Skin Drugs

Evid Based Complement Alternat Med. 2009 Aug 19.

Inhibition of Inflammatory Gene Expression in Keratinocytes Using a Composition Containing Carnitine, Thioctic Acid and Saw Palmetto Extract.
Chittur S,.et al

editd for Hair Loss Blog

Chronic inflammation of the hair follicle (HF) is considered a contributing factor in the pathogenesis of male pattern hair loss. Previously, we clinically tested liposterolic extract of Serenoa repens (LSESr) and its glycoside, beta-sitosterol, in subjects with AGA and showed a highly positive response to treatment. In this study, we sought to determine whether blockade of inflammation using a composition containing LSESr as well as two anti-inflammatory agents (carnitine and thioctic acid) could alter the expression of molecular markers of inflammation in a well-established in vitro system. Using a well-validated assay representative of HF keratinocytes, specifically, stimulation of cultured human keratinocyte cells in vitro, we measured changes in gene expression of a spectrum of well-known inflammatory markers. In particular, we found that the composition effectively suppressed LPS-activated gene expression of chemokines, including CCL17, CXCL6 and LTB(4) associated with pathways involved in inflammation and apoptosis. Our data support the hypothesis that the test compound exhibits anti-inflammatory characteristics in a well-established in vitro assay representing HF keratinocyte gene expression. These findings suggest that 5-alpha reductase inhibitors combined with blockade of inflammatory processes could represent a novel two-pronged approach in the treatment of AGA with improved efficacy over current modalities.

Evid Based Complement Alternat Med. 2009 Aug 19.

Inhibition of Inflammatory Gene Expression in Keratinocytes Using a Composition Containing Carnitine, Thioctic Acid and Saw Palmetto Extract.
Chittur S,.et al

Chronic inflammation of the hair follicle (HF) is considered a contributing factor in the pathogenesis of male pattern hair loss. Previously, we clinically tested liposterolic extract of Serenoa repens (LSESr) and its glycoside, beta-sitosterol, in subjects with AGA and showed a highly positive response to treatment. In this study, we sought to determine whether blockade of inflammation using a composition containing LSESr as well as two anti-inflammatory agents (carnitine and thioctic acid) could alter the expression of molecular markers of inflammation in a well-established in vitro system. Using a well-validated assay representative of HF keratinocytes, specifically, stimulation of cultured human keratinocyte cells in vitro, we measured changes in gene expression of a spectrum of well-known inflammatory markers. In particular, we found that the composition effectively suppressed LPS-activated gene expression of chemokines, including CCL17, CXCL6 and LTB(4) associated with pathways involved in inflammation and apoptosis. Our data support the hypothesis that the test compound exhibits anti-inflammatory characteristics in a well-established in vitro assay representing HF keratinocyte gene expression. These findings suggest that 5-alpha reductase inhibitors combined with blockade of inflammatory processes could represent a novel two-pronged approach in the treatment of AGA with improved efficacy over current modalities.

Geburtshilfe Frauenheilkd. 1988 Apr;48(4):203-14.

Hormonal diagnosis in androgenetic alopecia in women

Moltz L.

Pattern hair loss (a.A.) occurs quite frequently. Up to 79% of women suffer at least temporarily from varying degrees of intermittent diffuse hair loss in the centro-parietal and/or fronto-temporal regions. A.A. is caused by an androgen excess acting on the hair follicle for prolonged periods of time in the presence of a genetic predisposition. However, often hyperandrogenemia cannot be demonstrated in such patients. 125 women with clinically typical a.A. were investigated prospectively under standardized conditions. Patient age ranged from 18 to 68 year. Atypical uterine bleeding such as menorrhagia, hypermenorrhea and polymenorrhea were found in 69 women. The hair loss varied between 50 and 400 hairs per day. Additional signs of hyperandrogenism, i.e. seborrhea, acne and hirsutism, were often observed. Basal levels of total and free testosterone snip… Different methods of determining bound and unbound T were used; their diagnostic value is discussed in detail. In addition, a combined ACTH/TRH-stimulation test was performed in all patients. Pathologic changes of one parameter were detectable in 26.4% of patients, while 67.2% revealed deviations of two or more indices. Excluding clinically relevant borderline values, only 6.4% of patients were without any abnormalities. snip… Group and individual case analyses revealed significant correlations between (1) the levels of the various androgens, PRL and TSH and (2) the E2, SHBG and FT values; these, in turn, were correlated to (3) the occurrence of certain bleeding anomalies (amount, duration, interval) and corresponding ferritin deficiency. Therapy was directed at normalizing the disturbed estrogen-androgen-balance. Using low-dose antiandrogens, estrogens, prolactin suppressants, corticoids, iron-II-preparations as well as estrogen-containing hair lotions hair loss was arrested in 74 of 104 treated women, while regrowth of hair was accomplished in 16 patients.

Androgenetic alopecia or pattern hair loss is a dihydrotestosterone-mediated process, The aim of AGA treatment is to reverse or to stop the process of HF miniaturization.

Currently available systemic treatment options for AGA therefore involve either the use of antiandrogens such as cyproterone acetate in women, or steroidogenic enzyme inhibitors such as finasteride in men.

For the topical treatment of AGA, solutions containing either estradiol benzoate, estradiol valerate, 17beta- or 17alpha estradiol are commercially available in Europe and some studies show an increased anagen and decreased telogen rate after treatment as compared to placebo [3]. At present it is not precisely known how estrogens mediate their beneficial effect on pattern hiar loss. In guinea pigs estrogens have been shown to prolong anagen, but in contrast topical application of 17beta-E to the clipped dorsal skin of mice arrested HF in telogen produced a profound and prolonged inhibition of hair regrowth, while treatment with the biologically inactive stereoisomer, 17alpha-E, had no effect. snip… Estrogens at very high concentrations have been found to be non-competitive inhibitors of 5alpha-R. Other groups did not confirm these data when using skin fibroblasts. Moreover, in nearly all experiments showing that estrogens are able to inhibit 5alpha-R in vitro, an inhibition was only present at very high doses of estrogen. One study indicated that 17alpha-E at very high concentrations inhibits 5alpha-R in female rats.

Thus, the use of estrogens for the treatment of pattern hair loss is a treatment option which might be able to stop or reverse hair loss, but the exact success rates and the underlying mechanisms are unknown or open to question….

Dr Proctor treats hair loss