An Overview of Pattern Hair Loss Treatment Categories

Introduction: Pattern hair loss, a common condition impacting millions globally, can profoundly affect an individual’s self-esteem and quality of life (QoL). While the causes of hair loss range from genetic predisposition to environmental factors and health conditions, the advancements in treatment options have been significant in recent years. This article provides an overview of the various hair loss treatment categories, incorporating both traditional and emerging therapies.

1. Pharmacological Treatments: Pharmacological treatments are often the first line of defense against hair loss. Two widely recognized drugs in this category are Minoxidil and Finasteride.

• Minoxidil: Applied topically, Minoxidil is effective for both men and women, though only around 50% of users achieve a significant hair growth response. It’s thought to work by widening blood vessels and opening potassium channels, thus allowing more oxygen, blood, and nutrients to the follicle.
• Finasteride: Used primarily for male pattern hair loss, Finasteride is an oral medication that decreases the production of dihydrotestosterone (DHT), a hormone contributing to hair loss.

In addition to the traditional forms of application for Minoxidil and Finasteride, recent developments have seen the emergence of oral Minoxidil and topical applications of Finasteride and Dutasteride. Oral Minoxidil, initially used for treating high blood pressure, has shown some promising results in stimulating hair growth when used in low doses.

On the other hand, topical formulations of Finasteride and Dutasteride, traditionally used orally for hair loss, provide a localized approach to reducing DHT levels in the scalp. These topical solutions are gaining popularity as they potentially minimize systemic side effects while maintaining effectiveness in treating hair loss.

Other drug type treatments are under development for pattern hair loss including; JAK inhibitors, small molecules that target the Wnt signalling pathway, prostaglandin D2 receptor antagonists, anti-androgens, and Fibroblast Growth Factor 5 (FGF5) inhibitors, among other drug treatments.

2. Growth-Factor and Peptide-Based Therapies: Sometimes called “biologic drugs”, Peptide-based therapies are emerging treatments that utilize short chains of amino acids to stimulate hair growth. These peptides can act as growth factors, promoting hair follicle cell proliferation and preventing hair loss. In other instances the peptides are designed to interfere with cell/protein signalling systems in the hair follicle.

Osteopontin and peptides derived from the protein molecule are a focus of research and development at more than one company right now. Potentially these proteins and peptides may be direct stimulators of hair growth.

Peptide based Androgen Receptor (AR) inhibitors are being researched for their potential in directly targeting the androgen receptors in the scalp, which play a crucial role in androgenetic alopecia. They work by interfering with the ability of dihydrotestosterone (DHT) binding to androgen receptors on hair follicle cells.

Researchers are investigating the role of KROX20, a protein associated with nerve development, and SCF (stem cell factor), in hair pigmentation and growth. This could open new avenues for treatments targeting hair follicle stem cells.

Various other peptides derived from fibroblast growth factors and other hair growth promoting proteins have been investigated over the years. Some of these laboratory studies may be brought forward for further development into a clinical treatment in the future.

3. Cell Therapy and Regenerative Medicine: Cell therapy and regenerative medicine represent a cutting-edge approach in treating hair loss.

• Stem Cell Therapy: This involves the use of stem cells and similar cells to rejuvenate and regenerate hair follicles.
• Platelet-Rich Plasma (PRP) Therapy: PRP involves injecting a patient’s own platelets to promote hair growth. The growth factors in platelets can stimulate the hair follicles’ cells into an increased rate of growth and signalling activity.
• Exosomes: As a part of regenerative medicine, exosomes, which are extracellular vesicles released by cells, are being studied for their potential in promoting hair growth. They may work by delivering growth factors and proteins to hair follicles.

In the realm of cell therapy and regenerative medicine, significant advancements have been made in utilizing specific cell types for hair regrowth. Dermal Papilla Cells, located at the base of the hair follicle, play a crucial role in the regulation of hair growth and cycling. Researchers are exploring ways to cultivate these cells and reintroduce them into the scalp to rejuvenate miniaturized hair follicles in androgenetic alopecia. Similarly, Dermal Sheath Cup Cells, which provide support and nourishment to the hair follicle, are being studied for their regenerative capabilities in hair growth. Though it is somewhat speculative right now, some scientists have suggested that dermal papilla cells and/or dermal sheath cup cells have stem cell like properties.

 Additionally, Induced Pluripotent Stem Cells (iPSCs), which are adult cells reprogrammed into an embryonic stem cell-like state, represent a potentially groundbreaking approach to hair loss treatment. These iPSCs have the potential to differentiate into various cell types, including those relevant to hair growth. By harnessing these cells’ ability to transform and proliferate, researchers are aiming to create new hair follicles or repair damaged ones, offering a novel solution to hair loss. The utilization of these cells highlights the move towards more targeted and personalized treatment strategies in combating hair loss, though clinical application is still under rigorous investigation for safety and efficacy.

As well as injecting cells, some companies are looking at how to make exosomes from cells in culture. These cells can be dermal papilla cells, keratinocytes, stem cells, iPSCs, and potentially other cell types may be looked at in the future. The idea is to use the exosomes to promote hair growth by signalling increased activity in the resident hair follicle cells.

Platelet-Rich Plasma (PRP) therapy for hair loss has been around for a long time now. However, improvements are being made in terms of better ways to isolate and activate the platelets, and also ways to improve the consistency of the product.

4. Medical Devices: Low-Level Laser Therapy (LLLT) uses specific wavelengths of light to treat hair loss. It’s believed to enhance cell metabolism and improve blood flow, leading to stimulated hair growth. A wide variety of products are available from different companies and clinics. Some are for home use, while some are designed only for use in a hair clinic.

Microneedling is a procedure where tiny needles are used to create micro-injuries on the scalp. This process is believed to stimulate the body’s wound healing response, potentially leading to increased hair growth when combined with other treatments like minoxidil.

Though this might also go under the cell therapy category, in recent years there has also been the possibility to isolate adipose cells from fat and inject into scalp skin to promote hair growth. The machines to take and process the cells from fat are available from several different companies. The machines are used in hair clinics and take fat from a patient and the cells are injected into the same patient in the clinic within a few hours of processing.

Occasionally there are other medical devices that are the subject of small scale clinical investigations such as ultrasound machines for example. Due to the limited published research on these machines it is hard to know whether such machines will be brought into widespread clinical use for hair loss.

5. Surgical Treatments: For those seeking permanent solutions, surgical treatments like hair transplants are an option.

• Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) are two main types of hair transplant surgeries. FUT involves transplanting a strip of hair-bearing scalp, while FUE involves individual follicle transplantation.

6. Herbal and Natural Remedies: Many individuals turn to herbal and natural remedies for hair loss. These include supplements like biotin, as well as herbal extracts like saw palmetto, which may block DHT.

7. Cosmetic Options: Cosmetic solutions like wigs and hairpieces offer non-medical alternatives for managing hair loss.

8. Hormonal Treatments: This category is largely limited to use by women as the side effects of using hormones and their antagonists in men are quite significant. In cases where hair loss in women is due to hormonal disturbances, treatments like spironolactone or cyproterone acetate, which act as androgen blockers, can be effective.

9. Anti-inflammatory treatments: Anti-inflammatory shampoos like those containing ketoconazole can help in managing scalp conditions like dandruff, which can contribute to hair loss. Ketoconazole’s anti-inflammatory and antifungal properties make it useful in treating scalp conditions that can lead to hair thinning.

Right now there is research underway to investigate the potential for using JAK inhibitors to treat hair loss. While JAK inhibitors are anti-inflammatory drugs, they have also been shown to have a direct hair growth promoting effect. Whether the hair growth promoting action can be separated from the anti-inflammatory action, and whether one or both properties are useful for treating pattern hair loss, is under investigation.

Note: It’s important to note that many of these treatments are still in clinical trials or early stages of development, and their efficacy and safety profiles are yet to be fully established. The field of hair loss treatment is rapidly evolving, with ongoing research and clinical trials continually providing new insights and potential therapies. For the latest information on these treatments and their development status, consulting recent scientific publications or clinical trial registries is recommended. Always consult a healthcare professional before starting any treatment for hair loss to understand the potential risks and benefits.

Conclusion: The landscape of hair loss treatments is diverse and continuously evolving. While some treatments focus on stimulating hair growth or transplanting hair, others aim to address the underlying causes of hair loss, such as hormonal imbalances or scalp conditions. The choice of treatment depends on various factors, including the type and extent of hair loss, patient preferences, and tolerance for potential side effects. It’s crucial for individuals facing hair loss to consult with healthcare professionals to choose the most suitable treatment plan, ensuring a tailored approach that maximizes the chances of successful hair regrowth and restoration.

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