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Health Protocols

Hair Loss

Novel And Emerging Strategies

Novel and Off-Label Medications

Several new medications for treating androgenetic alopecia are currently under investigation (Gupta 2016; Vano-Galvan 2017; Cranwell 2016):

  • Dutasteride (Avodart). Dutasteride, like finasteride, is a 5-alpha reductase inhibitor used to treat benign prostate enlargement. While dutasteride has not been approved by the FDA as a treatment for hair loss, considerable evidence indicates it effectively improves scalp hair growth, possibly even more than finasteride, and is relatively well tolerated (Cranwell 2016; Shanshanwal 2017; Choi 2016; Chung 2016; Gold Standard 2014).
  • Prostaglandin analogs. Two drugs in this family, latanoprost (Xalatan) and bimatoprost (Latisse), have been studied for their effect on hair loss. Bimatoprost is FDA approved to promote eyelash growth, and one controlled study found latanoprost increased hair density and encouraged pigmentation of scalp hair in men with androgenetic alopecia (Choi 2015; Blume-Peytavi 2012).
  • Estrogens. Estrogens have anti-androgenic effects and may play a role in hair follicle growth cycles. Oral contraceptives that contain estrogens treat hair loss associated with polycystic ovarian syndrome, a condition in women associated with excessive levels of androgens. Topical estrogens are available for use in hair disorders in Europe (Goodman 2015; Levy 2013). In a trial in 53 women with female pattern hair loss, volunteers applied a topical 0.025% 17α-estradiol solution to their scalps daily for 8 months. The treatment led to improvements in hair density, and was well tolerated during the study period (Kim, Lee, Lee 2012).
  • Topical retinoids. Vitamin A plays an important and complex role in hair follicle function, and both deficiency and excess can trigger hair loss (Holler 2013; Duncan 2013; Cheruvattath 2006). A topical solution made with tretinoin (all-trans retinoic acid, a form of vitamin A, also known as Retin-A) and minoxidil may improve minoxidil’s efficacy (Kwon, Pyo 2007). In one such study, 5% minoxidil plus 0.01% tretinoin once daily was as effective in promoting hair growth as 5% minoxidil twice daily in men with androgenetic alopecia (Shin 2007). Tretinoin was shown in one trial to promote hair regrowth more effectively when combined with minoxidil than when used alone (Bazzano 1986).

Several medications that are not FDA approved for hair loss may be used off label in some cases (Table 1).

Table 1: Off-label hair loss drugs (McElwee 2012; Levy 2013; AHLA 2010; Gold Standard 2016)

Medication

Mechanism of Action

Drug Status

Dutasteride

5-alpha reductase inhibitor

Off -label

Spironolactone

Anti-androgen

Off-label

Ketoconazole

Imidazole antifungal

1% shampoo available over the counter (Nizoral); 2% shampoo, off-label, available by prescription only

Flutamide

Anti-androgen

Off-label

Hormone replacement therapy (i.e., estrogen, progestogens, and birth control in women)

Anti-androgen

Off-label

Prostaglandin analogs

Mimics naturally-occurring prostaglandin-like molecules

Off label

Topical Caffeine

Early research indicates topical caffeine may exert positive effects on hair growth, including a stimulatory effect on hair follicles. In hair follicle samples from men and women with androgenetic alopecia, caffeine exerted hair growth-promoting and anagen phase-lengthening effects. Caffeine’s positive effect on hair may result from inhibition of 5-alpha reductase, the enzyme involved in converting testosterone to dihydrotestosterone. It may also enhance blood flow to hair follicles (Herman 2013; Fischer 2014; Fischer 2007). In a laboratory study, treatment of hair fibers with a topical caffeine preparation that also contained vitamins B3 and B5, dimethicone, and an acrylate chemical led to growth of stronger hairs with wider shaft diameters (Davis 2011). In another study, caffeine blocked the inhibitory effect of testosterone on growth of hair follicles taken from scalp biopsies of men with androgenetic alopecia (Eicheler 1998).

Platelet-Rich Plasma Injections

Plasma—the fluid in which blood cells are suspended—contains proteins, glucose, electrolytes, and other compounds (URMC 2017). Plasma enriched with platelets, called platelet-rich plasma, is an abundant source of growth factors used successfully in several medical fields such as wound care, cosmetic surgery, and dermatology. Growth factors in platelet-rich plasma promote tissue regeneration and the growth of new blood vessels. Studies have shown platelet-rich plasma also prolongs the active growth (anagen) phase of the hair growth cycle (Ferneini 2016; Singh 2016).

In a randomized controlled trial, 25 participants with androgenetic alopecia received platelet-rich plasma injections on half of their scalp and placebo on the other half. Each participant received three treatments at one-month intervals. Six months after the first treatment, hair density increased on the platelet-rich plasma side of their scalps compared with placebo (Alves 2016). In a similar trial, 20 participants with pattern hair loss received platelet-rich plasma injections on half their scalp and placebo on the other. Each participant received three treatments at one-month intervals. After three treatment cycles, number of hairs in the target area and total hair density improved in areas treated with platelet-rich plasma versus control areas. No side effects were noted during treatment (Gentile 2015). Another clinical trial found platelet-rich plasma injections outperformed minoxidil (5%) in treating alopecia areata in 90 volunteers (El Taieb 2016).

New Medication Delivery

Iontophoresis is a technique in which a small electrical charge is applied to the skin to facilitate the penetration of molecules capable of being charged (ionizable) past the superficial layers of the skin. Iontophoretic delivery of minoxidil has increased drug accumulation in the hair follicle five-fold, and therefore has potential to increase the drug's effectiveness (Gelfuso 2013; Ashburn 1995). Microencapsulation, a technique in which a substance is coated with a delivery-enhancing chemical, has also increased minoxidil concentration in hair follicles. Combining microencapsulation with iontophoresis appears to have potential for improving uptake and possibly effectiveness of minoxidil, but this hypothesis awaits verification in clinical trials (Gelfuso 2015; Silva 2014).