Hair loss and hair regrowth

Aust J Biol Sci. 1983;36(4):419-34.
Morphological changes in the skin and wool fibres of Merino sheep infused with mouse epidermal growth factor.

Hollis DE, Chapman RE, Panaretto BA, Moore GP.

Intravenous infusion of 4.5-4.7 mg of mouse epidermal growth factor (mEGF) into nine castrated male Merino sheep for 26 h resulted in complete hair loss 6-8 days later. ..snio.. Hair fibres...were examined with the scanning electron microscope. Increased cell proliferation occurred in the epidermis and sebaceous glands, whereas the hair follicles regressed. ..snip.. Hair fibre and inner root sheath production, although markedly reduced, continued in about 60% of hair follicles which had partially regressed, but production ceased in the remainder in which tapered ends formed on the fibres prior to shedding. Follicles began to regenerate asynchronously 4-8 days after the beginning of infusion and completed their development during the next 3 weeks. The hair follicle regression and hair loss induced by mEGF infusion, and subsequent hair regrowth were completed more rapidly than observed previously with other hair loss agents,...

Edited for blog

Immunol Invest. 2009;38(5):383-97.

Alopecia areata universalis after phenobarbital-induced anti-convulsant hypersensitivity syndrome.
Huang YL, et al

edited for blog

Hair loss is an adverse effect in patients taking aromatic anti-convulsant drugs but is rarely reported after discontinuing such medications..... A 3-year-old boy developed hairloss due to alopecia areata (AA) universalis in the convalescent status of phenobarbital-induced AHS, compatible to the evidences of increased lymphocyte proliferation and increased dead cells percentages while his peripheral blood mononuclear cells were incubated with phenobarbital. Skin histology revealed peri-follicular, peri-bublar and supra-bublar lymphocyte infiltration. By searching for the key words AHS, alopecia areata (AA, punctuate loss of terminal scalp hair), AA totalis (complete loss of terminal scalp hair), and AA universalis (total loss of terminal scalp and body hair) using PubMed, only 2 cases, to date, developed hair loss in the convalescent status of phenobarbital-induced AHS. Among these 3 cases, all had favorable prognosis despite having jaundiced hepatitis. Their hair grew back after 2-3 months steroid therapy. snip....

Calif Med. 1958;89(5):322-30.

Noncicatrizing alopecias; with special reference to alopecia areata.
NEW WN, NICKEL WR.

A historic paper on alopecia areata, slighly edited for blog use

Since the epochal work of Hamilton there has been general acceptance of the causal relationship of the male sex hormone, age and familial inheritance in development of male pattern baldness. Some of the medicaments used in recent years may cause a diffuse loss of scalp hair. Hair loss that accompanies disease states is probably due to generalized toxemia and disturbances in metabolism. Sometimes male pattern baldness occurs in physiologic states, as exemplified by diffuse hair loss occasionally in the postpartum period.Alopecia areata deserves a critical appraisal, since it may be evidence of underlying neuropsychotic states that need psychiatric diagnosis and treatment. The development of alopecia totalis or universalis in 50 per cent of the prepuberal cases of alopecia areata is of real significance, especially since so very few patients recover their normal scalp hair.The conclusions reached by the authors of two articles reporting on 368 cases of alopecia areata, alopecia totalis and alopecia universalis that the evidence is overwhelming against the malfunction of the endocrine glands as the cause of alopecia areata must be considered real contributions to our understanding of this condition. A few conditions simulate alopecia areata. Probably the ones which are seen most often are trichotillomania and patchy baldness caused by agents used in hair waving and straightening.Our findings in 22 cases of alopecia areata of a persistent inflammatory perivascular and perifollicular infiltrate, massive plugging of the ostia, disappearance of robust hair follicles and diminution in total number of hair follicles and sometimes fibrosis are not necessarily diagnostic of alopecia areata but seem to be very definitely characteristic.Treatment for alopecia areata is of little avail. At this time we do not recommend the general use of the corticosteroids despite the improvement of scalp appearance in the majority of instances in which the systemic administration of these hormones have been employed.

J Invest Dermatol. 1993;101:135S
Prostaglandins protect against mouse hair injury produced by ionizing radiation or doxorubicin.

Malkinson FD, et al

edited for hair loss blog

....prostaglandins (PGs) are potent radioprotective agents. To investigate further the potential use of these compounds we employed quantitative measures of murine hair loss and hair regrowth to assess the effects of PG administration before...radiation exposures. ..snip... Three weeks after systemic administration of 16-16 dm PGE2 (Upjohn Company) or WR-2721,... regrowing hair counts increased up to 100% compared to irradiated-only skin sites.... Local applications of 16-16 dm PGE2 or WR-1065 given 15 min before each radiation fraction also enhanced post-radiation hair regrowth.. We also evaluated possible protective effects of PGs given before doxorubicin, measuring murine hair loss 1 week after parenteral injections of the drug. Five daily doses of doxorubicin, 0.1 mg/25 g animal, reduced the number of hairs in a 4.42 mm2 area of skin from 241 +/- 5 (controls) to 144 +/- 3. Misoprostol (G.D. Searle & Co.), 25 micrograms/mouse, applied locally 2 h before each dose of doxorubicin, resulted in 213 +/- 8 residual hairs. We conclude that clinical use of these compounds may provide significant protection of hair follicles and possibly other normal tissues (skin; oral, rectal, and bladder mucosa) lying within a radiation field or in patients treated with chemotherapeutic agents....

Arch Dermatol. 1992;128(1):68

The follicular degeneration syndrome in black patients. 'Hot comb alopecia' revisited and revised.

Sperling LC, Sau P.

BACKGROUND--The history, physical examination, and histologic findings in 10 black women with a common, distinctive form of scarring alopecia ( hair loss ) were retrospectively studied. A detailed history of hair care habits was obtained, and scalp biopsy specimens were examined after both vertical and transverse sectioning. OBSERVATIONS--Poor correlation is noted between the usage of a hot comb and the onset or progression of disease. The earliest observable histologic abnormality is the premature desquamation of the inner root sheath. In severely affected follicles this is followed by a chain of histologic events leading to complete follicular degeneration. CONCLUSIONS--The term follicular degeneration syndrome (FDS) is proposed for this clinically and histologically distinct form of scarring alopecia. Historical information is incompatible with the hypothesis that hot comb usage causes the hair loss. It remains unclear whether the use of any of a variety of hair care products and techniques plays a role in the pathogenesis of this condition. ..snip...

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J Clin Endocrinol Metab. 1990;71(2):335

Ketoconazole therapy for women with acne and/or hirsutism (excess hair growth).

Venturoli S, et al

(edited for hair loss blog)

The effects of ketoconazole were evaluated in 42 women affected by acne (17 cases) and/or hirsutism (excess body hair growth) (36 cases) treated with 400 mg/day for 3-6 months. Androstenedione, total and free testosterone, 5 alpha dihydrotestosterone and dehydroepiandrosterone levels progressively dropped during treatment while 17 alpha hydroxyprogesterone, estradiol, ACTH, cortisol, LH and FSH levels increased. Dehydroepiandrosterone sulfate decreased only towards the end of treatment, while estrone, sex hormone binding globulin, and PRL remained unchanged. Daily mean +/- SD rate of hair regrowth, measured by a special image analysis processor, decreased within 3 months of therapy together with decreasing hormone levels. The therapeutic effects of ketoconazole on hirsutism was evident at 6 months in only 14 subjects, while no significant change in hirsutism score was recorded in 22 women who failed to complete the therapy. Acne improved in all cases. Several side effects and complications arose during treatment, such as headache, nausea, loss of scalp hair, hepatitis, and biochemical changes...snip..

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Am J Forensic Med Pathol. 1986;7(4):337

Dermal surface morphology in wound healing. An experimental scanning electron microscope study.

Torre C, et al

The authors observed, with a scanning electron microscope, the dermal surfaces of experimental wounds, following the enzymatic digestion with trypsin of the dermo-epidermal junction. Cut lesions showed an early reconstitution of the basement membrane and progressive convergence of the margins. A peculiar arrangement of the dermal crests was also observed. In wounds with loss of substance, the complete coating by newly formed basement membrane took longer. There was an early deformation of the holes of hair follicles in the undamaged dermis surrounding the lesion, as well as the appearance of creases that moved toward the center. This process was over within a few days; then the lesion became very small and the holes of the hair follicles reappeared. snip

hair regrowth and hair loss treatment

Dermatologica.1985;171:327

Increased number of OKT6-positive dendritic cells in the hair follicles of patients with alopecia areata.

Kohchiyama A, et al

In 6 patients with untreated hair loss associated with alopecia areata in the progressive stage, 6 in the stationary stage, and 6 normal individuals as controls, an in situ analysis of OKT6-positive dendritic cells in hair follicles, and peribulbar and intrabulbar infiltrates was performed using the avidin-biotin-peroxidase method with monoclonal antibodies. ...snip... This indicates that the number of OKT6-positive dendritic cells increases in the hair follicles of progressive alopecia areata and that these cells may play an important role in cooperation with T cells in the pathogenesis of alopecia areata.

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Br Med J. 1973 Jun 2;2(5865):499-500. Links
Hair loss and contraceptives.

PIP: In a review of the relationship of hair loss to oral contraceptive (OC) use, several studies are examined. The effect of pregnancy on hair loss has been substantiated. After the 3rd month of pregnancy the proportion of follicles in active growth rises. Increased shedding follows childbirth due to the delayed physiological passage of some follicles into the resting phase, blood loss, and sometimes anticoagulants. In contraceptive studies it can be shown that in 1/2 of the patients there was a temporary increase in the proportion of resting during early treatment but that pretreatment status was regained in 6 months. In 11 patients in this study who showed high pretreatment levels of resting follicles, the proportion of actively growing follicles actually increased with OCs. The incidence of diffuse alopecia in women between 1952 and 1971 has remained unchanged although OC use has increased. This suggests the effect of OCs on alopecia is insignificant. There may be a causal relationship between stopping estrogen and hair loss. However, it may be possible that genetically suseptible women might be affected by OCs. In patients where hair loss is accompanied by seborrhea or where there is hirsuitism it is suggested that the pill be discontinued.

Z Hautkr. 1990;65(12):108o

Assessment of therapeutic hair growth--methods, possibilities and problems

Schell H.

With regard to hair regrowth induced by therapeutics, we must consider the activity of the hair follicle. This means that a study on the efficacy of hair regrowth treatments requires a selective investigation of different kinds of follicular activity. The decision which of the non-invasive, semi-invasive or invasive techniques should be applied depends on the reliability of the method in relation to the technical requirement, on the one hand, and the acceptance by the volunteer as well as the clinical type and degree of hair loss, on the other. Trichorhizogram results as the only means of evaluating the efficacy of hair growth therapeutics seem problematical, since an increase of the anagen rate does not absolutely correlate with a prolongation of the anagen phase.

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Br J Dermatol. 1990;123(6):717

Expression of extracellular matrix in hair follicle mesenchyme in alopecia areata

.McDonagh AJ, et al

"Human hair follicle mesenchyme contains a distinctive extracellular matrix which varies in volume and composition in concert with the hair regrowth cycle. To investigate the possibility that mesenchymal function is disturbed in hair loss due to alopecia areata we have studied the expression of extracellular matrix constituents in scalp biopsies from 14 patients by immunohistochemical staining for basement membrane proteins, proteoglycans and interstitial collagens. The staining patterns in follicles from non-lesional scalp were normal. Miniature anagen follicles from bald patches also showed relatively normal expression of basement membrane proteins and proteoglycans. ...snip..."

J Anat. 1992 Aug;181 ( Pt 1):47-60.

Changes in fibronectin, laminin and type IV collagen distribution relate to basement membrane restructuring during the rat vibrissa follicle hair growth cycle.

Jahoda CA, et al

Hair regrowth in adult mammals involves continuous dermal-epidermal interaction across the follicular basement membrane, and repeated reorganisation of lower follicle structure during the hair growth cycle. The immunolocalisation of 3 extracellular matrix components, fibronectin, laminin and type IV collagen was investigated during the course of the rat vibrissa follicle growth cycle, and their distribution correlated with changes in cellular and extracellular ultrastructure, particularly around the basement membrane zone. Laminin and type IV collagen were omnipresent at the follicular dermal-epidermal junction, but were also seen in granular extracellular form within the inner dermal component of the follicle, the dermal papilla. Both the inner papilla-epidermal junction and the thick specialised outer basement membrane (the glassy membrane) revealed labelling by these 2 antibodies around telogen (the period of nonfibre production). ..snip.. The work supports the idea that dermal papilla cells could contribute to basement membrane formation, and also that fibronectin may be involved in regulating cellular activities within the follicle. In the vibrissa follicle, dynamic cellular activity clearly takes place throughout the duration of the hair cycle.

Arch Dermatol. 1997 Jan;133(1):57-61.

Hair follicle structures targeted by antibodies in patients with hair loss due to alopecia areata.

Tobin DJ, et al

OBJECTIVE: To identify the structures in hair follicles (HFs) targeted by alopecia areata (AA) antibodies and the role of antigen expression in the development or localization of AA lesions. DESIGN: The identity of HF structures targeted by AA antibodies was determined by indirect immunofluorescence and the level of antigen expression from the intensity of the staining. SETTING: A university medical center. PATIENTS: Ten patients with active AA and 8 control individuals. RESULTS: Antibodies to anagen HFs were present in up to 90% of patients with AA but in less than 37% of controls. The antibodies in patients with AA reacted to antigens present only in HFs. The structures most commonly targeted were the outer root sheath and, less often, the inner root sheath, matrix, and hair shaft. The same HF structure contained several immunologically distinct antigens reactive with AA antibodies. The expression of some AA antigens was much greater in the scalp of patients with AA than in normal individuals. CONCLUSIONS: These findings indicate that the autoantibody responses to HFs in patients with AA are heterogeneous and target multiple structures in anagen HFs. The expression of some as-yet-unidentified HF antigens is increased in many patients with AA, suggesting that the initiation, localization, severity, and persistence of the disease may be related to the level of expression of some HF antigens.

J Cutan Pathol. 1993 Aug;20(4):344-9.

Human hair follicle in normal scalp and androgenetic alopecia.

Alcaraz MV, st al

We carried out a quantitative study of the matrix and dermal papilla of the human hair follicle of the scalp, both normal and in various degrees of androgenetic alopecia ( male pattern hair loss ). A stereological study showed the measured parameters to decrease with increase in the degree of alopecia, particularly as regards the total volume of the matrix and its papilla. The ratio of the two volumes increased by 30%, indicating a much more marked decrease in size of the papilla than in the matrix size. The number of cell nuclei in the matrix and the papilla of alopecic scalp was found to be 30% and 50% smaller, respectively, than those of normal scalp. Finally, a morphometric study revealed enlarged nuclei in the matrix and papilla, as shown by their increased areas, perimeters, and maximal diameters.

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Radiat Res. 1995 Oct;144(1):107-13

Relationship between cataracts and epilation in atomic bomb survivors.

Neriishi et al

Among 1713 atomic bomb survivors who underwent ophthalmological examinations from 1963-1964, the risk of cataract formation per unit dose of radiation was significantly greater for those who reported hair loss of 67% or more after exposure (the epilation group) than for those who reported less or no hair loss (the no-epilation group). Such an epilation effect has also been associated with leukemia mortality and the frequency of chromosome aberrations. Although this might be interpreted as indicating differential sensitivity to radiation between the epilation group and the no-epilation group, it could also be explained by imprecision in dose estimates. We have calculated that a 48% random error in DS86 dose estimates could be in accordance with the dose-response relationship for the prevalence of cataracts in the epilation group or the no-epilation group. Possible mechanisms for variation in radiosensitivity are discussed.

PMID: 7568764

Am J Pathol. 1995 Oct;147(4):955-64

Characterization of psoriasiform and alopecic ("hair loss") skin lesions in HLA-B27 transgenic rats.

Yanagisawa H, et al

We have previously reported a multisystem inflammatory disease in transgenic rat lines with high expression of HLA-B*2705 and human beta 2 microglobulin. Skin disease in these rats includes two predominant lesions: 1) marked psoriasiform dermatitis of the tail and digits; and 2) progressive alopecia ( hair loss ) of face, neck, trunk, and extremities. Here we present the results of a systematic survey of these lesions. Tail and digit skin showed psoriasiform hyperplasia of the epidermis associated with parakeratosis, with marked dermal and epidermal inflammation. The alopecic skin showed perifollicular and follicular mononuclear infiltration and increased numbers of atrophic hair follicles. Immunohistochemical analysis revealed that B27 expression was prominent on keratinocytes in hyperplastic epidermis where lymphocytic infiltrates were prominent, but was absent in the absence of inflammation. In alopecic lesions, B27 was strongly expressed on follicular epithelium and dermal hair papillae associated with mononuclear infiltrates. T cells, both CD8 and CD4, were most prominent in inflammatory lesions and rat MHC-II expression on keratinocytes, and follicular epithelium was dramatically increased. This study suggests that T cell-mediated immune mechanisms participate in development of cutaneous lesions in HLA-B27 transgenic rats.

hair regrowth and hair loss treatment

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Arch Dermatol. 1978 Mar;114(3):439-41

Uveitis, poliosis, hypomelanosis, and alopecia in a patient with malignant melanoma.

Sober AJ, Haynes HA.

Bilateral uveitis, poliosis, hypomelanosis, and alopecia (Vogt-Koyanagi-Harada syndrome) developed spontaneously in a 57-year-old woman following operation for metastatic malignant melanoma. She has been disease-free for 8 1/2 years in spite of a highly unfavourable prognosis. Within the framework of current concepts of cell-mediated and humoral immunity in patients with malignant melanoma, activity of the host's immune system is postulated for the destruction of normal melanocytes in the skin, hair follicle, and uveal tract, as well as for the favorable outcome.

J Cutan Pathol. 1978 Jun;5(3):93-104.

Differential patterns of elastic fibers in scarring and non-scarring alopecias (hair loss).

Pinkus H.

Elastic fiber stain (acid alcoholic orcein) reveals diagnostically significant differences between several types of alopecia of the scalp. A short outline of elastic fiber distribution on the normal hair follicle emphasizes the elastic coat of the follicular isthmus, the sparsity of elastic fibers on the cyclic lower portion of the hair root, and the presence in the neck of the dermal papilla of an elastin-like body which is formed anew with each hair cycle. This body provides a marker of the gradual shortening of successive anagen hairs in male pattern alopecia. Patterns of elastic fibers in the perifollicular and interfollicular dermis are helpful in differentiating idiopathic pseudopelade of Brocq from pseudopeladic states secondary to lupus erythematosus and other disease processes. Within the idiopathic group, the development of elastic fibres on the lower cyclic portion of the hair root identifies a sub-group that may have a different, non-inflammatory pathogenesis and is provisionally designated as fibrosing alopecia.

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