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FILLERS: Quackery and baldness BMJ 2004; 329: 565 [Full text]

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From quackery to modern drugs: alopecia

Dr. Naseem A. Qureshi MD, IMAPA, LMIPS, Dr.Ibrahim A. Al-Hoqail, Dean, College of Medicine, MOH, Riyadh, Saudi Arabia.   (8 September 2004)

Sabouraud revised

Armando J Soler   (19 October 2004)

From quackery to modern drugs: alopecia 8 September 2004
Dr. Naseem A. Qureshi MD, IMAPA, LMIPS, Director, CME&R POBox.2292, Buraidah Ment. Halth. Hosp., Saudi Arabia., Dr.Ibrahim A. Al-Hoqail, Dean, College of Medicine, MOH, Riyadh, Saudi Arabia. Send response to journal: Re: From quackery to modern drugs: alopecia	Sir: Notably, hairs are produced intermittently in hair follicles having cyclical active anagen phase, the catagen transitional phase and the resting telogen phase. A variety of drugs are known to cause hair loss through anagen effluvium (days to weeks) and telogen effluvium (2 to 4 months) after starting treatment. It is wise to remember that drug- induced hair loss is usually reversible after interruption of treatment. The therapeutic value of mineral supplements remains unclear. Besides many drugs, individual predisposition is also known to contribute to hair loss- alopecia. Reportedly, the principal categories of drugs that may cause alopecia are cytostatics/antineoplastic agents, anticoagulants, interferons, tretinoid derivatives such as vitamin A, antimalarials, beta-receptor blocking agents, sex hormones, oral contraceptives, ACE inhibitors, angiotensin II antagonists, anticoagulants, salicylates or nonsteroidal analgesics, antithyroid drugs (hypothyroidism), dopamine agonists such as bromocriptine and levodopa. Other drugs include cimetidine, amphetamines, hypocholesterolaemic agents, anti-infectious agents and mesalazine (used in Crohn’ disease, >4mg/day). With special reference to psychotropic drugs, most of the mood stabilizer and antidepressant drugs can lead to hair loss. Lithium causes hair loss in 12-19% of long-term users. Valproic acid precipitates alopecia in up to 12% of patients in a dose-dependent relationship. Incidences up to 28% are observed with high valproate concentration exposures. The occurrence of carbamazepine-induced alopecia is at or below 6%. Hair loss is less common with other mood stabilizers. Tricyclic antidepressants, maprotilene, trazodone, and almost all the new generation of antidepressants including SSRIs may on rare occasions lead to alopecia. The same applies to antipsychotics which are haloperidol, olanzepine, and risperidone and other atypicals too. Clonazepam, and buspirone amy also cause baldness. Notably, benzodiazepines, or barbiturates, some selected antihistamines, and antiparkinsonians do not cause alopecia. It is of great concern that alopecia might not be reported by some people, but physicians should be aware of this potential problem which may contribute, interalia, to noncompliance. Reference: Fillers-Quackery and baldness. BMJ 2004; 329: 565 Competing interests: None declared
Sabouraud revised 19 October 2004
Armando J Soler, Chemist E03600 Elda (Alicante) Spain Send response to journal: Re: Sabouraud revised	Raymon Sabouraud wrote one hunderd years ago: "We cannot cure baldness, nor restore hair to denuded scalps". Now we are able to restore hair by hair trasplant, but cannot cure baldness, especially essential baldness or common baldness. The reason is the same, our ignorance of the etiology of the disease. Interestingly enough, Sabouraud though about the possibles causes, and one of them was cutting the hair too short. In my work in Medical Hypotheses Journal (*) I set out the same reason in common baldness, bringing out the problems of drainage of sebum. According to this theory, common baldness is a degenerative process derived from certain inadequate cultural practices, such as excessive hair cutting or certain types of haircuts that prevent contact among hairs themselves and limit outside contact in ways that would alleviate balding. Blocking the flow of sebum towards the base of the hair follicle—and so interfering with the arrival of the stem cells to the dermal papilla with consequent hair miniaturization—ends up being the first negative physiological effect derived from certain cultural habits. As time goes by, other mechanisms become altered, which leads to a less and less reversibility of the process. (*) Cultural evolution as a possible triggering or causative factor of common baldness. Medical Hypotheses (2004) 62, 980-985 Armando Jose Yañez Soler e-mail: arm_ya@yahoo.es Competing interests: None declared