A Good Magazine
jbro...@sprynet.com
Common Drugs That Cause Hair Loss
Joan Brown*
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Hair plays a significant role in our life. Another person's hair is one of
the first characteristics
we notice upon meeting. Our own hair is one of the first and last things we
attend to before a
meeting or a social engagement. Hair disorder, especially when severe, often
profoundly
affects the lives of those afflicted. Severe hair loss evokes not only
cosmetic concerns but
may also evoke feelings of vulnerability (nakedness), loss of self-esteem,
alterations in
self-image, and, perhaps, even self-identity.
In 1992, researchers at Old Dominion University in Norfolk, Virginia,
surveyed 145 men, and
found that 84 percent of the balding men were preoccupied with their loss.
They described
themselves as filled with self-consciousness, helplessness, and envy of men
with full heads
of hair. Single men and woman who had begun losing hair in their early
twenties were more
likely to suffer from extremely low self-esteem.
While stressful, balding isn't the end of the world. Although the men
reported glancing in the
mirror constantly and wearing hats even in warm weather, they manage to make
it through
their daily lives without much problem. For some it even sparked
self-improvement tactics
like fiddling with hair styles, working out more, and dressing better.
Stereotypes associated with baldness are not flattering. A research back in
1971( reference)
had been conducted to investigate how one person was perceived by others can
be
influenced by quantity of scalp hair (regular, balding, and bald) as well as
color, length, and
quality of scalp hair. Pictures of the same person were presented to 60
judges. Differences
in appearances of this person (ie, experimental conditions of regular,
balding, and bald) were
manipulated through modifications made by a commerical artist. The results
revealed that
the person with a regular quantity of hair was rated as most handsome,
virile, strong, active,
and sharp. The person with a balding head of hair was rated as least potent,
weak, dull, and
inactive, and the person with a bald head of hair was rated as most unkind,
bad, and ugly.
Many other studies also show employment discrimination based on a person's
appearance
Motivation to avoid baldness is not confined to this century. In 1150 BC
Egyptian men smear
their pates with fats from ibex, lions, crocodiles, serpents, geese, and
hippopotamuses. In
modern society, this aversion is readily evident from the many available
remedies such as
creams, hormones, vitamins, hairpieces, wigs, scalp reduction and hair
transplants. A
government report in 1983 reveals that over the past 9 years the FDA has
overseen the
investigation of ingrediets in about 300,000 products claimed to help hair
regrowth, none of
them has any medical benefit, of course.
Part 2 Get to Know Your Hair
The amount of hair and where it grows vary with different mammals. The
entire body of the
dog, the sheep, the cow, and the horse is covered with a hairy coat. The
whale and the
hippopotamus have only a few hairs. In humans, hair is not found on palms of
the hands or
the soles of the feet. The coloration and pattern of coats in animals serve
both as a
camouflage for protection against enemies and as an allurement to mates. Fine
and
transparent, human hair is a vestige of our hairier animal forbears, that
probably evolved
from the scales of reptiles. The adult human body averages five million
hairs, of which
100,000 to 150,000 are on the scalp.
Hair is composed of keratin, the same protein that makes up nails and the
outer layer of our
skin. The part seen rising out of the skin is called hair shaft or strand.
Each strand consist of
three layers. The outermost protective layer (cuticle) is thin and
colorless. The middle layer,
or cortex , is the thicknest. It provides strength, determines your hair
color and whether your
hair is straight or curly.
Hair color is determined by melanin from your pigment cells. The more pigment
granules
there are, and the more tightly packed, the darker the hair. Two kinds of
melanin contribute
to hair color. Eumelanin colors hair brown to black, and an iron-rich
pigment, pheomelanin
colors it yellow-blonde to red. Whether hair is mousy, brown, brunette or
black depends on
the type and amount of melanin and how densely it's distributed within the
hair. For example,
deep-black African hair contains closely packed melanin in the cortex, a few
in the cuticle.
Very dark European hair, quite apart from having more melanin granules than
lighter or
blonde hair, has more melanin per granule. When pigment-producing cells cease
to function,
the result is the uncolored white or gray hair.
Scalp hair varies tremendously between races, between individuals of same
race, and even
within an individual. Mongolians have straight hair simply because their
scalp hair has the
greatest thickness and the roundest cross-section. In Caucasians the hair is
more elliptical
and slender; in Negroes it is flattened, resulting in kinky curls.
Mongolians, both male and
female, have much less public, axillary, facial, and body hair than
Caucasians. In
Caucasians, true blonds typically have more hair (about 140,000 hair) than
brunette (about
105,000) or redhead (about 90,000).
Below your skin is the hair root which is enclosed by a sack-like structure
called the hair
follicle. Tiny blood vessels at the base of the follicle provide
nourishment. A nearby gland
secretes a mixture of fats (called sebum) which keep the hair shiny and
waterproof to some
extent. Secretions from some sweat glands also produce a characteristic odor.
A dog can
differentiate a human being by the typical scent secreted by these glands.
Two sets of glands
discharge secretions through the skin. while sebaceous, or oil, glands arise
from the walls
of hair follicles and produce an oil
called sebum that lubricates the skin and hair, Sweat glands, embedded in the
subcutaneous
layer, are scattered over the body, particularly in the palms and soles.
Sweat glands produce
moisture called perspiration that reaches the skin's surface through the
pores and
evaporates to cool the body.
At the base of the follicle is the papilla, which is the "hair manufacturing
plant." The papilla is
fed by the blood-stream which carries nourishment to produce new hair. Male
hormones or
androgens regulate hair growth. Pubic and axillary (armpit) hair are
particularly androgen-
sensitive and grow at lower androgen levels than hair on the chest or legs.
In boys, most
pubic hair is grown by age 15, followed by the development of armpit hair two
to three years
later. In girls, too, an increase in androgens at puberty triggers growth of
pubic and armpit
hair. Scalp hair, not directly androgen-responsive, is influenced by local
amounts of a
testosterone derivative, dihydrotestosterone.
Hair follicles initially form in utero. No new follicles are created after
birth, and none are lost in
adult life. The first hair to be produced by the fetal hair follicles is
Lanugo hair, which is fine,
soft, and unpigmented. This is usually shed in about the eighth month of
gestation.
The first postnatal hair is vellus hair, which is fine, soft, usually
unpigmented, and seldom
more than 2 cm long. Vellus hair remains on the so-called hairless regions of
the body,
such as the forehead and balding scalp.
At puberty, the vellus hair in some areas is replaced by terminal hair, which
is longer,
coarser, and pigmented. Growth starts in the pubic region; then the eyelashes
and eyebrows
become thicker. Axillary hair and male facial hair appear about two years
after growth of
pubic hair begins. Body hair continues to develop long after puberty,
stimulated by male
hormones that paradoxically, also cause terminal hair to be replaced by
vellus hair when
balding begins.
Scalp hair fibers grow from 100,000 to 350,000 follicles which are reported
to occupy the
human scalp; however, not all the follicles are productive.[1] In each
producing follicle, the
duration of the hair's life cycle is influenced by age, pathology and a wide
variety of
physiological factors.[1,2] The life cycle is divided into the anagen
(active), catagen
(transitional) and telogen (resting) phases.
The anagen phase is the period of active hair growth where protein synthesis
and
keratinization are continuously occurring. In normal subjects, this phase
lasts for up to five
years, although longer durations have been documented.
The cessation of the anagen phase is characterized by a transitory phase
known as
catagen. This phase lasts for two to three weeks.
Following the catagen phase, the hair enters the telogen or "resting" phase.
In normal
subjects, telogen hair is retained within the scalp for up to 12 weeks before
the emerging
new hair dislodges it from its follicle.
During the anagen phase, protein s thesis is the main distinction of the hair
bulb. In the
telogen phase, the dermal papilla undergoes renewal. It is at this time that
structural
characteristics can be modified. The new hair should be identical to its
predecessor,
but with advancing age, and in some pathological states, a strict copy is not
maintained.
In these circumstances, the hair may become finer and shorter, modifying the
esthetic
profile. Since these effects occur over several hair cycles, years may elapse
before the
affected individual recognizes the difference.
Like skin cells, hair grows and is shed regularly. Shedding anywhere from
50 to 100 hairs
per day is considered normal. The average rate of growth is about 1/2 inch a
month. It is
now known that hair grows fastest in the summer, slowest in the winter,
speeds up under
heat and friction, but slows down when exposed to cold. Hair grows the best
between the
ages of 15 to 30. But, hair growth begins to wind down sometime between the
ages of 40
and 50. Progressive hair loss begins naturally in both sex about age 50,
accelerating in the
70s. About 40 percent of Caucasian men lose hair to some extent by age 35.
Hair Loss, Men and Women
Androgenic alopecia
By far the most common form of hair loss is determined by our genes and
hormones: Also
known as androgen-dependent, androgenic, or genetic hair loss. It is the
largest single type
of recognizable alopecia to affect both men and women. It is estimated that
around 30% of
Caucasian females are affected before menopause. Other commonly used names
for
genetic hair loss include common baldness, diffuse hair loss, male or female
pattern
baldness.
1. Male Pattern Baldness (MPB)
Signs and Symptoms
· Receding hairline
· Moderate to extensive loss of hair, especially on the crown
2. Female pattern Baldness (FPB)
Signs and Symptoms
· General thinning of hair all over the head
· Moderate loss of hair on the crown or at hairline
MPB is the hair loss most frequently encountered. It usually starts with the
hair at the
temples, which gradually recedes to form an "M" shape. You also may find
your hair is finer
and does not grow as long as it once did. The hair on the crown of your head
begins to thin
out and eventually at the top points of the "M" meet the thinned spot on your
crown. Over
time, you are left with a horse-shoe pattern of hair around the sides of your
head. Any
remaining hair in the balding areas usually manifests some miniaturization -
it is thinner
and grows at a below-normal rate, changing from long, thick, coarse,
pigmented hair into
fine, unpigmented sprouts.
Female pattern baldness usually begins about age 30, becomes noticeable
around age 40,
and may be even more noticeable after menopause. Female hair loss is usually
an overall
thinning--two hairs where five used to be--rather than a bald area on top of
the head, though
women may have a receding hairline, too. It's thought that about 20 million
American women
have such hair loss. As in males, hair follicles simply shut down, with
hormones playing
some role in the process.
A receding hairline reflects age, but not necessarily great age, since some
men start balding
quite young. With the spurt in androgen secretion at puberty, the hairline
moves back a little
in 96 per cent of boys and 80 per cent of girls. Most boys continue to
shed hair as they
mature and, if baldness runs in the family, lose increasing amounts. By age
35 to 40, two
thirds of Caucasian men are noticeably bald. The loss may begin at age 20,
then stop, only
to start up again a few years later. Since this type of baldness is largely
hereditary, a man
can usually, although not always, predict the extent of his future baldness
by examining
family portraits. About 50 per cent of children with a balding parent of
either sex will inherit
the dominant baldness gene.
The mechanism of balding
The rate of hair shedding in androgenic alopecia is speeded up by three
forces: advancing
age, an inherited tendency to bald early, and an over-abundance of the male
hormone
dihydrotestosterone (DHT) within the hair follicle. DHT is a highly active
form of testosterone,
which influences many aspects of manly behavior, from sex drive to
aggression.
The conversion from testosterone to DHT is driven by an enzyme called 5-alpha
reductase,
which is produced in the prostate, various adrenal glands, and the scalp.
Over time, the
action of DHT causes the hair follicle to degrade and shortens the anagen
phase. Thought
the follicle is technically still alive and connected to a good blood
supply--it can successfully
nurture a transplanted follicle which is immune to the effects of DHT--it
will grow smaller
and smaller (figure 3). Some follicles will gradually die, but most will
simply shrink to the
size they were when you were born which produce weaker hairs. With a steadily
shorter
anagen growing cycle, more hairs are shed, the hairs becoming thinner and
thinner until
they are too fine to survive daily wear and tear. Balding hair gradually
changes from long,
thick, coarse, pigmented hair into fine, unpigmented vellus sprouts.
However, the sebaceous gland attached to it remains the same size. As the
hair shafts
become smaller, the gland continues to pump out about the same amount of oil.
So as
your hair thins, you will notice that your hair becomes flatter and oilier.
Other physiological factors might cause hair loss. Recently, a group of
Japanese
researcher reported a correlation between excessive sebum in the scalp and
hair loss.
Excessive sebum often accompanying thinning hair is attributed to an
enlargement of the
sebaceous gland. They believed excessive sebum causes an high level of
5-alpha reductase
and pore clogging, thus malnutrition of the hair root.
Although this condition could be hereditary, they believe diet is a more
prominent cause.
The researchers note that Japanese hair was thick and healthy, with a small
gland and little
scalp oil, until the occidental habit of consuming animal fat crept into
their diet after World
War II. This change has led to a significant height increase in the Japanese
population, but
it has also resulted in more Japanese men losing hair. To some extent, their
observation
makes sense since problems with greasy hair have often been noted as much as
six
months to a year prior to when thinning hair becomes noticeable, but this
might be just one
of the symptons, not underlying cause, more research is needed. Most doctors
agree that
If you have a oily scalp with thinning hair, frequent shampooing is advised.
shampooing can
reduce surface sebum, which contains high levels of testosterone and DHT
that may
reenter the skin and affect the hair follicle.
Treatment for Male Pattern Baldness
Balding men and women seem to go to almost any lengths to regrow thinning
hair. Until now,
inherited balding in either sex has not responded well to any anti-balding
stimulants,
applications, injections, or other treatments. Specific foods or vitamins
don't regrow hair --
although good nutrition is essential for healthy hair.
Antiandrogen Therapy
In the United Kingdom, the most commonly used anti-androgen for women is CPA
(cyproterone acetate) in combination with ethinyl-estradiol. In the United
States, where
CPA is not available, the aldosterone antagonist spironolactone has been
given in dosages
from 75 to 100 mg per day with some benefit. However, higher doses (150 to
200 mg per
day) appear necessary to produce a significant increase in cosmetically
useful hair, as
occurs with CPA therapy.
Anti-androgen treatment must be continued for at least 12 months. Often two
years is
required before a subjective improvement is observed.
Complete reversal of the hair loss can never be achieved unless treatment is
instigated
within two years of its onset. This is probably due to the atrophy of the
miniaturized hair
follicles with time. The degree of benefit observed is dependent upon the
subject's age
and the duration of alopecia; however, most patients are satisfied with the
thought that no
further hair loss will occur. Some improvement in hair quality should be
expected in all
cases, although withdrawal of therapy results in further progression of the
alopecia.
Nonhormonal aspects are critical to ensure an optimal therapeutic response is
achieved.
And, the need to maintain vitamin and serum ferritin levels above values
previously thought
adequate has recently been demonstrated.
The side effects of oral CPA therapy in combination with ethinyl-estradiol
are well
documented and are similar to those associated with other oral contraceptive
regimens.
Spironolactone disrupts the menstrual cycle and increases menstrual bleeding
in some
patients; but, in general, it is well tolerated.
Rogaine
By far the most publicized medical treatment available for male pattern
baldness is minoxidil
(Rogaine). The idea of using minoxidil topically to grow hair was
serendipitous. This drug
was originally developed to treat high blood pressure and had the
unanticipated side effect
of stimulating hair growth, sometimes in unwanted areas. This observation led
to the testing
of topical minoxidil on balding areas of the scalp. Since its introduction in
1988, Upjohn, the
manufacturer, sells about $150 million worth of the drug each year, even
though its ability to
grow back hair is, at best, modest.
A large-scale clinical trial involved over 2,300 participants with male
pattern baldness
was carried out by having 1,547 patients apply 1 ml of 2% or 3% minoxidil
and 779 patients
apply 1 ml of placebo ( no active ingradients, only alcohol and propylene
glycol) twice a day
to the balding area. Actual counts of vellus hairs, indeterminate hairs, and
terminal hairs in
an one-inch patch were made before and after treatment. At 4 months, 5% to
8% of patients
had moderate to marked hair growth on the balding vertex of the scalp. This
figure is
statistically no different from the number of men who regrow hair in response
to a plcaebo.
another 15% to 20% of patients had some growth of vellus hair on the balding
area. At 12
months, 39% of patients had moderate to marked hair growth, while 11% of
those using
placebo reported an increase in hair growth. This result shows that you to
used minoxidil
for more than 4 months in order to decide whether this treatment works for
you.
Who is the best candidate for this drug? research showed that you have to be:
1) young man (20 to 30 years old), who only recently (within 5 years) had
begun to
bald
2) not completely bald, and
3) not bald at the temples
This drug works best on small areas of vertex baldness (smaller than 1 square
inch).
There is no evidence that topical minoxidil could regenerate hair on the
receding temple
area. Topical minoxidil was as effective at a concentration of 2% as at 3%.
A 1%
formulation was less effective.
Successful treatment, however, does require a lifetime commitment. The
topical solution
must be applied to the balding area twice a day, every day. Decreasing the
dosage to once
a day results in some hair loss, and discontinuing application causes
regression to
pretreatment baldness within 3 to 6 weeks. The cost? Anywhere between $600
to $1,000
a year, depending on the size of the area to be treated.
Why minoxidil works remain a mystery. It is know to be a powerful
vasodilator, but other
drugs the dilate blood vessels do not promote hair growth. It is postulated
that it delays or
prevents some follicles' entry into the next anagen phase for long periods
of time and
stimulate these follicles back into active production. But this theory
remains to be vindicated.
The disadvantages of minoxidil are: 1) lifetime commitment; 2) high cost : It
is not covered
by health insurance schemes as it's considered a cosmetic; 3)Its side
effects; including
itching and prickling, headaches (in 40 per cent), dizzy spells and, in some,
heartbeat
irregularities. Although apparently safe when rubbed into the scalp - since
little is absorbed
into the bloodstream - it is a vasodilator and not recommended for anyone
with heart trouble.
Its safety in men over age 49 and its long-term safety remain unknown. Some
scientists
believe that minoxidil is more effective in preventing hair loss than in
promoting regrowth,
but no controlled trials are available.
At the time of writing this book, the only away you can obtain rogaine is
through a doctor's
prescription. That could be changed soon. Upjohn is confident it will obtain
FDA approval to
take the drug over the counter.
Other nonsurgical baldness remedies
Medical researchers in Asia believe that hair loss is caused mainly by
insufficient blood
supply to the scalp. The other possibility is excessive sebum in the scalp
which causes
pore clogging and malnutrition in the hair root( "sebaceous Gland
Hypothesis", proposed
by Dr. Yoshikata Inaba of The Inaba Aesthetic Surgery in Tokyo). The
so-called 101 hair
regrowth lotion is formulated to attack the problems. 101 became famous
after it had won
several international awards, among them, "gold medal" from 14th
International Inventors
Exposition in New York (June 4, 1991). According to Dr. Zhuang-Guang Zhao,
the inventor,
101 promotes blood circulation by removing blood stasis in the scalp and
dilating the blood
capillaries, it also remove sebum in the scalp. Unlike other treatments, it
has no side
effects, the active compounds in this lotion are isolated from plants,
According to
Newsweek and New York Times reports (references at page 48), there is no
questioning
its popularity with the 3 million bald folks in Japan. Masashi Sada, a
popular Japanese singer,
said recently on the radio
that the product worked wonders on his head. Millions of men and women in
Asia reportedly
have used 101 and 90 percent are said to have found it effective in hair
regrowth and a
significant reduction of hair loss. According to a spokesperson for the 101
products the
improved formula called Fabao 101D will be introduced to USA. But will 101D
work on
American heads? (Interested reader can obtain a copy of brochure by writting
to: Pan State
Health Products, 84-25 Elmhurst Ave, #3N, Elmhurst, NY 11373 or e-mail:
PanS...@WebSpan.net)
Common drugs that cause hair loss
While male- and female-pattern baldness result in permanent hair loss, other
factors can
cause temporary loss of hair. For instance, the drop in the level of estrogen
at the end of
pregnancy can cause a woman's hair to shed more readily. Two or three months
after a
woman stops taking birth control pills, she may experience the same effect,
since birth
control pills produce hormone changes that mimic pregnancy.
It is well known that many cancer chemotherapy medications cause baldness.
Most people
are willing to put up with hair loss when accepting treatments for
life-threatening diseases.
But a large number of popular medications can cause hair loss while neither
pharmaceutical
industry nor your doctor will tell you about this side effect.
Here we compile a list of drugs that are know to cause hair loss in some
patients:
Cholesterol-lowering drug:
clofibrate (Atromis-S) and gemfibrozil (Lopid)
Parkinson Medications:
levodopa (Dopar, Larodopa)
Ulcer drugs:
cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid)
Anticoagulents:
Coumarin and Heparin
Agents for gout:
Allopurinol (Loporin, Zyloprim)
Antiarthritics:
penicillamine, auranofin (Ridaura), indomethacin (i\Indocin), naproxen
(Naprosyn),
sulindac (ClinorilÒ), and methotrexate (FolexÒ)
Drugs derived from vitamin-A:
isotretinoin (Accutane) and etretinate (Tegison)
Anticonvulsants for epilepsy:
trimethadione (Tridione)
Antidepressants:
tricyclics, amphetamines
Beta blocker drugs for high blood pressure:
atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), propranolol
(Inderal)
and timolol (Blocadren)
Antithyroid agents:
carbimazole, Iodine, thiocyanate, thiouracil
Others:
Blood thinners, male hormones (anabolic steroids)
Next time your doctor prescribes any drug for you, ask if it will cause hair
loss. You doctor
may not realize this side effect. You can ask him or her to look it up in the
Physicians'
Desk Reference, which lists the side effects of all prescription medications.
If the drug is
linked to reversible alopecia, ask if another can be substituted. And just
to make sure your
physician has given you accurate information, when you get the prescription
filled, ask your
pharmacist as well.
Surgical Treatment of Baldness
If you do not respond to medical treatments and If you have time, money, and
a stoic attitude
toward pain, Surgical hair restoration is the only truly permanent solution
to baldness. It
involves a series of operations that extract plugs of scalp from the sides an
back of your
head, where hair grows densely, and implant them on top and in front, where
you're going
bald.
The procedure, which usually isn't covered by medical insurance, can cost as
much as
$15,000 and takes a year or two to complete. Despite the time and expense,
an estimated
250,000 American men each year elect to have the surgery.
Before Making Any Decision
In US any licensed physician can perform hair the surgery, it is easy to end
up with
Unsatisfactory results--scarring, patches of thin transplanted hair over
scalp sections that
continue to grow bald, a "doll's hair" look, or loss of hair that leaves the
scars from
transplantation visible--are no longer as likely as they once were, but they
are still a risk.
If you decide to go this route, choose your surgeon with care, and beware of
seductive
advertising brochures showing "after" photos of men with thick, way hair.
Ask to see some
real people whom the doctor has treated. The best way, actually,
to find a surgeon is through a referral from a satisfied customer, but even
then you should
be sure the doctor's credentials check out. Check with the department of
plastic surgery or
dermatology at your nearest university medical school. You can also call or
write to the
American Hair Loss Council (100 Independence Place, Texas), or the
American Academy
of Facial Plastic and Reconstructive Surgery (1110 Vermont Avenue NW, Suite
220, Washington, DC 20005; telephone 800-332-3223).
**Source: Health Review Magazine, January 1996. All rights reserved.
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BrentEF
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aa
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Andy
