PRP in Alopecia Areata

I have blogged about the probability of PRP being an effective modality for hair loss though its wider indications in cosmetic dermatology is less convincing. A new study has demonstrated that PRP may be useful in Alopecia Areata as well. The study published in BJD compares PRP to intralesional Triamcinolone and placebo and demonstrates superiority of PRP.[1] Though it is pilot study with less power, the Ki-67 an excellent marker to determine the growth fraction of a given cell population was included as a secondary outcome measure.

Alopecia areata. Español: Alopecia areata. Italiano: Un esempio di alopecia areata classica. Polski: Łysienie plackowate. Türkçe: Saçkıran. (Photo credit: Wikipedia)

Objective assessment of alopecia and its response to treatment is very difficult and is not often sensitive enough. Changes in hair mass is influenced by both the density and diameter of hair. A new device called HairCheck can measure and represent hair caliber and hair density together in a single number. Here is a study that demonstrates the use of HairCheck.[2] The authors have named this method cross-section trichometry (CST) a less attractive name than the device itself!

References:

1. Trink, A. "A randomized, double-blind, placebo and active-controlled, half ..." 2013. <http://www.ncbi.nlm.nih.gov/pubmed/23607773>

2. Wikramanayake, TC. "Cross-section Trichometry: A Clinical Tool for Assessing the ..." 2012. <http://www.ijtrichology.com/article.asp?issn=0974-7753;year=2012;volume=4;issue=4;spage=259;epage=264;aulast=Wikramanayake;type=0>

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Coiled hair shafts in keratosis pilaris

Keratosis Pilaris (KP) is a common complaint in adolescent girls. KP may not be a single entity as different morphological types are described. The most common variant of KP presents as reddish bumps on the back and outer aspects of the arm. It aggravates after waxing and I have personally noticed good improvement after laser hair removal. Till now it was considered a disorder of keratinisation.

keratosis_pilaris (Photo credit: ladypictureshow)

Dermatologists from Seth GS Medical College and King Edward Memorial Hospital, Mumbai, have proposed an interesting new pathogenic mechanism for this common condition.[1] They have observed coiled hair shaft inside KP on dermoscopy that retained the coiled nature even after extraction. There was no obvious keratin plug. That explains the improvement following laser hair removal. Coiled hair may also make hair removal procedures more traumatic making the perifollicular inflammation more prominent.

Would hair softeners be of any help? Checkout curlynikki’s take on natural hair softners:

Here is an interesting article that describes the use of topical melatonin in androgenetic alopecia.[2] Out of curiosity I checked the wikipedia page on melatonin. Readers may be interested to know that melatonin supplementation causes vivid dreaming! Any perceived connection is likely to be just a coincidence.  :-)

References:

1. Keratosis Pilaris Revisited: Is It More Than Just a Follicular Keratosis?. 2013. 3 May. 2013 <http://www.ijtrichology.com/article.asp?issn=0974-7753;year=2012;volume=4;issue=4;spage=255;epage=258;aulast=Thomas> (Full article available from journal website free)

2. Fischer, TW et al. "Topical Melatonin for Treatment of Androgenetic Alopecia." International Journal of Trichology 4.4 (2012): 236.

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Putting a cap on ......

Today I shall evaluate a product mentioned by my friend Dr Akshat in Dermatologist facebook group as a biomimetic 5-alpha-reductase inhibitor used in the treatment of androgenetic alopecia. In line with my blogging convention I shall refer to the product as 'The CAP'. Please stick to this rule if you comment on this post.

Recently I evaluated a product from the same cosmetic company for reversing the graying of hair. Please read the conclusion here. In general, I am skeptical about hairloss treatments. Please read my personal views here.

English: Red clover (Trifolium pratense), Wellington, New Zealand (Photo credit: Wikipedia)

Let me start with the claims from their promotional material:

1. The active ingredients include an Acetyl Tetrapeptide -3 and Red clover (Trifolium Partense) extract.  This is based on the assumption that butylene glycol, water and dextran are inactive.
Water as far as I know is active only in homeopathy.(Read this)

2. Reduces 5-alpha reductase and IL-8 and improves Extra Cellular Matrix.

3. For hairloss, hair regrowth, anti-ageing! and eye lashes treatment!!

The theory seems fascinating for a cosmetic, so we shall explore the active ingredients:

Acetyl Tetrapeptide 3, in spite of the long and appealing name is a simple molecule. It has the general formula AX-Gly-His-Lys-Y where A is the acetyl group, X stands for 1-2 lysine residues and Y is OH group. The Gly-His-Lys tripeptide is known to have minimal effect on hair growth. They claim to have a patent for the Acetyl tetra peptide 3. They applied for the patent in 2004, but the patent was not granted because Acetyl Tetrapeptide was not considered significantly different from the core Gly-His-Lys. So the patent claim is wrong and the "biomimetic signal peptide" is just old wine in new bottle!

English: 2D structure of 5-alpha reductase inhibitor finasteride (Photo credit: Wikipedia)

Bichanin A in Red clover extract is a phytoestrogen that stimulates fibroblasts to make collagen and HA. It has mild 5-alpha-reductase activity but more on type 2. Several other natural and synthetic polyphenolic compounds were more effective inhibitors of the type 1 than the type 2 isozyme, including alizarin, anthrarobin, gossypol, nordihydroguaiaretic acid, caffeic acid phenethyl ester, and octyl and dodecyl gallates.
Ref: http://www.ncbi.nlm.nih.gov/pubmed/11931850 (Structure-activity relationships for inhibition of human 5alpha-reductases by polyphenols.)

The "cosmetic claim" of an effect on eye lashes still needs to be explained.

But could it have some other mechanism of action not known to the manufacturer. In fact, the product corroborates my views (read here) and I feel The CAP might be more effective than a mild type II 5-alpha-reductase inhibitor.

I submitted a similar product plan on a website called inventionUnited.com. My project was selected as the best project, but never got the promised cash award!! My project is still listed as a featured project in their website http://www.inventionunited.com Now they have started charging their users for viewing the proposal. I feel this is outright cheating!!


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The Hair Robot

Robots can be effectively used to accurately perform repetitive tasks. The surgical technique of hair transplantation is an extremely time consuming repetitive process. Now specially designed Robots are set to lend a helping hand in this surgical procedure. Robots may even increase the effectiveness and success rate of hair transplantation.

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A favourable pattern

I have been reviewing the potential utility (or otherwise) of platelet-rich plasma (PRP) in my dermatology blog. I came across this article that propounds the use of CD34+ cell containing PRP in pattern hairloss in men and women.


J Eur Acad Dermatol Venereol. 2012 Dec 20. doi: 10.1111/jdv.12062. [Epub ahead of print]
The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study.

English: Bald head (Photo credit: Wikipedia)

I don't have access to the full article and have seen only the abstract. The study compares the CD34+ cell containing PRP injection, not to a placebo, but to placental extract injection. Both have angiogenic potential. The sample size is only 13 in each arm. Only six month follow-up data is available.


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Dopamine and Hirsutism

hair follicle (Photo credit: Wikipedia)

Dopamine is a novel, direct inducer of catagen in human scalp hair follicles in vitro - Langan - 2012 - British Journal of Dermatology - Wiley Online Library:

There are many reports of reversible hair loss following treatment with dopamine agonists like levodopa. This study provides evidence that dopamine promotes anagen to catagen conversion and has a negative effect on hair growth. Hence the authors tout dopaminergic agonists as the next big thing in hirsutism management.

Surprisingly the study does not mention the sample size and there is a statement that non-parametric tests were performed when the number was not big enough to ensure normal distribution. This makes me skeptical about the power of the study. The D2R conjuncture based on its murine homologue also needs experimental proof.

Treatment of unwanted facial hair in females (especially laser hair removal) is a multi-million dollar industry. The preliminary findings of this study may still be relevant in guiding research in this field in the right direction.

Here is a summary  and DermKnowledgeBASE Triples* on hirsutism.
3 peels for this article.

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Hair fall - The root pressure theory (Part - II)

The Maze (Photo credit: beapen)

The root pressure theory is simple. It is not the hormones that make you bald, but the pressure on the hair roots though hormones could still have an indirect effect. I was planning to write a detailed description of the evidence in favour of this theory, but I submitted it as a product plan to the new portal www.inventionunited.com that aims to "Unite Inventions across Industry and Academia". And guess what, it is the top product plan till now! Though the description may be technical it covers most of the points I wanted to blog. You can read it here. (Opens in a separate window) If you have a facebook account, please don't forget to recommend and comment on the plan. They have promised $500 for the best product plan in medicine and the competition ended last month. But I have not heard from them still!!

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