New Hair-Loss Treatments in the Pipeline

New Hair-Loss Treatments in the Pipeline

By Denise Mann
Reviewed by Brunilda Nazario, MD
Source: WebMD Health News

March 31, 2014 -- New hair loss treatments on the not-too-distant horizon may be game-changers.

“The development of new treatments, including drugs and cell-based approaches for hair loss, is at an all-time high,” says Kenneth J. Washenik, MD, PhD. He's a clinical assistant professor at NYU Langone Medical Center and the medical director at Bosley Medical. “We have never had this many provocative treatments in the pipeline.”

Washenik spoke about advances in treating hair loss during March’s annual meeting of the American Academy of Dermatology in Denver. Treatments discussed include:

Cell-Based Hair Follicle Regeneration: This treatment takes cells found around hair follicles and grows them in a lab. The cells are then re-injected into the scalp to help grow hair, Washenik says.

In a study by his group, 60% of participants had more hair 1 year after the cell-based treatment. “It’s promising, and there are a number of groups looking at this,” he says.

Latisse: Rebooting hair follicles with cells is not the only avenue of research, Washenik says. Latisse, the drug that is FDA-approved for eyelash growth, may also help regrow hair on the scalp.

Still, he says, there have been some hiccups along the way. “It’s proving a little more difficult to get the medication to penetrate the scalp, but studies are under way,” he says.

Combination Therapy: The true Holy Grail may come from combining a drug like Latisse with a certain type of medication commonly used to treat allergies and asthma. The medication blocks a hormone-like substance that prevents hair from growing. A treatment like this might help with hair growth.

“Using these drugs in combination is like taking your foot off-break and stepping on gas at the same time,” Washenik says.

FDA-Approved Medications: Many medications available today treat hair loss, says Nicole E. Rogers, MD, an assistant clinical professor of dermatology at Tulane University School of Medicine in New Orleans.

Options include minoxidil (Rogaine), an over-the-counter lotion that is applied to the scalp, and finasteride (Propecia), a prescription that is taken once daily as a pill. Certain hormonal treatments can also help treat hair loss.

At-Home Treatments: Low-level laser light combs and helmets do work, but the devil is in the details, Washenik says. There is not enough evidence to say which product works better. “Convenience and ease of use seem to be the two most important factors,” he says. “The ones that people like best are those where you just sit on the couch and read while wearing a helmet.”

Hair Transplants : These may be the only feasible treatment for some people. The good news: Hair transplant techniques are improving, says Michael S. Kaminer, MD, a Boston-based dermatologist.

“The old pluggy, noticeable hair transplant is a thing of the past.” He says today they are more natural looking, as they use smaller pieces of scalp during the transplants, as opposed to large clumps.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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Minoxidil (loniten)

Minoxidil (loniten)

Minoxidil is an antihypertensive vasodilator medication. It also slows or stops hair loss and promotes hair regrowth. Now off-patent, it is available over-the-counter for the treatment of androgenic alopecia. Minoxidil must be used indefinitely for continued support of existing hair follicles and the maintenance of any experienced hair regrowth. It is marketed under many trade names, including Avacor Physician's Formulation, Loniten (oral), Mintop, Amexidil, Rogaine, Spectral.DNC, and Vanarex. Kopexil is a derivative of minoxidil missing the piperidine substituent.

History

Originally, minoxidil was used exclusively as an oral drug (with the trade name 'Loniten') to treat high blood pressure. However, it was discovered to have an interesting side effect: hair growth.

Minoxidil may cause increased growth or darkening of fine body hairs, or in some cases, significant hair growth. When the medication is discontinued, the hair loss will return to normal rate within 30 to 60 days. Upjohn Corporation produced a topical solution that contained 2% minoxidil to be used to treat baldness and hair loss, under the brand name Rogaine in the United States and Canada, and Regaine in Europe and the Asia-Pacific. Treatments usually include a 5% concentration solution that is designed for men, whereas the 2% concentration solutions are designed for women. The patent on minoxidil expired February 11, 1996. While the drug is available in the United Kingdom, it cannot be prescribed on the NHS, so patients must either buy it over-the-counter or have a private prescription for it. A foam-based formulation of 5% minoxidil, which is claimed to be as effective as the liquid-based formulation, was introduced by Upjohn and marketed under the brand name Rogaine/Regaine Foam.

Mechanism

The mechanism by which minoxidil promotes hair growth is not fully understood. Minoxidil contains the nitric oxide chemical moiety and may act as a nitric oxide agonist. Similarly, minoxidil is a potassium channel opener, causing hyperpolarization of cell membranes. Minoxidil is less effective when there is a large area of hair loss. In addition, its effectiveness has largely been demonstrated in younger men who have experienced hair loss for less than 5 years. Minoxidil use is indicated for central (vertex) hair loss only. Minoxidil is also a vasodilator. Hypothetically, by widening blood vessels and opening potassium channels, it allows more oxygen, blood, and nutrients to the follicle. This may cause follicles in the telogen phase to shed, which are then replaced by thicker hairs in a new anagen phase.

Side effects

Common side effects of minoxidil include burning or irritation of the eye, itching, redness or irritation at the treated area, as well as unwanted hair growth elsewhere on the body. Users should stop treatment and seek medical attention right away if they experience any of the following serious side effects: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; dizziness; fainting; fast heartbeat; sudden, unexplained weight gain; swollen hands or feet.

Alcohol and propylene glycol present in some topical preparations may dry the scalp, resulting in dandruff and contact dermatitis. Some formulations of minoxidil substitute lipid Nanosomes in order to reduce contact dermatitis from the alcohol and propylene glycol vehicle.

Paradoxically, hair loss is a common side effect of minoxidil treatment. Manufacturers note that minoxidil-induced hair loss is a common side effect and describe the process as "shedding". Although this phenomenon demonstrates that minoxidil is indeed affecting hair follicles, manufacturers offer no guarantee that the new hair loss will be replaced with hair growth. The speculated reason for this shedding is the encouragement of hairs already in the telogen phase to shed early.

Side effects of oral minoxidil may include swelling of the face and extremities, rapid and irregular heartbeat, lightheadedness, cardiac lesions, and focal necrosis of the papillary muscle and subendocardial areas of the left ventricle. There have been cases of allergic reactions to minoxidil or the non-active ingredient propylene glycol, which is found in some topical minoxidil formulations. Pseudoacromegaly is an extremely rare side effect reported with large doses of oral minoxidil.

Another side effect of minoxidil is that of dry skin, dark under-eye circles, and skin redness. Studies have shown that minoxidil can cause collagen depletion as it is a lysyl hydroxylase inhibitor, an enzyme which is key in collagen production.

Minoxidil is highly toxic to cats and may cause death with just inadvertent skin contact.

Application

Minoxidil needs to be applied once or the recommended twice daily, and may be used indefinitely for continued support of existing hair follicles and the maintenance of any experienced hair regrowth. To achieve maximum effect, the solution should be in contact with the scalp for at least 4 hours before allowing hair to get wet. Minoxidil stimulates hair follicles and growth, but does not reduce DHT or the enzyme responsible for its accumulation around the hair follicle, 5-alpha reductase, which is the primary mediator of male pattern baldness in genetically susceptible individuals. Therefore, when treatment is stopped, the DHT has its expected effect of shrinking and ultimately destroying the genetically predisposed hair follicles.

Minoxidil products involve contact with hair strands which may cause problems with hair styling as minoxidil must be in an alcohol-based solution. If the solution does not pose any problems, hair styling products may be applied after it has dried. (Source: Wikipedia)



 

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