Combined Strategies to Effectively Reverse Hair Loss

Combined Strategies to Effectively Reverse Hair Loss

The fact is, hair loss is distressing, and it’s prevalent, affecting up to 70 percent of men and 40 percent of women in later life. (1,2) Not only does hair loss subtract years from one’s overall appearance, but it can also negatively affect a person’s self-esteem, a reality which has spurred the development of a plethora of drugs and products targeted to maintaining and encouraging the growth of the hair. Thankfully, with so many proven treatments to choose from, hair loss is a potentially reversible condition that does not have to be an inevitable consequence of aging. IAS offers a varied range of products, from oral medications to topically applied shampoos, conditioners, sprays and lotions, which can be used individually, or for greater effect, synergistically, to combat the major mechanisms of hair loss while fostering the growth and vitality of the new hair. But when first confronted with balding, it may be difficult to know where to start in identifying an appropriate regimen. This article will provide some guidance: we will examine each product individually and then suggest protocols for their combined use to maximize effectiveness.

About Hair Loss and its Treatment

Hair loss, also known as alopecia, can result from a variety of factors including hormonal alterations, illness, certain medications, or even emotional upset. The most common type is known as androgenetic alopecia, which exhibits as male-pattern baldness in men (a receding hairline at the temples and balding at the top of the head) and female-pattern hair loss in women (a general diffuse thinning of the crown area). As the name implies, androgenetic alopecia is androgen-dependent and hereditary, resulting in the atrophy or miniaturization of predisposed hair follicles and progressive decline in hair density. Of all androgens, the one most destructive to follicles is 5-α-dihydrotestosterone (DHT), which is synthesized from testosterone by the enzyme 5-α-reductase. (1,3,4) Many treatment modalities for hair loss target the inhibition of this enzyme, preventing the conversion of testosterone to DHT. Other therapies encourage growth by other mechanisms, such as increasing blood supply to the scalp and follicles, inhibiting follicle inflammation and collagen build-up, and prompting follicles to prematurely enter the growth phase of the hair cycle.

Four Clinically Studied Anti-Alopecia Drugs

To begin, let’s look at four drugs that have undergone clinical investigation: the first two, topical minoxidil and oral finasteride, are FDA- approved for the treatment of androgenetic alopecia; the second two, oral dutasteride and ketoconazole shampoo, are approved for other indications, but are used “off-label” as effective hair loss treatments.

Finasteride is an inhibitor of type 2 5-α-reductase and prevents the synthesis of follicle shrinking DHT. (1,4,5) Daily oral administration of finasteride (at a 1 mg dose in most clinical studies) has been shown to be effective in the prevention and treatment of androgenetic alopecia in men. (1,3,6,7) Finasteride is available from IAS as Proscar®, 5 mg (which is the usual dose for the treatment of benign prostatic hyperplasia, or enlarged prostate, an indication for which it is also approved). If desired, the tablets may be broken into quarters to approximate the dosages used in the alopecia clinical studies. (Note: oral finasteride is contraindicated for use in premenopausal women.) Finasteride is also an active ingredient in Hair Pro™, a topical spray-on product (see below).

A related compound, dutasteride, inhibits both types 1 and 2 5-α-reductase (2,8,9) and may be a stronger blocker of DHT than finasteride. It is also approved for the treatment of benign prostatic hyperplasia and is presently on hold in Phase III trials for androgenetic alopecia. Phase II studies demonstrated a dose-dependent effect on hair growth, and greater efficacy when compared to finasteride. (2,9) (Note: this drug is also contraindicated for use premenopausal women.) Dutasteride is available as Avodart®, 0.5 mg tablets.

Ketoconazole is an anti-fungal agent FDA-approved for the treatment of dermatitis and dandruff. As a topical shampoo (brand name Nizoral®, 2% ketoconazole), it has also been shown to improve hair growth in androgenetic alopecia due to its inhibitory effect on the DHT pathway and anti-inflammatory effect on hair follicles. (2,14)

Minoxidil, a long-studied drug, stimulates hair growth by a non-androgen based mechanism: it induces cell proliferation, improves follicle vascularization (blood vessel formation), increases follicle size, and prompts the follicles to prematurely enter the growth phase (anagen) of the hair cycle. (1,2) Clinical trials of topical 2% and 5% minoxidil in both men and women have all demonstrated significant increases in hair growth. (1,10-12) IAS carries a multi-ingredient topical liquid, MinSaw™, which contains a potent 8% minoxidil (compared with concentrations of 2% and 5% used in the clinical studies), plus three natural ingredients that further encourage hair growth: melatonin, resveratrol and saw palmetto (an herbal DHT-blocker). The product also contains tretinoin, a vitamin A derivative shown to increase the cutaneous absorption of minoxidil (13). MinSaw™ is the newest version of previous formulas. Thanks to the high percentage of minoxidil in MinSaw™ and tretinoin-induced superior absorption, only once-daily application to the scalp is required, in contrast to products with lower minoxidil concentrations that require twice-daily use.

The Best Results are achieved with a Combined Regimen Initiated Early

Research indicates that optimal hair restoration is achieved when these treatments are initiated early in the onset of alopecia. (1,14) And while each is effective when used individually, a combined regimen will yield even greater hair growth effects, as demonstrated in an ambitious 2002 study which compared the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution, and 2% ketoconazole shampoo, alone and in combination. One hundred men with androgenetic alopecia were randomized into four groups: the first was administered oral finasteride, the second received a combination of oral finasteride and topical minoxidil, the third applied minoxidil alone, and the fourth received a combination of oral finasteride and ketoconazole shampoo. After one year of treatment, the researchers observed that the best hair growth effect was achieved in the combination finasteride and minoxidil group, followed by the combination finasteride and ketoconazole group, then the finasteride alone group, and finally the minoxidil alone group. (14) These results indicate that the therapeutic efficacy is enhanced with a combination protocol that, ideally, acts on different mechanisms of hair loss, especially when initiated early. (It would have been interesting and informative to evaluate an additional group with a combined regimen of all three treatments; it follows that even greater benefits might have been obtained.) See section on Synergistic Regimens to Combat Hair Loss for tips on combined use of these treatments.

In addition to the four treatments just discussed, IAS carries additional anti-alopecia products, including Hair Pro™, Dercos® Shampoo and the latest Nanogen® brand

Hair-Pro™

Hair Pro™ is a multi-ingredient topical spray ─ a comprehensive hair growth regimen in one product ─ containing finasteride, which we have seen blocks the lethal effects of DHT on hair follicles. For those who prefer topical treatments to oral medications, spray-on Hair Pro™ is a good alternative to Proscar®. The product is also formulated with three polypeptide growth factors: IGF-1 and bFGF encourage the growth of hair follicles, (3,15) and VEGF establishes a highly developed blood vessel network around the hair follicles necessary for hair growth. (16,17) Other ingredients, nicotinic acid and L-carnitine, further induce growth, while hyaluronic acid and dexpanthenol moisturize the scalp and condition the hair. Hair Pro™ is sprayed onto clean areas of the scalp exhibiting hair loss. For an even greater effect, Hair Pro™ may be applied after cleansing the hair with Nizoral®, Dercos®, or Nanogen® Shampoos. See section on Synergistic Regimens to Combat Hair Loss.

>Dercos® Shampoo

Dercos® Shampoo contains the active ingredient aminexil, a drug developed by the French company Vichy that targets yet another mechanism of hair loss. In the early onset of androgenetic alopecia, inflammation of the hair follicles often develops, which leads to thickening of the area around the follicle from increased deposition of collagen, a condition known as perifollicular fibrosis. (5)This results in miniaturization or complete destruction of the affected follicles if not checked. Dercos® Shampoo blocks this pathogenic process by preventing the build-up of collagen. According to the manufacturer, regular Dercos® use by 350 men and women improved the condition, thickness, strength, and quantity of the hair. The liquid is massaged into a clean scalp as a leave-in treatment. Alternatively, Dercos® Shampoo may be followed by other products, such as Hair Pro™ or MinSaw™. See section on Synergistic Regimens to Combat Hair Loss.

Nanogen® Products

The newest addition to the IAS store of anti-alopecia treatments is the Nanogen® range

Nanogen® Shampoo is formulated to block DHT and contains a combination of natural ingredients, including saw palmetto extract, green tea extract, pygeum africanum extract, zinc and Vitamin B6. Nanogen® Conditioner is a hair thickening agent that employs a novel delivery system and dual mode of action: two ingredients, d-panthenol and pentavita, cause the hair shaft to swell while translucent silicon coats it, creating the appearance of a fuller, smoother, healthier head of hair. Nanogen® Hair Growth Factor Hydrator Spray provides relief for scalp irritation, dryness, or itchiness that may result from topical product use, and remedies dull, straw-like hair. The spray encourages growth while soothing and moisturizing the scalp and conditioning the hair. Spray throughout dry hair or directly onto the scalp, then massage in gently and allowed to dry.

Nanogen® Hair Growth Factor Treatment Serum is a gentle leave-in hair growth serum that conditions the hair and protects the scalp from damage and irritation. The serum contains the growth factor VEGF (also contained in Hair Pro™), which we have seen increases follicle vascularization and induces hair growth, plus other ingredients to foster a healthy environment for growth. Free of solvents, preservatives or other chemicals that can irritate and dry the scalp, it is suitable for everyday use. The serum is applied directly to a clean scalp, preferably after using the Scalproller® (see below), massaged in, and allowed to dry.

The Scalproller® is a cylindrical barrel with precision- engineered titanium micro-needles.  When rolled across areas of the scalp, the Scalproller® creates tiny channels through the outer layer of the scalp known as the stratum corneum, a protective layer that often reduces or blocks the penetration of topical products. This device dramatically increases absorption of externally applied treatments (such as MinSaw™, Nanogen® Treatment Serum or Hair Pro™) in areas such as the frontal scalp, which is often resistant to penetration. The Scalproller® can even be used independently to promote new hair growth, if desired. Use a sterilized Scalproller® on a dry scalp after shampooing and before applying topical treatments, according to the directions provided with the product. When used correctly, the ultra-sharp titanium needles that penetrate the upper layers of the scalp should not cause bleeding or pain.

Suggested Synergistic Regimens to Combat Hair Loss

Our understanding of the complex factors involved in the progression of alopecia has substantially grown in recent years, leading to the development of a wide range of treatments yielding beneficial results, especially when used in combination in the early stages of hair loss. The goal of this article was to provide an overview of the many anti-alopecia products carried by IAS and suggest recommendations for their combined use. Below is a summary of suggested Synergistic Regimens to Combat Hair Loss. You may only want to start with one or two products, assess the results, and then add in an additional product(s) as needed. Or you may want to switch or rotate your regimen from time to time, depending on your goals and results. The synergistic regimens listed below are to be used as a guide and modified as desired.

Regimen I:

Nizoral® Shampoo (can use three times a week; alternate with Dercos® or Nanogen® Shampoo, follow with the Nanogen® Conditioner)

+

MinSaw™**

Regimen II:

Nanogen ® Shampoo

+

Nanogen® Conditioner

+

Nanogen® Hair Growth Factor Treatment Serum**

Regimen III:

Oral finasteride (Proscar®) or dutasteride (Avodart®) (contraindicated in premenopausal women)

+

Nizoral® Shampoo (can use three times a week; alternately, shampoo with Dercos® or Nanogen® Shampoo, follow with the Nanogen® Conditioner)

Regimen IV:

Nizoral® Shampoo (can use three times a week; alternate with Dercos® or Nanogen® Shampoo, follow with the Nanogen® Conditioner))

+

Hair Pro™**

Notes:

**Scalproller® may be used after shampooing on a dry scalp- before applying these topical treatments.

The Nanogen® Hair Growth Factor Hydrator Spray can be added in cases of scalp irritation/ dryness.

References

    1. Trüeb RM. Pharmacologic interventions in aging hair. Clin Interv Aging. 2006;1(2):121-9.
    2. McElwee KJ, Shapiro JS. Promising therapies for treating and/or preventing androgenic alopecia. Skin Therapy Lett. 2012 Jun;17(6):1-4.
    3. Jankovic SM, Jankovic SV. The control of hair growth. Dermatol Online J. 1998 Oct;4(1):2
    4. Hugo Perez BS. Ketoconazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men. Med Hypotheses. 2004;62(1):112-5.
    5. Yoo HG, Kim JS, Lee SR, et al. Perifollicular fibrosis: pathogenetic role in androgenetic alopecia. Biol Pharm Bull. 2006 Jun;29(6):1246-50.
    6. Rossi A, Cantisani C, Scarnò M, Trucchia A, Fortuna MC, Calvieri S.
    7. Dermatol Ther. Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up. 2011 Jul;24(4):455-61.
    8. Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.
    9. Eun HC, Kwon OS, Yeon JH, et al. Efficacy, safety, and tolerability of dutasteride 0.5 mg once daily in male patients with male pattern hair loss: a randomized, double-blind,placebo-controlled, phase III study. J Am Acad Dermatol. 2010 Aug;63(2):252-8. Epub 2010 Jun 3.
    10. Olsen EA, Hordinsky M, Whiting D, et al. The importance of dual 5alpha-reductase inhibition in the treatment of male pattern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride. J Am Acad Dermatol. 2006 Dec;55(6):1014-23.
    11. Olsen EA, Weiner MS, Amara IA, et al. Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil. J Am Acad Dermatol.1990; 22:643–6.
    12. Price VH, Menefee E. Quantitative estimation of hair growth I. Androgenetic alopecia in women: effect of minoxidil. J Invest Dermatol. 1990;95:683–7.
    13. Lucky AW, Piacquadio DJ, Ditre CM, et al. A randomized, placebo controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol. 2004;50:541–53.
    14. Shin HS, Won CH, Lee SH, Kwon OS, Kim KH, Eun HC. Efficacy of 5% minoxidil versus combined 5% minoxidil and 0.01% tretinoin for male pattern hair loss: a randomized, double-blind, comparative clinical trial. Am J Clin Dermatol. 2007;8(5):285-90.
    15. Khandpur S, Suman M, Reddy BS. Comparative efficacy of various treatment regimens for androgenetic alopecia in men. J Dermatol. 2002 Aug;29(8):489-98.
    16. Su HY, Hickford JG, Bickerstaffe R, Palmer BR. Insulin-like growth factor 1 and hair growth. Dermatol Online J. 1999 Nov;5(2):1.
    17. Yano K, Brown LF, Detmar M. Control of hair growth and follicle size by VEGF-mediated angiogenesis. J Clin Invest. 2001 Feb;107(4):409-17.
    18. Kozlowska U, Blume-Peytavi U, Kodelja V, et al. Expression of vascular endothelial growth factor (VEGF) in various compartments of the human hair follicle. Arch Dermatol Res. 1998 Dec;290(12):661-8.

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