Skincare News

Hair Loss: A Common Male (and Female) Problem

     In December 1997, the Food and Drug Administration approved Merck and Company's Propecia (finasteride) for the treatment of male pattern hair loss on the crown of the head and the front of the scalp. Propecia is an enzyme inhibitor. It is safe and has few or no side effects associated with its use. Further, in the rare instance (<2%) that a man should have any side effects, there is 100% reversibility with discontinuation Propecia works at the follicle level almost immediately. However, regrowth of hair takes several months due to the length of the hair growth cycle. Two year clinical studies demonstrate that Propecia stabilized hair loss in 83 percent of the patients. Further, 66 percent of the patients regrew natural hair. Stabilization of hair loss is evident relatively quickly (one to three months), while cosmetically significant hair regrowth takes 6 to 12 months, depending on the individual. Propecia is also simple to take and it has been proven safe to take with HIV medications. Available in tablet form, Propecia is taken once daily, any time of the day, with or without food. Propecia is the first oral treatment for male pattern hair loss. In a two-year study, efficacy was established in men, with mild to moderate hair loss on the vertex and anterior mid-scalp area. Since hair loss is a progressive condition (i.e. it does not get better on its own) treatment can help arrest the process. If you are experiencing hair loss, ask Dr. Melanie S. Hecker about Propecia. It just may be the answer you are looking for!

TREATMENT OF HAIR LOSS

     Hair loss is a common and distressing symptom. With the approval of two drugs that promote hair growth - finasteride and minoxidil - we can now treat patients with some types of hair loss. Both drugs influence the length and diameter of existing hair, although each drug works in its own way.

THE HAIR-GROWTH CYCLE

Hair growth is cyclic, with phases of growth (anagen), involution (catagen), and rest (telogen). The cycles of active growth and rest are regulated complex messages between the epithelium and the dermis that are not yet well understood. In a normal scalp, most follicles are growing (90 to 95 percent), a few are undergoing involution (less than 1 percent), and the remainder are resting (5 to 10 percent). At the end of telogen hair is released and shed and the next cycle is initiated. Each day, up to 100 hairs in telogen are shed from the head and about the same number of follicles enter anagen.  The duration of anagen determines the length of hair, and the volume of the hair bulb determines the diameter.
     We are born with all our terminal hair follicles - approximately 100,000 on the scalp - that are predetermined to grow long, thick hair.  Other follicles are predetermined to grow vellus hair, which is short, fine, and relatively non pigmented and covers much of the body. Follicles can become larger or smaller under systemic and local influences that alter the duration of anagen and the colume of the hair matrix.
     Androgens are important in regulating hair growth. At puberty, androgens increase the size of follicles in the beard, chest, and limbs and decrease the size of follicles in the bitemporal region, which reshapes the hairline in men and many women (the typical "M" shape hairline).

ANDROGENETIC ALOPECIA

     Androgenetic alopecia is thinning and eventual scarring over of the hair follicle,  induced in part by dihydrotesterone (DHT) in genetically susceptible men and women. This condition is also known as male-pattern hair loss or common baldness in men and as female-pattern hair loss in women. Thinning of the hair usually begins between the ages of 12 and 40 years in both sexes, and approximately half the population expresses this trait to some degree before the age of 50.
     In post menopausal women, androgenetic alopecia is prevalent. Some researchers feel that the estrogens (that are no longer being produced) may have had a protective factor associated with them. Further research needs to be done in this area.

Treatment In Men

     In men, adrogenetic alopecia ranges from the bitemoral recession of hair, to thinning of the frontal and vertex regions of the scalp, to complete baldness and loss of all hair except the occipital and temporal fringes. In some cases, men have diffuse thinning all over the scalp, similar to female hair loss patterns. The pattern of hair loss, combined with onset at an early age and the presence of miniaturized hairs, supports the diagnosis. Further, this trait tends to run strongly in families but isn't necessarily the key to diagnose androgenetic alopecia.
     The goal of therapy is to increase coverage of the scalp and to retard further hair thinning. In the United States, oral finasteride, at a dose of 1mg per day, and topical solutions of 5 percent minoxidil are currently the only drugs approved for promoting hair growth in men with androgenetic alopecia. Propecia can increase coverage of the scalp by enlarging existing hairs, as well as retarding further thinning, in both the vertex and the frontal regions. This is great news because market research shows that 88% of men who are losing their hair would consider a treatment successful if it stopped them from losing more! A good candidate for treatment is a man that has many miniaturized hairs and/or thinning hair. Neither Propecia nor Minoxidil benefit men who are completely bald or expect to regain all the hair they had as teenagers. In general, treatment for 6 to 12 months is needed to improve scalp coverage. Continued treatment is needed to maintain benefit; if treatment is stopped, the benefits will be lost within 6 to 12 months and hair density will be the same as it would have been without treatment.

Male Patient on Propecia for 24 months
Start of treatment	Month 6	Month 24

Treatment In Women

     Androgenetic alopecia occurs as often in women as in men but is camouflaged by hair styling. In women, the thinning of hair is diffuse but is most marked on the frontal or parietal areas of the scalp. The process is milder in women than in men because of differences in the level of 5a'-reductase and cytochrome P-450 aromatase and in the number of androgen receptors in the hair follicles of the scalp. Women typically retain a rim of hair along the frontal hairline, even when the scalp is visible. Increased spacing between hairs makes the "central part" look wider over the frontal region of the scalp. The patient may note that her "ponytail" is much thinner. The diagnosis of androgenetic alopecia is supported by these clinical features, the presence of miniaturized hairs with large variation in diameter and length, and onset at an early age. Biopsy of the scalp is not routinely needed but is helpful when the diagnosis is uncertain.
     Most women with androgenetic alopecia have normal periods, pregnancies, and endocrine function, including normal serum androgen levels. Extensive hormonal evaluation is not usually needed unless other symptoms and signs of androgen excess are present. Other causes of hair loss may need to be ruled out.
     Women with androgenetic alopecia are often more devastated by their thinning hair than are men. They need to be reassured that they will not becaome bald and that they may safely use hair sprays, dyes, and permanents to make their hair appear fuller. If you are having hair loss, schedule an appointment with Dr. Melanie Hecker to discuss your concerns.

Ask Doctor Hecker
NEW LASERS ALLOW HAIR REMOVAL
IN DARKER SKIN TYPES & TANNED SKIN

Q. Who is a candidate for laser hair removal?

A. The candidate pool for laser hair removal is now expanding to include those with darker and suntanned skin. The ideal candidate for laser hair removal is a person who has dark hair and light skin, no suntan, and hair anywhere on the body. Other important attributes include realistic expectations and a stable endocrine status, since endocrine changes can change the amount of hair.

Q. Is laser hair removal painful?

A. Dr. Melanie S. Hecker uses a laser with a cooling spray before and during treatment and tracks patients' pain closely. If patients experience anything more than a pinprick, she backs off on the fluence, to be conservative.

Q. Can my blond hairs be treated with lasers?

A. Removing white hair with lasers remains problematic. You cannot treat light hair with lasers effectively. In that case, Eflornithine cream (Vaniqa), recently approved for reducing unwanted facial hair, can be used to treat white and wispy blond hair.

Before Laser	After Laser Hair Removal
LEG
UNDERARM

 Q. What precautions should be taken before and after treatment?

A. Avoid the sun 4-6 weeks before and after treatment. You must avoid electrolysis, plucking or waxing hair for 6 weeks prior to treatment.