From 2014 ISHRS Meeting -Is a glaucoma drug the next treatment for hair loss?

ISHRS 2014 Meeting

Is a glaucoma drug the next treatment for hair loss?

Professor Valerie A. Randall, PhD, FIBMS, FSB

Professor of Biomedical Sciences, Centre for Skin Sciences, School of Life Sciences University of Bradford, Great Britain, U.K

Hair Loss causes significant negative effects on the quality of life of affected individuals. This occurs in every culture due to hair’s importance in human social and sexual communication across the world. As common as alopecia is, treatments are very limited and vary in their effectiveness. Current treatments involve cosmetic wigs or hairpieces to surgical techniques. The main medical therapies in current use include hormone action modifiers for androgen-dependent hair loss and non-hormonal treatments for other alopecias.

Glaucoma drugs are recently being researched for hair growth. They are used to reduce intraocular pressure, but seemed to stimulate eyelash growth as a side effect. Then came about Latisse (bimatoprost), previously a glaucoma drug that is now indicated for eyelash growth. Eyelash follicles differ from scalp hair as they specialize in the protection of the eyes. When bimatoprost was tested on isolated scalp follicles it showed increased human hair synthesis of organ cultures. It also stimulated hair growth in rodent pelage follicles. Bimatoprost appears to offer a new approach to stimulate scalp hair growth clinically. It is currently in phase 2 clinical trial in the US as a topically-applied treatment for androgenetic alopecia in men. Overall, increased understanding of the hair follicle function both in health and disease and careful observation of drug side-effects are leading to new approaches for therapies for alopecia.

From 2014 ISHRS Meeting -Aging Scalp and Gray Hair

Aging Scalp and Gray Hair

ISHRS 2014

Desmond J. Tobin, PhD, FSB, FRCPath.

Desmond J. Tobin is Professor of Cell Biology and Director of Centre for Skin Sciences at University of Bradford.

Although humans have over 5 million individual hair follicles on their bodies, most attention be it academic or commercial is focused on the paltry 2% of these that are distributed on our scalps. 

The hair follicle produces several different types of hair fiber during a normal lifetime. It is worth emphasizing that hair will grow up to 4 meters all  within the same single hair follicle. Hair growth rates also vary significantly during human aging and for different body sites. Indeed, when these are averaged for post-40 year old non-balding males, hair actually grows most rapidly and with greater individual fiber thickness in certain body sites in individuals during their 50-70 years of age. 

Increasing age can leave its mark on several phenotypic properties of the hair fiber. While the most visually apparent of these include hair thinning, hair loss, reduction in the rate of growth, pigmentation loss, aging can also affect change in the surface morphology of hair. The hair follicle is somewhat unusual however, in that some of its interactive cell systems appear to be non-essential for overall hair follicle survival. Indeed, strikingly gray and white hair follicles may paradoxically grow hair even more vigorously than their pigmented predecessors. 

Much of the recent research has focused on both the oxidative stress that appears to increase with aging and to which the hair follicle melanocytes appears especially sensitive, and the fate of hair follicle melanocyte stem cell capacity. This is likely to reflect significant differences in the epidermal and follicular melanocyte microenvironments.  The hair follicle may provide richer information in this context. Pre-proliferative, proliferative, differentiated, terminally-differentiated and ‘senescent‘ melanocytes all co-exist in the same growing hair follicle.

Is the latest technique the best technique?

With technology, the saying has always been: the latest, the better; like smart phones and new cars. However, this does not apply with hair transplantation. The human body is a very intricate and complicated system. Pharmaceutical companies invest years, billions of dollars, and multiple phases of clinical tests to develop the newest medications. But even with extensive research, the medications still get recalled occasionally.

Basically, a hair transplant is only a relocation of hair from the back of the head to the desired area. It’s a very easy and simple procedure. However, this makes it difficult to stand out from other clinics. In order to convince potential clients, you have to create something brand new and different. Something that is very convincing and feasible.  For example, laser hair transplants were very popular twenty years ago. At that time, lasers were the the latest invention. It was the best marketing tool which is why doctors spoke so highly of the many laser hair transplant advantages. However, they did not realize that the laser sealed the blood supply as well. When people discovered that laser hair transplants held very poor yield rates and results, a few years had already passed. A lot of donor hair was wasted and a great amount of damage was done. Currently, no one mentions laser hair transplants anymore. Scalp reduction, flap, extension, expansion and ultra slim dense packing claim to transplant more than 3,000 very slim SFU to qualify as being advantageous. However, body hair transplants and eyelash transplants went through that course and all failed. Concurrently, there has been a lot of improvement on hair transplantation. But so far it is still only a relocation of the hair.

The latest techniques on hair transplantation always have a different surgical approach.

A surgical trend like FUE is very convincing and catches the interest of a lot of patients. More importantly is how profitable it is for the doctors. Doctors concentrate on how to produce the perfect grafts but they overlook the more important aspect. How efficient can FUE use the donor area? After the first surgery there will be thousands of punch scars around the donor site. This is worrisome because scar tissues will have a big impact on the hair growth direction. What will be the quality of the grafts by the second surgery? If patients keep losing hair, how will they handle the thousands of scars that will show someday? What is the maximum donor area that can be used? No one currently has the right answer and no one dares to bring up the problems either.

For patients who choose the latest technique for hair transplantation, they are taking a lot of  risks. 

When you want to have the latest hair transplant surgery, you should always be very cautious and use your own judgement. I am sure the FUE technique will be one that will cause major problems in the future.

FUE was called "punch graft" 30 years ago, the only difference is that size of punch is reduced. The scars are smaller but still stay forever. 

FUT Donor Scar-Videos

You can barely see the donor scar from the videos.

FUT Scars

The scar on the donor site is nearly invisible with with Trichophytic Closure.

These photos below are taken on the suture removal days (10 days after surgery)