Wednesday, 6 June 2012

Medical Hair Restoration

 Medical hair restoration in the literal sense includes the hair loss treatment which depends on the use of drugs.

Unusual hair loss in both men and women are caused by changes in androgen metabolism. Androgens are male hormones that have a major role to play in the regulation of hair growth or hair loss. Dermal papilla is the most important structures in the hair follicle responsible for hair growth. It is the dermal papilla, the cells divide and differentiate to give rise to new hair follicles. Dermal papilla is in direct contact with blood capillaries in the skin to obtain nutrients for growing hair follicle. Research has shown that dermal papilla got many androgen receptors and studies have confirmed that males have more androgenic receptors in dermal papilla their follicles as compared with women.

Metabolism of androgen involves an enzyme called 5 alpha reductase which combines with the hormone androgen (testosterone) to form the DHT (dihydro-testosterone). DHT is a natural metabolite of our body which is the root cause of hair loss.

Proper nutrition is essential for the maintenance of hair. When DHT into the hair follicles and roots (dermal papilla) prevents necessary proteins, vitamins and minerals from providing food required to sustain life in their hair follicles. As a result, hair follicles are reproduced at a much slower rate. This shortens their growing stage (anagen phase) and or extend their resting stage (telogen phase) of the follicle. DHT also causes hair follicles to shrink and get progressively smaller and more delicate. This process is known as miniaturization and causes the hair to ultimately fall. DHT is responsible for 95% of hair loss.
Some people both men and women are genetically pre-disposed to produce more DHT than the normal. DHT also creates a wax-like substance around the hair roots. It is the accumulation of DHT in the hair follicles and roots which is one of the main causes of male and female pattern loss of hair.

Blocking the synthesis of DHT at molecular level forms the basis for the treatment of MPHL (pattern hair loss male) and female pattern hair loss FPHL). There are many natural DHT blockers and a number of drugs used for medical hair restoration.

Let's look at the main drugs available for medical hair restoration in men and women.

Minoxidil

Minoxidil has the distinction of the first drug used to promote hair restoration. This medical hair restoration treatment drug used previously as an oral antihypertensive drug, but after its hypertrichosis (excessive body hair) effects are noticed, a topical solution was tested for potential drugs to grow hair. Minoxidil then approved as medical hair restoration treatment drug for men by the Food and Drug Administration (FDA) in 1988 as a 2% solution, followed by a solution of 5% in 1997. For women, 2% solution was approved in 1991. Although a solution of 5% is not approved for women, is used as a hair restoration treatment in the medical world by many dermatologists. Both solutions are available without a prescription in the United States.

Mechanism of action

Minoxidil is thought to have a direct mitogenic effect on epidermal cells, as has been observed both in vitro in vivo. Although the mechanism of its action for causing cell proliferation is not very clear, minoxidil is thought to prevent intracellular calcium entry. Calcium normally increases epidermal growth factor inhibits hair growth, and Minoxidil by getting converted to minoxidil sulfate acts as a potassium channel agonist and increased potassium ion permeability to prevent calcium ions enter the cell.

Thought the exact action of minoxidil preventing the formation of DHT has not been proven but the drug has been shown to have a stabilizing effect on hair loss. The results of the drug takes about few months time to become apparent because it is the time required to restore the normal growth cycle of hair fibers.

Use of Minoxidil has been approved by the FDA for men (Norwood II-V) and women (Ludwig I-II) older than 18 years. It is used as a medical hair restoration treatment either for frontal or vertex scalp thinning. This brings about an increase in density is largely due to the conversion of miniaturized hairs into terminal hairs rather than de novo stimulate regrowth. Hair loss becomes stabilized after continued use of the drug, which takes about a year for medical hair restoration treatment shows complete results.

Hair loss restoration treatment with betamethasone dipropionate 0.05% and minoxidil 5% topical minoxidil are found to be superior.
Topical minoxidil is very well tolerated and side effects, especially in dermatology. The most common side effect is irritant contact dermatitis.

Although minnoxidil not have any effect on blood pressure, it should be used with caution in patients with cardiovascular disease. It is also contraindicated in pregnant and lactating mothers.

Finasteride

The drug finasteride was earlier used as treatment for prostate enlargement, under the name of the medical Proscar. But in 1998, was approved by the FDA for the Medical hair loss restoration in MPHL.

Mechanism of Action

Medical hair restoration treatments with Finasteride depends on the specific action as inhibitors of type II 5╬▒-reductase, an enzyme that converts intracellular androgen male hormone into DHT (dihydro testosterone). Its actions result in a significant reduction in serum and tissue DHT levels in even in concentrations as low as 0.2mg. Finnasteride able to stabilize hair loss in 80% of patients with Vertex hair loss and in 70% of patients with frontal hair loss. Most patients are able to grow more hair or retain what they have. The odd thing about Propecia is that its effect is more pronounced than at the front of the crown area. Hair that grows after the medical hair restoration treatments are better in texture and are thicker, more like the terminal hair.

The best thing about medical hair restoration treatment with finnasteride is that it is well tolerated and has minimal side effects. Sexual dysfunction (decreased sex drive, erectile dysfunction, and decreased semen volume) are observed in approximately 3.8% of cases. But these side effects disappear within a few months of Medical hair restoration treatments or disappear within a week as soon as treatment is stopped.

This usually takes about 6 to 12 months for m edical hair restoration become apparent but the side effects appear earlier. So, even after medication is discontinued, there is no possibility of hair loss that has been obtained, but the side effects are sure to disappear.
Many hair restoration surgeons find Propecia (finasteride) to act as an excellent addition to surgical hair restoration. There are several advantages of this type of combination therapy. As the Medical hair restoration with Propecia brings back the growth of hair in crown area, it has a complementary action, which allows the surgeon to have more donor hair will be available for frontal hair transplant and design the hairline at his own will. Since finasteride has no effect on the frontal area of ​​the scalp, it has no interference with the surgical hair restoration.

Combination Therapy

There are reports saying that the use of finasteride and topical minoxidil combination therapy as a medical hair restoration treatment is more advantage in cases of mild to moderate MPHL. Further studies are in progress. Many hair restoration doctors have started to use combination therapy to obtain better hair growth.

Anti-androgen therapy

For women with hyperandrogonism (with elevated levels of androgen) who do not respond well to minoxidil, antiandrogen therapy is another option of Medical hair restoration. In the UK the most commonly used anti-androgen for women is CPA (cyproterone acetate), used in combination with ethinyl estradiol-.

However, in the United States, where CPA is not available, the aldosterone antagonist spironolactone is the alternative choice of hair restoration physician.

Flutamide

Medical hair restoration with flutamide has shown improvement as hair loss restoration treatment in women with hirsutism. For hyperandrogenic premenopausal women, flutamide is a better medical hair restoration agent than both the CPA or finestride.

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