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Treatments for Androgenetic Alopecia and Alopecia Areata

Current Options and Future Prospects

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Abstract

Androgenetic alopecia and alopecia areata are common disorders of the hair follicle which may heavily influence self esteem and self image. Androgenetic alopecia is caused by the heightened sensitivity of scalp follicles to dihydrotestosterone whereas alopecia areata is induced by an autoimmune reaction. Current drug treatment approaches include the use of regrowth stimulators such as topical minoxidil and oral finasteride for androgenetic alopecia, as well as topical minoxidil, dithranol (anthralin), corticosteroids, contact sensitisers, and psoralen plus ultraviolet A irradiation (PUVA) therapy for alopecia areata. Combination regimens are also proposed. However, extreme cases of either type of alopecia do not generally respond well to these existing treatments. For this reason, new therapeutic strategies are directed towards both improving the targeting of existing agents, as well as the development of novel hypertrichotic modalities.

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References

  1. Davies K. Hair apparent. Nature 1998; 391: 537–9

    Article  PubMed  CAS  Google Scholar 

  2. Olsen E. Androgenetic alopecia. In: Olsen E, editor. Disorders of hair growth. New York: McGraw-Hill Inc., 1994: 257

    Google Scholar 

  3. Hibberts NA, Howell AE, Randall VA. Balding hair follicle dermal papilla cells contain higher levels of androgen receptors than those from non-balding scalp. J Endocrinol 1998; 156(1): 59–65

    Article  PubMed  CAS  Google Scholar 

  4. Sawaya ME, Price VH. Different Levels of 5α-reductase type 1 and 2, aromatase, and androgen receptor in hair follicles of men and women with androgenetic alopecia. J Invest Dermatol 1997; 109: 296–9

    Article  PubMed  CAS  Google Scholar 

  5. Price VH. Testosterone metabolism in the skin: a review of its function in androgenetic alopecia, acne vulgaris, and idiopathic hirsutism including recent studies with antiandrogens. Arch Dermatol 1975; 111: 1496–1500

    Article  PubMed  CAS  Google Scholar 

  6. Gollnick H, Orfanos CE. Alopecia areata: Pathogenesis and clinical picture. In: Orfanos CE, Happle R. editors. Hair and hair diseases. New York: Springer-Verlag, 1990: 59–69

    Google Scholar 

  7. Jackow C, Puffer N, Hordinsky M, et al. Alopecia areata and cytomegalovirus infection in twins: genes versus environment? J Am Acad Dermatol 1998; 38(3): 418–25

    Article  PubMed  CAS  Google Scholar 

  8. Hoffmann R, Happle R. Update on hair disorders: topical immunotherapy in alopecia areata. Dermatol Clin 1996; 14(4): 739–44

    Article  PubMed  CAS  Google Scholar 

  9. Gilhar A, Ullmann Y, Berkutzi T. Autoimmune hair loss (alopecia areata) transferred by T-lymphocytes to human scalp expiants on SCID mice. J Clin Invest 1998; 101(1): 62–7

    Article  PubMed  CAS  Google Scholar 

  10. Kurata S, Uno H, Allen-Hoffmann BL. Effects of hypertrichotic agents on follicular and nonfollicular cells in vitro. Skin Pharmacol 1996; 9: 3–8

    Article  PubMed  CAS  Google Scholar 

  11. Michelet JF, Commo S, Billoni N, et al. Activation of cytoprotective prostaglandin synthesase-1 by minoxidil as a possible explanation for its hair growth-stimulating effect. J Invest Dermatol 1997; 108(2): 205–9

    Article  PubMed  CAS  Google Scholar 

  12. Shapiro J, Price VH. Hair regrowth: therapeutic agents. Dermatol Clin 1998; 16(2): 341–56

    Article  PubMed  CAS  Google Scholar 

  13. Ohtsuyama M, Morhashi M. Minoxidil sulfate effect on internal calcium of cell in the epidermis and epidermal appendages. In: Van Neste D, Randall V, editors. Hair research for the next millenium. Amsterdam: Elsevier-Science, 1996: 481

    Google Scholar 

  14. Lachgar S, Chaveron M, Gall Y, et al. Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells. Br J Dermatol 1998; 138: 407–11

    Article  PubMed  CAS  Google Scholar 

  15. Philpott M, Sanders D, Kealy T. Whole follicular culture. Dermatol Clin 1996; 14: 595–607

    Article  PubMed  CAS  Google Scholar 

  16. Uno H, Schroeder B, Fors T, et al. Macaque and rodent models for the screening of drugs for stimulating hair growth. J Cutan Aging Cosmet Dermatol 1990; 1: 193–204

    Google Scholar 

  17. Uno H, Kurata S. Chemical agents and peptides affect hair growth. J Invest Dermatol 1993; 101: 143S-7S

    Article  Google Scholar 

  18. De Villez RL. Topical minoxidil therapy in hereditary androgenetic alopecia. Arch Dermatol 1985; 121: 197–202

    Article  PubMed  Google Scholar 

  19. Olsen E, Weiner MS, DeLong ER, et al. Topical minoxidil in early male pattern baldness. J Am Acad Dermatol 1985; 13: 185–92

    Article  PubMed  CAS  Google Scholar 

  20. Price VH. Rogaine (topical minoxidil) in the management of male-pattern baldness and alopecia areata: summary. J Am Acad Dermatol 1987; 16: 749–50

    Article  Google Scholar 

  21. Price VH, Menefee E. Quantitative estimation of hair growth: comparative changes in weight and hair count with 5% and 2% minoxidil, placebo and no treatment. In: Van Neste D, Randall V, editors. Hair research for the next millenium. Amsterdam: Elsevier Science, 1996: 6

    Google Scholar 

  22. Pierard-Franchimont C, De Doncker P, Cauwenbergh G, et al. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology 1998; 196: 474–7

    Article  PubMed  CAS  Google Scholar 

  23. Rietschel RL, Duncan SH. Safety and efficacy of topical minoxidil in the management of androgenetic alopecia. J Am Acad Dermatol 1987; 16: 677–85

    Article  PubMed  CAS  Google Scholar 

  24. Olsen E, DeLong E, Weiner MS. Long-term follow-up of men with male pattern baldness treated with topical minoxidil. J Am Acad Dermatol 1987; 16: 688–95

    Article  PubMed  CAS  Google Scholar 

  25. Olsen EA, Weiner MS, Amara IA, et al. Five year follow-up of men with androgenetic alopecia treated with topical minoxidil. J Am Acad Dermatol 1990; 22(4): 643–46

    Article  PubMed  CAS  Google Scholar 

  26. Schupack JL, Kassimir JJ, Thirumoorthy T, et al. Dose response study of topical minoxidil in male pattern alopecia. J Am Acad Dermatol 1987; 16: 673–6

    Article  Google Scholar 

  27. Chiang CM, Flynn GL, Weiner ND, et al. Bioavailability assessment of topical delivery systems: effect of vehicle evaporation upon in vitro delivery of minoxidil from solution formulations. Int J Pharm 1989; 55: 229–36

    Article  CAS  Google Scholar 

  28. Tsai JC, Flynn, Weiner N, et al. Effect of minoxidil concentration on the deposition of drug and vehicle into the skin. Int J Pharm 1993; 96: 111–7

    Article  CAS  Google Scholar 

  29. Eller MG, Spunzar GJ, Della-Coletta AA. Absorption of minoxidil after topical application: effect of frequency and site of application. Clin Pharmacol Ther 1987; 45(4): 396–402

    Article  Google Scholar 

  30. Ferry J, Shepard JH, Szpunar GJ. Relationship between contact time of applied dose and percutaneous absorption of minoxidil from a topical solution. J Pharm Sci 1990; 79(6): 483–6

    Article  PubMed  CAS  Google Scholar 

  31. Rushton DH, Fenton DA. Quantitative Evaluation of topical 5% minoxidil in the treatment of diffuse androgen-dependent alopecia in Females. Br J Dermatol 1992; 127: 423

    Google Scholar 

  32. De Villez RL, Jacobs JP, Szpunar CA, et al. Androgenetic alopecia in the female: treatment with 2% topical minoxidil solution. Arch Dermatol 1994; 130: 303–7

    Article  Google Scholar 

  33. Savin RC, Atton AV Minoxidil: update on its clinical role. Dermatol Clin 1993; 11(1): 55–64

    PubMed  CAS  Google Scholar 

  34. Boeck C, Parker J, Shank J, et al. Safety of long term therapy with 3% and 5% topical minoxidil in female androgenetic alopecia. In: Van Neste D, Randall V, editors. Hair research for the next millenium. Amsterdam: Elsevier Science, 1996

    Google Scholar 

  35. Dallob A, Sadick N, Unger W, et al. The effect of finasteride, a 5αreductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness. J Clin Endocrinol Metab 1994; 79: 703–6

    Article  PubMed  CAS  Google Scholar 

  36. Kaufman K. Clinical studies on the effects of oral finasteride, a type II 5α-reductase inhibitor, on scalp hair in men with male pattern baldness. In: Van Nesteb D, Randall V, editors. Hair research for the next millenium. Amsterdam: Elsevier Science, 1996: 363

    Google Scholar 

  37. Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia: Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol 1998; 39: 578–89

    Article  PubMed  CAS  Google Scholar 

  38. Hordinsky MK, Ericson ME. Relationship between follicular nerve supply and alopecia. Dermatol Clin 1996, 14: 651–60

    Article  PubMed  CAS  Google Scholar 

  39. Hordinsky M, Worel S, Lee WS, et al. Endothelial localization of substance P (SP) in innervated and non-innervated blood vessels in the scalp skin of patients with scalp burning, pain and hair loss [abstract]. J Invest Dermatol 1997; 108: 706

    Google Scholar 

  40. Schaefer H, Watts F, Brod J, et al. Follicular penetration. In: Scott RC, Guy RH, Hadgraft J, editors. Prediction of percutaneous penetration: methods, measurements, and modelling. London: IBC Technical Services, 1990: 163–73

    Google Scholar 

  41. Li L, Hoffman RM. Topical liposome delivery of molecules to hair follicles in mice. J Dermatol Sci 1997; 14: 101–8

    Article  PubMed  Google Scholar 

  42. Dervault AM, Doucet O, Marty JP, et al. Evaluation of dioxalane derivatives as percutaneous absorption enhancers for topical minoxidil. Skin Pharmacol 1989; 2: 51–2

    Article  Google Scholar 

  43. Waldstreicher J. The effects of finasteride in men with frontal male pattern hair loss [abstract]. Australas J Dermatol 1997; 38: 101

    Article  Google Scholar 

  44. Niemec S, Ramachandran C, Weiner N. Influence of nonionic liposomal composition on topical delivery of peptide drugs into pilosebaceous units: an in vivo study using the hamster ear model. Pharm Res 1995; 12: 1184–8

    Article  Google Scholar 

  45. Mazzarella F, Loconsole F, Cammisa A, et al. Topical finasteride in the treatment of androgenic alopecia: preliminary evaluations after a 16-month therapy course. J Dermatol Treat 1997; 8: 189–92

    Article  Google Scholar 

  46. Amichai B, Grunwald MH, Sobel R. 5α-reductase inhibitors: a new hope in dermatology? Int J Dermatol 1997; 36: 182–4

    Article  PubMed  CAS  Google Scholar 

  47. Harry RG. Hair tonics. In: Harry RG, editor. Harry’s cosmeticology. London: George-Godwin Ltd, 1976: 426–36

    Google Scholar 

  48. Greenberg JH, Katz M. Treatment of androgenetic alopecia with a 7.5% herbal preparation. J Dermatol Treat 1996; 7: 159–62

    Article  Google Scholar 

  49. Fiedler-Weiss VC. Topical minoxidil solution in the treatment of alopecia areata. J Am Acad Dermatol 1987; 16: 745–8

    Article  PubMed  CAS  Google Scholar 

  50. Fiedler VC, Alaiti S. Treatment of alopecia areata. Dermatol Clin 1996; 14(4): 733–7

    Article  PubMed  CAS  Google Scholar 

  51. Fiedler VC. Alopecia areata. Arch Dermatol 1992; 128: 1519–29

    Article  PubMed  CAS  Google Scholar 

  52. Pascher F, Kurtin S, Andrade R. Assay of 0.2% fluocinolone acetonide cream for alopecia areata and totalis. Dermatologica 1978; 141: 192–202

    Google Scholar 

  53. Shapiro J. Alopecia areata. Dermatol Clin 1993; 11: 35–40

    PubMed  CAS  Google Scholar 

  54. Sawaya ME, Hordinsky MK. Glucocorticoid regulation of hair growth in alopecia areata [abstract]. J Invest Dermatol 1995; 194: 30S

    Google Scholar 

  55. Winter RJ, Kern F, Blizzard RM. Prednisolone therapy for alopecia areata: a follow-up report. Arch Dermatol 1976; 112: 1549–52

    Article  PubMed  CAS  Google Scholar 

  56. Healy E, Rogers S. PUVA treatment for alopecia areata: does it work? A retrospective view of 102 cases. Br J Dermatol 1993; 22: 242–50

    Google Scholar 

  57. Taylor C, Hawk J. PUVA treatment of alopecia areata, partialis totalis and universalis: audit of 10 years experience at St Johns Institute. Br J Dermatol 1995; 133: 914–8

    Article  PubMed  CAS  Google Scholar 

  58. Fiedler-Weiss VC, Buys CM. Evaluation of anthralin in the treatment of alopecia areata. Arch Dermatol 1987; 123: 1491–3

    Article  PubMed  CAS  Google Scholar 

  59. Pericin H, Trueb RM. Topical immunotherapy of severe alopecia areata with diphenylcyclopropenone: evaluation of 68 cases. Dermatology 1998; 196: 418–21

    Article  PubMed  CAS  Google Scholar 

  60. Morhenn VB, Orenburg EK, Kaplan J, et al. Inhibition of a Langerhans cell-mediated immune response by treatment modalities useful in psoriasis. J Invest Dermatol 1983; 81: 23–7

    Article  PubMed  CAS  Google Scholar 

  61. Lebwohl M. New treatments for alopecia areata. Lancet 1997; 349: 1041–2

    Article  Google Scholar 

  62. Fiedler VC, Wendrow A, Szpunar GJ, et al. Treatment-resistant alopecia areata response to combination therapy with minoxidil plus anthralin. Arch Dermatol 1990; 126: 756–9

    Article  PubMed  CAS  Google Scholar 

  63. Fiedler VC. Alopecia areata: current therapy. J Invest Dermatol 1991; 96: 69S-70S

    Article  Google Scholar 

  64. Ferry JJ, Fiedler VC. Pilot study to evaluate the effect of topical betamethasone dipropionate on the percutaneous absorption of minoxidil from 5% topical solution [abstract]. J Invest Dermatol 1990; 94: 504

    Google Scholar 

  65. Whiting D. The treatment of alopecia areata. Cutis 1987; 40: 248–53

    Google Scholar 

  66. Cotsarelis G, Sun TT, Lavker RM. Label-retaining cells reside in the bulge area of pilosebaceous unit: implications for follicular stem cells, hair cycle, and skin carcinogenesis. Cell 1990; 61: 1329–37

    Article  PubMed  CAS  Google Scholar 

  67. Li L, Margolis LB, Paus R. Hair shaft elongation, follicle growth and spontaneous regression in long-term, sponge-gel supported histoculture of human scalp skin. Proc Nat Acad Sci U S A 1992; 89: 8764–8

    Article  CAS  Google Scholar 

  68. Hoffman RM. Topical liposome targeting of dyes, melanins, genes, and proteins selectively to hair follicles. J Drug Target 1997; 5(2): 67–74

    Article  Google Scholar 

  69. Kyoizumi S, Suzuki T, Teraoka S, et al. Radiation sensitivity of human hair follicles in SCID-hu mice. Radiat Res 1998; 149: 11–8

    Article  PubMed  CAS  Google Scholar 

  70. Uno H. Quantitative models for the study of hair growth in vivo. Ann N Y Acad Sci 1991; 642: 107–24

    Article  PubMed  CAS  Google Scholar 

  71. Rhodes L, Harper J, Uno H, et al. The effects of finasteride (proscar) on hair growth, hair cycle stage, and serum testosterone and dihydrotestosterone in adult male and female stumptail macaques. J Clin Endrocrinol Metab 1994; 79(4): 991–6

    Article  CAS  Google Scholar 

  72. Fabin B, Touitou E. Localization of lipophilic molecules penetration into rat skin by quantitative autoradiography. Int J Pharm 1991; 74: 59–65

    Article  CAS  Google Scholar 

  73. Touitou E, Alkabes M, Fabin B, et al. Quantitative skin autoradiography: an efficient tool in measuring drug localized in skin layers, hair follicles and glands. Proceedings of the International Symposia on Controlled Release Bioactive Materials: 1994 Jun 27–30, Nice. Deerfield (IL): Controlled Release Society, Inc., 1994; 21: 431–2

    Google Scholar 

  74. Touitou E, Meidan VM, Horwitz E. Methods for the quantitation of drugs in the skin. J Control Release 1998; 56: 7–21

    Article  PubMed  CAS  Google Scholar 

  75. Touitou E, Levi-Schaffer F, Dayan N, et al. Modulation of caffeine skin delivery by carrier design: liposomes versus penetration enhancers. Int J Pharm 1994; 103: 131–6

    Article  CAS  Google Scholar 

  76. Hordinsky M, Lorimer S, Worel S. Innervation and vasculature of the normal and alopecia areata (AA) scalp hair follicle: absence of a neuronal marker on blood vessels associated with the lower third of the follicle [abstract]. J Invest Dermatol 1996, 106: 498

    Article  Google Scholar 

  77. Wananukul S, Lewis S, Kist D, et al. Localization of gammainterferon (IFN-Gamma) expression to the precortical matrix and inner root sheath of hair-follicles in normal controls and patients with alopecia-areata [abstract]. J Invest Dermatol 1995; 104: 653

    Google Scholar 

  78. Delaney PM, Bussau LJ, Papworth GD, et al. A miniaturised fibre optic confocal endoscope for in vivo subsurface microscopy [abstract]. Austral Physiol Pharmacol Soc Proc 1995; 26: 236P

    Google Scholar 

  79. Bussau LJ, Vo LT, Delaney PM, et al. Fibre optic confocal imaging (FOCI) of keratinocytes, blood vessels and nerves in hairless mouse skin in vivo. J Anat 1998; 192: 197–4

    Article  Google Scholar 

  80. Diani AR, Shull KL, Zaya MJ, et al. The penetration enhancer SEPA™augments stimulation of scalp hair growth by topical minoxidil in the balding stumptail macaque. Skin Pharmacol 1995; 8: 221–8

    Article  PubMed  CAS  Google Scholar 

  81. Lauer AC, Ramachandran C, Lieb LM, et al. Targeted delivery to the pilosebaceous unit via liposomes. Adv Drug Deliv Rev 1996; 18: 311–8

    Article  CAS  Google Scholar 

  82. Osborne DW, Hatzenbuhler DA. The influence of skin surface lipids on topical formulations. In: Osborne DW, Amann AH, editors. Topical drug delivery formulations. New York: Marcel-Dekker, 1990: 69–85

    Google Scholar 

  83. Touitou E, Dayan N, Bergelson L, et al. Ethosomes — novel vesicular carriers: characterization and delivery properties. J Control Release 2000; 65: 403–18

    Article  PubMed  CAS  Google Scholar 

  84. Touitou E, Godin B, Weiss C. Novel approaches for delivery of drugs into and across the skin. Drug Dev Res 2000; 50: 406–15

    Article  CAS  Google Scholar 

  85. Li L, Lishko V, Hoffman RM. Liposomes can specifically target entrapped melanin to hair follicles in histocultured skin. In Vitro Cell Dev Biol 1993; 29A: 192–4

    Article  PubMed  CAS  Google Scholar 

  86. Li L, Hoffman RM. Model of selective gene therapy of hair growth: liposome targeting of the active lac-Z gene to hair follicles of histocultured skin. In Vitro Cell Dev Biol 1995; 31A: 11–3

    Article  Google Scholar 

  87. Bazzano G, Terezakis N, Galen W Topical tretinoin for hair growth promotion. J Am Acad Dermatol 1986; 15: 880–3

    Article  PubMed  CAS  Google Scholar 

  88. Diani AR, Mulholland MJ, Shull KL, et al. Hair growth effects of oral administration of finasteride, a steroid 5α-reductase inhibitor, alone and in combination with topical minoxidil in the balding stumptail macaque. J Clin Endocrinol Metab 1992; 74(2): 345–50

    Article  PubMed  CAS  Google Scholar 

  89. Walsh DS, Dunn CL, James WD. Improvement in androgenetic alopecia (stage V) using topical minoxidil in a retinoid vehicle and oral finasteride. Arch Dermatol 1995; 131(12): 1373–5

    Article  PubMed  CAS  Google Scholar 

  90. Pierard GE, Pierard-Franchimont C, Nikkels-Tassoudji N, et al. Improvement in the inflammatory aspect of androgenetic alopecia: a pilot study with an antimicrobial lotion. J Dermatol Treat 1996; 7: 153–7

    Article  Google Scholar 

  91. McElwee KJ, Rushton DH, Trachy R, et al. Topical FK506: a potent immunotherapy for alopecia areata? Studies using the Dundee experimental bald rat model. Br J Dermatol 1997; 137: 491–7

    Article  PubMed  CAS  Google Scholar 

  92. Kiesch N, Stene JJ, Goens J, et al. Pulse steroid therapy for children’s severe alopecia areata. Dermatology 1997; 194: 395–7

    Article  PubMed  CAS  Google Scholar 

  93. Sawaya ME. RU58841 a new therapeutic agent affecting androgen receptor molecular interactions in human hair follicles. In: Van Neste D, Randall V, editors. Hair research for the next millenium. Amsterdam: Elsevier Science, 1996

    Google Scholar 

  94. Ahmad W, Haque WFU, Brancolini V, et al. Universalis associated with a mutation in the human hairless gene. Science 1998; 279: 720–4

    Article  PubMed  CAS  Google Scholar 

  95. Domashenko A, Gupta S, Cotsarelis G. Efficient delivery of transgenes to human hair follicle progenitor cells using topical lipoplex. Nat Biotechnol 2000; 18: 420–3

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Professor Elka Touitou is affiliated with the David R. Bloom Centre for Pharmacy at the Hebrew University of Jerusalem.

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  1. Department of Pharmaceutics, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, POB 12065, Jerusalem, 91120, Israel

    Victor M. Meidan &  Elka Touitou

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Meidan, V.M., Touitou, E. Treatments for Androgenetic Alopecia and Alopecia Areata. Drugs 61, 53–69 (2001). https://doi.org/10.2165/00003495-200161010-00006

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