Hair loss and inflammation: Seeking the connection

Neil S. Sadick, MD, (left) and Maria K. Hordinsky, MD, answer questions from the audience during “Advanced Novel Therapies for the Treatment of Alopecia in Men and Women.”

New therapies are fueling new studies to determine the role of inflammation in androgenetic alopecia. Those studies combine established interventions with newer approaches, such as the use of platelet-rich plasma (PRP) and exploring the role of genetics. Those novel interventions and established approaches to hair loss were examined during a July 27 education session.

Interventions reviewed during “Advanced Novel Therapies for the Treatment of Alopecia in Men and Women” (U010) included combinations of minoxidil corticosteroid lotions, PRP, low-energy lasers, and photobiomodulation, as well as determining the role of signaling cytokines.

“The role of 5α reductase has been well established in men with hair loss. The role of hair loss in women is less well understood,” said presenter Neil S. Sadick, MD. “It appears there is an inflammatory component to hair loss in many women that can be addressed by a novel approach of utilizing anti-inflammatory targeted therapy plus nutritional supplementation with anti-inflammatory products.”

Role of inflammation

The inflammatory component is present in men as well, but men have not been studied to the extent of women, so the role of inflammation is not clear, Dr. Sadick said.

Dr. Sadick, a clinical professor of dermatology at Weill Cornell Medical College and a private practitioner, focused on novel therapies in his presentation. Maria K. Hordinsky, MD, professor and chair of the department of dermatology at the University of Minnesota, presented an update on more conventional therapies.

The combination of minoxidil and corticosteroid lotions is one of the leading new approaches to reducing inflammation, Dr. Sadick said. A study is now gathering data.

“We usually biopsy the women to see if they fall into a common genetic hair loss or whether they have this inflammatory phase of hair loss, and we segregate them into two groups,” he said. “If they have this inflammatory phase, we usually treat them with high-dose minoxidil plus topical corticosteroid lotion. In both groups, we use low-energy lasers, which have been shown in a number of studies to stimulate hair growth, decrease hair fallout, and increase hair shaft diameter.”

Another study adds PRP to the mix. PRP, which is approved by the FDA as a device, spins a patient’s blood, isolating a platelet-rich layer and growth factors that can be activated with an additive, and then returned to the patient.

A different approach is taken in an ongoing study of the role of signaling cytokines in combating hair loss. They are associated with the inhibition of hair follicles that are genetically programmed to fall out and the stimulation of new hair follicle formation, Dr. Sadick said.

Yet other studies are examining the effect of a nutraceutical on scalp inflammation.

“It has some effect on diminishing inflammation,” Dr. Sadick said. “It is a holistic supplement approach to decrease inflammation, decrease oxidative free radical damage to hair follicles, and decrease hormone-induced stresses as well as environmental stresses to the hair follicle.”

Recruiting hair

Dr. Sadick also reviewed new advances in hair transplantation, including follicular unit extraction with automated and robotic devices.

“The goal is to save hairs that can still be recruited and that, under genetic influence, might be programmed to fall out,” he said. “With these new therapeutic targets, hairs can hopefully be saved and really have a positive effect on progression of hair loss in men and women.”

Dr. Hordinsky reviewed the use of established therapies, including topical minoxidil and 5α reductase inhibitors.

“These are treatments that dermatologists have easy access to,” Dr. Hordinsky said. “They can prescribe them and set expectations. As part of the treatment, one has to always focus on and discuss maintaining a healthy scalp. Any inflammation on the scalp needs to be treated for these treatments to be successful. The practitioner can always move on to recommending hair transplantation or other novel approaches.”

The use of low-level laser light is an evolving treatment. Also known as photobiomodulation or photobiostimulation, these treatments have been linked with changes in mitochondrial oxidative metabolism and the stimulation of transcription factors, she said.

At least 14 light devices are approved by the FDA, but not all have been studied in double-blind placebo-controlled clinical trials. The University of Minnesota department of dermatology is studying seven of the devices in a randomized manner and is using a sophisticated Canfield camera system to take images of scalps and gather data, Dr. Hordinsky said.

“We are collecting data on how it feels when you are having these treatments and what it is like to sit with one of these on your head — in some cases for 20-30 minutes, two to three times per week,” Dr. Hordinsky said. “We are getting patient information about these devices and what they are like when you are being treated.”

Dr. Hordinsky also discussed clinical studies of an oral medication and a topical agent still in clinical trials. The oral medication affects the prostaglandin D2 pathway, which blocks the growth of human hair follicles in cultures. The topical agent is a steroidal anti-androgen that is being tested for the treatment of male andogenetic alopecia.

“Patients are savvy and frequently come to the clinic and ask about these treatments,” Dr. Hordinsky said when asked about the promise of the numerous interventions. “Dermatologists need to be knowledgeable and need to be aware of established and evolving therapies to be able to counsel their patients. For example, you may or may not believe in the efficacy of the light treatment or photobiomodulation devices, but your patients have access to them, and will probably buy them and use them and ask you for your opinion.”

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