Clearly, minoxidil is not a miracle drug. While it can produce some new growth of fine hair in some — not all — women, it can't restore the full density of the lost hair. It's not a quick fix, either for hair loss in women . You won't see results until you use the drug for at least two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you'll need to keep using it to maintain those results. If you stop, you'll start to lose hair again.
In the initial decade after the first identification of the hedgehog gene around 1980, there was almost no research devoted to the impact of the SHH pathway upon human hair. However, this started to change in the mid-1990s (e.g., this from 1998) and culminated in the seminal work on this subject that was published in the US in 1999: “Induction of the hair growth phase in postnatal mice by localized transient expression of Sonic hedgehog“.
Examination of the scalp in patients with telogen effluvium typically shows uniform hair thinning. The presence of erythema, scaling, or inflammation; altered or uneven hair distribution; or changes in shaft caliber, length, shape, or fragility may suggest other diagnoses. Laboratory investigations are indicated if the history and physical examination findings suggest underlying systemic disorders (e.g., iron deficiency anemia, zinc deficiency, renal or liver disease, thyroid disease).
Recent update: “Breakthrough” in South Korea (11/21/17). We don’t want to get anyone’s hopes up prematurely, and we definitely hope this is not just another false alarm, but this recent discovery does seem to hold some promise. At best it would probably be 3-5 years out for wide availability, we think it’s still worth checking out. Professor Kang-Yell Choi of South Korean University Yonsei lead research indicating that they may have discovered a new protein that controls hair growth. The study in the Journal of Investigative Dermatology as well as a news article in the Korea Herald are good places to start reading about this new development.
SOURCES: George Cotsarelis, MD, director, Hair and Scalp Clinic, University of Pennsylvania School of Medicine, Philadelphia. Andrew Kaufman, MD, assistant professor, department of dermatology, University of California, Los Angeles; medical director, Center for Dermatology Care, Thousand Oaks, Calif. Tom Barrows, PhD, director of product development, Aderans Research Institute Inc., Atlanta. Cotsarelis, G. and Millar, S.E. Trends in Molecular Medicine, July 2001; vol 7: pp 293-301. American Society for Dermatologic Surgery web site. American Academy of Facial and Reconstructive Plastic Surgery web site. American Hair Loss Council web site. Springer, K. American Family Physician, July 1, 2003; vol 68: pp 93-102. Hair Loss Help web site, "Interview with Dr. Ken Washenik from Bosley." Fuchs, E. Developmental Cell, July 2001: vol 1: pp 13-25.
While the drug is generally safe for use, some possible side effects are mild irritation of the scalp, dryness and growth of hair on some parts of the body, especially the sides of the face and hands. In some cases, you might observe some increased hair loss around the first few days of use. If the hair fall continues after two weeks upon application of minoxidil, stop the treatment first and see a doctor.
The follicles on the sides of the scalp are more genetically resistant to DHT, which is why male pattern baldness often results in a “crown” of hair. But its downsides are serious. “With women, finasteride is not an option,” says Dr. Wolfeld. “It’s not FDA-approved for women to take, so we don’t prescribe it.” In fact, due to the drug’s effect on hormone levels, pregnant women are advised to not even touch broken or crushed tablets.
As I entered a small operating room at Bernstein’s Midtown East medical practice, a front-desk secretary shouted out, “Hope you got a strong stomach!” Inside, a patient dozed in an operating chair, while nurses held a strip of back-of-the-head skin—something like a fat hairy caterpillar—with tweezers. They began dissecting the follicular units under a microscope.
The history and physical examination are often sufficient to determine a specific etiology for hair loss. It is convenient to divide the various causes into focal (patchy) and diffuse etiologies, and proceed accordingly. Patchy hair loss is often due to alopecia areata, tinea capitis, and trichotillomania. Diffuse hair loss is commonly due to telogen or anagen effluvium. Androgenetic alopecia may be diffuse or in a specific pattern, and may progress to complete baldness.
The patient, a small, vaguely European man in his late forties, had rings on his fingers and a bloody, rectangular gash on the back of his head. It looked like a chunk of missing carpet. Bernstein pointed at the white opening of exposed scalp, and explained how easy it would be to stitch skin together over the gap. This was a traditional process for follicular-unit transplantation. Then Bernstein led me into a second room, where another patient was seated with his face in a massage-table-like padded hole. A portion of the back of his head was marked off. To his right was a boxy gray machine, roughly four feet by four feet, with a jutting mechanical arm. This was the ARTAS Robotic Hair Transplant.
The Rogaine rep we spoke to explained that the different packaging (and therefore different prices) has to do with the FDA-approval process: “We discovered in clinical trials that the hair loss patterns between men and women are different,” she said by way of explanation. “Men typically have that bald spot on the crown of their head, where women generally have a general thinning throughout, but concentrated more on the top of the head. So for FDA approval, we had to come up with two different, gender-specific products, so the directions were more explanatory.”
Key features: Dr. Zeichner recommends the Keratin Oil Shampoo and Conditioner by OGX for thinning or fine hair that needs the extra strength. This budget-friendly option uses keratin proteins mixed with argan oil to nourish, condition, and strengthen strands, and it's only $16 for the set. The smoothing formula can also increase elasticity for less breakage and split ends.
“We don’t know why, but we have universally established that the cells back there are immune to the attack,” Buckler said. That’s why doctors have worked at relocating follicles from the back of the head to the front to attempt to cure baldness. “That’s proven. If you relocate those cells, they’ll remain immune. “But that is a messy, bloody surgical procedure.”
Scientists from the Indiana University School of Medicine have for the first time created skin with hair follicles using mice stem cells. Research was led by Professor Karl Koehler. The team was able to grow both the epidermis and dermis layers of skin to create a realistic skin model. An interesting quote from Professor Koehler: “It looks like a little ball of pocket lint that floats around in the culture medium. The skin develops as a spherical cyst and then the hair follicles grow outward in all directions – like dandelion seeds.”