Topical Hair Loss Medication - Bernstein Medical - Center for Hair Restoration
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An article in the New York Times discusses research surrounding a potential new hair loss treatment. The NY Times’ article “Old Transplant Drug May Have A Fringe Benefit” states that an immunosuppressant used to prevent organ rejection in those having liver, kidney or heart transplants also stimulated hair growth.

First prescribed in the 1980’s it is now used for the treatment of many diseases including rheumatoid arthritis and psoriasis. Nathan Hawkshaw, at the University of Manchester found that cyclosporine A stops the production of a protein that inhibits the growth of some tissues, one of them being hair follicles.

Old Transplant Drug May Have A Fringe Benefit

What was important to the first patients who took cyclosporine A was that it made their bone-marrow transplants work; few reported the increased luster of their hair. Now scientists think the drug may hold the key to an effective treatment for baldness.

Patients began using cyclosporine A in the Eighties and it is now prescribed for dozens of conditions, including rheumatoid arthritis. Like all immunosuppressants it has serious side-effects, so hirsutism (increased body hair) was never considered a big downside. And neither was it seriously considered an upside.

Increasing your vulnerability to infection to reverse hair loss is not a risk many would take. But a team at the University of Manchester think they have found a way to mimic the hair promoting effects without the serious consequences.

Nathan Hawkshaw, then a PhD student, found that the drug decreased production of the protein SFRPI, which acts as a brake on the growth of some tissues, among them hair follicles. He and his colleagues then learned that another compound already existed that was designed to target SFRPI – and not do much else.

In a paper in Plos Biology they wrote that the compound enhanced follicle growth better than cyclosporine A, and Dr. Hawkshaw believes that this could work as a topical hair treatment. However, since the test follicles were healthy, it is not known whether actual balding could be reversed.

If the compound turns out to be safe and effective, it will still take several years to make it onto the market.

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Q: What is more important against baldness, decreasing DHT in serum with oral finasteride or decreasing DHT in the scalp with topical finasteride? — A.G. ~ Brooklyn, N.Y.

A: Decreasing serum DHT with oral finasteride is more effective in combating hair loss, as the decreased blood levels also lowers the DHT in follicles and seem to do it better than finasteride applied topically.

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Dr. Angela Christiano and her team of researchers at Columbia University studying the autoimmune disease alopecia areata, have shed new light on how to move hair follicles from their resting stage (telogen) into the growth stage (anagen) in which they can produce normal hairs. The study, published in the October issue of Science Advances, introduces the possibility of a new topical medication for hair growth stemming from a class of chemicals that block enzymes in the Janus kinase (JAK) family. ((Harel S, Higgins CA, Cerise JE, Dai Z, Chen JC, Clynes R, Christiano AM. Pharmacologic inhibition of JAK-STAT signaling promotes hair growth. Sci Adv. 2015 Oct; 1(9): e1500973.)) The findings on the topical application of JAK inhibitors have implications in the treatment of common hair loss as well as alopecia areata, which causes a non-scarring form of localized hair loss.

Scientists had, until now, tried unsuccessfully to use drugs to induce follicles en masse into the anagen phase. The two FDA-approved medications currently used to treat hair loss each use a different approach. Finasteride (Propecia) blocks the conversion of testosterone to dihydrotestosterone (DHT) – the hormone that causes genetically susceptible hair follicles to progressively shrink or miniaturize. Minoxidil (Rogaine) extends the anagen phase, thereby delaying the onset of hair follicle miniaturization. JAK inhibitors could develop into a third major medical option for the treatment of hair loss.

Background: Research Investigating Alopecia Areata

Dr. Christiano, herself diagnosed with alopecia areata, has made several significant breakthroughs involving hair loss and its treatment in the past. Bernstein Medical has written extensively about her study of alopecia areata, hair loss genetics, and hair cloning.

Building on initial research in 1998 implicating a type of white blood cell known as “T lymphocytes” in the development of alopecia areata, ((Gilhar A, Ullmann Y, Berkutzki T, Assy B, Kalish RS. Autoimmune hair loss (alopecia areata) transferred by T lymphocytes to human scalp explants on SCID mice. J Clin Invest. 1998 Jan 1; 101(1):62-7.)) Dr. Christiano and her team set out to find ways to modulate them. In research published in the September 2014 issue of Nature Medicine, they looked at two different FDA-approved chemicals, ruxolitinib and tofacitinib, and how they act as inhibitors of enzymes in the family Janus kinase (JAK). Inhibiting JAK cut off communication to the T cells. Without an accumulation of T cells, alopecia areata could not progress. ((Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, de Jong A, Harel S, DeStefano GM, Rothman L, Singh P, Petukhova L, Mackay-Wiggan J, Christiano AM, Clynes R. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014 Sep; 20(9):1043-9.)) The JAK inhibitors both prevented the onset of the disease, and reversed the condition where it was already established.

The most surprising finding of this study concerned the effect of topically applying the inhibitors.

“We found that topical ruxolitinib and topical tofacitinib were both highly effective in reversing disease in treated lesions (applied to back skin). A full coat of hair emerged in the ruxolitinib- or tofacitinib-treated mice by 7 weeks of treatment, and we observed complete hair regrowth within 12 weeks following topical therapy.”2

Findings: JAK Inhibitors and Hair Growth in Normal Subjects

Having successfully tested JAK inhibitors against alopecia areata, Dr. Christiano and her team sought to investigate JAK inhibition on normal mice and humans.

The researchers applied solutions of tofacitinib and ruxolitinib to one side of the backs of mice with hair in the telogen phase, while the other side was treated with a control solution. Within seven days of treatment, each mouse saw robust hair growth on the treated side, while the control side did not. This indicates a rapid transition of the hair cycle from telogen (resting) to anagen (growth). Furthermore, they found that treatment with JAK inhibitors resulted in “significant proliferation” of hair follicle stem cells, indicating that the inhibitors activated progenitor stem cells within the follicles. The topical application of JAK inhibitors in mice unmistakably resulted in rapid onset of hair growth.

Next, the team looked at the effects of JAK inhibitors on cultured dermal papilla (DP) spheres. In 2013, Dr. Christiano achieved a breakthrough in using an ingenious technique, called a “hanging drop culture.” Using this process, her team caused dermal papilla cells to clump together in a spherical (tear drop) shaped configuration. They found that DP cells in this three-dimensional mass more easily communicate with one another and are then capable of forming new hair follicles. When cultured in a solution containing the JAK inhibitor, tofacitnib, the DP spheres showed an enhanced ability to induce hair follicle development in larger sizes and in significantly greater numbers.

Conclusion/Summary

Topical application of JAK inhibitors leads to the activation and proliferation of hair follicle stem cells and a rapid transition to the anagen phase of the hair growth cycle. This research could be the catalyst for the development of a new topical treatment for hair loss that could potentially benefit individuals who are not indicated for, or who have not seen a positive response from, traditional hair loss medications or are not candidates for hair transplantation. Additionally, JAK inhibitors may be developed into a topical treatment for alopecia areata and potentially other autoimmune conditions that cause localized hair loss or other skin problems. JAK inhibitors might even aid in the development of hair cloning techniques, which could effectively cure hair loss.

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Q: Have you any experience with Azelaic Acid as a hair loss treatment — is this something you would recommend using with Rogaine (minoxidil) 2% or 5% solutions? — S.V., Short Hills, N.J.

A: Azeleic acid has no direct benefit in promoting hair growth. Azelaic acid (like retinoic acid) increases the absorption of minoxidil, but also the side effects, so I would especially not recommend it in your case.

Read more about Rogaine (minoxidil)

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Journal of the American Academy of DermatologyA double-blind scientific study published in the May 2012 issue of the Journal of the American Academy of Dermatology has found that latanoprost, a drug that mimics naturally-derived compound molecules called prostaglandins, significantly increases hair density on the scalp after 24 weeks of treatment in young men with mild hair loss.

Latanoprost, like the eyelash restoration drug bimatoprost (better-known by its brand name Latisse), has been used to treat glaucoma. And like bimatoprost, latanoprost has been used to treat eyelash alopecia. The scientists who conducted the study sought to determine if latanoprost could stimulate hair growth when applied topically on the scalp.

While the sample size of the study was small (only 16 subjects), the researchers found that 50% of the subjects had statistically significant differences in hair density associated with increased hair pigmentation and thickness. Overall, at 24 weeks into the study, hair density had increased 22% in the entire study population. Another interesting finding is that the proportion of hairs in the anagen phase versus the telogen phase — referred to as the anagen/telogen ratio — remained stable. The authors of the study describe the significance of this finding:

“The stabile anagen/telogen ratio might indicate that latanoprost does not modify the length of anagen and telogen phases of individual hair follicles. However, as the absolute number of both anagen and telogen hair increased, it seems latanoprost recruits new hairs into the growth phase.”

In conclusion, the authors suggest that the study shows the possibilities of using prostaglandin analogues, like latanoprost, to treat androgenetic alopecia, or common hair loss on the scalp. More research is needed on latanoprost, or other prostaglandin analogues, to determine the ideal dosage and duration of treatment for hair loss.

Latisse, the brand owned by American pharmaceutical company Allergan, is currently being studied as a topical hair loss medication. The study will conclude in September 2012.

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Journal of Drugs in DermatologyThe January 2012 issue of the Journal of Drugs in Dermatology contains an article, written by Drs. Schweiger and Bernstein, which is the first case study of eyebrow growth from the topical use of bimatoprost.

Latisse (bimatoprost) is a topical medication that is FDA-approved for eyelash growth. Some physicians have used the medication for “off-label” use, such as use with eyelashes and scalp hair. However, until recently, there had not been any published medical literature describing the off-label use.

In the case report, a 47-year-old Caucasian woman visited Bernstein Medical for an evaluation of hair loss in one of her eyebrows, also known as eyebrow hypotrichosis. The hair loss was gradual, but had become cosmetically significant, and so she became interested in treating her thinning left eyebrow.

At her evaluation, the doctor discussed treatment options with the patient, including Follicular Unit Transplantation (FUT) and medical treatment with bimatoprost. She decided on medical treatment, and so started a four month treatment regime.

At a follow-up visit four months later, the patient reported significant thickening of her left lateral eyebrow. […] Physical examination revealed increased left eyebrow density, hair length, darker color, slight skin pigmentation, and eyelash treatment.

The conclusion of the article states:

We report one of the first cases of topical bimatoprost for successful treatment of eyebrow hypotrichosis. Studies are needed to confirm the efficacy and safety of topical bimatoprost to treat eyebrow hypotrichosis.

Also noted is that if the efficacy and safety of the medication are confirmed through additional testing, it would be a viable non-surgical option for eyebrow restoration.

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Dr. Scweiger on GMA - Eyelash Enhancement

From hair extensions to eyelash enhancement, our resident expert on hair loss in women is on the case. Dr. Eric Schweiger was featured in a segment on Good Morning America where he discussed the enhancement of eyelashes, which he called, “a universal sign of beauty.”

According to Dr. Schweiger, eyelash enhancement is growing in popularity. One way to enhance your lashes is through topical hair loss medication called Latisse. Here is what Dr. Schweiger said on the topic:

“Latisse is a medicine you apply to the eyelash skin, and it actually increases the growth phase of the eyelashes,” Schweiger said, referring to the prescription treatment that is the first and only FDA-approved eyelash growth product. “You get longer, fuller eyelashes.”

In recent years, Latisse has attracted media attention for its eyelash growing properties. Testing has begun for use as an eyebrow enhancer and begun testing for hair loss on the scalp.

Read more about Latisse, which is the brand name for the product. The active ingredient in the medication is called bimatoprost.

The GMA segment goes on to discuss eyelash enhancement using eyelash extensions. Watch the segment below, or visit the article on ABC News:

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Q: I use Nizoral for my dandruff. Does it work for hair loss too? — M.D., Danbury, CT

A: The active ingredient in Nizoral is Ketoconazole. This medication, originally developed to treat fungus infections, has slight anti-androgen action. It is supposed to work in hair loss by inhibiting the action of DHT on hair follicles. Although, in theory, it should be useful for androgenetic hair loss, there have not been conclusive scientific studies to show that it works to treat balding when used as a topical application for balding.

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