteride. 

Clark et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004

Clark et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004

 

The other important part of their studies was the increased in DHT that follows stopping the medication. The graph above shows that DHT levels rise much more slowly when dutasteride is stopped than when finasteride is stopped. This is on account of the long half life of dutasteride compared to finasteride (6 hours for finasteride and 4-5 weeks for dutasteride).

 

 

Reference

Clark RV, et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. Randomized controlled trial. J Clin Endocrinol Metab. 2004.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Dermatology and Urology: United by the Androgen Receptor

The Benefits of Urology Research

At first glance, it would seem that the medical specialists of Urology and Dermatology and quite different.  One deals with the physiology and functioning of the urinary system and the other deals with the dermatological system which comprises skin, hair and nails. The two however, are much more closely linked that you might imagine. 

 

The Androgen Receptor

The Androgen Receptor is a protein that sits in the outer layer of cells (known as the cytoplasm). One of its jobs is to bind to androgens that diffuse into the cell and form an androgen receptor-androgen complex.  The types of androgens that bind to the androgen receptor are many but the most commonly studied ones are testosterone and dihydrotestostone. The newly formed androgen receptor-androgen complex then translocates from the cytoplasm into the deepest regions of the cell (known as the nucleus) where the complex binds to DNA and stimulates the machinery needed for the cell to make new types of proteins (called transcription and translation).

 

What's the connection?

The androgen receptor has an important role in many fields of medicine including Urology and Dermatology. It's very clear that aberrant signals from the androgen receptor help prostate cancer cells to grow and so an understanding of androgen receptor physiology drives much of the field of prostate cancer research. Some of the drugs that are used to treat prostate cancers are blockers of some kind of androgen receptor function. Common examples are non-steroidal anti androgens like bicalutamide, nilutamide, enzalutamide, apalutamide, and steroidal anti androgens like cyproterone acetate.

In dermatology, the androgens and the androgen receptor also has an important role. Conditions like acne, hair loss and even syndromes associated with increased hair growth can be driven by androgens. Androgenetic alopecia (male balding and female pattern hair loss) are androgen dependent to some degree and medications that block androgens are commonly used. This includes finasteride, dutasteride, spironolactone, cyproterone acetate, flutamide.

 

Research Research in Urology

I continue to closely follow the field of Urology. There's no doubt in my mind that advances in Urology (especially in prostate cancer research) will directly translate into benefits to dermatology.   Just this week, I was asked about the use of an experimental prostate cancer drug Darolutamide for treating male balding. Darolutamide, which is a close cousin of enzalatumide and apalutamide, is not approved for use yet even for treating prostate cancer but clearly many minds have recognized this important link between drugs in Urology and drugs that may be useful to the hair loss world. 

As yet another example of the commonality between Urology and the field of hair loss dermatology, studies continue to show that balding in the crown (vertex) in men has some link to an increased risk of prostate cancer. Clearly, there are some genes that unite the two conditions, and research into prostate cancer genes and genes for balding will continue to merge together over time. 

 

Conclusion

It makes good sense for any hair loss specialist to follow the latest happenings in the field of urology. Many urological diseases, especially prostate cancer, are affected by androgens and medications that block the function of androgens provide benefit to these diseases. 

 

REFERENCE

Liang W, et al. Possible association between androgenic alopecia and risk of prostate cancer and testicular germ cell tumor: a systematic review and meta-analysis. BMC Cancer. 2018.

 

Jin T, et al. Association between male pattern baldness and prostate disease: A meta-analysis. Urol Oncol. 2018.

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Stress and Hair loss

A Study of Medical Students

stress hair loss.png

An interesting study examined the effects of stress on a wide range of skin and scalp related symptoms. Study participants were medical students studying at College of Medicine, King Saud University (KSU), Riyadh, Saudi Arabia. A standard questionnaire was used to assess stress levels as well as the presence or absence of a range of health conditions - including those affecting the scalp. When compared to least stressed students, highly stressed students (ie students self reporting that they were experiencing high stress levels) were much more likely to report experiencing a range of scalp symptoms including 1) having more oily, waxy patches and flakes on the scalp, 2) having hair loss and 3) experiencing the self induced pulling-out of one’s hair (trichotillomania).

Conclusion

It’s clear that stress can impact a range of dermatological conditions including hair loss. This study supports the notion that a variety of hair-related changes are possible with higher levels of psychological stress.

Reference

Bin Saif GA et al. Association of psychological stress with skin symptoms among medical students. Saudi Med J. 2018.
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Azithromycin and the Heart: Where are we at in 2018?

Azithromycin: Are there any cardiac concerns?

Azithromycin is an antibiotic which is widely used to treat a variety of infections. It is sometimes used by hair loss specialists for treating folliculitis decalvans. In 2013, the Food and Drug Administration added a new warning to prescriptions for azithromycin (read FDA Warning). The warning stated that azithromycin has the potential to affect heart rhythms in some patients and even raised the possibility some of these could be fatal. Specifically, the FDA has updated azithromycin package labeling to include the risk of prolonged cardiac repolarization and QT prolongation, which increase the possibility of cardiac dysrhythmias and torsades de pointes, especially in older adults. Since that time, there has been intensive research looking at the cardiac side effects of azithromycin.

 

2018 Studies

A recent 2018 study by Hertz and colleagues identified over 29,000 patients with out of hospital cardiac arrest.   The researchers concluded that the risk of cardiac arrest during treatment with macrocodes (like azithromycin) was similar to that of penicillin V, suggesting that there was no additional risk associated with macrolides.

 

2017 Studies

A 2017 study by Sutton and colleagues evaluated over 283,743 prescriptions for azithromycin; 143,191 for amoxicillin; 52,714 for clindamycin; 38,133 for clarithromycin and 49,734 for the quinolone.  The authors concluded that odds of cardiovascular mortality between azithromycin and other antibiotics were not statistically significantly different and previous published findings may not be applicable to the general population.

In 2017, Quinn and colleagues examined over 39,000 patients who died suddenly while receiving digoxin. Their data analysis showed that there was no statistically significant increase in the risk of sudden death following treatment with any of the macrolide antibiotics (erythromycin, clarithvmycin, or azithromycin) compared to a comparison antibiotic cefuroxine. Again, these authors felt the these findings actually reinforced the cardiovascular safety of macrolide antibiotics in a high-risk population.

In 2017, Trifiro examined data from over 14 million antibiotic users. Their data showed that azithromycin use was associated with an increased risk of ventricular arrhythmia when compared with nonuse of antibiotics, but not when compared with current amoxicillin use. The decreased risk with an active comparator suggests significant confounding by indication.

 

2016 Studies

A large 2016 study of over 600,000 seniors by Trac and colleagues showed that cmpared with nonmacrolide antibiotics, macrolide antibiotics were not associated with a higher risk of ventricular arrhythmia. The authors concluded that among older adults, macrolide antibiotics were not associated with a higher 30-day risk of ventricular arrhythmia than nonmacrolide antibiotics. Moreover, the authors proposed that the current warnings from the US Food and Drug Administration may be overstated.  The authors concluded that these results were reassuring for health care providers who prescribe macrolide antibiotics to a wide range of patients in routine care. 

 

Conclusion

At present, we need to be aware for the FDA warming on azithromycin. However, we equally need to be aware of the abundant evidence that has arisen since that time of the original FDA warning which has provided further data. The current evidence would suggest that users of azithromycin are not an increased risk for ventricular arrhythmias compared to other antibiotics. For folliculitis decalvans, where a physician must often chose among antibiotics, there is no good evidence to suggest that use of azithromycin would put  patient at increased risk for serious heart rhythm abnormality compared to using another antibiotic.

 

REFERENCES

Sutton SS, et al. Appraisal of the cardiovascular risks of azithromycin: an observational analysis. J Comp Eff Res. 2017 Sep;6(6):509-517. 

Hertz FB, et al. Does macrolide use confer risk of out-of-hospital cardiac arrest compared with penicillin V? A Danish national case-crossover and case-time-control study.  BMJ Open. 2018.

Quinn KL, et al. Macrolides, Digoxin Toxicity and the Risk of Sudden Death: A Population-Based Study.  Drug Saf. 2017.

Trifirò G, et al. Use of azithromycin and risk of ventricular arrhythmia. CMAJ. 2017.

Sacks HS. In older adults, macrolide antibiotics were not linked to increased risk for ventricular arrhythmia.  Ann Intern Med. 2016.

Espadas D, et al. Lack of effect of azithromycin on QT interval in children: a cohort study. Arch Dis Child. 2016.

Trac MH, et al.  Macrolide antibiotics and the risk of ventricular arrhythmia in older adults. CMAJ. 2016.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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French Fries and Hair Growth?

Will eating french fries make your hair grow?

frenchfries.png

Let me begin by stating that eating french fries will not help hair to grow. However, an important Japanese study has caught the attention of the worldwide media thanks to a laboratory chemical that is also used in making french fries.

Dimethylpolysiloxane (DMPS) is sometimes used as an ingredient in deep frying - including the deep frying of french fries.  It prevents oils from foaming up and therefore reduces burn injuries in workers. It also plays an important role as an antioxidant in the process. Interestingly, DMPS is also used in the scientific research laboratory - in tissue culture. This comes about because of the ability of DMPS to help oxygen diffuse.  And so when cells in culture are mixed together and need to grow, DMPS is sometimes used by scientists to ensure oxygen gets to the cells. 
A new study from Japan used DMPS to help early staged hair follicle cells come together to form tiny balls of cells known as hair follicle germs (HFGs). In fact, DMPS was found to be critical to helping create these HFGs. Hair follicle germs were shown to grow hair when injected into mice - which is where the excitement comes in. 
When the media discovered that DMPS was used in this important study, they immediately realized it was the same ingredient used to deep fry french fries- especially the ever popular McDonald’s french fries. Despite being the same ingredient, there is no truth to the numerous reports last month that eating french fries will promote hair growth.

However, the study does offer hope that the tissue culture system this research group created could help created thousand and thousands of hair follicle germs for injection into human scalps in the very near future. Whether these future cell models make use of DMPS will await further testing.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Hair Growth, McDonald's Fries and Dimethylpolysiloxane

How a laboratory chemical caught the attention of the media

It's quite interesting that an important study from Japan will likely go down in history as the McDonald's French Fry study. All thanks to a chemical known as dimethylpolysiloxane (DMPS).

Dimethylpolysiloxane (DMPS) is a key ingredient used in deep frying.  It prevents oils from foaming up and therefore reduces burn injuries in workers. It also plays an important role as an antioxidant in the process. Interestingly, DMPS is also used in the research laboratory - in tissue culture. This comes about because of its ability to help oxygen diffuse.  And so when cells in culture are mixed together and need to grow, DMPS is sometimes used by scientists to ensure oxygen gets to the cells. 

 

A New Study Makes use of DMPS

A new study from Japan make use of DMPS to help early staged hair follicle cells come together to form tiny balls of cells known as hair follicle germs (HFGs).  In fact, DMPS was found to be critical to helping create these HFGs - and in only 3 days.  Hair follicle germs were shown to grow hair when injected into mice. 

 

When the media takes it just a bit too far

Junji Fukuda, Professor at Yokohama National University in Japan is to be congratulated for the brilliant study. The study brings hope that the tissue culture system this research group created could help created thousand and thousands of hair follicle germs for injection into human scalps in the very near future. Whether these future cell models make use of DMPS will await further testing. 

The study has caught the attention of the media. Headlines around the world all make use of some reference to the McDonald's restaurant chain at their use of DMPS.  Headlines such as the following are unfortunate as they misrepresent what the study was all about:

Scientists Think McDonald's Fries can Reverse Balding

Ingredients in McDonal's Fries Cited to Cure Baldness

McDonald's Fries Cure Baldness

 

Conclusion

This is an important study. If the bizarre spin on McDonald's fries has given this study more attention, then I am certainly pleased. My worry is that somehow the message of the study was missed altogether and countless numbers of people are enjoying their french fries with a new found hope. I was happy to be interviewed today by Global news about the story and hope that the story gives this incredible research a more accurate light:

Study suggests a chemical found in McDonald’s fries could cure baldness. Is it true?


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Low dose Naltrexone: The Potential Uses are Many

LDN in Scalp Dermatology

LDN-uses

Low dose naltrexone (LDN) is a relatively inexpensive medication that may have benefit in many aspects of dermatology including hair dermatology. I have prescribed it to patients with lichen planopilaris, alopecia areata and even the so called scalp dysesthesias (scalp pain syndromes). It is believed that our internal opioid and endorphins have an important effect on the immune system.

It is now understood that various immune system cells also have opioid receptors on their surface. It is the ability to block opioid receptors in the body between 2 am and 4 am that is proposed to give the beneficial effects. Blockade in this manner lead to changes in the immune system and increase in the body’s endorphin and encephalin levels. These are powerful modulators of the immune system.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Hair Care in The Era of the Vikings

Hair care, combs and the Vkings

combs-viking

Humans have sought to distinguish themselves through changes in their appearance for thousands of years. 


This photo shows combs used by Vikings in the 10th century. Archaeologists have come to understand that hair was important to the identity of Vikings. Comb making became a particular skill and to own a comb like the one shown was a symbol of status. Combs were made from a variety of materials including bones and antlers (especially deer antlers). Viking warriors took combs on their voyages.

Source: Royal Ontario Museum, Viking Exhibition, 2017-2018. Toronto, Canada


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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2017 in Review: 20 Research Papers that Made a Difference

Hair Research in 2017

2017 was an exciting year in hair loss research. As the new year unfolds, I consider it important to pause and reflect on some of the most influential research articles of the 2017.  The article can be accessed through the link below

2017: A YEAR IN REVIEW

Download PDF version 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Low dose naltrexone for LPP

New Avenues for Treating Lichen Planopilaris

LPPLDN

Download PDF on LDN

Naltrexone is a medication that was approved in 1984 (at 50 mg) for treating addiction to opioids. Subsequently, it was shown that low doses rather than high doses sometimes have a remarkable effect on the immune systems. This opened the door to trying to better understand the benefits of low dose naltrexone (LDN). Studies have shown that LDN can help people respond better to many immunological conditions including HIV, cancer, and autoimmune diseases like lupus, Crohn’s disease, multiple sclerosis. It has also been used in chronic pain. New evidence suggested benefit in lichen planopilaris as well. A very small study in 4 patients suggested that LDN at a dose of 3 mg can reduce the signs of symptoms of this scarring alopecia. Side effects were not noticed. 

 

Low dose naltrexone: How does it work?


It is believed that our internal opioid and endorphins have an important effect on the immune system. It is now understood that various immune system cells also have opioid receptors on their surface. It is the ability to block opioid receptors in the body between 2 am and 4 am that is proposed to give the beneficial effects. Blockade in this manner lead to changes in the immune system and increase in the body’s endorphin and encephalin levels. These are powerful modulators of the immune system.

The typical dose of “low dose naltrexone” is 1.5 to 4.5 mg taken at bedtime. A compounding pharmacy generally takes the 50 mg pills and compounds in a topical solution. The perfect way of compounding LDN is not entirely clear, although use of calcium carbonate as a 'filler' is generally best avoided as it may interfere with absorption. 

 

Side effects of LDN


Many patients take LDN without side effects. However, the side effects include difficulty sleeping (one of most commonly seen in our practice), vivid dreams, and rare headaches. A full review of side effects is important for anyone starting LDN. 


Conclusion

More study is needed of LDN in various hair loss conditions. I have no doubt this study of LPP (referenced below) will open the floodgates to increasing use in patients with LPP in 2018. Good study is needed to monitor the short term and long term benefits.



Reference
 


Strazzulla LC, et al. Novel Treatment Using Low-Dose Naltrexone for Lichen Planopilaris. J Drugs Dermal 2017
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Treating Frontal fibrosing Alopecia (FFA): Are retinoids better than finasteride?

Retinoids in FFA Treatment

FFA 102

Frontal fibrosing alopecia ("FFA") is an autoimmune disease that mostly affects women. It is classified as a "scarring" hair loss condition and hair loss is often permanent for many women. A variety of treatments are available including topical steroids, topical calcineurin inhibitors, steroid injections as well as oral treatments like finasteride, doxycycline, hydroxychloroquine and isotretinoin.

A new study from Poland set out to compare benefits of finasteride and "retinoids" (isotretinoin and acitretin) in women with FFA. The study included 29 women who were treated with a dose of 20 mg isotretinoin, 11 women treated with 20 mg acitretin and 14 treated with oral finasteride at a dose of 5 mg/daily.  Interestingly, 76% of patients treated with isotretinoin, 73% of patients treated with acitretin, and 43% of patients treated with finasteride had their disease halted over a 12 month observation period. 

 

Comments

This study is small and should be interpreted with caution for this reason. Nevertheless it is interesting and points to a potentially valuable role for retinoids that we really don't seem to see with classic lichen planopilaris (a closely related condition). The data in this present study however do not match other much larger studies of finasteride use in FFA which have suggested that a much higher proportion of FFA benefitted from use of this drug.

For now, this study provides us with evidence that retinoids can benefit some patients and should be at considered. Many women with FFA do have a tendency for increased cholesterol levels and the use of retinoids can significantly worsen this so caution and monitoring are needed.


Reference

Rakowska A, et al. Efficacy of Isotretinoin and Acitretin in Treatment of Frontal Fibrosing Alopecia: Retrospective Analysis of 54 Cases. J Drugs Dermatol. 2017.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Case Reports in the Research World: Are they helpful?

Case Reports in Hair Loss: Cautiously Optimistic.

 

A Case Report is a published medical study which presents a particular finding as it relates to a single patient. Common Examples of Case Reports are:

 

1.     Reports of a New Diagnostic Finding

For example, a new feature that clinicians might consider to improve their ability to diagnose a particular condition

 

2.     Reports of a New Treatment

For example,  a new treatment or revised method of using a currently available treatment that improves the way we treat hair loss

 

3.     Reports of a New Prognostic Finding

For example, a new finding either clinical or through blood tests/biopsy that helps predict the course of a patient’s hair loss

 

Interpreting the Value of Case Reports: Time is the Best Judge.

Case Reports are wonderful in many ways because they have the potential to stimulate additional research and thinking around the world on a particular subject.  Case Reports can sometimes be the key fuel that triggered additional studies in a particular subject area.

However, case reports need to be interpreted cautiously because the results only apply to a single patient. One can not conclude that the finding will be applicable to all patients. In order to conclude that a case report has widespread applicability,  further large scale studies are needed.

Take for example, the case report of sexual dysfunction from use of topical minoxidil. The study is very interesting. I can not conclude based on this study that topical minoxidil is associated with sexual dysfunction in men. However, it sets us up for further studies in this area and keep me alert to monitor these side effects in patients who use topical minoxidil. In my mind the study is extremely valuable.

 

Conclusion

Time will tell how any case report will go down in history as a valid or not valid contribution to the medical literature.  Time is ultimately the best judge of case reports.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Can we predict if minoxidil will work or not?

Predicting the chance of benefit before starting

Minoxidil is the only topically approved agent that is approved but the FDA for treating androgenetic alopecia. The drug does not help everyone but does help 25-30 % of users. I've written in previous articles about the future of minoxidil pre-testing kits. It is well known that in order for minoxidil to have a chance to work, the body needs to convert the minoxidil to minoxidil sulphate. Some people have the enzyme (known as minoxidil sulphotransferase) to do this; other people simply do not. Those who lack the enzyme are more likely to be non-responders.

I was interested to read today in a press release that kits to test minoxidil sulphotransferase activity are moving forward in the FDA approval process.  The FDA journey can be lengthy, but the possibility exists that we might see these kits in the clinic in the near future. These will help physicians to predict if it's a good idea to prescribe minoxidil or not. 

Read the press release here: Press Release


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Emerging Hair Loss Therapies.

What's new in hair loss research?

emerging

I'm honoured to speak this weekend at the 2017 "Dermatology Update" conference in Vancouver. I'll be speaking about "Emerging Therapies for Hair Loss." In the last 5 years we have witnessed a remarkable increase in new options for treating various types of hair loss - and I'll have an opportunity to summarize these for the attendees.

Concerns about long-term side effects of some medications and a demand for more effective therapies are driving the development of new treatments for androgenetic alopecia. Topical anti-androgens (particularly topical finasteride) are increasingly used for treating male patterned hair loss. Topical bimatoprost (ie higher concentrations of Latisse) is actively being studied. Drugs which inhibit PGD2 (Setipiprant) are being studied and are among the exciting therapies to watch for. Low dose oral minoxidil (0.25 mg to 1 mg) is increasingly being considered as an option. Platelet rich plasma therapy has evidence now to support a therapuetic benefit in some patients.

One of the biggest breakthroughs in the last 5 years has been the recognition that inhibition of the Janus kinase (JAK) pathway can facilitate hair growth in many patients with alopecia areata. Both ruxolitinib and tofacitinib, in both topical and oral formulations, have shown benefit in treating alopecia areata and I will review these studies at the conference.

Cold caps have been popular in Europe for well over a decade but were banned in the US in 1990 on account of a lack of data on safety and efficacy. The recent FDA clearance of the Dignicap in 2015 and the Paxman cooling system this year offer new options for preventing hair loss from chemotherapy.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Caffeine and Hair loss: Where is the Research to date?

Mixed Results to date

caffeine

Caffeine continues to be studied with respect to its role as a hair growth promoting agent. Studies are ongoing. To date there are only very limited studies examining the role of caffeine - with mixed results.

A 2013 study by Sisto et al from Italy showed that men using a caffeinated shampoo for 6 months were more satisfied with their outcome than men using the placebo (84.8 % vs 36.4 %, p<0.001). The study did not examine hair growth and other parameters in a rigorous manner. 


As we think about the role of caffeine in hair growth, I would like to draw your attention to 2 studies which examined coffee consumption. A study of 93 identical male twins looked at a variety of factors associated with hair loss. The survey based study suggested that increased coffee consumption was associated with increased hair thinning. In contrast a study of 98 identical female twins by the same author suggested that a lack of caffeine was associated with increased hair loss in women.


Conclusion:

Studies of the role of caffeine in hair loss and growth are still in their early stages. Limited conclusions can be made at present.



References
 

Gatherwright J, et al. The contribution of endogenous and exogenous factors to male alopecia: a study of identical twins. Plast Reconstr Surg. 2013.

Gatherwright J, et al. The contribution of endogenous and exogenous factors to female alopecia: a study of identical twins. Plast Reconstr Surg. 2012.

Efficacy of a Cosmetic Caffeine Shampoo in Androgenetic Aloepcia Management. J Appl Cosmetol 2013;


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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What’s new in androgenetic alopecia research ? 

What’s new in AGA based research ? 

MB.png


It is indeed an exciting time in biomedical research! Several companies are actively researching new treatments with the hopes to bring to market new options for androgenetic alopecia. Here are just a few of the nearly two dozen companies actively pursuing new treatments for men with balding. Some of course may apply to female androgenetic alopecia too.

 

Who are some of the key companies?

Shisedo, Replicel and Tsuji-Rekin are studying cell based therapies for balding. Follica is studying how specific therapies in conjunction with microwounding can stimulate hair growth. Specific molecular pathways are being targeted by companies such as Samumed (WNT pathway), Allergan (prostaglandins), Aclaris (JAK inhibitors). Cassopia is studying novel topical antiandrogens. Histogen is studying how factors produced by neonatal cells grown under embryonic-like conditions can stimulate hair growth.

New treatments for male balding could be around the corner!


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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What cells play key roles in hair growth?

What cells play key roles in hair growth?.png

If you've ever gone deep into the basement of a large building, factory or even a house, you will likely be amazed at how complex the machinery, wires, circuits that all work together are to make the building function optimally.

As far as the hair follicle goes, it takes a considerable amount of coordination by many cell types to finally produce a normal hair fiber. The dermal papilla (or "DP") has an important role in making it all happen.

The DP is found at the base of the hair follicle. It is made up of a group of very specialized cells known as fibroblasts.

The DP is an important control centre for the hair follicle. It tells another collection of cells known as the "hair matrix" exactly what to do in order to make a hair fiber.

The more cells the DP contains and the more active it is .... the bigger and wider the hair follicle that will be produced. 

The DP has the remarkable potential to form brand new hairs when transplanted into other areas of the skin. DP are therefore said to be "trichogenic" (hair forming). One day, it could theoretically be possible to take a patient's skin and increase the number of DP cells they have and inject them back into their scalp. This could lead to an endless supply of hairs.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Biotin and Hair Loss

Why Does the World Love Biotin So Much?

Biotin is a well-known and popular supplement for treating hair loss. Let's face it - the world loves biotin. However, true deficiencies in biotin are rare given the ability of bacteria in the gastrointestinal system to produce biotin. Nevertheless, many individuals and physicians turn to biotin in the search for treatment options. 

Soleymani and colleagues from New York University School of Medicine set out to critically examine the evidence for biotin use for treating hair loss. Their findings point out that there are no randomized trials to support the use of biotin in treating hair loss and that the public’s interest in biotin over the past decades is not supported by medical evidence. 

There is really no evidence to support routine biotin supplementation for individual’s with hair loss. Exceptions do exist, of course, and true biotin deficiency may be considered in individuals who are elderly, pregnant, using anticonvulsants or chronically using alcohol. 

Reference

Soleymani T et al. J Drugs Dermatol. 2017 May 1;16(5):496-500


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Plan b: Is There a Plan B to Treating Hair Loss?

The first step in determining how to help someone with hair loss is figuring out his or her diagnosis. There is no bypassing this step.  The second step is determining a treatment plan that is based on the best medical evidence. 

 

Plan B: What is Plan B, Doc?

After reviewing a treatment plan with my patients, I'm often asked what treatment will be considered next. "What's plan B, doc?" Well, every treatment plan needs Plan B as well as a Plan C and Plan D.

Consider the 28 year old female with androgenetic alopecia. The best treatment option for her based on all her facts, review of her blood tests and scalp exam might be topical minoxidil. Plan B might be oral spironolactone with or without minoxidil. Plan C might be the addition of a laser comb or changing the anti androgen used. Plan D for her might be a trial of PRP. A solid treatment plan has an alphabet of plans. Not guesswork and not a random pull out of a hat option. But rather options based on a delicate combination of medical science and expert consensus, and personal experience.

What about the 53 year old female with frontal fibrosing alopecia? Plan A for her might be finasteride & steroid injections with hydroxychloroquine as Plan B. Doxycycline is reserved for her as Plan C. For another patient with FFA, Plan A might start with hydroxychloroquine & steroid injections. For her, finasteride is not on the list given the past history of breast cancer the patient had. Plan B is doxycycline and plan C is methotrexate.

 

Conclusion

Every treatment plan should have an alphabet of plans. That does not necessarily mean one will need to move down the list but the physician should have a clear plan for how to navigate.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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