Hair Loss

Pathophysiology and some treatment agents


More questions and answers

Pattern Balding

Emerging Model for Pattern Balding (after Kligman, others )

Hormones do something to hair follicle which causes it to be read as "foreign body" by your immune system, which then mounts an attack. The main damage in balding is probably immunologically-mediated. Damage to lining of blood vessels, which produces hair growth-stimulatory factors, makes this worse.

Medical Treatment of Hair Loss

Aside: Forget looking in the medical literature for new hair loss treatment agents. Because of the commercial potential, everyone (including me) goes after patents. Most drug companies want to keep things secret as long as possible and so often don't publish on a new drug until it's ready for commercial release.

BTW, when developing any drug, the first place a PhD pharmacologist ( the guys who really develop drugs ) looks is in the patent literature. Most physicians and nonpharmacologists biomedical researchers do not know about about looking at patents, so you will rarely see them quoted. Most media. writers don't know about patents either, so they get surprised by new products all the time.

Even if a researcher is just interested in basic mechanisms, this is a bad mistake. For example, several patents indicate that superoxide dismutases or "SODases" stimulate hair growth. Still another patent from the Procter and Gamble company indicates that an SODase inhibitor blocks hair growth.

The important implication is that superoxide radical ( an important messenger in many other systems ) is also a messenger modulating hair growth. Similarly, another patent claims that inhibitors of the systhesis of nitric oxide ( the "natural minoxidil" ) inhibit hair growth. There is not a hint of this in the "open" biomedical literature.

Besides, at last count, over forty US and several hundred foreign patents are issued in this area. Probably most work at least some--few if any have been published.

Antiandrogens: E.g.: Proscar, Cyoctal, spironolactone.

Poorly-effective alone. Mainly useful as adjuvants to other therapy where they 1) make it work better 2) Help prevent tolerance. Every few years, a new antiandrogen will be presented as the ultimate "solution for balding". This has yet to work out. E.g., clinical trials with cyoctal, arguably the most potent topical antiandrogen, were terminated because of lack of effectiveness.

We'll see about Proscar. aka finesteride, the weakest one.Reports suggest it works about as well as topical spironolactone, about a 50% response rate. Merck sent the protocols into the FDA in December, 1996, so it may be FDA approved soon.

BTW, I have prime patents in this area ( for growth stimulators plus antiandrogens ). In fact, because of the publication of our patents, the combination of a hair growth stimulator plus and antiandrogen is now " obvious " and thus unpatentable. I sure wish antiandrogens worked better.

Possible explaination: Male hormones only initiate balding. Further, whatever hormones do seems to be mostly irreversible. The main damage to the hair follicle seems to be done by other factors, especially immunological. But I reserve the right to change my mind about this


Finally, I am always getting questions about some new substance touted as the ultimate cure for balding.

To avoid unnecessary questions, I'll give my standard answer: There are so many things that grow some hair on some persons that a company would have to try pretty hard to get something that did not work at all. E.g., the Rogaine vehicle is responsible for about half of what you get from Rogaine. So, you can assume just about everything that is claimed to grow hair works at least a little.

Similarly, as is common in dermatology, no single agent works all that well, so questions about " what is best " are hard to answer. I am always changing my mind about such things, but, the SODases are arguably the best single agents. While there is a lot of good science behind the individual agents, the real secret to treating hair loss is rather crude. You use a lot of different agents which work in different ways and you use lots of them.

Peter H. Proctor, PhD, MD

hair loss

Key words: regrowth alopecia hair loss

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