Latisse and eye color changes

Can bimatoprost (Latisse) change eye color?

Bimatoprost (Latisse) is a popular product for growing longer lashes. Users of the product are likely very familiar with the fact that the drug was originally used for glaucoma to lower eye pressures. 

The actual drug stimulates pigmentation in the iris because of  the ability of bimatoprost to  increase in pigment granulates in melanocytes. This side effect is mostly observed when individuals put the bimatoprost drops right into the eyes (as is done for those using the medication for glaucoma).

Pigmentation of the iris is not typically observed with those used bimatoprost for the eyelids or eyebrows. However, pigmentation of the surrounding skin can be observed.

Dutasteride for Male Pattern Balding: New study point to low incidence of side effects

Dutasteride, a dual inhibitor or 5 alpha reductase type 1 and 2

Dutasteride is approved in Korea for the treatment of male pattern balding. It is used "off label" in many other countries. Whereas finasteride (Propecia) inhibits 5 alpha reductase type 2, dutasteride inhibits 5 alpha reductase types 1 and 2.

Finasteride has received press on account of its side effect profile (especially sexual side effects) and possibilities of long lasting, possibly permanent side effects in a low proportion of users.  

Dutasteride is known to have a similar array of overall side effects, and given the greater inhibition of 5 alpha reductase that dutasteride has, one might expect a similar if not greater number of side effects. Interestingly, this has not been the case in all studies to date. In fact, most studies support the efficacy and tolerability of dutasteride at 0.5 mg with relatively low incidence of side effects.

New study

A new study published by Choi et al looked at over 700 men ranging in age from 18-41. These men were using dutasteride at 0.5 mg. The frequency of side effects were low. 1.3 % of patients experienced decreased libido, impotence in 1 %, fatigue in 0.7 %, breast enlargement was seen in 0.3 %. Over 79 % of men reported improvement with their hair.

FINAL COMMENT

This study was not set up to compare dutasteride to placebo. This was simply an observational study as part of routine "post marketing" surveillance. Overall, the findings are encouraging and expected- pointing to a low risk of adverse events with this dual inhibitor of 5 alpha reductase.

 

REFERENCE

Choi GS et al. Ann Dermatol. 2016 Aug;28(4):444-5

Coenzyme Q 10: What are the roles in hair loss?

Co Q 10 (Ubidecareneone)

Coenzyme Q 10 is an interesting supplement with anti inflammatory and anti oxidant activity. I've been investigating whether it has any benefits in hair loss ... but the evidence is certainly not in yet.

Coenzyme Q 10 may have some benefits - under certain conditions. The best studies conditions include heart failure, various neurological problems (especially a condition known as multisystem atrophy) and in blood sugar control. It can lower inflammatory markers in the blood, including C reactive protein (CRP). Coenzyme Q 10 may have a variety of helpful effects on obesity too. Patients on cholesterol reducing medications (i.e. statins) may be at increased risk for coQ10 deficiency so that warrants further study. 

In the autoimmune condition rheumatoid arthritis, a randomized study showed 100 mg per day of coQ10 reduced several inflammatory markers in the blood (such as tutor necrosis factor alpha). It's still too soon for those with various types of hair loss to start taking coQ10. But I am reminded of a 1995 study published in the Lancet that showed an improvement in hair loss in 2 patients who used coQ10 to treat hair loss caused by a blood thinner known as warfarin. The reference to this study is below. 

Oxidative stress occurs from a variety of sources including normal cellular functions in the body but also from irritants, ultraviolet radiation, smoking, and microbes on the skin surface. Even bad dandruff and seborrheic dermatitis generate significant oxidative stress. The abnormal scalp lipids in some scarring alopecias are a particular source of potential oxidative stress and a key research interest of mine.

Overall more research is needed to better understand the uses and benefits of coenzyme Q 10.

Reference
Nagao et al. Treatment of warfarin induced hair loss with ubidecarenone. Lancet. 1995; 21: 346:1104

Minoxidil use after ages 65: Should I just go for it?

Minoxidil (Rogaine, etc) is FDA approved for ages 18-65

I'm often asked by patients if they should just give minoxidil a 'try'. Give it a 'go'. I respond that minoxidil can certainly be helpful but minoxidil is certainly not for everyone.

Minoxidil is FDA approved for men and women 18-65 with a type of hair loss known as androgenetic hair loss. If an individual has some other hair loss condition besides androgenetic hair loss (there are actually dozens of other kinds) and if the individual is over 65, they should check with their physician if minoxidil is safe or not.

Minoxidil is not for everyone

I don't prescribe minoxidil if:

1.     the patient has heart problems, especially ischemic type heart disease or certain types of heart failure

2. the patient has heart rhythm issues (like atrial fibrillation)

3. the patient has certain internal conditions (like pheochromocytoma)

4. the individual has allergies to any of the components of minoxidil, such as propylene glycol in minoxidil solution or allergy to the minoxidil itself

 

Final Comments:

Minoxidil has a good safety profile and that has lead to its availability as an over the counter product.  But minoxidil is not for everyone. An 82 year old patient with heart failure and two previous heart attacks is not a candidate for minoxidil. A patient with hair loss due to dissecting cellulitis of the scalp (a different condition than genetic hair loss), will likely find little to no use from minoxidil application. Minoxidil is not for everyone.

Bimatoprost (Latisse) for treating alopecia areata: New study

New study supports use of bimatoprost for alopecia areata 

Bimaprost is FDA approved for treating glaucoma. It's also FDA approved for treating thin eyelashes in those with sparse eyelashes, and in this case is known popularly as Latisse. The use of bimatoprost in treating alopecia areata has only recently been investigated. Studies have suggested a role in treating eyelash loss in those with alopecia areata. 

Bimatoprost in Treating Scalp Loss

A new study, published in Paediatric Dermatology, supports the use of bimatoprost in treating scalp hair loss in patients with alopecia areata. The authors described a 9 year old girl with alopecia areata who had been treated with steroid injections, topical steroids and minoxidil. Despite these treatments, she did not experience regrowth. A decision was made to initiate treatment with bimatoprost solution one drop twice daily on the patches of hair loss. 

Within one month the patient experienced the first signs of regrowth and by 7 months the patient had regrown her hair and was able to stop the bimatoprost. 

Reference

Li and Antaya. Successful Treatment of Pediatric Alopecia Areata of the Scalp Using Topical Bimatoprost. Pediatr Dermatol. 2016

What's new in male balding research?

NEW DRUGS MAY BE IN THE PIPELINE FOR MALE BALDING

According to a news release, Kythera Holdings has acquired licensing rights to setipiprant - potential drug for hair loss. Setipiprant is a selective oral antagonist to the prostaglandin D2 (PGD2) receptor.  

Why is blocking the PGD2 pathway important?

About three years ago, I shared a blog 

Breakthrough in Baldness? Blocking the Prostaglandin D2 Pathway May be the Answer 

In that blog, I described research showing that PGD2 levels were higher in bald areas of the scalp than non bald areas. Theoretically, blocking this pathway could have important roles for baldness. 

And so here we are three years later. Kythera Holdings, a subsidiary of Kythera Pharmaceuticals, announced that it has acquired  licensing rights to setipiprant, in the agreement with Actelion. Apparently, human studies are next for the company. What is so interesting about this drug is that it's already been studied for other uses. Setipiprant has previously been studied as a type of alley treatment, including a phase 3 study in patients with seasonal allergic rhinitis and a phase 2 study in patients with asthma. There were no serious side effects in these studies and treatment was well tolerated. According to the news release, Actelion suspended the development of setipiprant due to lack of efficacy seen in the allergy and asthma studies. So we haven't heard more about the drug. 

READ MORE  

New Roles for the Hair Loss Drug Finasteride: Treating Heart Failure

A Drug for Hair Loss, Prostate Enlargement ... and Maybe Heart Failure!
 

It is well known that androgen hormones like dihydrotestosterone (DHT) have an important role in hair loss in those who are genetically predisposed. Recent scientific evidence also indicates that androgen hormones like testosterone or the more potent dihydrotestosterone (DHT) contribute to the development of heart failure. About 700,000 individuals die of heart disease in the USA and Canada every year.

Does blocking male hormones help improve heart failure?

Researchers from Germany recently set out to design a study to determine whether anti-androgenic therapy with the drug finasteride improves the ability of the heart to function under states of heart failure. Instead of studying humans, the researchers studied mice with heart failure.

What did the researchers find?

The researchers found the heart function was markedly improved in response to treatment with finasteride in mice. In addition, finasteride treatment also allowed mice with heart failure to live longer.  

Final Conclusions

The researchers concluded that finasteride has the potential to reverse heart failure in mice and could be a potential therapy for human trials in the future 

Reference

Zwadio C et al. Anti-Androgenic Therapy with Finasteride Attenuates Cardiac Hypertrophy and Left Ventricular Dysfunction. Circulation. 2015 Jan 28. 

Cholesterol Lowering Drugs for Treating Alopecia Areata? A New Study says Yes

STATIN DRUGS FOR HAIR LOSS? 

Alopecia areata is considered an autoimmune condition. Medications that reduce or modify the effects of the immune system are traditionally used to treat alopecia areata. You may be familiar with treatments such as steroid injections, topical steroids, diphencyprone (DPCP), anthralin, or  immunosuppressive pills such as methotrexate, sulfasalazine and prednisone.  These all affect the immune system in some way or another.

New research now suggests that cholesterol lowering medications may also be helpful. Interestingly, in addition to the ability of these medications to lower cholesterol levels, these drugs also reduce inflammation. The reduction of inflammation is a key step in treating alopecia areata.

What are statins?

The ‘statins’ are a well-known group of medications used to treat high cholesterol.  In fact,  it is estimated that about 3 millions Canadians and 30 millions Americans use statins to control their cholesterol.  Ezetimibe is a second type of cholesterol lowering medication and works by blocking the absorption of cholesterol.

In a new study, 19 patients with advanced alopecia areata were treated with two cholesterol medications – simvastatin and ezetimibe for 24 weeks.  Remarkably, after 24 weeks, 14 of 19 patients (nearly 75% of patients) were found to regrow hair so some extent. The majority of those who continued the drug after then 24 week period maintained their hair and the majority of stopped the drug after then 24 week period lost their hair again.

Comment

This is a tremendously exciting study, opening the doors to even larger studies of the use of these cholesterol lowering drugs in the treatment of alopecia areata. These drugs are well known in the population as cholesterol lowering drugs and so we have many years of experience with these drugs. Although side effects such as muscle pains, muscle damage, diarrhea, irritation of the liver, and a rise in blood sugars can occur with these medications – these are relatively infrequent. 

Study: Lattouf C and colleagues. Treatment of alopecia areata with simvastatin/ezetimibe. J Am Acad Dermatol 2015; 72: 359

Dutasteride and Finasteride: New data suggests no Link with breast cancer in men

Dutasteride and Finasteride: Do they cause breast cancer?

Finasteride (Propecia) and dutasteride (Avodart) are prescribed for the treatment of male pattern baldness. Many of my male hair transplant patients receive finasteride or dutasteride in order to help reduce the progression of balding in existing hairs.  

Finasteride and dustasteride belong to a group of drugs called "5 alpha reductase inhibitors." They block the enzyme 5 alpha reductase and decrease the levels of the potent androgen hormone DHT (dihidrotestosterone). In addition to reducing DHT, the drugs increase the levels of estrogen slightly which has raised questions from physician and researchers around the world as to whether these drugs increase the risk of breast cancer in men.

US researchers set out to examine the relationship between the use of 5 alpha reductase inhibitors and male breast cancer. They studied men using the higher 5 mg dose of finasteride used in prostate enlargement (rather than the 1 mg dose used in hair loss) and the 0.5 mg dose of dutasteride.  They looked at the use of these drugs in 339 men with breast cancer and 6,780 men without breast cancer.

What were the findings and conclusions from the study?

The authors did not find an association between using 5 alpha reductase inhibitors and the development of breast cancer in men. Overall, the authors concluded that the "development of breast cancer should not influence the prescribing of 5 alpha reductase inhibitor therapy."

Reference

Bird ST et al. Male breast cancer and 5 alpha reductase inhibitors finasteride and dustasteride. J Urology; 190:1811-4

Minoxidil - Does it help with hair loss ... in the front ... or top .. or both?

Accumulating evidence suggests minoxidil helps with hair loss in the crown (top) but may help hair loss in the front and temples in men as well.

Minoxidil - Does it help with hair loss in the front?

Minoxidil is a topical medication that is FDA approved for treating genetic hair loss (sometimes referred to as androgenetic alopecia). If you pick up a bottle of minoxidil it will state that it is to be used for hair loss in the crown in men and may not benefit other areas of hair loss. The original studies of minoxidil focused on the crown and did not address the benefit in the front of the scalp.

So the question that remains is:  

Does minoxidil help men with hair loss in the front of the scalp or not?

Certainly, the answer is yes.   Many hair loss specialists around the world, including myself,  have witnessed benefit to minoxidil in the front of the scalp in balding men.  However, the companies which produce minoxidil are not setting out to formally prove the benefit in the front of the scalp and are not seeking approval from health regulatory authorities to be able to change the labelling on the bottles to indicate that it "works in the front and back."

New study shows 5 % minoxidil benefits men with hair loss in the temples

Back in the month of May 2013, I attended the World Congress of Hair Research in Edinburgh Scotland. A really nice study was presented by Dr. Blume Peytavi and colleagues from Berlin, Germany. They studied 70 men with moderate genetic hair loss and studied whether minoxidil 5 % foam could help hair loss in the crown and in the front.  The German group showed that men using minoxidil 5 % foam did obtain benefit from using the medication in the front and in the crown.  This was one of the very first studies showing the minoxidil foam benefits hair loss in the front.

Conclusion: 

Minoxidil has long been known to benefit men with hair loss in the crown. Accumulating evidence suggests it also benefits men with hair loss in the front (temples). More studies are needed to determine just 'how much' it helps men with hair loss in the front. In general, minoxidil seems to work better in the earliest stages of hair loss - as hairs are thinning and miniaturizing. 

Reference

Hillman K, Bartels GN, Stroux A, Canfield D, and Blume-Peytavi U. Investigator-initiated double blind, two-armed, placebo-controlled, randomized clinical trial with an open -label extension phase, to investigate efficacy of 5 % Minoxidil topical foam twice daily in men with androgenetic alopecia in the fronto-temporal and vertex region concerning hair volume over 24/52 weeks.  Poster at: World Congress of Hair Research, Edinburgh Scotland May 2013.

Benefits of Combining Minoxidil and Finasteride

Benefits of Combining Minoxidil and Finasteride

Minoxidil and Finasteride are two FDA approved treatments for hair loss. Minoxidil is a topical solution that is rubbed on the scalp and finasteride is an oral treatment (pills). Many men with genetic hair loss (androgenetic alopecia) consider the use of these medications and may consider hair restoration as a more permanent solution.

Both minoxidil and finasteride have their own set of side effects. Finasteride, however, is much more effective. GIven that these two agents are clinically proven to help with hair loss, I'm often asked - "Is it better to use both of these products or should I just pick one?"

Combination Minoxidil and Finasteride better than single treatment

The answer is - 'yes.' There is clinical evidence that men using finasteride for hair loss who add minoxidil to their treatment plan have a slightly better result than men who only use finasteride. The benefits, however, are small. It makes sense that the two medications act synergisticially in treating hair loss given that they act differently. Minoxidil helps hair growth by directly stimulating the hair follicle. In contrast, finasteride works by blocking the action of the potent male hormone dihydrotestosterone or "DHT". 

Conclusion

Both minoxidil and finasteride should be considered. For men with early hair loss, the use of both might help and may be considered prior to a hair transplant. Minoxidil and finasteride have less benefit for men with advanced hair loss. In these cases, a hair transplant is the primary treatment.

This blog has been filed into the following folders:

The Secret to Growing More Hair? Just Ask a Wounded Mouse

NEW RESEARCH UNCOVERS ONE OF IMPORTANT MISSING PIECES OF THE HAIR LOSS PUZZLE

 Researchers from the University of Pennsylvania have discovered an important scientific finding that offers good news to the 60-90 million men and women in North America affected with hair loss.

Humans are born with about 100,000 hairs on the scalp. At present, it is thought that the number of hair follicles an individual is born with is the maximum number of hair follicles that person will ever develop during their lifetime. For humans, it seems that it is not possible to produce new hair follicles beyond the number generated at birth. Hair loss conditions like genetic hair loss, reduce the number of follicles on the scalp.

Exciting research over the last few years has challenged the concept that new hairs can never be generated after birth.    For years, it has been recognized that when the skin of a mouse is wounded, new hair follicles can be created. This phenomenon of new hair creation after skin injury does not happen in humans -  a finding that has stumped researchers.  The answer may now have been uncovered.

New Research from UPenn

Researchers from the University of Pennsylvania showed that when the skin of mouse is injured, immune cells residing in the skin known as gamma delta T cells are triggered to produce a chemical known as Fgf9.  Fgf9 stimulates the wound repair machinery of the skin to produce additional chemicals that not only heal the skin but stimulate creation of brand new hair follicles.

Interestingly the skin of humans was shown to have much lower numbers of the gamma delta immune cells compared to mice. When skin injury occurs in humans, a wound is healed with creation of a scar, and no new hair follicles are created.

With the new discovery of the importance of the Fgf9 protein in creating new hairs, the race is on to better understand how to use this information to generate new hairs in humans and to design drugs that prompt creation of new hair follicles.  One might imagine the possibility that if a minor wound could be introduced on human scalp and FgF9 like drugs were applied to the skin, new hair follicles could theoretically be generate. This remains to be tested, but offers hopes to the millions of individuals across North America with hair loss.

SOURCE: Gay D et al. Fgf9 from dermal gamma delta T cells induces hair follicle neogenesis after wounding. Nature Medicine. Published Online June 2 2013

 

This blog has been filed into the following folders:

DPCP for Children and Adolescents: Is it Effective?

DPCP for Children and Adolescents

Diphencyprone or “DPCP” is frequently prescribed for individuals with alopecia areata who develop more extensive amounts of hair loss or for individuals who aren’t improving with steroid injection treatments.  As shown in the photo to the right, DPCP is a liquid and is applied to the scalp weekly, usually in a dermatology clinic setting.  It causes a mild allergic reaction in the scalp skin, which in turn promotes hair regrowth in some individuals. In adults, DPCP treatment promotes hair regrowth in approximately 30-50 % of individuals. 

What about DPCP in Children & Adolescents?

We decided to examine this question. Prior to our study, the use of DPCP in children had not been thoroughly explored is whether DPCP is effective for children with alopecia areata. In fact, the use of DPCP in children has been the focus of only a 3-4 of research studies - and these studies were quite small.  One previous research study of 26 children indicated that DPCP helped with hair regrowth in 35% of patients. A second study of 12 patients indicated hair re-growth in 67% of patients.  

We recently published our research findings in the journal Archives of Dermatology. We looked back through the medical charts of 108 children who received DPCP at Sunnybrook Hospital in the past 10 years.    Children ranged in age from 4 months to 18 years. Most children had tried other treatments, such as steroids or minoxidil, prior to starting DPCP. However, none of those treatments were helpful and so DPCP was started.

Does DPCP have side effects in Children and Adolescents?

Overall, treatment with was safe, but minor side effects did occur in about one-half of patients. These included swelling, hives, small blisters and skin breadkdown and swollen lymph nodes.  About 13 % of patients stopped treatment after 2 months owing to a variety of factors, such as these side effecsts, difficulties commuting to the treatment center, and/or the disruption caused by weekly absences from school.

Was DPCP Beneficial ?

Overall, our research data showed that about one-third of children benefitted from DPCP treatment. 25 % of children had a partial improvement and 10 % had full regrowth.   

Conclusion

Our study is one of the largest research studies looking at whether DPCP is beneficial for children and adolescents with alopecia areata. It is a valuable study because it provides us helpful information that we can share with parents who bring their child to the DPCP clinic. Overall,  DPCP will help about 1 out of every 3 children who go through treatment.  However, only 1 out of every 10 children will experience full regrowth with treatment.  Right now, it’s not possible to predict which children will benefit from DPCP and who will not.  Certainly, more research is needed to understand how to make DPCP even more effective for children.

 References of Interest

1. Salsberg, J and Donovan, J. The Safety and Efficacy of Diphencyprone for the Treatment of Alopecia Areata in Children.  Archives of Dermatology 2012; 148: 1084-5.

2. Schuttelaar ML, Hamstra JJ, Plinck EP, et al. Alopecia areata in children: treatment with diphencyprone. Br J Dermatol. 1996;135(4):581-585.

3. Hull SM, Pepall L, Cunliffe WJ. Alopecia areata in children: response to treatment with diphencyprone. Br J Dermatol. 1991;125(2):164-168.

4. Mukherjee N, Burkhart CN, Morrell DS. Treatment of alopecia areata in children. Pediatr Ann. 2009;38(7):388-395.

 

Topical Estrogen for Androgenetic Alopecia:

Topical Estrogen for Androgenetic Alopecia:

Topical estrogens were used many years ago for the treatment of androgenetic alopecia as well as other hair loss problems. Their use dimished when other medications, such as minoxidil, became available.

In 2004, researchers from Greece studied the benefit of estrogens in 75 post menopausal women with androgenetic alopecia

25 patients applied the medication for 12 weeks (15 drops every evening for 4 weeks and then every other night for 8 weeks),

25 patients applied the medication for 24 weeks (15 drops every evening for 4 weeks and then every other night for 8 weeks),

25 applied placebo medication for 12 weeks.

What were the results ?

Side effects included  mild itchiness, redness and scaling in the scalp. 2 women receiving the 24 week course developed uterine bleeding about 4 and 5 months into the study. Overall, about 60 % of patients receiving the estrogen had an increase in the number of growing hairs (anagen hairs) and a decrease in the number of telogen hairs (resting hairs). “Before and after” data or assessments of patients views on their treatment were not included in this particular study.

Comment:

This 2004 study is an interesting research paper.  It reminds us of the well known fact that estradiol has important benefits  for hair. Estrogen therapy is too often forgotten about in the treatment algorithms of hair specialists. More studies in how best to administer topical estrogen are needed – especially in combination with treatments such as minoxidil, prostaglandin analogues (like Latisse) and the laser comb.

REFERENCE

Georgala S et al. Topical estrogen therapy for androgenetic alopecia in menopausal females. Dermatology 2004; 208: 178-179

 

Question from Website Visitors: H1N1 Vaccine and Hair Loss

H1N1 Vaccines: Do they cause Hair Loss/

QUESTION FROM READER 

I have had hair shedding for about 2 and a half years now.  Been told I have telogen effluvium, but I also have burning, itching and scalp pain.  The burning comes and goes and sometimes my scalp is so red. Recently I also had a blood test showing elevated DHT levels. This all started about 4 months after I received the H1N1 vaccine in November of 2009, but is now getting worse. Could there be a relation between this vaccine and hair loss?  Also could the burning be a sign of scarring alopecia?

ANSWER FROM DR. DONOVAN

Thanks for this interesting question.  My main recommendation would be to ask your dermatologist for a biopsy.

You are absolutely correct that individuals with itching, burning and pain in the scalp may have an increased chance of having a scarring alopecia. However, many other conditions are possible too (inclduing conditions called chronic telogen effluvium and alopecia areata) and a thorough scalp evaluation and detailed medical history are required before reaching a diagnosis. If you haven't already, a basic blood work profile for hemoglobin levels, thyroid tests, lupus, and iron studies should be done. Other blood tests might be helpful too depending on the answers to a range of medical questions your doctor will ask you.

The elevated DHT levels may be normal, but a thorough work up for free testosterone and total testosterone and possibly other hormones could be considered to get a better sense of whether or not your elevated DHT levels are concerning or not.  

It would be anyone's guess as to whether your vaccination had any contribution to your hair loss. We do know that in a very, very small proportion of individuals vaccinations and infections can trigger various autoimmune conditions. In terms of autoimmune hair loss conditions, a very small number of individuals note that a hair loss condition known as "alopecia areata" is worsened by vaccinations. However, this proportion is very small and the vast majority of individuals recieve vaccinations without any hair loss.

At present, there is no evidence that the H1N1 vaccine causes hair loss. It is intriguing that a Japanese study from 2012 reported 7 patients who developed the hair loss condition alopecia areata within 1-4 months of getting an infection with the H1N1 virus. These patients had an actual infection with the virus not the vaccine. It's really difficult to know if this was coincidence or not because 2 % of the world will develop the hair loss condition alopecia areata at some point in their lives (it's that common).  Whether the H1N1 vaccination could cause hair loss is not known.

You might find the previous blog I wrote on scalp redness helpful as well.

What are the Causes of Scalp Redness? 

I hope this information offers you help.

- Dr. Jeff Donovan  

Reference

Ito T. Alopecia areata triggered or exacerbated by swine flu virus infection. J Dermatol 2012; Oct 39:863-4

 

A New Era in the Treatment of Androgenetic Alopecia: Focus on the "Prostaglandin Pathway"

The "Prostaglandin" Pathway

Recently, we've been hearing a lot about a group of hair growth drugs that affect "prostaglandins".  Several recent blogs of mine have discussed the role of prostaglandin F2a analogues in stimulating eyelash growth (click here for article).  A few months ago a major buzz was created in the hair world when Dr. Cotsarelis at the University of Pennsylvania showed that blocking the prostaglandin D2 pathway might be relevant to the treatment of androgenetic alopecia (click here for article).

New Study Highlights Role of Prostaglandin Analogues

Latanoprost is a prostaglandin F2alpha drug that is often used in treating glaucoma (an eye disease characterized by elevated eye pressures). Recently the drug has been shown to be useful in stimulating eyelash growth. 

In yet another study, researchers from Germany examined the use of the drug latanoprost 0.1% in the treatment of men with androgenetic alopecia (male balding). 16 men participated in the study.  All men had early staged androgenetic alopecia  Men applied one drop (50 microliters) of latanoprost solution to one small area of the scalp daily and one drop of the placebo drug (mock drug) daily for 24 weeks. 

What were the results?

Overall about 50% of men benefitted from the drug.  Patients who did end up benefitting from the drug showed evidence of improved growth by 16 weeks. The drug was well tolerated with the most common adverse effect being scalp redness. Interestingly, the patients who developed scalp redness also experienced hair growth.  How exactly these two are related remains to be clarified.

Comment

These results are exciting and highlights the importance of this prostaglandin pathway.  We will certainly be hearing a whole lot more about the pathway in the years ahead. Its important to note that all participants in the study were men, so we don't know if the results are generalizable to women.  Furthermore, all men in the study had early stage androgenetic alopecia so we dont know if the drug will have benefit for men with more advanced stages of balding.

Reference

Blume- Peytavi et al. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24 week topical treatment by latanoprost 0.1 % on hair growth and pigmentation in healthy volunteers with androgenetic alopecia.  Journal od the Amaerican Academy of Dermatology 2012; 66:794-800.

Do Patients Receiving DPCP for Alopecia Areata Treatment Get Absorption into the Bloodsteam?

Do Patients Receiving DPCP Get Absorption into the Bloodsteam?

DPCP is a liquid chemical which is used as a topical treatment for alopecia areata. It's used in both children and adults with alopecia areata. One question that I’m often asked is whether DPCP gets absorbed into the body.

Does DPCP get absorbed?

In 1994, researchers from the UK set out to determine if DPCP is absorbed following topical application.  The researchers analyzed the blood and urine of 18 patients with alopecia areata who received approximately 0.5 mL of a 1 % DPCP solution. DPCP was not detected in any of the blood or urine samples.  These data suggest that DPCP is not absorbed following topical application onto the scalp.

Reference

Berth-Jones et al. Diphencyprone is not detectable in serum or urine following topical application. Acta Derm Venerol 1994; 74: 312-3.

 

Finasteride Use by Young Men: Not only for Baldness in the Crown !

Finasteride Use by Young Men

For years, we've largely assumed that finasteride helps men with hair loss in the crown, but does little for men with hair loss in the front of the scalp or the temples.

A new study by US researchers has nicely shown that finasteride 1 mg daily can help young men with male pattern balding regardless of where on the scalp the man has hair thinning.

The researchers studied men 18 to 60 years of age for a period of two years. Four areas of the scalp were examined: (1) vertex (crown), (2) the mid-scalp, (3) the frontal hair line and (4) the temples.

What were the results of the study?

The study showed that young men benefitted from taking finasteride - regardless of where there hair thinning occured. Young men (age 18-40) with hair loss in front, temples, mid-scalp or crown all had benefit from taking finasteride. However, the same was not true of men age 41-60. Men in this slightly older group benefitted most if their hair loss was in the crown and the mid-scalp.

Reference

Olsen EA et al. Global photographic assessment of men aged 18 to 60 with male pattern hair loss receiving finasteride 1 mg or placebo.  J Am Acad Dermatol 2012; 67: 379-86. (click for abstract)

 

Treating Alopecia Areata with Antihistamines: Just a Co-incidence or a New Avenue of Study?

Alopecia Areata & Antihistamines:

It’s challenging to conduct research studies in alopecia areata. One of the reasons is that hair growth can occur spontaneously – even if no treatments are administered. For this reason, it’s important that any new drug promising benefit in alopecia areata be carefully studied.

Several studies have suggested that antihistamines might be helpful for treating alopecia areata. However, these studies were small and we still don’t know if this might be a helpful treatment.

For example, researchers from Japan recently reported a 19 year old woman patient with alopecia areata at the back of the scalp (called the ophiasis pattern of alopecia areata) who improved following treatment with fexofenadine (marketed under the trade names Allegra, Telfast, Fastofen, Tilfur, Vifas, Telfexo, Allerfexo). The young woman was initially treated with strong topical steroids but had no improvement over a four month period. After adding fexofenadine, an improvement was seen within 3 months.

Is this a co-incidence or a real effect?

The answer is - we don't know.

A previous study of 121 patients with advanced alopecia areata suggested that fexofenadine could help patients with alopecia who were receiving treatment with immunotherapy (either DPCP or squaric acid dibutyl ester). But the improvement was only seen in patients who had atopic eczema, asthma or hayfever. A handful of other studies have suggested that other types of antihistamines may be beneficial for alopecia areata.

Reference

Nonomura Y et al. Case of intractable ophiasis type alopecia areata presumably improved by fexofenadine. The Journal of Dermatology 2012; 39: 1-2.

Inui S. Fexofenadine hydrochloride enhances the efficancy of contact immunotherapy for extensive alopecia areata: Retrospective analysis of 121 cases. Journal of Dermatology 2009; 36:323-327.

 

EGFR Inhibitory Cancer Drugs: Increasing Reports of Scarring Alopecia

EGFR Inhibitory Cancer Drugs: Do they cause hair loss?

"Epidermal growth factor" is a growth factor that not only plays a role in the normal healthy growth of skin but also other tissues in the body as well. In certain types of cancers, EGF signals inside cells have been shown to be harmful and sometimes promotes the growth of those cancers.

"EGFR Inhibitors"

These are a group of drugs that block the actions of EGF. These drugs have been approved for treatment of some types of lung cancer, pancreatic cancer, colon cancer and some types of head and neck cancers. These include drugs with names like erlotinib, cetuximab and gefitinib.

These drugs can sometimes have side effects on the skin, nails and the hair. As a hair specialist, I see patients with the hair related side effects of these drugs. EGFR inhibitors can sometimes cause excessive eyebrow and eyelash growth and can cause changes in the texture of the hair. EGFR inhibitors can also cause hair loss (both scarring and non-scarring kinds). It's important to note that these hair-related side effects are not common.

Back in 2008, my colleagues and I published a report in the journal Archives of Dermatology of a patient with lung cancer who developed a scarring alopecia following use of the drug gefitinib. Now Korean researchers reported a 61 year old woman with metastatic lung cancer who reported a scarring alopecia following use of another EGFR inhibitor drug (erlotinib). This hair loss developed 9 months after starting the drug. It started out as painful pustules. A biopsy was done which proved that the patient had a scarring alopecia.

This study is interesting and provides further evidence that scarring alopecia may be a side effect of this class of cancer drugs.  More research is needed to determine just how frequently this side effect occurs.

Reference

Yang Bo Hee et al. A case of circatricial alopecia associated with erlotinib. Ann Dermatol 2011; 23:350-353.

Donovan JC et al. Scarring Alopecia Associated with the Use of Gefitinib. Archives of Dermatology 2008.144: 1524-5